Surgery for Thyroid Conditions
Based on your diagnosis, a Mount Sinai thyroid physician may recommend surgery as your best option for treatment. Skilled in the newest technologies—including minimal scarring techniques—our surgeons personalize a treatment plan for your unique needs.
Types of Thyroid Surgery
Your surgeon will thoroughly discuss your condition and the optimal surgical approach for you. At Mount Sinai, our physicians have extensive experience in performing the following types of thyroid surgery:
- Total thyroidectomy: Removing your entire thyroid gland may be the best way to treat thyroid cancer, Graves’ disease, and goiter under certain circumstances. To replenish your thyroid hormones, you will need to take a thyroid hormone medication.
- Thyroid lobectomy/Hemi-thyroidectomy: This procedure involves removing half of the thyroid gland to treat thyroid conditions such as nodules and goiter. With half of your thyroid gland in place, you may not need to take hormone replacement medication, depending on the ability of your thyroid to regulate your hormone levels.
Our surgeons use the safest and most effect techniques during surgical procedures. We are happy to explain the techniques we will be using during your procedure.
- Minimally invasive thyroid surgery: In this type of surgery, the surgeon makes small incisions using special techniques to reach the area of your thyroid gland. Your surgeon may be able to camouflage the incision along the natural creases of your neck.
- Open thyroid surgery: If open surgery is the best approach for you, the typical incision made for thyroid surgery runs several inches along your neck above your collarbone, so that your surgeon can easily access the area of your thyroid gland and nearby tissue for possible further diagnosis and treatment. To minimize scarring if needed, we can perform follow-up reconstructive procedure, at your discretion.
Lymph Nodes in Thyroid Cancer Surgery
Lymph nodes are structures that act as filters in the body’s lymphatic system. There are roughly 150 lymph nodes on each side of the neck as well as between 10 - 40 nodes in the central portion of the neck. In some cases, thyroid cancer can spread to these lymph nodes. The degree of lymph node involvement may influence your treatment.
Lymph nodes are the most common site of recurrent disease following initial therapy. The management of your thyroid cancer may involve surgical removal of your lymph nodes. Your lymph nodes are located in the central compartment of the neck (next to your thyroid gland) or in the lateral compartments (located in the side of your neck).
Prior to your surgery, an assessment entailing a physical exam, ultrasound and biopsy will be conducted. Additional imaging may be also be ordered. Your surgeon will then remove at-risk lymph nodes during surgery. After the procedure, a pathologist will examine the lymph nodes in the lab to ensure there has been no microscopic spread that was not previously detected. The pathology report will determine your final/revised staging and follow-up plan going forward.
Preservation of Vocal Function
Mount Sinai’s thyroid surgeons are highly experienced in the preservation of your vocal function during surgery. A significant risk associated with thyroid and parathyroid gland surgery is damage to the nerves that control the function of the voice box (larynx). These nerves control your normal conversational voice and your ability to change the pitch and volume of your voice.
In addition to a surgeon’s level of experience contributing to a good outcome, the use of sophisticated monitoring equipment during surgery can help to protect your vocal function.
At the Center for Thyroid and Parathyroid Diseases, we are developing novel approaches to monitoring. We believe that our discovery holds great promise to revolutionize how we protect your voice.
If you have any voice or swallowing disturbance when we examine you, we will recommend that you undergo an examination of your vocal cords with a fiberoptic laryngoscopy (a tiny camera is inserted through the nostrils to view vocal cords). In addition, to protect these vital nerves, our surgical experts are able to identify a nerve injury and take the appropriate steps at the time of that surgery in order to help correct it.
Management of Invasive Thyroid Cancer
Our Thyroid Center experts are highly skilled in treating invasive thyroid cancer and achieve the best outcomes for our patients. If you have an advanced or reoccurring cancer, you may have a more invasive form of the disease, which could spread beyond the thyroid gland or the associated lymph nodes. Surrounding structures, such as your trachea, larynx and esophagus, carotid artery and jugular vein may be affected. Nerves to the vocal cords are often at risk as well. We use appropriate imaging before surgery to identify if you may have this more aggressive form of thyroid cancer.
However, this invasive form of the disease might be discovered during surgery, which would require expert management of the involved structures. It is our surgeons’ goal to restore function of the structures involved, while reducing the risk of local cancer recurring. We will repair the trachea, larynx, and esophagus to preserve normal breathing, voice, and swallowing.
Before, during, and after thyroid surgery, we are here for you, monitoring your recovery, and ensuring that you have the long-term care that you need. Our Center and our doctors remain your leading medical team for you, long after your surgery.