THYROID SURGERY

 

There are two basic operations: removal of the entire gland on one side only (“hemithroidectomy” or “thyroid lobectomy”) or total thryoidectomy (as the name implies).

The former is done for diagnosis-i.e. when we cannot diagnose whether a lump is cancerous or not on the basis of FNAC; or for the definitive treatment of a troublesome benign lump or goitre that is predominantly or soley affecting one side only. Total thyroidectomy is done as part of treatment for thyroid cancer; or for goitres that are large enough to merit surgery; or for treatment of thyrotoxicosis.

 

Complications of thyroid surgery

I discuss potential complications at the time of consultation if surgery is being pursued. However the main complications are described here:

Hemi- and total thyroidectomy 

  • Scar- the scar is placed in a natural skin crease and tends to heal very well in most patients. On occasion, some patients, especially afro-caribbean, can be prone to keloid formation- thicker, raised scars. 

  • Voice- the main concern is potential damage to the recurrent laryngeal nerve- the main nerve that supplies the vocal cord in the voice box. It is a routine part of the operation to find and respect this nerve. The chances of permanent injury to it are less than 1%, in my hands. If damaged, it can give rise to a weaker and breathy voice.  More subtle changes in voice do occur more frequently than most surgeons are probably aware of. This is due to any injury to more minor nerves that are around the gland that have a bearing on voice (particularly pitch control). This needs to be stressed to singers in particular.

Total thyroidectomy

  • All patients will need lifelong thyroxine replacement.

  • Hyocalcaemia- Around (and sometimes within) the thyroid gland are 4 glands called parathyroid glands. Their role is to regulate the amount of calcium within the bloodstream. They can be damaged through removal or disruption of blood supply. If this occurs, patients may need calcium and vitamin D supplentation. Often when it occurs, it is a temporary problem. It is more likely to occur when having total thyroidectomy for cancer when lymph glands around the thyroid gland are removed (“level 6 neck dissection”).

 

How long will I be in hospital?

Hemithyroidectomy- 1 night usually.

Total thyroidectomy- 2-3 nights, depending on any problemswith calcium post-operatively (see above).

 

Retrosternal goitre

This refers to a goitre that either is entirely enlarged below the beast bone in the thorax or one that is enlarged both in the neck andthorax. Retrosternal goitres are more likely to cause compressive symptoms (trachea, oesophagus). The surgery is usually straightforward and in 95% of cases can be done through the neck. In some cases, I arrange for a cardiothoracic surgeon colleague to be at least on “stand-by” in case it is necessary to split the breast bone (“sternal split”) for access.