Thyroid Surgery

What is thyroid surgery?

There are various types of thyroid surgery, but they all share the common aim of removing as much or as little of your thyroid gland as necessary.

Why choose a thyroidectomy?

The thyroid is a gland in the body situated in the base of your neck involved in metabolism. Shaped like a butterfly, this gland releases hormones into your body that regulate how quickly your metabolism works, how quickly your body puts proteins together, and where calcium ends up in the body.

The advantage of surgery involving the thyroid is that even if the whole thyroid is removed, the hormones it produces can be replaced by a tablet which acts just the same way. When the thyroid gland is removed in part or entirely, this surgery is referred to as a thyroidectomy.

Many things can happen to your thyroid requiring part or all this gland to be removed. Those which require surgery are usually ones that result in the thyroid gland being overactive, producing more thyroid hormones than normal.

This is called hyperthyroidism - hyperactivity of the thyroid. When this occurs, your body metabolism is increased resulting in weight loss, increased appetite, as well as anxiety and intolerance of heat. These changes causing hyperthyroidism are often the result of an autoimmune process, where your immune system sticks antibodies to thyroid activating receptors much like it would to bacteria, causing them to be always switched on.

Sometimes, tumours or other lumps on the thyroid can cause hyperthyroidism as well. It is safer to treat these causes of hyperthyroidism by removing either part of or the whole thyroid, as the job of the thyroid can be done easily using medication. Rather than risking spread of cancer or the dangers of ongoing hyperthyroidism, the thyroid is often removed to be safe.

However, surgery can be needed in some cases without hyperthyroidism. A range of cancers can affect the thyroid without causing any obvious changes. There can also be structural changes or problems of the thyroid, including large swellings such as goitre that compress surrounding tissues of the neck. As with hyperthyroidism, the thyroid is often removed or reduced in size for safety and to give you the best outcome.

What kinds of problems can thyroid surgery treat?

• Thyroid cancer
• Graves’ disease, the most common autoimmune condition which causes hyperthyroidism
• Goitre, an enlargement of the thyroid which can compress on nearby organs and cause problems with swallowing and breathing
• Thyroid nodules
• Other conditions of the thyroid that cause hyperthyroidism
• Enlargements of the thyroid which is uncomfortable and/or unsightly

Thyroid surgery is a popular surgery because it offers a variety of benefits for those that need it, and the work done by the thyroid can be replaced by medication. Some of these benefits include:

• Life-saving surgery. Cancers affecting the thyroid may pose a significant threat and spread elsewhere in the body. These tumours are carefully removed to ensure no traces are left behind and confirmed with pathology testing to give complete peace of mind.
• Quality of life. For people living with a hyperactive thyroid, removal of the thyroid surgically is a direct cure. The transition from this to taking tablets to bring levels to normal without a thyroid is a life-changing procedure, allowing the body to function normally without problems like anxiety, heat intolerance, palpitations and sweating.
• Comfort. A swollen thyroid can be very uncomfortable and unsightly. Hyperthyroid diseases can also cause goitres, large swellings of the neck that are distinct and embarrassing. Thyroid surgery addresses the underlying cause of these swellings and often these are resolved immediately, which is often a great relief. Along with the other benefits of correcting these swellings, a better night’s sleep is often an added benefit as people realise how much of an impact this was having on their comfort!
• Peace of mind. Lumps and other growths in the thyroid can be concerning, especially if scans aren’t clear as to what they are. If there is any doubt as to if a growth is cancerous, surgery is often performed as the safest option as both prevention and treatment.

What are the risks of surgery?

Every significant surgery carries risks, including infection, bleeding and adverse reactions to anaesthesia. Risks specific to thyroid surgery include:

• Hypothyroidism. Whilst some people may need their entire thyroid removed, there are many people where surgery is only needed in a smaller part. The thyroid is a sensitive gland however, and surgery carries the risk of the thyroid not being able to produce as much hormones as needed. Tablets are used to supplement or replace these hormones if the thyroid is unable to keep up with demand. If you need your whole thyroid removed, your body will be unable to produce any thyroid hormones and you will need to take tablets daily to replace these.
• Laryngeal nerve injury. This rare complication is related to a nerve which runs very close to the thyroid. The surgeon must be extremely careful not to damage this nerve, as damage may cause changes in voice. In even rarer cases, blockage of the larynx – the voice box – may occur. As this is part of the normal breathing pathway, any blockage is an emergency and may need immediate surgery to restore normal breathing. Whilst extremely rare, your surgeon will explain these risks to you and carefully prepare around your own personal situation.
• Decreased parathyroid function. The thyroid shares space with the parathyroid glands, which produce parathyroid hormone that helps regulate your calcium levels. In many patients these may dip in their production for a short period after surgery, but in rare cases this may last a long time or even rarer become permanent, needing supplementation of calcium levels.

Is it easy to perform a thyroidectomy?

Due to the location of the thyroid in your neck, it is not surprising that your surgeon needs to be extremely careful when performing surgery. These are some of the key considerations your surgeon will need to make about your unique situation:

• Surrounding structures in the neck. The thyroid sits close to your larynx or voice box and has nerves, lymph and blood vessels running nearby. Your surgeon will need to examine the location of these nearby structures carefully, so you will usually need scans such as ultrasound or an iodine thyroid scan to get a clear picture.
• General anaesthesia is needed for surgery. Being a major surgery involving the neck, thyroid surgery requires the anaesthetist to use general anaesthesia, where you will be unconscious for the surgery.
• There are many options for surgery. Not all thyroidectomies involve removing the entire thyroid gland. If nodules or low-risk cancer is limited to only one side a hemithyroidectomy may be performed where only half of the thyroid is removed. For small tumours, an isthmusectomy can be performed in which the isthmus – a piece of tissue that connects the two halves of the thyroid – is removed.

Can you go home soon after surgery?

In some cases, yes. Thyroidectomies are almost always performed under general anaesthesia, so some observation time is needed to ensure you have recovered fully. Sometimes, a drain is required to help clear fluids from the site, which are usually removed the next morning requiring you to stay in overnight.

What is recovery like?

Most patients who have thyroid removal surgery can get back to their regular activities as soon as they get home. You will want to give yourself at least 10 days to avoid some strenuous activities such as heavy lifting or intense exercise, and a few people may have some neck pain or hoarseness of voice for a short period of time.

This hoarseness or weakness of the voice doesn’t necessarily mean there is any lasting damage and is often temporary irritation due to the breathing tube needed for general anaesthesia. Your surgeon will look at your unique personal situation to best optimise your procedure and recovery and will examine any specific risks you may have personally.