What Type of Thyroid Cancer Surgery Do I Need?

Hi everyone, I'm Dr. Michael Yeh from UCLA Health Endocrine Surgery. If you're watching this video, chances are you've been diagnosed with thyroid cancer—most likely papillary thyroid cancer, which is by far the most common type.

In fact, over 90% of thyroid cancers diagnosed around the world in 2024 are papillary, and thankfully, it tends to grow very slowly.

So, what kind of surgery do you need?

There are three main surgical options:

1. Thyroid lobectomy – removal of half of the thyroid gland
2. Total thyroidectomy – removal of all of the thyroid gland
3. Total thyroidectomy with lymph node dissection – total removal plus removal of affected lymph nodes

1. Who should get a lobectomy?

Lobectomy is appropriate for patients with:

• A single tumor that is
• Less than 4 cm,
• Fully contained within the thyroid (intrathyroidal), and
• No spread to lymph nodes or invasion of surrounding structures

This is actually the most common scenario today—more than half of our thyroid cancer patients qualify for lobectomy alone.

2. Who needs a total thyroidectomy?

A total thyroidectomy may be recommended if:

• The tumor is larger than 4 cm
• There are cancers on both sides of the thyroid
• The cancer is located in the isthmus (the middle part of the thyroid)
• There is evidence of local invasion—for example, cancer extending into nearby muscles or close to the airway

Importantly, we make this decision based on high-resolution ultrasound, and I personally perform that ultrasound for every patient. Why? Because the quality of the operation depends on understanding the full 3D anatomy of the neck and how the cancer relates to nearby structures and lymph nodes. I want zero surprises on the day of surgery. I want the surgery to be boring—completely planned, with no guessing.  Here at the UCLA Endocrine Center, the surgeons take full responsibility and ownership for the imaging that goes into planning a high-quality thyroid cancer operation. 

3. Who needs total thyroidectomy with lymph node dissection?

This is necessary when we see suspicious or abnormal lymph nodes on ultrasound—either:

• In the central neck (near the thyroid), or
• In the lateral neck (along the sides)

Identifying abnormal lymph nodes requires a great deal of experience. Every year, we review thousands of lymph nodes, honing our ability to distinguish normal from abnormal.

That’s why we, the surgeons, do our own ultrasounds—not a technician, not a radiologist. While they may be great, this step is critical in determining exactly the right surgery for you.

Why Surgeon-Performed Ultrasound Matters

We have ultrasound machines in every exam room and every operating room. Before every thyroid cancer surgery, we remap the thyroid and the lymph nodes while the patient is asleep—one last check to ensure we’re doing exactly what’s needed. “I can’t imagine doing thyroid cancer surgery without surgeon-performed ultrasound. It’s my roadmap. I would be lost without it.”

Our goal is to choose the operation that’s:

• Not too much surgery
• Not too little surgery
• But just right for you

Thanks for listening—and thank you for trusting us with your care.

Find your care

We deliver effective, minimally invasive treatments in a caring environment.
Call 310-267-7838 to connect with an expert in endocrine surgery.

Request an appointment | Our locations | Find a provider