Thyroid is a butterfly shaped gland in neck which produces thyroid hormone , essential for our body
metabolism. Thyroid gland has two lobes on either side and connected in centre . It is quite common
to have lumps in thyroid gland which may be completely benign or cancerous.
Many patients start noticing swelling in anterior neck with no pain or discomfort. These may
gradually increase in size and become large lumps overtime. Many a times these lumps are multiple
and present on both lobes , which can progress to form a large swelling. Most of these are non –
cancerous and would require surgery for cosmetic reasons or as the size of lumps may cause
pressure on surrounding structures like air pipe and food pipe.
Most of the times thyroid cancer also present as pain less lump in thyroid which slowly progress in
size. So its difficult to differentiate from non cancerous ones. However few cases present with
1) Rapidly increasing lump in thyroid
2) Enlarged neck nodes due to cancer spread
3) Change in voice
4) Difficulty in breathing
1)Ultrasound scan of thyroid gland
Based on features of lump we can segregate them into highly suspicious for cancer, borderline or
non cancerous lumps.
2) FNAC
Cytology is quick and easy test done after USG . This can pick up cancer in lump or at least guide us
with risk of cancer in the sampled lump(BETHESDA CLASSIFICATION )
3)IMAGING – MRI / CT scan are rarely done in patients with large lumps or with ominous symptoms
of advanced thyroid cancer.
Removal of one half of thyroid gland is called hemi thyroidectomy . This is generally done for
-Benign lumps in one thyroid lobe.
-Early stage thyroid cancer
– Diagnostic for follicular adenoma.
Removal of complete thyroid gland is called total thyroidectomy. Most common indications are
-Benign nodules in both lobes
-Thyroid cancer
Thyroid cancer patients presenting with spread of cancer to neck nodes , requires appropriate neck
dissection along with thyroidectomy to completely clear disease.
In experienced hands thyroidectomy is a completely safe surgery.
Three structures of concern during surgery are
-Recurrent laryngeal nerve which supplies muscles of vocal cords.
-External branch of superior laryngeal nerve which also supply to muscle of vocal cord.
PARA THYROID glands which maintain calcium levels in blood
(In the above picture blue arrow indicates Recurrent laryngeal nerve and yellow marks parathyroid gland)
All these nerves and parathyroid glands are dissected meticulously and preserved during surgery so that patients doesn’t have long term surgery morbidity
EXPERIENCE OF SURGERY TEAM– With our experience of more than a decade operating on thyroid lumps and cancers , operative complications are rare.
ANAESTHESIA – Hypotensive anaesthesia prevents bleeding during surgery and enable surgeon to
delicately separate nerves and gland.
NERVE MONITORING – Continuous nerve monitoring of RLN and EBSLN will warn surgeon of any nerve injury due to stretching of nerve.
White arrow-Recurrent laryngeal nerve.Yellow- para thyroid gland
Wite arrow -External branch of superior laryngeal nerve(EBSLN) during total thyroidectomy for thyroid cancer
White arrow – Recurrent laryngeal nerve
We routinely do locally advanced thyroid surgeries with neck nodal enlargement, tumour infiltrating into surrounding structures and extension into chest
Huge thyroid mass extending into chest. Chest bone is split to remove the mass.
RADIO IODINE THERAPHY– Advanced cancers of thyroid (papillary and follicular) require post surgery Radio iodine theraphy to ablate metastatic disease.
Well placed neck scar for thyroidectomy heals well and align with neck folds so that it is not visible obviously after 4 months of surgery. Steps taken to produce a fine thyroidectomy scar
1) Incision placed in natural neck fold.
2) Sub-cutaneous suturing done with absorbable sutures so that scar is thin.
This patient underwent thyroidectomy with neck dissection on both side of neck with 10 cm incision which is well healed .
Another fine thyroidectomy with neck dissection scar for cancer of thyroid.
Robotic thyroidectomy can be done from mouth called trans oral thyroidectomy vestibular approach(TORTVA) or from behind the ear called retro auricular approach.
In TORTVA three small incisions are made in lower lip for robotic arms to enter into neck and thyroid gland is removed from mouth .Excellent cosmetic results with no visible scar in neck.
In post aural robotic thyroidectomy incision is given behind hairline behind the ear for access into neck. So scar is actually concealed and not visible in neck.
1)Non cancerous lump in thyroid
2)Size less than 4 cm
3)No involvement of neck nodes.
ADVANTAGE – No visible scar in neck
DISADVANTAGE-Increased surgery time
-Expensive when compared to open surgery
We are experienced in management of recurrent nerve injury. Voice change can be treated with THYROPLASTY and injection laryngoplsty.
LASER CORDECTOMY is done in patients with injury to both side recurrent laryngeal nerves with breathing difficulty .
Most patients need a average stay of 4 days for minor surgery to 7 days in major surgeries. ICU stay is required for major surgery. Patients will have feeding tube for maintaining nutrition during hospital stay. Radiotherapy is done as outpatient procedure
It is around 1 lakh - 2 lakhs, sometimes vary on seriousness of the cancer
Most likely Eating vegetables every day can prevent from thyroid cancer
1 week is the recovery period for Thyroid Cancer treatment treatment but again it depends on the condition of the patient
Dr Rahul Buggaveeti is the best Thyroid Cancer doctor in Hyderabad
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