Thyroid Surgery / Thyroidectomy
What is the thyroid?
The thyroid is a butterfly-shaped gland located in front of the neck, just below the voice box or larynx and wraps around the windpipe. It consists of two lobes on either side connected by an isthmus. The thyroid converts iodine from your diet into the thyroid hormone, thyroxine. This hormone controls most of your body's metabolic functions including temperature, heart rate and growth. Disease or abnormality of this gland can result in various physiological problems.
What is thyroid surgery?
Thyroid surgery is an operation to remove part or all of the thyroid gland. Depending on the indication for surgery, Dr Graham will discuss whether removal of half of your thyroid (hemithyroidectomy) or all of your thyroid (total thyroidectomy) is required.
Thyroid operations that can be done include:
Total thyroidectomy - removal of the whole thyroid
Hemithyroidectomy - removal of half the thyroid
If a total thyroidectomy is performed, you will need to take thyroxine tablets (thyroid hormone replacement) for the rest of your life. If less than a total thyroidectomy (hemithryoidectomy) is performed, most commonly, you will not need to take thyroxine. Around 15% of people still require some thyroxine supplementation after a hemithyroidectomy.
What are the indications for thyroid surgery?
Dr Graham will discuss your condition with you in details and discuss the different treatment options available. Thyroid surgery is usually recommended for thyroid conditions that include:
Nodules
Overproduction of hormones
Cancerous and noncancerous tumours
Goitre or swelling of the thyroid that can cause difficulties swallowing or breathing
It may be necessary to have a biopsy of the thyroid gland or a nodule in order to help with the diagnosis. Dr Graham may organise a fine needle aspiration biopsy where a sample of thyroid tissue is obtained using ultrasound guidance and analysed in the laboratory. This is also often organised by your GP prior to your appointment.
How is thyroid surgery usually performed?
Thyroid surgery is almost always performed under a general anaesthetic. An incision is made in the front of the neck, above the clavicle. Half or all of the thyroid is removed through this incision. Great care is taken not to injure the nerves that control the voice box (laryngeal nerves) and to preserve the parathyroid glands (responsible for controlling calcium levels in the blood).
At the end of the operation, a small plastic tube is often inserted into the operation site to drain any blood or fluid that may accumulate. The wound is closed with dissolving stitches and a dressing is placed.
How long do I stay in hospital and what is the recovery like?
Following the surgery, you will be taken to the recovery ward and then to a post-operative ward and monitored carefully. You will be prescribed medication to help alleviate any pain you may have. You will be allowed to start eating and drinking soon after surgery. Whilst the drain is in, you will remain in hospital. Most people stay in hospital for one or two nights after the surgery.
You will be able to do most things to care for yourself after surgery and are encouraged to do so. You may shower as normal. You will need to avoid strenuous activities for at least 2 weeks and any heavy lifting or straining for 6 weeks.
What are the risks and complications of thyroid gland surgery?
All operations have potential side effects and complications. Fortunately, these are uncommon and surgery usually proceeds without any problems. Dr Graham will the risks and possible complications with you in detail at your consultation.
Risks specific to thyroid surgery include but are not limited to:
Bleeding – any visible bleeding is controlled during the surgery using a combination of blood vessel sealing devices and small metal clips. Sometimes, after surgery, vessels can reopen and bleeding can restart. A build up of blood in the neck may cause obstruction of the airway and require urgent return to theatre to evacuate the blood. This is uncommon.
Hypoparathyroidism – this results from damage to the parathyroid glands. Most commonly it is usually temporary, but rarely, calcium replacement is required permanently to help maintain normal calcium levels.
Injury to nerves that supply the vocal cords – rarely, this important nerve may be damaged. This can result in a permanent hoarse voice, or difficulty with higher pitch of the voice. It can also significantly impact swallowing. It is common to have a temporary hoarse voice in the days after surgery. Most commonly changes in speech and swallowing are temporary and resolves. A speech therapist can help with exercises to improve the voice in this setting. If both of these nerves are damaged, severe breathing difficulty may occur and assistance with breathing may be required. Very rarely, this may be permanent.
Scarring - in some people, healing of the wound can become thickened, red and painful (a keloid scar).
Infection - infection of the wound after thyroid surgery is very uncommon. Symptoms include swelling, redness, heat and discharge from the wound. If it occurs, antibiotics and further treatment may be required.
Dr Graham advocates the National Law and Australian Health Practitioner Regulation Agency (AHPRA) guidelines that any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.