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Thyroid Surgery

What is thyroid surgery?

Thyroid surgery typically involves a total or hemi-thyroidectomy, the removal of all or part of a diseased thyroid gland. Removal of only part of the gland is called a hemi-thyroidectomy. In some cases, total thyroidectomy is necessary where the entire gland is removed.

What is the thyroid gland?

The thyroid gland is a butterfly-shaped gland located in front of the neck, just below the voice box or larynx. It consists of two lobes on either side connected by an isthmus. The thyroid produces hormones which are necessary for metabolism and proper functioning of the body. Disease or abnormality of this gland can result in various physiological problems.

What are the indications for thyroid gland surgery?

Thyroid surgery is usually recommended for thyroid conditions such as nodules, overproduction of hormones, cancerous and noncancerous tumours, and goitre or swelling of the thyroid that can make it difficult to swallow or breathe. To identify cancer, your doctor may organise a fine needle aspiration biopsy where a sample of thyroid tissue is obtained using ultrasound guidance and analysed in the laboratory.

How is thyroid gland surgery performed?

Thyroid surgery is performed under general anaesthesia. Your surgeon makes a 5-cm horizontal incision in the centre of your lower neck. A single lobe or the entire gland is removed through this incision. Cancer of the thyroid is usually treated by complete removal of the gland. Less aggressive cancers may be treated by removal of only one of the lobes.

The parathyroid glands that regulate calcium as well as the recurrent laryngeal nerve that runs behind the thyroid supplying the larynx or voice box are identified and preserved as far as possible. After removal of the tissue, a small tube (catheter) is inserted at the site to drain accumulated blood and fluids. The incisions are then closed with sutures.

In the case of thyroid cancer, lymph nodes in the neck adjacent to the thyroid may also need to be removed.

What is the post-operative care after thyroid gland surgery?

Following the surgery, you will be taken to the recovery room and monitored carefully. You will have a drain tube coming from the incision to allow drainage and prevent fluid accumulation. Your doctor will prescribe medications to help alleviate pain and discomfort. You will begin on a liquid diet the day after surgery and progress to solid foods as tolerated. Before leaving the hospital, you will be taught how to care for your incision.

Patients who have their entire thyroid gland removed will require thyroid replacement medication for life, and sometimes when just one lobe is removed.

What are the risks and complications of thyroid gland surgery?

As with all surgical procedures, thyroid surgery may be associated with certain risks and complications such as:

  • Bleeding – this may cause obstruction of the airway and require urgent return to theatre to evacuate the blood. This is uncommon.
  • Hypoparathyroidism – Damage to the parathyroid glands that may require medication to help maintain normal calcium levels.
  • Injury to nerves that supply the vocal cords – this is an uncommon occurrence that can significantly impact on a patients’ speech and swallow. Often it is only temporary and resolves by 6 months. A speech therapist can help with exercises to improve the voice in this setting.