Thyroidectomy

Thyroidectomy

Thyroidectomy is an operation that involves the surgical removal of the thyroid gland either complete or partial. Surgeons often perform Thyroidectomy when a patient has thyroid cancer or some other condition of the thyroid gland.

Thyroid is a butterfly-shaped gland located at the base of your neck. It produces hormones that control every aspect of your metabolism, from your heart rate to how quickly you burn calories. Thyroidectomy is used to treat thyroid disorders, such as cancer, noncancerous enlargement of the thyroid gland (Goitre) and overactive thyroid gland (hyperthyroidism).

How much of your thyroid gland is removed during thyroidectomy depends on the reason for surgery. If you need only part of your thyroid removed (partial thyroidectomy), your thyroid may work normally after surgery. If your entire thyroid is removed (total thyroidectomy), you need daily treatment with thyroid hormone to replace your thyroid’s natural function.

Why is it done

Your doctor may recommend a thyroidectomy if you have conditions such as:

Thyroid cancer. Cancer is the most common reason for thyroidectomy. If you have thyroid cancer, removing most, if not all, of your thyroid will likely be a treatment option.

Noncancerous enlargement of the thyroid (goitre)

Removing all or part of your thyroid gland is an option if you have a large goitre that is uncomfortable or causes difficulty breathing or swallowing or, in some cases, if the goitre is causing hyperthyroidism.

Overactive thyroid (hyperthyroidism). Hyperthyroidism is a condition in which your thyroid gland produces too much of the hormone thyroxine. If you have problems with anti-thyroid drugs and don’t want radioactive iodine therapy, thyroidectomy may be an option.

Indeterminate or suspicious thyroid nodules

Some thyroid nodules can’t be identified as cancerous or noncancerous after needle biopsy. Doctors may recommend that people with these nodules have thyroidectomy if the nodules have an increased risk of being cancerous.

How you prepare

Food and medications

If you have hyperthyroidism, your doctor may prescribe medication — such as an iodine and potassium solution — to control your thyroid function and lower the bleeding risk after surgery.

You may need to avoid eating and drinking for a certain period of time before surgery, as well, to avoid anesthesia complications. Your doctor will provide specific instructions.

Before the procedure

Surgeons typically perform thyroidectomy under general anesthesia, so you won’t be conscious during the procedure. The anesthesiologist or anesthetist gives you an anesthetic medication as a gas — to breathe through a mask — or injects a liquid medication into a vein. A breathing tube will then be placed in your trachea to assist breathing throughout the procedure.

During the procedure

Once you’re unconscious, the surgeon makes a cut (incision) low in the center of your neck. 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.

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.

There are several approaches to thyroidectomy, including:

Conventional thyroidectomy. This approach involves making an incision in the center of your neck to directly access your thyroid gland. The majority of people will likely be candidates for this procedure.

Transoral thyroidectomy. This approach avoids a neck incision by using an incision inside the mouth.

Endoscopic thyroidectomy

This approach uses smaller incisions in the neck. Surgical instruments and a small video camera are inserted through the incisions. The camera guides your surgeon through the procedure.

After the procedure

After surgery, you’re moved to a recovery room where the health care team monitors your recovery from the surgery and anesthesia. Once you’re fully conscious, you’ll be moved to your hospital room.

Some people may need to have a drain placed under the incision in the neck. This drain is usually removed 48 hrs after surgery.

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 next day of your procedure or your doctor may recommend that you stay for 2 days 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 (Synthroid, Unithroid, others).

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.