Thyroid nodules are very common: they are found in one in two people after 40 years.

Those who produce thyroid hormones (15% of cases) can cause severe hyperthyroidism , but they are still benign.

The other nodules (called "cold") must be closely monitored because 5% of them are likely to become cancerous.

Thyroid: too many unnecessary surgeries

The prestigious British Medical Journal has sounded the alarm over the explosion in the number of surgeries. The sophistication of medical imaging techniques facilitates the detection of smaller and smaller nodules (up to 2 mm), which increases their detection and therefore the temptation to suppress them.

However, few nodules evolve spontaneously into malignant tumors. Of the 40,000 thyroid ablations performed each year in France, at least one in five is unjustified according to the Institut Gustave-Roussy (Villejuif).

Who should have thyroid surgery?

All thyroid cancers must be operated on. They are diagnosed by ultrasound and cytopuncture, that is to say by direct removal of a fragment of nodule with a thin needle slipped through the skin of the neck. Sometimes a scintigraphy is also needed to refine the treatment, to assess whether the nodules are able to fix iodine.

An unsightly goitre or bulky nodules, bothersome to swallow or to talk about, can also be removed. But small harmless nodules (less than 1 cm) should not lead to the operating room. An ultrasound follow-up is enough.

Significant side effects

Once the thyroid is extracted, a drug treatment for life becomes essential because it is impossible to live without thyroid hormones .

But surgery can also cause some small complications. It happens that the vocal cords are affected , to the extent that the nerves that drive them pass very close to the thyroid gland. In 5% of patients, removal of the thyroid causes a partial extinction or derailment of the voice , which requires speech therapy.

The parathyroid glands can also be altered. As they play a key role in regulating calcium levels, calcium supplements must be absorbed post-operatively, either transiently or permanently.

Thyroid scar and surgeon robots

After the surgery, 95% of patients with thyroid cancer heal, but a scar (3-6 cm) remains visible at the base of their neck . To avoid this, robot surgeons have appeared.

Guided by an operator seated behind a console, they perform the incision under the armpit or behind the ear , then intrude through the tissues to the thyroid that they dissect with extremely precise gestures. As their ability is remarkable, the sequelae are reduced.

"There is only 0.5% of vocal cord problems, ten times less than with conventional surgery," says Dr. Patrick Aïdan, head and neck surgeon at the American Hospital in Paris . Not to mention the best aesthetic result. The thyroid ablation assisted by a robot is also practiced at the Gustave-Roussy Institute, Lille, Montpellier and Nancy CHUs.