The thyroid gland is located in front of neck just below larynx (voice box). The thyroid gland is part of the endocrine system, which regulates hormone in the body. The thyroid gland absorbs iodine from bloodstream to produce thyroid hormones, which regulate a person’s metabolism.

Thyroid glands contain 2 types of cells, Follicular cells and C cells. Follicular cells are responsible for producing thyroid hormone. C cells produces calcitonin, a hormone that participates in calcium metabolism.

Thyroid cancer starts when healthy cells in thyroid change and grow out of control, forming a mass called a tumour. There are five types of thyroid cancer- papillary thyroid cancer, follicular thyroid cancer, hurthle cell cancer, medullary thyroid cancer and anaplastic thyroid cancer.

Thyroid cancer presents as swelling in the neck in the region of thyroid or swelling in the sides of neck. When tumor is advanced and involves adjacent structures, patient may have symptoms like hoarseness of voice, difficulty in swallowing and difficulty in breathing.

Ultrasound of neck for specific information about the nodules, Thyroid function test (Serum T3,T4 and TSH) and Ultrasound guided FNAC from the suspicious thyroid nodule as well as neck nodes are initial investigations for confirmation of diagnosis. In case of locoregionally advanced disease, CT scan or MRI of neck is required to know the extent of tumor as well as neck nodal spread.

Surgery is the mainstay of treatment for thyroid cancer. For small size papillary thyroid cancer, hemithyroidectomy may be sufficient in selected patients as recommended by American Thyroid Association or NCCN guidelines, but final decision is always taken after histopathology report. In some patients, completion thyroidectomy may be required. For larger tumors, total thyroidectomy is recommended. Central compartment clearance is recommended if patient has central compartment nodes or in high-risk cases or with lateral neck nodes. Unilateral or bilateral neck dissection is required in case of lateral neck nodal metastasis.

For Follicular neoplasm, hemithyroidectomy followed by completion thyroidectomy is recommended depending upon final histopathology report.

For medullary thyroid cancer, total thyroidectomy with central compartment clearance with or without unilateral/bilateral neck dissection is recommended based upon size, location, nodal metastasis and calcitonin value.

There are different surgical techniques available for thyroidectomy for better cosmesis. These are called remote access thyroidectomy. There are different approaches described- transaxillary, retroauricular, transoral and BABA (Breast-axilla-breast -axilla) approaches. There are advantages and disadvantages of each approach. These approaches utilise either CO2 gas insufflation or skin retractor system for creating spaces for surgery to be completed. These again can be completed either with endoscope assisted or robot assisted. Robot assisted surgery has many advantages over endoscope assisted surgery.

Endoscopic thyroidectomy – During this procedure, the surgeon makes many small incisions or a large incision in well-hidden areas to hide the scar. The scope and video monitor guided surgical procedure done with endoscopic instruments.

Robotic thyroidectomy – The surgeon makes an incision to hide surgical scar an armpit, hairline of neck, mouth or chest, use robotic tool to perform the thyroidectomy.