Thyroid Surgery: An Introduction / Thyroid Disease Information Source

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Thyroid Surgery: An Introduction
Information on Thyroidectomy and Other Thyroid Surgeries

by Mary Shomon

Thyroid surgery is performed in a number of circumstances:

When cancerous cells are found in and around the thyroid gland, all or part of the thyroid is typically surgically removed.
When the thyroid enlargement - or goiter - has become so large that it is cosmetically necessary to remove it, or the size is making swallowing or breathing more difficult
When thyroid nodules enlarge and make swallowing or breathing more difficult
When radioactive iodine (RAI) treatment for Graves Disease or hyperthyroidism has been performed several times and is still not effective, in the U.S. (Note: In some countries other than the U.S., surgery is considered the first treatment for hyperthyroidism and Graves' disease.)
When a woman is pregnant, and her hyperthyroidism cannot be controlled by other means

In most cases, surgery of the thyroid is not highly complicated, and usually takes no more than two hours. It is frequently performed on an outpatient or overnight basis. There are few complications that result, but when they do, they typically fall into one of two categories: damage to the voice box and / or vocal cords, or damage to the parathyroid glands. If there is damage to the parathyroid glands, this will affect the levels of calcium in the blood, however, this is very rare.

Types of Surgery

The most common type of surgery is a Total Thyroidectomy, sometimes abbreviated as a TT. Total Thyroidectomy means complete removal of the thyroid. This surgery is frequently preferred by doctors over other options and is used for cancers such as medullary and/or anaplastic that are larger and more aggressive.

The next most common type of surgery is a Subtotal Thyroidectomy. For this operation, the cancer must be small and non-aggressive -- follicular or papillary -- and contained to one side of the gland. During this procedure, the half of the gland in which the cancerous cells exist, the isthmus, and a portion of the opposite globe are removed.

Thyroid Lobectomy (removal of only about a quarter of the thyroid) with Isthmusectomy is less commonly used for thyroid cancer, as the cancerous cells must be small and non-aggressive for this to be successful.

What You Are Likely to Experience

General anesthesia is usually used, however, some surgeons in the U.S. are now using local anesthesia plus a sedative, to perform thyroid surgery.

In the surgery, a 3 to 5 inch incision will be made in the base of the neck, and then the skin and muscle is pulled back to expose the thyroid gland. Blood supply to the gland is "tied off" and the parathyroid glands are identified so that they may be preserved. Next, the surgeon separates the trachea from the gland, pulls it to the side and removes the cancerous part. If the entire thyroid is being removed, this is then done on the opposite side of the neck as well. Removal of half of the thyroid takes forty five minutes to an hour, so if the entire gland is being removed the surgery will last about an hour and a half.

Recuperation

Although you must stay in bed initially, your doctor will probably encourage you to begin moving about as soon as possible. You may not be able to eat or drink anything for the first twenty-four hours, so may be fed intravenously if still in the hospital. After this, a "soft" diet will likely be prescribed. As for resuming to normal activities, a one or two week recuperation time is generally needed before the patient may return to work.

After the surgery, many people report stiffness in the neck and / or tenderness at the incision site, as well as a hoarse voice, but this generally subsides in four to six weeks. The scar left by the surgery also will become less noticeable as time progresses.

Thyroid Hormone Replacement

Once part or all of the thyroid has been removed, thyroid replacement drugs will almost always be necessary for the remainder of the patient's life. If you have had a partial thyroid removal, your doctor may not discuss the possibility of needing to start thyroid hormone replacement drugs with you, so be sure you have a conversation about this before you are discharged.

Watch carefully for any signs of hypothyroidism, and insist on full testing as soon as any symptoms might appear.

Symptoms of hypothyroidism include fatigue, exhaustion, feeling run down and sluggish, depression, difficulty concentrating, brain fog, unexplained or excessive weight gain, dry skin, coarse and/or itchy skin, dry hair, coarse and/or thinning hair, feeling cold, especially in the extremities, constipation, muscle cramps, joint pain, carpal tunnel syndrome, increased menstrual flow, more frequent periods.

Finding a Top Thyroid Surgeon

Columbia Presbyterian's Thyroid Center in New York is considered one of the nation's better locations for thyroid surgery. They also offer referrals to doctors in other places in the U.S. who are experienced thyroid surgeons. For a referral, contact:

The Thyroid Center
161 Fort Washington Avenue
New York, NY 10032
email: surgery@columbia.edu
phone: (212) 305-0440
fax: (212) 305-0445

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All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician or health practitioner before starting a new treatment program. Please see our full disclaimer.