5 Reasons to Remove the Rest of Your Thyroid

Thyroid surgery is one of the most common surgeries performed in the United States. Despite all of the testing and advances in medicine, sometimes we are forced to remove a part of your thyroid because we don't know whether or not it contains cancer. This can result in a situation where you find out, after the fact, that you had cancer. In some situations, your doctor will then reach out to talk to you about removing the rest of your thyroid. Should you do it?

Before we go into the details about why you SHOULD remove the rest of your thyroid, let's consider that most patients don't need to have a completion thyroidectomy. For almost all small thyroid cancers, there is no need, and it only increases the surgical risk without improving your prognosis. We may recommend a completion thyroidectomy if your cancer is high risk, and sometimes if it is intermediate risk. But your opinion matters, because these aren't always black or white decisions.

So why SHOULD you have a completion thyroidectomy?

1. The primary reason to remove the rest of your thyroid is so that you can have radioactive iodine. Radioactive iodine (or RAI) doesn't necessarily kill any residual thyroid cancer cells, but it does make it easier to follow up after surgery and see if the cancer has spread. Partly because we can rely on labs such as thyroglobulin (Tg) more, but also because we can use additional imaging techniques such as a Whole Body Scan (WBS) to help us know if your cancer has spread anywhere else.

2. You might need radioactive iodine (and thus a completion thyroidectomy) if your cancer is bigger than 4cm on the first side. These tumors are more likely to spread or be more aggressive, and so we worry about them more.

3. You might need radioactive iodine (and completion thyroidectomy) if you have cancer in your lymph nodes. We try to evaluate these before surgery, but we aren't always perfect. Your surgeon should do their own ultrasound, and they will be less likely to miss metastatic spread to the lymph nodes according to some studies!

4. You might need a completion thyroidectomy because there are nodules that become problematic in the other side.

5. Finally, you might need to remove the rest of your thyroid because you have multifocal thyroid cancer. But... this isn't always necessary, and requires a thorough conversation with your surgeon and endocrinologist.

The decision to remove the rest of your thyroid can be traumatic. Let us know if we can help you make this hard decision!