Treatment

Endocrine surgery

Only thyroid surgery is discussed here.

Thyroid Surgical Options

Partial Thyroid Lobectomy. This operation is not performed very often because there are not many conditions which will allow this limited approach. Additionally, a benign lesion must be ideally located in the upper or lower portion of one lobe for this operation to be a choice.

Thyroid Lobectomy. This is typically the "smallest" operation performed on the thyroid gland. It is performed for solitary dominant nodules which are worrisome for cancer or those which are indeterminate following fine needle biopsy. Also appropriate for follicular adenomas, solitary hot or cold nodules, or goitres which are isolated to one lobe (not common).

Thyroid Lobectomy with Isthmusectomy. This simply means removal of a thyroid lobe and the isthmus (the part that connects the two lobes). This removes more thyroid tissue than a simple lobectomy, and is used when a larger margin of tissue is needed to assure that the "problem" has been removed. Appropriate for those indications listed under thyroid lobectomy as well as for Hurthle cell tumours, and some very small and non-aggressive thyroid cancers.

Subtotal Thyroidectomy. Just as the name implies, this operation removes all the "problem" side of the gland as well as the isthmus and the majority of the opposite lobe. This operation is typical for small, non-aggressive thyroid cancers. Also a common operation for goitres which are causing problems in the neck or even those which extend into the chest ( substernal goitres ).

Total Thyroidectomy. This operation is designed to remove all of the thyroid gland. It is the operation of choice for all thyroid cancers which are not small and non-aggressive in young patients. Many (most?) surgeons prefer this complete removal of thyroid tissue for all thyroid cancers regardless of the type.