Thyroid Gland Surgery

The thyroid is a small endocrine gland, shaped like a butterfly, located at the front of the neck, just below the Adam’s apple. Despite its size, it plays an essential role in the body’s metabolic balance.

It produces two key hormones: thyroxine (T4) and triiodothyronine (T3), which regulate metabolism, body temperature, heart rate, growth, energy, and neurological development.

Thyroid function is controlled by the pituitary gland, which releases the TSH hormone. When the thyroid produces too little hormone, TSH rises; when it produces too much, TSH decreases.

When this balance is disrupted, different conditions may appear—most commonly hypothyroidism and hyperthyroidism. In addition, the thyroid gland is a very common site for the development of tumors or lumps, known as thyroid nodules. Some of these nodules may be malignant, meaning they correspond to thyroid cancer.

When is surgery indicated?

Not all thyroid diseases require surgery. Thyroid surgery is indicated only when it is truly necessary. Many times, observation is enough, but in other cases surgery is the safest and most definitive way to solve the problem.

Common indications:

1. Thyroid cancer or suspicion of thyroid cancer
Surgery is the cornerstone of treatment. It allows:

  • Confirming the diagnosis through definitive histopathological examination
  • Removing the tumor and any suspicious area
  • Reducing the risk of recurrence
  • Facilitating adjuvant treatment with radioactive iodine when needed
  • Achieving long-term oncologic control

2. Thyroid nodules
Indicated when:

  • They are malignant or suspicious according to FNA (Bethesda V–VI)
  • They are indeterminate with high risk or positive biomarkers
  • They are larger than 4 cm or cause compressive symptoms
  • They show progressive growth
  • They cause significant aesthetic concerns

3. Hyperthyroidism
Surgery is especially useful in:

  • Toxic nodule or autonomous adenoma
  • Toxic multinodular goiter
  • Intolerance to or lack of response to medical treatment
  • Patients who want definitive treatment and CANNOT receive radioactive iodine (such as in Graves’ ophthalmopathy)

4. Multinodular goiter
Indicated when it causes:

  • Partial airway obstruction
  • Difficulty swallowing
  • Voice changes
  • Tracheal deviation or compression
  • Progressive growth or aesthetic deformity

Choosing the best strategy: a truly personalized approach

Every patient is different, and every thyroid is different as well. There are no “standard” surgeries. There is the right surgery for each person.

Thyroid lobectomy (hemithyroidectomy)
Indications:
  • Unilateral benign disease
  • Low-risk indeterminate nodules
  • Small, low-risk differentiated thyroid cancer
  • Focal lesions without bilateral involvement

Advantages:
  • A more limited surgery with less exposure of delicate structures
  • Fewer complications
  • Most patients do not need thyroid medication
  • Rapid recovery

Total thyroidectomy
Indications:
  • Intermediate- or high-risk cancer
  • High likelihood of requiring radioactive iodine
  • Symptomatic multinodular goiter
  • Bilateral disease
  • Resistant hyperthyroidism
  • High risk of recurrence

Neck lymph node dissections
In papillary, medullary, and oncocytic thyroid carcinoma, it is common for neck lymph nodes to also be affected by the disease. For this reason, in many patients, in addition to removing the thyroid gland, the fatty tissue containing the lymph nodes in the suspicious region of the neck is also removed. This procedure is called a lymph node dissection, and there are two types:

Types:
  • Prophylactic: preventive removal in the central compartment in selected cases
  • Therapeutic: when there is evidence or strong suspicion of lymph node involvement

    • When the affected lymph nodes are located in the central region of the neck, a central (recurrent) dissection is performed. When they are located in the lateral region of the neck, a lateral dissection is indicated, usually combined with a central dissection.

Scarless neck surgery: endoscopic and robotic approaches

For many patients, the possibility of avoiding a neck scar is very valuable. Today there are safe and effective alternatives that make this possible.

Options available in our setting:

  • Transoral (endooral) approach
  • Retroauricular approach
    • These techniques require the use of endoscopic instruments, although they can also be performed with robotic technology.

    Robotic thyroidectomy allows, in selected patients, removal of the gland without a visible scar. Robotic lymph node dissections can also be performed. Robotic thyroidectomy uses an advanced surgical system that allows the surgeon to work with high-definition three-dimensional vision and articulated instruments with a range and precision greater than those of the human hand.

Safety: technology explained for patients

Safety in this surgery depends not only on technique, but on a combination of experience, technology, and teamwork. According to numerous published studies, high-volume surgeons have fewer complications and better overall outcomes. In broad terms, removal of the thyroid gland involves the following risks:

  • Temporary dysphonia: 1–5%
  • Permanent dysphonia: <1%
  • Transient hypocalcemia: 10–20%
  • Permanent hypocalcemia: <2%
  • Hematoma: 0.5–1%
  • Infection: <0.5%


To reduce these risks, surgeons have different tools available.

Intraoperative monitoring of the laryngeal nerve:
It allows identification of the nerve that controls the voice and verification of its function throughout the surgery.

Continuous neurostimulation:
It protects the nerve while we work, alerting us if there is traction or irritation.

Magnification loupes:
They enhance anatomical detail and allow precise dissection.

Indocyanine green (ICG) fluorescence:
It helps identify the parathyroid glands and assess their blood supply.

Advanced hemostasis:
Energy devices that seal vessels safely and effectively.

Specialized team:
Anesthesia, instrumentation, and surgical assistance trained specifically in thyroid and parathyroid surgery.

These tools are used at the surgeon’s discretion, depending on each case and the patient’s needs.

Supported recovery

Recovery is usually quick. After a short hospital stay —between 12 and 24 hours— many patients return to their usual activities within 3 to 14 days. Physical activity can be resumed gradually between 2 and 4 weeks. Postoperative support is essential for the patient’s peace of mind and safety.

Conclusion

Thyroid surgery is a precise, safe, and highly effective tool when performed by experienced hands. When a patient needs it, it is an appropriate treatment that allows them to resolve their condition and, in the vast majority of cases, return to full and active life quickly.

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