Should I Remove Half of My Thyroid or All of My Thyroid for Thyroid Cancer?

Well, you just found out that you have thyroid cancer. It's stressful. Most of the time, thyroid cancer is diagnosed in relatively young people who are otherwise healthy. For many patients at the Russell Center, thyroid cancer is the first significant medical problem they have faced in their life. It's stressful.

In the midst of that stress, you will meet with various doctors. Your primary care doctor is the quarterback of the situation, the one who is with you through it all and provides perspective. Your OB plays a huge role, especially if you are considering questions about fertility. Your endocrinologist is the one who will help you balance hormones before and after surgery, and is often the one who first makes the diagnosis of thyroid cancer. And of course your surgeon, who you specifically seek out because of their experience and breadth of options. (I am biased in thinking that the choice of the surgeon is the one you should spend the most time on- everyone else you can always change later if the fit isn't perfect. But an unsuccessful surgery can't be undone).

As you meet these doctors, you will start to learn that you have to make a choice: should you remove all of your thyroid (total thyroidectomy), or just part of your thyroid (thyroid lobectomy or hemithyroidectomy)? (We also do RFA for thyroid cancer, but we aren't going to talk about that here).

Before we dig into the pros and cons of these approaches, let's review who should USUALLY remove all of their thyroid: those with metastatic disease or advanced cancer that is more than 4cm in size. The reason that these people need to remove their entire thyroid is so that they can have radioactive iodine, which makes it easier for your endocrinologist to follow you over time and see if the cancer is under control. Special exceptions exist for anaplastic thyroid cancer and some other types of cancer.

Why should you remove only half of your thyroid?

1- Removing only half of your thyroid is safer. Your risk of complications, especially the risk of losing too much parathyroid tissue, go down significantly (or even disappear) when you have half of your thyroid still in place. Also, your voice is more likely to be safe.

2- Most people don't need extra thyroid hormone if they still have half of their thyroid. This tends to help some people feel better and adjust better after surgery. And, in the event of a zombie apocolypse, you won't need to find a place to source your thyroid hormone! :)

3- Fertility rates are better if you still have half of your thyroid according to some studies.

4- Hemithyroidectomy Surgery is almost always outpatient. While total thyroidectomy is often outpatient, half of a thyroid surgery is almost always same-day surgery.

5- Removing half of the thyroid is curative for most people with small thyroid cancers.

Why should you remove all of your thyroid?

1- It is easier for your doctor to know if the cancer is back or has spread elsewhere if your entire thyroid has been removed. After your whole thyroid has been removed, your doctor can follow labs (usually the Thyroglobulin or Tg) to know if the cancer is still present. It's not a perfect measure at all, but it is something that can be valuable.

2- After a total thyroidectomy, you are eligible for radioactive iodine. (Usually) Only people who have their entire thyroid removed can have radioactive iodine. This can slow the spread of thyroid cancer in other parts of your body if it has spread.

3- You are less likely to need more surgery. If you have a hemithyroidectomy and then your doctor discovers that the cancer is more aggressive than originally expected, you may need more surgery. If you have that surgery up front, you are less likely to need it later.

4- It might be easier to control your thyroid hormone levels. For some people with Hashimoto's thyroiditis or other conditions, hormonal fluctuations significantly impact quality of life. By removing all thyroid tissue, it can be easier for some people to control these fluctuations.

5- Removing your entire thyroid might be better if you have another thyroid problem in addition to thyroid cancer. Sometimes patients have Graves' disease or a multi nodular goiter that will require additional treatment. In these situations, treating all of the problems with a single surgical treatment can offer advantages.

So there you have it. Turns out that there are great reasons to choose either a total thyroidectomy or a hemithyroidectomy. As with all thyroid conditions, finding a team who will review all of the options and help you prioritize your goals of care is critical.

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