Thyroid Operations
Several Surgical Options for the Thyroid Gland Depending on the Problem
Which operation is performed on a thyroid gland depends upon 2 major factors.
The first is the thyroid disease present which is necessitating the operation. The second is the anatomy of the thyroid gland itself.

If a dominant solitary nodule is present in a single lobe, then removal of that lobe is the preferred operation (if an operation is even warranted). If a massive goiter is compressing the trachea and esophagus, the the goal of surgery will be to remove the mass and usually this means a sub-total or total thyroidectomy (occasionally a lobectomy will suffice). If a hot nodule is producing too much hormone resulting in hyperthyroidism, then removal of the lobe which harbors the hot nodule is all that is needed.

Most surgeons and endocrinologists recommend total or near total thyroidectomy in virtually all cases of thyroid carcinoma. In some patients with papillary carcinomas of small size, a less aggressive approach may be taken (lobectomy with removal of the isthmus). A lymph node dissection within the anterior and lateral neck is indicated in patients with well differentiated (papillary or follicular) thyroid cancer if the lymph nodes can be palpated. This is a more extensive operation than is needed in the majority of thyroid cancer patients. All patients with medullary carcinoma of the thyroid require total thyroidectomy and aggressive lymph node dissection.

Surgical Options
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 goiters which are isolated to one lobe (not common).

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 goiters which are causing problems in the neck or even those which extend into the chest (substernal goiters).

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.