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Thyroid surgery that removes one or both of your thyroid lobes is called a ThyroidectomyRemoval of part of the thyroid can be classified as :1. A hemithyroidectomy or thyroid lobectomy- where on lobe (one half) of the thyroid is removed.2. An isthmusectomy- removal of just the bridge of thyroid tissue between the two lobes; used specifically for small tumours that are located in the isthmus3. A total or near-total thyroidectomy- where most of the thyroid tissue is removed.The extent of your thyroid surgery will be determined by the reason for your surgery and this should be discussed between you and your surgeon.
Your doctor may recommend you undergo thyroid surgery for any of these reasons:1. You have a nodule in your thyroid that might be thyroid cancer.2. You have a confirmed diagnosis of thyroid cancer3. You have a nodule or thyroid swelling that is causing symptoms- e.g. compression of your trachea, difficulty swallowing or an unsightly mass4. You have a nodule or thyroid swelling that is causing symptoms due to the production and release of excess thyroid hormone- either a toxic nodule, toxic multinodular goitre or Grave’s disease.
The surgery is performed under general anaesthesia. For most patients, the removal of the surgery will be done using an incision placed in the front of the neck. If the surgery is being done because there is a cancer or suspected cancer, your doctor may discuss with you about removing some of the lymph nodes in your neck as well (neck dissection).
For some patients that are concerned about having a scar in the neck, your doctor may discuss with you the option of endoscopic or robotic surgery to hide the scar. This procedure is not suitable for every patient (e.g. large tumours, cancers). The incisions may be hidden in the lower lip (transoral endoscopic thyroidectomy vestibular approach (TOETVA), in the armpit area and the chest (transaxillary approach) or behind the ear (post-aural approach).
In experienced hands, thyroid surgery is usually very safe and complications are uncommon. Some of the more serious possible risks of thyroid surgery include:1. Bleeding- this can happen after surgery and this rarely can be life-threatening from airway compromise.
2. Voice changes: Injury to the nerves that supply the muscles that move your vocal cords (recurrent laryngeal nerves) that can cause temporary or permanent hoarseness or possibly even acute respiratory distress in the very rare event that both nerves are injured.
3. Voice changes: Injury to nerves that help tense your vocal cords (external branch of the superior laryngeal nerves). This may result in some patients having problems with reaching high notes when they sing, and also feeling their voice gets tired more easily when they talk for too long.
4. Low calcium levels: Damage to the parathyroid glands that control calcium levels in the blood, leading to temporary, or more rarely permanent low parathyroid hormone levels and low calcium levels in the blood. If this happens, patients may develop numbness and cramps of their hands and may need to take calcium and vitamin D supplements to prevent this from occurring. In most cases this is temporary, but in a small proportion of patients this may be lifelong.
5. Bad scarring. The majority of incisions in the neck heal well, but a few people are more predisposed to having thick and ugly scars (hypertrophic scars). Your doctor will advise you on how to take care of your incision after your surgery to minimize the risk of this happening.
Patents will usually stay in the hospital for 1-2 days after a hemithyrodectomy and about 3 days after a total thyroidectomy depending on the individual patient’s condition.
You will usually be allowed to eat and drink once you are fully awake.
You may experience some mild pain at the surgical site. This is often well controlled with pain relieve medications that your doctor will prescribe after the surgery. If you still experience significant pain let the nursing staff know and they will contact your doctors to adjust your medication if necessary.
A nurse will usually monitor your vital signs (temperature, heart rate, blood pressure ) every hour for the first 6 hours. This may seem bothersome to some patients but it helps us keep you safe.
This depends how much of the thyroid gland is removed. If only half the gland is removed (hemithyroidectomy), there is an 80% chance that you will not require a thyroid pill (levothyroxine) unless you are already on thyroid medication for a low thyroid hormone level. In some cases where the final pathology report shows thyroid cancer, your doctor may also start you on a thyroid pill to reduce your risk of the cancer coming back.
If you have your entire gland removed (total thyroidectomy) or you have had prior surgery and are removing the remaining thyroid (completion thyroidectomy), you will have no internal source of thyroid hormone remaining and you will definitely need lifelong thyroid hormone replacement.
Wound CareIt is alright to shower with soap and water but avoid scrubbing or excessive pressure over your surgical wound in your neck. After showering, pat the wound dry gently with a towel but do not rub the wound forcefully.
Physical ActivityAvoid strenuous exercise or carrying heavy loads (>10kg) for the first week after surgery.Standing and walking is alright. Check with your doctor when it is okay to restart strenuous exercise.
Pain medicationYour doctor will usually prescribe you some medication to help with any pain you might have after the surgery. Take your medication as advised by your doctor. If you continue to have significant pain despite taking the medication, let your doctor or nurse know.
Seek medical attention if you have any of the following:- Fever (Temperature > 38 C)- Increase redness and pain over your neck wound- Yellowish, foul-smelling discharge from the wound. - The surgical wound starts to open up. - Sudden swelling in the neck- Difficulty breathing.- Numbness or cramps in your hands or face.
Hypocalcemia (Low Calcium Levels)If you have had surgery to remove both sides of your thyroid gland, some patients may experience a low calcium level after surgery due to the parathyroid glands being affected. Your doctor may have started you on some oral calcium tablets and vitamin D (calcitriol tablets).However, if despite taking the medications you experience increasing numbness of your hands or around your mouth, or have cramps in your hand, this may be a sign that your calcium levels are too low. If this occurs, take an extra dose of your calcium tablets and seek medical attention immediately.
Drain CareYour doctor may decide put a surgical drain in your neck at the time of surgery. This is a tube placed to remove excess fluid to prevent it from collecting in your neck. The nurses will teach you how to care for the drain and how to measure the output of the drain.
Your doctor will remove the drain once the amount coming out every day is minimal.