What to do if I had thyroid cancer 23 years ago and my thyroid was removed but I did not have radiation does this mean it has come back?

No. thyroid cancer behaves differently at different ages. If one is in the 60's and has a thyroidectomy for cancer, frequently the lesion is locally aggressive invading the larynx and making surgery very difficult. When you had your tumor removed at age 18, even in the face of metastasis to many cervical nodes, resection without radiation is virtually curative.