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The removal of the thyroid is called a thyroidectomy and is usually the treatment of choice for MTC. The diagnosis is usually known from a biopsy done before surgery. Sometimes only half of the thyroid is removed, called a thyroid lobectomy. A lobectomy is usually performed when there isn’t a diagnosis before surgery. If the cancer is diagnosed as MTC after a lobectomy, a patient should talk with their doctor to decide if they want another surgery to remove the rest of the thyroid (called a completion thyroidectomy).
Thyroidectomy
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We only need one working parathyroid gland (of the four that we have) to have normal parathyroid function and normal calcium levels in our blood. However, doctors try to preserve as many parathyroids as possible. If a parathyroid’s blood supply is reduced during the operation, the surgeon can reimplant it in muscle in the neck or arm (called an autograft). The parathyroid will often begin to work normally again.
Preserving Parathyroid
Gland Function
Gland Function
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The right and left recurrent laryngeal nerves (RLN) innervate the voice box and help in speech, swallowing, and breathing. Injury to one or both of these nerves by cancer or surgery for cancer can affect speech, swallowing, and/or breathing. The RLN is sometimes stretched when the thyroid is mobilized during surgery. 95% of the time, the RLN is not bothered by this stretch and functions like normal, with no change in voice. 4% of the time the nerve is temporarily bruised by being stretched and a patient can experience temporary hoarseness while the nerve is healing. The RLN is permanently injured about 1% of the time, which can cause permanent hoarseness. Very rarely, if both nerves are not working because of cancer or surgery for cancer, this can cause airway obstruction and require a temporary or permanent tracheostomy (breathing tube through the neck). Fortunately, this happens only about 1 in 10,000 times during routine thyroid surgery.
Preventing Nerve Damage
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Central Neck Dissection
Most patients diagnosed with MTC prior to surgery will undergo a central neck dissection (CND), as denoted in blue, along with their thyroidectomy. A CND involves removing the lymph nodes within the central neck (the area between the two carotid arteries) and is sometimes called a Level VI lymph node dissection. The goal of a CND is to remove any cancer that may have spread to the lymph nodes immediately around the thyroid.
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Risks Associated with Central Neck Dissection
Risks of a CND include the removal or disruption of the blood supply of the parathyroid glands. Often the two inferior glands are removed during this dissection in order to perform a complete resection. Sometimes a parathyroid gland may be inadvertently removed or autotransplanted (re-implanted in muscle) during CND. The recurrent laryngeal nerves (RLN) are also at risk. Ideally the CND would be performed at the same time as the thyroidectomy. Neither surgeons nor patients want to enter the central neck more than once if possible; each reoperation is more challenging because scar tissue makes injuring the parathyroids and RLN more possible.
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Lateral Neck Dissection
Patients who have evidence of disease in the lateral neck area will usually undergo a lateral neck dissection (LND), as denoted in blue. The lateral neck contains the carotid artery, jugular vein, and important nerves. The vagus nerve is an important nerve in this area and affects the voice and swallowing function. The spinal accessory nerve is also in this area and allows someone to shrug their shoulders and raise their arms above their head. Another important nerve in this area is the phrenic nerve, which moves the diaphragm up and down while someone breathes. A risk of a lateral neck dissection is the development of a lymphatic leak. These leaks can cause lymphatic fluid (chyle) to build up in the neck and may require a temporary low-fat diet or other treatments.
A bilateral central neck dissection is when both the right and left sides of the central neck are dissected. Unilateral means only one side was dissected (sometimes called right central neck or left central neck).
A bilateral central neck dissection is when both the right and left sides of the central neck are dissected. Unilateral means only one side was dissected (sometimes called right central neck or left central neck).





