Surgery for papillary thyroid microcarcinomas usually consists of removing the lobe of the thyroid gland containing the microcarcinoma. Lymph nodes around the thyroid gland are typically not removed unless they appear enlarged or suspicious on a neck ultrasound or at the time of surgery. In contrast to more advanced thyroid cancers, generally there is no need to administer radioactive iodine after surgery for papillary microcarcinomas.
Survival after surgery for papillary thyroid microcarcinoma is greater than 99%. The chances of a recurrence of thyroid cancer after surgery are between 2-4%. If there is a recurrence, it typically occurs in the other lobe of the thyroid or in lymph nodes in the central neck area (around the thyroid). These lymph nodes would have been too small for the surgeon to notice and remove at the time of the initial operation. These lymph nodes may or may not grow over time and if they do, they grow very slowly. The likelihood of thyroid microcarcinomas spreading to distant parts of the body outside of the neck area is far less than 1%.
While surgery for microcarcinomas is very safe in the hands of experienced surgeons, there are complications that have to be taken into consideration. As with any surgery, thyroid surgery is subject to the typical risks of any operation including bleeding, infection, and problems with anesthesia. In addition to these risks, thyroid surgery will commonly result in a 1-2 inch scar at the base of the neck that may heal differently in different people. The two major problems specifically associated with thyroid surgery are voice complications and low calcium levels. Both can be temporary or permanent, but permanent changes are very uncommon in the hands of an experienced thyroid surgeon.
Other factors to take into account when choosing to go through surgery are the recovery time and follow up. The typical recovery time after thyroid surgery is between 5 and 7 days. Some patients do not feel quite right until 8 weeks post-surgery. This recovery time is largely due to the time required to determine if thyroid hormone supplementation will be necessary after the surgery and if it is necessary, adjusting the thyroid hormone to the proper dose. Approximately half of patients undergoing removal of half of the thyroid will need thyroid hormone supplements, while all of the patients having their entire thyroid removed will require thyroid hormone pills.
Most people feel the same with or without their thyroid. Some patients have to try different thyroid hormone doses until they feel just right. A small minority continue to complain of weight gain, energy and emotional problems, as well as cognitive decline, even if their thyroid hormones are in the normal range.
Following thyroid surgery, life-long follow-up is required. It entails annual blood tests to ensure that thyroid hormone levels are normal and an occasional ultrasound every 5 years.