Thyroidectomy

About the Procedure

A Thyroidectomy is an operative procedure to removal all or part of the thyroid, a hormone secreting gland located in the lower central neck. Reasons for removing the gland include diseases such as hyperthyroidism, thyroid cancer, nodules, or goiter, an obstruction which is causing difficulties, e.g., swallowing, breathing, and for cosmetic concerns due to an enlarged gland. The primary function of the thyroid is producing several hormones which regulate the body's metabolism. After the removal of the entire thyroid, patients must take oral hormones, either synthetic or natural, for the remainder of their life to prevent developing signs and symptoms of hypothyroidism.

Depending on the specific thyroid disease and its severity, there are alternatives to removing the entire gland. They are: the removal of only one of two lobes in the butterfly-shaped gland (thyroid lobectomy), one lobe plus the area between the two lobes (thyroid lobectomy and isthmusectomy), or one complete lobe along with the isthmus and a significant section of the second lobe (subtotal thyroidectomy). There is agreement among the majority of endocrinologists and surgeons that a total thyroidectomy is mandated for thyroid cancer unless it is a small, non-aggressive cancer. Others prefer to remove the entire gland whenever cancer is present.

The procedure is done under general anesthesia on an in-patient basis with an expected hospital stay of 24 hours. After an incision is made in the lower neck, the surgeon examines the thyroid and surrounding tissues. The area contains many small but vital ducts, blood vessels, other glands, organs and muscles, and extreme care must be taken to avoid damaging them. The surgeon removes all or part of the thyroid, inserts a drainage tube, and closes the incision with sutures, medical glue, or skin clips.

What to Know Before the Procedure

There is potential for complications during a thyroidectomy, therefore it is recommended to find a surgeon with extensive experience and continuing education to do this procedure. A small percentage of patients have nerve injuries resulting in a permanent hoarse voice which can be avoided using a procedure called electronic nerve monitoring. Hypoparathyroidism, which creates abnormal levels of calcium and phosphorus in the blood, has been cited in 1-4% of patients.

Preparation for this procedure is similar to other operations. A health assessment, blood work, x-rays, adding or changing medications to avoid excess blood loss during the operation, and pre-operative instructions on food and water intake will be provided by the doctor. Advanced planning for a ride at discharge and assistance for the first day is recommended because pain and tiredness are the chief complaints during recovery.

What to Know After the Procedure

Discharge from the hospital is usually the following day; after the incisional drain is removed and the patient demonstrates the ability to drink and eat. Talking and swallowing will be very painful, and the patient's voice will be hoarse until healing begins. A soft diet and cool drinks can help. A 3" to 4" scar, initially red, raised and sore, will fade over time. A thyroidectomy, especially when more than one-half of the gland is removed, prevents the production of hormones regulating metabolism. As a result the patient may feel especially sluggish initially. To replace the hormones patients must take Thyroxine tablets for the remainder of their life. Blood tests will be performed before leaving the hospital to check that hormone levels are safe, and the patient will need to consult an endocrinologist soon after the surgery. Everyone recovers at their own pace, so it's recommended for patients to increase their activity level gradually. Without complications, a return to work is possible after two weeks.

If you Need to Travel Outside of your Local Hospital

An uncomplicated thyroidectomy allows for a quick return to normal activities as long as the patient cooperates with periods of rest and their medication routine. The thyroidectomy procedure is common in all areas of the world. The decision to have this procedure done domestically or internationally should be based on personal and financial needs, the ability to travel and stay in the location traveled to, and most importantly, the skill and expertise of the surgeon.