Thyroidectomy

The thyroid is a butterfly-shaped gland at the base of the neck. For a small gland, it produces the hormones, which regulate every aspect of our body’s metabolism from the rate at which the heart beats, blood pressure, immune system, and calorie burn-out. Like all internal organs of the body, even the thyroid gland is vulnerable to disorders such as goiter (enlargement of the thyroid, hyperthyroidism (overactive thyroid functioning) and cancer.

Thyroidectomy is surgery to remove the thyroid gland partially or completely. How much of the gland is removed depends on the condition and its extent? The remainder of the thyroid can gland may be able to function normally after partial thyroidectomy. After a total thyroidectomy, in which the entire gland is removed, the patient needs daily doses of thyroid hormone, to substitute the natural functioning of the thyroid.

Reasons for Thyroidectomy

A thyroidectomy may become necessary for the following conditions if non-surgical treatment fails to achieve desired results:

  • Thyroid Cancer: Most thyroidectomies are performed to treat thyroid cancer. Thyroidectomy for cancer will likely remove most of the thyroid gland, if not all. 
  • Non-cancerous Enlargement of the Thyroid (goiter): Removing all or part of your thyroid gland is an option if you have a large goiter that is uncomfortable or causes difficulty breathing or swallowing or, in some cases, if the goiter 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 non-cancerous after testing a sample from a needle biopsy. Doctors may recommend that people with these nodules have thyroidectomy if the nodules have an increased risk of being cancerous.

Complications

Generally, thyroidectomy is a safe procedure, but as with after any surgery, there may uncomfortable surprises, which may include:

  • Bleeding
  • Infection
  • Low parathyroid hormone levels (hypoparathyroidism) caused by surgical damage or removal of the parathyroid glands. These glands are located behind your thyroid and regulate blood calcium. Hypoparathyroidism can cause numbness, tingling or cramping due to low blood-calcium levels
  • Airway obstruction caused by bleeding
  • Permanent hoarse or weak voice due to nerve damage

Preparations

The doctor will give you specific instruction on how to prepare for the thyroidectomy. For hyperthyroidism, the doctor may require you to take some medication before the surgery like a solution of iodine and potassium. This regulates the thyroid function and decreases the risk of bleeding. You may also need to stop eating and drinking for between and 8 to 10 hours prior to surgery to avoid anesthesia-related complications.

Before the Procedure

Thyroidectomy is typically performed under general anesthesia. The anesthesia will be administered as a gas, which you will breathe through a mask or an injection through the vein. A breathing tube is placed inside the windpipe or trachea to assist your breathing throughout the surgery.

The surgical team places various monitors on your body to monitor your blood pressure, heart rate, and blood oxygen levels. This equipment includes a blood pressure on an arm and a heart monitor attached to your chest.

Into the Procedure 

The surgeon makes an incision in the lower region in the middle of the neck after the patient is unconscious. If there is a crease in the skin, the incision may be made there where the scar is difficult to see after the surgery. All or part of the thyroid gland is then extracted based on the reason for surgery.

If the thyroidectomy is for cancer, the surgeon may also remove the lymph nodes around the thyroid gland to examine if cancer has spread. The procedure generally takes between one and two hours depending on the extent of the surgery.

There are different types of thyroidectomies, which include:

  • Conventional Thyroidectomy: This procedure makes an incision in the center of the neck to get direct access to the thyroid gland. The majorities of thyroidectomies are of the conventional variety.
  • Transoral Thyroidectomy: In the transoral variety of the procedure, the incision is made through the mouth. 
  • Endoscopic Thyroidectomy: In this type of procedure, several small incision is made in the neck, through which a tiny video camera and surgical instruments are inserted. The camera transmits the internal images on a television screen, which guides the surgeon to maneuver the surgical instruments inside the neck. 

After the Procedure 

When the thyroidectomy is over, the patient is moved to the recovery room, where he or she is constantly monitored as the anesthesia wears off. Once fully conscious, the patient is shifted to a hospital ward. Some patients may require a tube to be attached under the incision to drain excess fluids. This tube is normally removed on the morning after surgery.

Neck pain is common after a thyroidectomy. Some patients’ voices become weak or hoarse. This does not mean the nerves that regulate the vocal cords are damaged. It may be due to the irritation from the breathing tube (endotracheal tube) that was inserted in the windpipe to assist with breathing during the surgery. Voice modulations may also be the result of nerve irritation post surgery.

Patients are able to eat and drink as usual. Depending on the type and extent of the surgery you just underwent, you will be able to go home on the same day or the doctor may want to keep you under observation for the night. Patients can usually return to their normal activities immediately after coming home. However, no strenuous activity is allowed for at least 10 days to two weeks.

The scar from the thyroidectomy can take about a year to fade. The doctor may prescribe a sunscreen to minimize the visibility of the scar.

Results of Thyroidectomy

The long-term results of the procedure will depend on how much of the thyroid has been removed. After a partial thyroidectomy, the remaining part of the gland is usually able to resume its entire function smoothly. There will be no need for thyroid hormone therapy. 

If the whole thyroid gland has been removed in a complete thyroidectomy, thyroid hormone therapy is mandated. Without the thyroid gland, the body cannot produce thyroid hormones and the patient develops symptoms of hypothyroidism or underactive thyroid. Thyroid hormone therapy involves taking a daily pill, which contains levothyroxine, a synthetic thyroid hormone.

Levothyroxine replaces the hormones previously made by the thyroid gland and performs all of the earlier function. The doctor will prescribe the dosage of the thyroid hormone replacement your body needs based on blood tests.