Thyroid surgeries are used for patients who have a variety of thyroid conditions, whether cancerous or benign (non-cancerous).
Common Thyroid Conditions include:
Thyroid nodules- Thyroid nodules are solid or fluid-filled lumps that form within your thyroid. Thyroid cancer accounts for only a small percentage of thyroid nodules.The large majority of thyroid nodules aren’t serious and don’t cause symptoms. Thyroid nodules often go unnoticed until your doctor discovers it during a routine medical exam. Some thyroid nodules, however, may become large enough to be visible or make it difficult to swallow or breathe.
Large thyroid glands (goiters)- A goitre is an enlarged thyroid gland. Some people with a goitre (but not all) have an underactive or overactive thyroid. This means that they make too much or too little thyroid hormone. There are various causes of goitre and treatment depends on the cause.
Overactive thyroid glands- Hyperthyroidism is a condition in which the thyroid gland is overactive and makes excessive amounts of thyroid hormone. The thyroid gland releases hormones that controls your metabolism (the way your body uses energy), breathing, heart rate, nervous system, weight, body temperature, and many other functions in the body. When the thyroid gland is overactive (hyperthyroidism) the body’s processes speed up and you may experience nervousness, anxiety, rapid heartbeat, hand tremor, excessive sweating, weight loss, and sleep problems, among other symptoms.
There are several thyroid surgeries that your doctor may recommend. There are specific indications for each of these operations.
Possible Thyroid Surgery Options Include:
- Biopsy or lumpectomy – removing a small part of the thyroid gland;
- Lobectomy – removing half of the thyroid gland;
- Removing nearly all of the thyroid gland – 2 types below:
- Subtotal Thyroidectomy – leaving a small amount of thyroid tissue bilaterally, or
- Near-total Thyroidectomy – leaving about one gram of thyroid tissue on one side
- Total thyroidectomy– removal of all identifiable thyroid tissue.
In most thyroid surgery, one or both of the thyroid lobes will be removed. The surgeon must utilize proper technique to avoid injury to the nerves to the vocal cords. One of the risks of thyroid surgery is temporary or even permanent weakness of the vocal cords which results in hoarseness. Fortunately, in skilled hands, this complication is rare (less than 1%).
The parathyroid glands, 4 in number, lie behind the thyroid gland. They share some common blood supply with the thyroid and are quite small (about 1 cm each). They are very active little glands, producing a hormone called Parathyroid Hormone (PTH) which together with Vitamin D regulates and maintains blood calcium at a normal level.
Depending on how much of the thyroid gland is removed, the operation will take between 1.5 and 3 hours including anesthesia time. The procedure is performed under general anesthesia. The incision is located in the lower neck and its size will vary based on the size of the thyroid to be removed and the patient’s anatomy; overweight patients and those with very large necks may need larger incisions. The surgery is kept as minimally invasive as possible and the scar is rarely anything to be concerned about, even in young people. There is very little bleeding during the procedure and the patient rarely complains of intense postoperative pain – although this varies from patient to patient. A small drain is often used for 24 hours and patients may either go home the same day or be observed overnight. If the entire thyroid gland is removed, blood calcium levels are checked postoperatively to make sure they are stable before the patient is discharged home. Again, depending on how much of the thyroid gland is removed, patients may need to take thyroid hormone replacement after surgery.
Possible Risks with Surgery
As with any surgical procedure, there are risks, and these will be discussed with the patient by the thyroid surgeon. The two issues which must be discussed relate 1) the nerve to the vocal cords (recurrent laryngeal nerve & external laryngeal nerve), and 2) the parathyroid glands.
Once the patient is discharged home, light activity is recommended. Avoid heavy lifting and strenuous exercise for one week. Avoid ibuprofen, aspirin, or other medications that can increase the risk of bleeding. Bathing and showering is permitted on the first day after surgery, although it is recommended to keep the incision dry for about 48 hours. It is normal to have a sore throat and some pain around the incision after thyroidectomy. Staying on a soft diet for a few days after surgery will help. Postoperative appointments are usually made for one week after the operation.