Thyroid Surgery has a Marketing Problem

When you think about thyroid surgery, it's easy to see why it gets a bad rap:

Doctors to patients: "Hey, do you want to have surgery where we make a scar on your neck, insist that you take a pill every day for the rest of your life, and maybe make you gain weight? Oh by the way, your voice could change forever and you might have low calcium."

Other surgeries that I do, like parathyroid surgery, are designed to make people feel better and almost always succeed. But thyroid surgery, for most people, only helps to prevent a future problem. And it's less exciting to do surgery for that reason.

So why would ANYONE sign up for thyroid surgery with that sort of explanation? Let's dig into a few reasons, and then talk about some alternative treatments. First, you should know that you should not have any surgery unless you need it. But... deciding when you need it can be subjective, especially for something like your thyroid.

You may need thyroid surgery if:

1- You have thyroid cancer. This one's the easiest, because we all understand that any cancer can be scary. Many thyroid cancers do well, however, and not all of them need surgery. Some patients may be eligible for active surveillance (we watch the cancer with repeated ultrasounds). Other cancers can be treated with RFA. And finally, most cancers don't require a total thyroidectomy.

2- You have a big thyroid that is causing symptoms. This one is also simple. If your thyroid is causing symptoms, you might decide that those symptoms are worse than the risks of surgery. This is more appealing if the risks of surgery are lower. The best way to lower your risks is to speak with a high volume thyroid surgeon. The more a surgeon has done, the safer you will be. And the highest volume surgeons often have other tools as well, including scarless surgery or non-surgical options. And they will usually recommend to remove as little of your thyroid as is safely possible.

3- You have an overactive thyroid. This one is harder, as many patients feel desperate to hang on to their thyroid. If only it would just stop trying to kill them and ruin their life! But Graves' disease and Hashimoto's thyroiditis both can cause thyroid symptoms to wax and wane so frequently that they can be very disabling. While there are other treatment options for some patients, a percentage of patients will eventually reach a point where surgery is the most definitive and necessary step. There are sometimes other options for toxic thyroid nodules, but Graves' disease usually does require a total thyroidectomy. As with the others, scarless surgery is usually safe, and high volume surgeons are always safer than low volume surgeons.

There are lots of other reasons as well, and sometimes patients present with a combination of all of those. When other options have run out, you should know that the majority of patients actually do super well after thyroid surgery. In fact, more than 250,000 Americans have thyroid surgery every year according to conservative estimates. And thyroid hormone is the second most prescribed pill in America. In other words, you will be in good company. If you need to have thyroid surgery, find the right team and move forward with confidence.

And as for the intro paragraph: yes, all of those things could happen. But they are not normal for most patients. And - we will be here to support you on your journey!