A B C D E F G H I J K L M N O P R S T U V W

THYROIDECTOMY

Why is a Thyroidectomy performed ?

There are several reasons for removing part or all of the thyroid gland. These vary from removal of an overactive gland, a simple goitre (enlarged thyroid gland) for cosmetic or comfort reasons, or the removal of the gland when it contains a cancer. A simple goitre may give no more inconvenience that a rather full appearance to the neck. However, on occasions it may become so big that it causes pressure on the windpipe or gullet, causing breathing or swallowing problems. One of the ways of managing an overactive thyroid gland (hyperthyroidism) is to remove the gland, particularly after a course of anti-thyroid drugs has failed to treat the condition. Thyroidectomy is one of the methods of permanently dealing with the condition.

Preparations needed for a Thyroidectomy

These will depend on why the operation is being performed. You will probably be admitted to hospital the day before the operation and should expect to stay in hospital for 5 to 7 days. An ear, nose and throat surgeon will check your voice box (larynx) before the operation to ensure that the vocal cords are healthy. Certain types of goitre may affect the nerve which controls the voice box. On rare occasions, minor voice changes may occur following thyroid surgery consisting of a very mild huskiness or an inability to sing. If the purpose of the thyroidectomy is to treat an overactive thyroid, the high thyroid hormone levels will have to be corrected by drug treatment first. It is essential that you are not hyperthyroid at the time of surgery. This could cause serious illness in the post-operative period. You will have a test to be sure all is well before operation.

What Happens during a Thyroidectomy

The thyroid gland is found low in the neck and is shaped like a butterfly. It is located to the front and either side of the windpipe. It extends backwards, on either side of the gullet. The thyroid gland produces two hormones, thyroxine (T4) and triiodothyronine (T3), which affect the body's function in may ways. Before surgery, you will be sedated either by injection or tablets, so that you are calm and any anxiety completely controlled. The operation is almost always performed under general anaesthesia. A small cut is made in the neck near the collar line. The soft tissues of the neck are explored and all or part of the thyroid gland is removed. Attempts are made to leave as much normal thyroid tissue behind as is possible. This is to avoid the long-term need for replacement of thyroid hormones by tablets (usually using thyroxine). If there is a suggestion of cancer, then the growth is removed with a surrounding collar of normal thyroid tissue. Lymph glands near the thyroid need to be removed as well. During the operation, the surgeon will locate the nerves in the neck which control the voice box. They have to be carefully handled. Four small glands (the parathyroids) near the thyroid are also identified carefully. A small drain connecting to a suction bottle is placed in the area of the wound, and the wound is then closed with fine sutures or metal clips. After several weeks the wound heals well and is almost invisible after 12 months.

Possible Complications

Complications in thyroid surgery are rare. Following the operation you will be up and about within 2 days. Complications such as clotting in the veins, chest infection and pneumonia are uncommon. Damage to one of the nerves to the voice box on either side will result in hoarseness. This may be temporary if there is minor damage to the nerve. Sometimes it may be permanent. Such a problem is now very uncommon, but it is essential that you are aware of the possibility when the consent form for the operation is signed. Damage to both nerves is exceedingly rare and if this occurs the voice is lost and it may be necessary for a hole in the windpipe (tracheostomy) to be made to allow air into the lungs: it is difficult for air to pass through a paralysed voice box. Quite a few people find that they cannot sing so well: this is due to damage to another smaller nerve which is not so easy to protect at the time of the operation. The parathyroid glands control the body's calcium metabolism. Damage to these glands can occur and may result in a low blood-calcium level. This may be temporary and cause tingling around the mouth and cramps in the muscles of the hands and feet. On occasions, all four parathyroids are inadvertently removed. This happens particularly with the more difficult operations in patients with cancer of the thyroid. It may then be necessary for daily calcium supplements and special varieties of vitamin D to be taken by mouth permanently. Very occasionally the scar becomes a little heaped up and highly coloured (keloid). This is more common in people with coloured skin or in whom a keloid has occurred following another operation.

Afterwards

After the thyroid operation, you will be kept for an hour or so in the recovery unit of the operating theatre and will then return to the ward. You will be sat up first to reduce the risk of bleeding. Blood transfusion is rarely necessary. A small drain from the wound will be attached to a suction bottle. You will be able to talk normally and swallow fluids within an hour or so and to eat a soft diet within 24 hours. The drip and drain will then be removed and you will be able to be up and about. After 4 or 5 days the stitches or metal clips will be removed and you will be discharged home. Most patients are able to return to work 2 or 3 weeks after their thyroidectomy and to lead a normal and active social life. A blood test to assess thyroid function and calcium level will be done on a return visit. If the operation was done for an overactive thyroid, a thyroid test is often done every 6 to 12 months to check that the thyroid has not become underactive, or that overactivity has not recurred.

If a Thyroidectomy is not performed

Patients with large goitres often have surgery for cosmetic reasons, or to relieve the pressure symptoms in the neck. Such goitres, if left untreated, may enlarge and become unsightly and or even more uncomfortable. If a patient with hyperthyroidism does not wish to have surgery, the alternative is to have radioactive iodine or long-term drug treatment. If no treatment at all is given for this condition, weakness, heart failure and even coma can develop.