When is thyroid surgery recommended?
- A nodule that is suspicious or confirmed as cancer on needle biopsy.
- A large goitre causing pressure symptoms – difficulty swallowing or breathing, voice change – or visible neck swelling.
- Goitre extending behind the breastbone (retrosternal).
- Overactive thyroid (Graves' disease or toxic nodules) when medicines or radioactive iodine are unsuitable.
Investigations
- Thyroid function tests (TSH, T3, T4).
- Neck ultrasound to assess nodules using a risk system such as TI-RADS.
- Fine-needle aspiration cytology (FNAC), reported using the Bethesda system (categories I–VI) to estimate the risk of cancer.
- Vocal cord check (laryngoscopy) and, when needed, CT scan for large goitres.
Types of operation
Hemithyroidectomy (lobectomy)
Removal of one lobe. Used for a single indeterminate nodule or small low-risk cancer. Many patients do not need thyroid tablets afterwards.
Total thyroidectomy
Removal of the whole gland, for multinodular goitre affecting both sides, Graves' disease or many thyroid cancers. Lifelong levothyroxine tablets are required.
Neck dissection
Removal of lymph nodes when cancer has spread to them.
Some centres offer scarless (remote-access or endoscopic) approaches for selected small nodules.
The procedure and recovery
Surgery is done under general anaesthesia through a 4–6 cm incision in a natural neck crease and usually takes 1–3 hours. Most patients stay 1–2 nights, eat normally the next day and return to work in 1–2 weeks. The scar typically fades to a fine line.
Risks
- Voice change: injury to the recurrent laryngeal nerve can cause hoarseness – temporary in a few percent, permanent in under 1–2% in experienced hands. Nerve monitoring may be used.
- Low calcium: the parathyroid glands next to the thyroid may be stunned, causing tingling; usually temporary and treated with calcium and vitamin D.
- Bleeding in the neck (rare but requires urgent attention), infection and scarring.
Frequently asked questions
Will I need tablets after thyroid surgery?
After total thyroidectomy, yes – one levothyroxine tablet daily for life. After hemithyroidectomy, about 1 in 4 people need them.
Are most thyroid nodules cancer?
No. Over 90% of thyroid nodules are benign. Ultrasound and FNAC help identify the few that need surgery.
When can I use my voice normally?
Most people speak normally straight away. Mild hoarseness or voice tiredness for a few weeks is common and usually settles.
Last reviewed: October 2026. This page is general information and does not replace advice from your own doctor.