Thyroid Surgery Overview
The thyroid is a small gland, shaped something like a butterfly. It is located in the lower front part of the neck, just below the voice box. The thyroid produces hormones that are carried in the blood to every tissue in the body. It helps regulate metabolism, or how the body turns food into energy. It also plays a role in keeping the organs functioning properly and helping the body conserve heat.
Sometimes the thyroid produces too much hormone. It may also develop structural problems, such as swelling and the growth of cysts or nodules. When these problems occur, thyroid surgery may be necessary.
Thyroid surgery is used to remove all or a portion of the thyroid gland. The surgery is performed in a hospital under general anesthetic.
Reasons for Thyroid Surgery
The most common reason for thyroid surgery is the presence of nodules or tumors on the thyroid gland. Most of these nodules are benign but some are cancerous or pre-cancerous. Even benign nodules can cause problems if they grow large enough to obstruct the throat or if they stimulate the thyroid to over-produce hormones, a condition called hyperthyroidism.
Another reason for thyroid surgery is the swelling or enlargement of the thyroid gland. This is referred to as a goiter. Like large nodules, it can block the throat and interfere with eating, speaking, and breathing.
Finally, surgery is often performed to correct hyperthyroidism. Hyperthyroidism is frequently caused by an autoimmune disorder called Grave’s disease. Grave’s disease causes the body to misidentify the thyroid gland as an alien body and send antibodies to attack it. These antibodies inflame the thyroid, causing hormone over-production.
Types of Hormone Surgery
There are several different types of hormone surgery. The most common are lobectomy, subtotal thyroidectomy, and total thyroidectomy
Sometimes a nodule, inflammation, or swelling affects only half of the thyroid gland. When this happens only one of the two lobes is removed. The part left behind should retain some or all of its function.
A subtotal thyroidectomy removes the thyroid gland but leaves behind a small amount of thyroid tissue. It is done to preserve at least some thyroid function, but many individuals who have had this surgery develop hypothyroidism, a condition that occurs when the thyroid doesn’t produce enough hormone.
A total thyroidectomy removes all of the thyroid and the thyroid tissue. This surgery is appropriate when nodules, swelling, or inflammation affect the entire thyroid gland or in cases where cancer has been diagnosed.
How is Thyroid Surgery Performed?
Thyroid surgery is performed in a hospital. You will arrive on the day of the procedure. It is important that you not eat or drink anything after midnight on the day of your surgery.
When you arrive at the hospital, you will check in and be taken back to a preparation area. There you will remove your clothes and put on a hospital gown. A nurse will insert an IV in your wrist or your arm so that you can receive fluids and medication during and after surgery.
Before surgery, you will meet with your surgeon who will do a quick examination and answer any questions you may have about the procedure. You will also meet with the anesthesiologist who will be administering the medicine that makes you sleep throughout the procedure.
When it is time for the surgery, you will be wheeled into the operating room on a gurney. The anesthesiologist will inject medicine into your IV. The medicine may feel cold or sting a little as it enters your body, but it will quickly put you into a deep sleep.
The surgeon will make an incision over the thyroid gland and carefully removes all or part of the gland. Because the thyroid is small and is surrounded by nerves and glands, the procedure may take two to three hours or more.
You will wake up in the recovery room. The recovery room staff will make sure you are comfortable, administering pain medication as needed. They will also check your vital signs. When they are satisfied you are in stable condition, they will transfer you to a room in the hospital where you will remain under observation from 24 to 48 hours.
You may resume most of your normal activities the day after surgery. Wait for at least ten days, or until your doctor gives you permission, to engage in strenuous activities such as high-impact exercise.
Your throat will probably feel sore for several days. The doctor may prescribe narcotic pain medication to help with the soreness, but you may be able to take an over-the-counter pain medication such as ibuprofen or acetaminophen to relieve the soreness.
After your surgery, you may develop hypothyroidism. If this occurs, the doctor will prescribe some form of levothyroxine to help bring your hormone levels back into balance. It may take several adjustments and blood tests to find the best dosage for you.
As with every major surgery, thyroid surgery carries with it the risk of having an adverse reaction to the general anesthetic. Other risks include heavy bleeding and infection.
Risks specific to thyroid surgery occur only rarely. The two most common risks are:
• damage to the recurrent laryngeal nerves (They are connected to your vocal cord)
• damage to the parathyroid glands (They control the level of calcium in your body)
Low levels of calcium are easily treated with supplements, but the treatment should start as soon as possible. Notify your doctor right away if you feel nervous or jittery or if your muscles start twitching because these are signs of low calcium.