Thyroid Surgery

What is the thyroid gland?

The thyroid gland is situated in the neck and makes a hormone called thyroxine. This hormone regulates the oxygen consumption of the body’s tissues. The thyroid gland is shaped like a butterfly with a left and a right side (lobe) joined in the middle by a small bridge. Situated in the four corners of the butterfly’s wings are four tiny glands called parathyroid glands. These produce a hormone which controls the level of calcium in the blood; parathyroid hormone (PTH).

Why do I need a thyroid operation?

There are two distinct reasons why a thyroidectomy may be necessary. Surgery is either carried out because the thyroid has grown in size (a goitre) or because it is making an excess of thyroxine.

Why is surgery necessary for a goitre?

There are a number of reasons why a thyroid operation is considered in patients with an enlarged thyroid;
– There may be pressure on the trachea (windpipe) with difficulty in breathing
– There may be pressure on the oesophagus (foodpipe) with difficulty in swallowing
– There may be concern about thyroid cancer
– The goitre may result in cosmetic embarrassment.

Why is surgery necessary for an overactive thyroid?

Surgery is one of a number of ways to treat an overactive thyroid and your surgeon will discuss the advantages and disadvantages of each option before a decision about thyroidectomy is taken.

How is a diagnosis of thyroid cancer made?

Thyroid lumps (goitre) are very common whereas thyroid cancer is very rare. The best way to determine whether a lump is benign or malignant is to undertake a biopsy of the lump using a fine needle. This test is simple, relatively painless and can be undertaken in the outpatient clinic.

Will I need to take thyroxine replacement after surgery?

The normal thyroid has considerable spare capacity for making thyroxine and so normally removal of as much as half of the gland can be undertaken without the need to give thyroxine replacement in the form of daily tablets after the operation. Thyroine replacement will be necessary if all of the thyroid gland is removed.

What happens before the operation?

You will usually be seen one or two weeks before operation and be admitted to hospital on the day of surgery. Pre-operative tests may include a chest X-ray, a heart recording (e.c.g.) and various blood tests. An inspection of the voice box and vocal cords using a fine telescope through the nose is occasionally undertaken by an ENT doctor.

What does the operation involve?

The surgery is carried out under a general anaesthetic. A collar incision in the creases of the neck provides access to the thyroid gland. The length of the scar is proportional to the size of the goitre, usually about 4 – 6cm. Generally, the surgeon will either remove one or both lobes of the thyroid gland. Most patients are fit to go home 24 hours after surgery.

Are there any risks to the operation?

Thyroid surgery requires a general anaesthetic. In experienced hands most thyroid operations are straightforward and associated with few problems. General complications that can befall thyroidectomy include bleeding into the wound and wound infections, but these are rare. There are some specific complications relate to thyroid surgery:

The Voice: Intimately related to the thyroid gland are two nerves, one on each side of the neck. These recurrent laryngeal nerves provide the electricity for the movement of the vocal cords – which generate the voice. Injury to the nerve causes a weak and husky voice. Most injuries are a temporary bruising, with full recovery. However a permanent injury will result in a permanently weak voice. The risk of a permanent injury is about 1% (one in one hundred).

The Blood Calcium: During thyroid surgery, the surgeon strives to identify and preserve all four parathyroid glands, but bruising or inadvertent removal of the glands may result in temporary or permanent loss of function. This results in a fall in blood calcium levels. The symptoms of low calcium are pins and needles in the hands, feet and lips. If this happens then you will require to take calcium and/or vitamin D supplements. Bruised parathyroids usually recover their function within 6 weeks. Permanent injury to the parathyroid glands requires lifelong vitamin D and calcium supplementation The risk of needing long-term medication because of low calcium applies only to patients undergoing surgery to both sides of the thyroid gland and is about 5% (1 in 20).

The Scar: Thyroid surgery is undertaken through a scar that follows the natural creases in the neck. Usually it heals well leaving only a thin line. The stitches that are used are dissolvable and so there is no need for them to be removed. Application of Vitamin E to the wound greatly improves the cosmetic result.

Thyroid function: If all of the thyroid gland is removed you will require lifelong replacement of thyroxine. This is a once a day dose, with little need for adjustment.

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