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, follicular etc. that are larger and more aggressive.
Hemithyroidectomy (removal of one lobe of the thyroid with isthmus and pyramidal lobe) is another common oeration for thyroid nodules.
In olden days, the surgery used was Subtotal Thyroidectomy. In this, a part of thyroid was left behind. However, this kind of surgery is almost obsolete now.
What You Are Likely to Experience
General anesthesia is usually used 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.
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 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 few days 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, 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.
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.