Often it can. If the cancer is small, lies in only one lobe and hasn’t spread to the neck nodes, removing just that lobe, a partial thyroidectomy, may be all that is needed. What the surgeon decides rests on the cancer type, the tumour’s size and exact position, and the histopathology report that comes back after the operation. Some cancers, though, need the whole gland out from day one. This blog explains which is which, what each option means for tablets and follow-up, and how the decision is made.
According to Prof. Dr. Sandeep Nayak, Surgical Oncologist in Bengaluru at MACS Clinic, patients commonly arrive assuming a cancer diagnosis means the entire gland has to be removed. Often that isn’t the case, and the news is a real relief. The first decision comes from the needle biopsy and the scans, but the report on the removed tissue can alter it afterwards. The plan is therefore best discussed in full before the operation.
Been told you have thyroid cancer and unsure how much needs to come out? A surgical oncologist can go through your reports with you.
Which Thyroid Cancers Can Be Treated With a Partial Thyroidectomy?
- Small, low-risk papillary cancer. It’s the commonest thyroid cancer. The American Thyroid Association’s 2015 guidelines say lobectomy alone is acceptable when the tumour is 4 cm or smaller, sits within the thyroid and hasn’t reached the lymph nodes. The thyroid cancer treatment page describes the types and how each is treated.
- Very small tumours. For papillary cancers under 1 cm, lobectomy is the usual operation, and some very low-risk ones are simply watched.
- Low-risk follicular cancer. A minimally invasive follicular cancer can sometimes be managed the same way.
- A healthy other lobe. There should be no suspicious nodules in the opposite lobe, no family history of thyroid cancer and no earlier radiation to the head or neck.
- Outcomes in selected patients. In pooled data on low-to-intermediate-risk papillary cancer, around 96% of patients were free of recurrence five years after lobectomy. After total thyroidectomy it was 95%.
- Sometimes a second operation follows. Now and then the report on the removed lobe shows higher-risk features, and the other lobe has to be taken out later. How often depends on the study: about 1 in 10 in some, nearer 1 in 3 in others.
What Changes for Tablets and Follow-Up After a Partial Thyroidectomy?
- Tablets. A fair number of patients get by on the lobe left behind. Others become hypothyroid, meaning the thyroid is underactive, and need levothyroxine.
- Radioactive iodine. It is usually not needed after a lobectomy. It is used mainly after the whole gland has been removed, in cancers that need it.
- Monitoring. Serum thyroglobulin is the blood marker doctors track after thyroid cancer surgery. It becomes harder to read when thyroid tissue is still there. So the checks lean on neck ultrasound and TSH instead.
- Fewer surgical risks. A lobectomy carries a lower chance of low calcium from parathyroid injury, and of injury to the voice nerves on both sides.
- Scarless options. Robotic and open surgery both allow lobectomy, and the approach does not change how much is removed. The robotic cancer surgery page describes them.
- Completion thyroidectomy. If the report shows higher-risk features, a second operation can take out the other lobe.
What Decides Whether the Entire Thyroid Must Come Out?
Four things decide it.
The type of cancer. Papillary and follicular cancers (the differentiated types) give some room for choice. Medullary and anaplastic cancers generally call for total thyroidectomy, and medullary cancer also needs clearance of the central neck nodes.
The size and spread. A tumour over 4 cm, one growing through the thyroid capsule, or one with spread to nodes or distant organs usually calls for total thyroidectomy, with neck dissection in many cases. The head and neck cancer treatment page explains when the nodes are treated.
The other lobe and the history. Nodules in the other lobe, thyroid cancer running in the family, radiation to the neck in the past or an inherited syndrome all point towards taking the whole gland.
The final pathology and your preference. Aggressive features on the report can change the plan, and the patient’s views on tablets and follow-up matter too.
Key Takeaways
- A small, low-risk cancer in one lobe can often be treated with a partial thyroidectomy.
- Large tumours, spread to the nodes, and medullary or anaplastic cancers usually need the whole gland removed.
- In well-chosen patients, lobectomy and total thyroidectomy have similar recurrence and survival.
- A minority of patients need a second operation when the final report shows higher-risk features.
- The plan should be settled before surgery, with the surgeon going through the scans and biopsy.
Frequently Asked Questions
Can thyroid cancer be treated without taking out the whole thyroid?
Yes, for small, low-risk cancers confined to one lobe, a partial thyroidectomy can be enough.
What is a partial thyroidectomy?
It is removal of the affected lobe, called a lobectomy, with the other lobe left in place.
Could a partial thyroidectomy lead to a second operation?
Occasionally, when the final report shows higher-risk features, though most patients don’t need one.
Do I need radioactive iodine after a partial thyroidectomy?
Usually not, as it is mainly used after the whole thyroid has been removed.
References
- American Thyroid Association. Clinical Thyroidology for the Public: Lobectomy for low-risk papillary thyroid cancer and the 2015 guidelines. https://www.thyroid.org/?p=40788 Explains when removing one lobe may be adequate for low-risk papillary thyroid cancer.
- Journal of Surgical Research (2019). Lobectomy Compared to Total Thyroidectomy for Low-Risk Papillary Thyroid Cancer: A Systematic Review. https://pubmed.ncbi.nlm.nih.gov/31103828/ Compares survival, recurrence and the need for a second operation after lobectomy.
Disclaimer: This article is for general information and is not a substitute for medical advice. Please consult a qualified specialist for diagnosis and treatment.
