Thyroidectomy
Background
Thyroidectomy is the surgical removal of all or part of your thyroid gland.
Your thyroid is a butterfly-shaped gland located at the base of your neck. It produces hormones that control your metabolism, (The way your body produces energy to perform all vital processes)
Thyroidectomy is used to treat enlargement of the thyroid, nodules or cysts in the thyroid, cancer or an overactive thyroid (hyperthyroidism).
If only part of your thyroid removed it is called a partial thyroidectomy.
If only the left of right side of the thyroid is removed, it is called a thyroid lobectomy and if the entire thyroid is removed it is called a total thyroidectomy.
If some of the thyroid is left behind, most patients do not require supplemental thyroid medication, but after total thyroidectomy, you will require daily treatment with thyroid hormone replacement to restore the thyroid’s natural function.
The term “goitre” is sometimes used for an enlarged thyroid and is not a specific condition.
When is it done?
We may recommend a thyroidectomy if you have conditions such as:
- Indeterminate or suspicious thyroid nodules: If, after appropriate investigation of a concerning thyroid nodule, it cannot be confidently classified as cancerous or noncancerous, a partial thyroidectomy (Lobectomy) may be the only way of getting a definitive answer.
- Nodular enlargement of the thyroid: Many patients develop nodules within the thyroid causing gradual enlargement of part of, or the whole thyroid. This might continue to raise a concern of cancer or they may cause progressive pressure symptoms. This might require removal of all or part of your thyroid.
- Thyroid cancer: Cancer is the next most common reason for advising thyroidectomy. If you have thyroid cancer, removing the thyroid will be considered in most cases. In most cases a total thyroidectomy would be suggested.
- Hyperthyroidism (Overactive thyroid): Hyperthyroidism is a condition in which your thyroid gland produces too much of the hormone thyroxine. This is usually treated with anti-thyroid medication or radioactive iodine therapy but in some cases thyroidectomy may be a preferred option.
The Surgical procedure
Surgical removal of the thyroglossal cyst is the only treatment option available. The operation is called the Sistrunk procedure, named for the surgeon who first described it.
Most cases can be performed with a same day discharge although patients may occasionally stay one night in hospital.
Surgery is performed under a short general anaesthetic and most operations are performed in under 1 hour by our experienced surgical team
To reduce the risk of recurrences, it is important to do the following during the operation:
· removing the cyst completely,
· Removing the central part of the hyoid bone where the cyst is attached to.
· Removing the part of the duct in the base of the tongue above the hyoid bone.
Risks
Thyroidectomy is considered a safe procedure with very low risks, but as with any surgery, thyroidectomy carries a small risk of complications. The best way of reducing this risk is to have your surgery done by an experienced surgeon who performs more than 20 such operations per year.
Potential complications include:
- Bleeding in the wound in the first few hours after the operation. If this is not dealt with appropriately, it could result in airway obstruction.
- Damage to the nerves running to the vocal cords resulting in a hoarse or weak voice. Although many patients will have some vocal changes in the weeks after the operation due to swelling and irritation of the nerves, this is usually recovers fully. Permanent damage is rare.
- Low parathyroid hormone levels (hypoparathyroidism) resulting in low calcium levels may be caused by damage or removal of the parathyroid glands. This is only applicable in total thyroidectomy or someone who has had a previous lobectomy and now has an operation for the other side. Parathyroids are tiny glands, located behind your thyroid and they regulate blood calcium. Hypoparathyroidism can cause numbness, tingling or cramping due to low blood-calcium levels.
- Infection is exceedingly rare after thyroidectomy.
How you prepare
Food and medications
If you have low Vitamin D levels and are schedules for a total thyroidectomy, we may give you Vitamin D3 supplementation to use in preparation of the operation.
You may not eat any solid foods within 6 hours of your operation but you may drink water up to 2 hours before your surgery. If you are on blood thinning agents or blood pressure medication, please inform us and we will advise when you should stop these medications.
Other precautions
Please ensure that you have authorization from your medical aid well in advance of your scheduled procedure. Be sure to leave jewellery and valuables at home.
The Surgical Procedure
Your surgeon will perform your thyroidectomy under general anaesthesia, so you won’t be conscious during the procedure. The anaesthetist will visit you before the operation.
A breathing tube will then be placed in your windpipe to assist your breathing throughout the procedure.
The surgical team places several monitors on your body to help make sure that your heart rate, blood pressure and blood oxygen remain at safe levels throughout the procedure. These monitors include a blood pressure cuff on your arm and heart-monitor leads attached to your chest.
During the procedure:
Once you’re unconscious, the surgeon makes a cut (incision) low in the centre of your neck. The length of the incision depend on the extent of your operation. It can often be placed in a skin crease where it will be difficult to see after the incision heals. All or part of the thyroid gland is then removed, depending on the reason for the surgery. During the operation, care it taken to control any blood vessels and avoid bleeding, identify and protect the nerves going to the vocal cords and preserve the parathyroid glands.
If you’re having thyroidectomy as a result of thyroid cancer, the surgeon may also examine and remove lymph nodes around your thyroid. Thyroidectomy usually takes one to two hours. It may take more or less time, depending on the extent of the surgery needed.
Some people may need to have a drain placed through the incision in the neck. This drain is usually removed the morning after surgery.
There are other possible approaches to thyroidectomy, including endoscopic or transoral routes, but these are not offered by our team..
After the procedure
After surgery, you’re moved to a recovery room where the health care team monitors your recovery from the surgery and anaesthesia. Once you’re fully conscious, you’ll be moved to a hospital room.
After thyroidectomy, a few people may experience neck pain and a hoarse or weak voice. This doesn’t necessarily mean there’s permanent damage to the nerve that controls the vocal cords. These symptoms are often short-term and may be due to irritation from the breathing tube that’s inserted into the windpipe during surgery, or be a result of nerve irritation caused by the surgery.
You’ll be able to eat and drink as usual after surgery. Depending on the type of surgery you had, you may be able to go home the day of your procedure or your doctor may recommend that you stay overnight in the hospital.
When you go home, you can usually return to your regular activities. Wait at least 10 days to two weeks before doing anything vigorous, such as heavy lifting or strenuous sports.
It takes up to a year for the scar from surgery to fade. Your doctor may recommend using sunscreen to help minimize the scar from being noticeable.
Results
The long-term effects of thyroidectomy depend on how much of the thyroid is removed.
Partial thyroidectomy:
If only part of your thyroid is removed, the remaining portion typically takes over the function of the entire thyroid gland. So you might not need thyroid hormone therapy.
Complete thyroidectomy:
If your entire thyroid is removed, your body can’t make thyroid hormone. Without replacement, you’ll develop signs and symptoms of underactive thyroid (hypothyroidism). Therefore, you’ll need to take a pill every day that contains the synthetic thyroid hormone levothyroxine (Euthyrox or Eltroxin new Formulation).
This hormone replacement is identical to the hormone normally made by your thyroid gland and performs all of the same functions. Your doctor will test your blood to know how much thyroid hormone replacement you need.