Thyroidectomy | Dr Russell Manley | General, Endocrine and Gastrointestinal Surgeon

What is Thyroid Surgery (Thyroidectomy)?

Surgery can be used to remove a large goitre or a hyperfunctioning nodule within the gland. Surgery is necessary when there is a possibility of thyroid cancer.

Thyroid surgery can also be used in Graves' Disease and was the treatment of choice prior to RAI therapy and anti-thyroid medications.

Types of Thyroid Surgery

Thyroid surgery typically involves a

Total Thyroidectomy - the removal of all the thyroid gland
Hemithyroidectomy - the removal of part of a diseased thyroid gland.

If the thyroid gland is removed entirely, the individual will need to take synthetic thyroid hormone for life. If only half the gland is removed ( hemithyroidectomy) then there is an 80% chance the patient will not require hormone supplementation

What is the thyroid gland?

The thyroid gland is a butterfly-shaped gland located in front of the neck, just below the voice box or larynx. It consists of two lobes on either side connected by an isthmus.

The thyroid produces hormones that are necessary for the metabolism and proper functioning of the body. Disease or abnormality of this gland can result in various physiological problems.

Indications for Thyroid Gland Surgery?

Thyroid surgery is usually recommended for thyroid conditions such as nodules, overproduction of hormones, cancerous and noncancerous tumours, and goitre or swelling of the thyroid that can make it difficult to swallow or breathe.

To identify cancer, your doctor may organise a fine needle aspiration biopsy where a sample of thyroid tissue is obtained using ultrasound guidance and analysed in the laboratory.

How is Thyroid Surgery Performed?

Thyroid surgery is performed under general anaesthesia. Your surgeon makes a 5-cm horizontal incision in the centre of your lower neck.

A single lobe or the entire gland is removed through this incision. Cancer of the thyroid is usually treated by complete removal of the gland. Less aggressive cancers may be treated by the removal of only one of the lobes.

The parathyroid glands that regulate calcium, as well as the recurrent laryngeal nerve that runs behind the thyroid supplying the larynx or voice box, are identified and preserved as far as possible.

After removal of the tissue, a small tube (drain) is on rare occasions inserted at the site to drain accumulated fluids. The incisions are then closed with absorbable sutures and a waterproof glue applied as a dressing.

In the case of thyroid cancer, lymph nodes in the neck adjacent to the thyroid may also need to be removed.

Following the surgery, you will be taken to the recovery room and monitored carefully.

Blood tests are performed during your admission to ensure calcium levels have not been impacted upon by the operation.

Patients usually are able to be discharged from hospital the morning after surgery

Before leaving the hospital, you will be taught how to care for your incision and advised on how to minimise scarring.

What are the risks and complications of thyroid gland surgery?

As with all surgical procedures, thyroid surgery may be associated with certain risks and complications such as:

Bleeding – this may cause obstruction of the airway and require an urgent return to the theatre to evacuate the blood. This is uncommon.
Hypoparathyroidism – Damage to the parathyroid glands that may require medication to help maintain normal calcium levels. (usually temporary)
Injury to nerves that supply the vocal cords – this is an uncommon occurrence that can significantly impact a patients’ speech and swallowing. Often it is only temporary and resolves in 6 months. A speech therapist can help with exercises to improve the voice in this setting.

After Thyroid surgery

Following the surgery, you will be taken to the recovery room and monitored carefully.

Blood tests are performed during your admission to ensure calcium levels have not been impacted upon by the operation.

Patients usually are able to be discharged from hospital the morning after surgery

Before leaving the hospital, you will be taught how to care for your incision and advised on how to minimise scarring.

Emergencies

Emergency Department - if you have a fever, shortness of breath, difficulty breathing, numbness or tingling in your fingers, hands, or mouth, muscle spasms, or if you notice signs of wound infection (redness, tenderness around the incision).

Pain Management

A prescription for mild pain medication will be given to you. You are not required to take it. If you do take it, please do not drive or drink alcohol as these in combination may make you drowsy. Most patients do not need strong pain medicine by the time they leave the hospital.
Numbness of the skin under the chin or above the incision is normal and should go away in a few weeks.

Post Operative Follow Up

Follow up is normally scheduled at 2 weeks following surgery in the office.
Your voice may be hoarse or weak. Pitch or tone may change. You may have difficulty singing. This usually goes back to normal within days but can improve upto 6 months post surgery

Medication Management

You will require lifelong thyroid supplementation following surgery. Take your thyroid medication (thyroxine) as prescribed when you go home. These medications are identical to the hormone made by the thyroid. Thyroid medication should be taken on an empty stomach.
Thyroxine tablets should be kept in their original container and stored out of sunlight in a cool dry place (often they are stored in a fridge).
Temporary drop in your calcium may occur after surgery requiring calcium medication on discharge. Blood tests will be used to guide this medication which is normally stopped after 3-4 weeks. Calcium and thyroid hormones should be taken 1-2 hours apart.

Activity

Patients are able to return to full-time work within 1-2 weeks, however, this may vary according to your job.
Do not drive a car until you are able to turn the neck side to side, which may take 1-2 weeks.
Do not drive while you are taking pain medicines.

Diet

You may have temporary throat discomfort or difficulty swallowing. This is due to the surgery around your larynx (voice box) and oesophagus (swallowing tube). These symptoms will gradually improve over the course of several weeks.
You may be able to return to your usual diet in a couple of days.

Wound Care

A waterproof glue is used as the dressing. Do not pick at the glue film following surgery. It will fall off within 2 weeks
You may shower after surgery but please do not swim or soak in a tub for at least 2 weeks. After you are done showering, just pat your incision dry. If it is draining clear fluid, you can cover it with a dry dressing (such as gauze).
Use sunscreen or wear a scarf for protection if in the sun for the first 6 months to a year as the sun can darken your scar.
Your incision may feel itchy while it heals. Avoid rubbing or scratching if possible.
You may begin to use a moisturizing cream or oil (Bio-Oil or Vitamin E cream) along the incision after 2 weeks