It depends on the reason for your surgery. If your thyroid is overactive (hyperthyroid from Graves’ disease or a what’s called a toxic multinodular goiter), or the whole gland is enlarged and causing symptoms—such as a feeling of pressure or difficulty talking, breathing or swallowing—the whole thyroid should be removed in a procedure called total thyroidectomy, said former Duke endocrine surgeon Dr. Julie Sosa, MD. “If only half your thyroid is enlarged and causing symptoms, but the other half is normal, then half should be removed,” said Sosa.
For the most common type of thyroid cancer, which is generally low-risk, your doctor may recommend removing all or half your thyroid, depending on your circumstances. “If you have intermediate- or high-risk cancer—meaning it has spread outside the thyroid—we recommend total thyroidectomy,” said Sosa.
Sophisticated imaging called neck mapping can help your surgeon determine ahead of time how much of your thyroid and which lymph nodes, if any, need to be removed. While not in use everywhere, neck mapping is routine at Duke. “The best chance for a cure for thyroid cancer is making sure we remove all of the disease,” said former Duke endocrine surgeon Dr. Sanziana Roman, MD. “We don’t want to overtreat, but we also don’t want to undertreat. So knowing exactly how much surgery a patient needs is very important.”