Thyroidectomy
Definition
Thyroidectomy is the surgical removal of all or part of the thyroid gland. This gland is in the neck. It produces hormones that regulate metabolism. The surgery may be a:
- Total or near-total thyroidectomy—all of the thyroid is removed
- Thyroid lobectomy or partial thyroidectomy—removal of only a part of the thyroid (the right or left lobe and/or center)
| The Thyroid Gland |
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Reasons for Procedure
All or part of the thyroid gland may be surgically removed for any of the following reasons:
- Overactive thyroid ( hyperthyroidism ) due to Graves disease or an over-functioning nodule
- Enlarged thyroid (goiter) causing significant symptoms because of its size
- Thyroid nodule(s) are suspicious or cause concern for thyroid cancer
- Thyroid cancer
Possible Complications
Complications are rare, but no procedure is completely free of risk. If you are planning to have a thyroidectomy, your doctor will review a list of possible complications, which may include:
- Damage to the parathyroid gland, which controls calcium metabolism (could lead to nerve and heart problems)
- Voice changes due to damage to nerves leading to the voice box (rare)
- Scarring
- Bleeding
- Infection
- Thyrotoxic crisis (sudden excessive release of thyroid hormone at toxic levels) (very rare)
Some factors that may increase the risk of complications include:
- Severity of hyperthyroidism
- Size of goiter
- Obesity
- Smoking
- Alcoholism
- Poor nutrition
- Long-term illness
Some factors that may increase the risk of complications include:
- Severity of hyperthyroidism
- Size of goiter
- Obesity
- Smoking
- Alcoholism
- Poor nutrition
- Long-term illness
What to Expect
Prior to Procedure
Your doctor may do the following:
- Physical exam
-
Laboratory and/or imaging tests
to assess thyroid function
and anatomy,
such as:
- Ultrasound —uses sound waves to evaluate organs in the body
- MRI —uses magnetic waves to produce images of the inside of the body
- Thyroid medicine to suppress thyroid activity in patients with hyperthyroidism
- Thyroid scan—uses a radioactive substance and scanning tool to evaluate the thyroid gland
Leading up to your procedure:
-
Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
- Aspirin or other anti-inflammatory drugs
- Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
- Do not eat or drink anything after midnight the evening prior to the procedure.
- Arrange for transportation to and from the hospital.
Anesthesia
General
anesthesia will be used.
You will be asleep.
Description of Procedure
An incision will be made in the front of the neck. Bleeding vessels will be clamped and tied off. All or part of the thyroid gland will be cut away from other tissues in the neck. Care will be taken to avoid injury to other nearby glands and nerves. Bleeding is controlled with special tools that compress and seal the ends of the vessels. The incision will be closed. The edges of skin will be stitched together. A drain will often be left in overnight. It will help drain any extra fluids.
The thyroid may be removed to treat thyroid cancer. In this case, lymph nodes in the area may also be removed. This will test if the cancer has spread.
In some cases, the doctor may be able to remove the thyroid using endoscopic surgery. This involves making small incisions, instead of a large incision in the neck.
How Long Will It Take?
About 2-4 hours
How Much Will It Hurt?
Anesthesia prevents pain during the procedure. Pain after the procedure is common. You will be given medicine to help manage this.
Average Hospital Stay
The usual length of stay is one day. Your doctor may choose to keep you longer if complications arise.
Post-procedure Care
At the Hospital
- There will be discomfort in your neck for several days. The pain can be treated with medicine.
- In some cases, you may have a hoarse voice for a few days.
- Depending on how much of the thyroid is removed, you may need to take replacement thyroid hormone.
- In some cases of thyroid cancer, you may need radioactive iodine treatments. This is called remnant ablation.
At Home
When you return home, do the following to help ensure a smooth recovery:
- Keep the incision clean and dry.
- Ask your doctor about when it is safe to shower, bathe, or soak in water.
- Do not get the incision wet until your doctor allows. If it does get wet, dry it immediately.
- Do not apply make-up, lotion, or cream to the incision area.
- Perform neck exercises as instructed by your doctor.
- Take all medicines as prescribed by your doctor.
- Be sure to follow your doctor's instructions.
Call Your Doctor
After you leave the hospital, contact your doctor if any of the following occurs:
- Numbness or tingling around the lips or extremities
- Twitching or muscle spasms (indicates dangerously low levels of calcium in the blood)
- Excessive and progressive fatigue
- Difficulty swallowing, talking, or breathing
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
- Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which persist for more than two days after discharge from the hospital
- Cough, shortness of breath, or chest pain
- Pain that you cannot control with the medicines you have been given
- Pain, burning, urgency or frequency of urination, or persistent bleeding in the urine
RESOURCES
The American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) http://www.entnet.org/
National Cancer Institute http://www.cancer.gov/
CANADIAN RESOURCES
Canadian Cancer Society http://www.cancer.ca/
Canadian Society of Otolaryngology http://www.entcanada.org/
References
American Association of Clinical Endocrinologists website. Available at: http://www.aace.com/ .
Meeker MH, Rocthrock JC. Alexander's Care of the Patient During Surgery . 11th ed. Philadelphia, PA: Mosby; 1999.
Sabiston DC Jr. Textbook of Surgery . 17th ed. Philadelphia, PA: WB Saunders Co.; 2004.