Thyroidectomy (Thyroid surgery) at Parkside Hospital

A thyroidectomy is an operation to remove all or part of your thyroid gland, the butterfly-shaped gland at the front of your neck that produces hormones controlling your metabolism. Depending on your condition, your surgeon may remove just one side (a lobectomy), most of the gland (a subtotal or near-total thyroidectomy), or the whole gland (a total thyroidectomy).

What conditions does it treat?

A thyroidectomy may be recommended if you have:

• an enlarged thyroid (goitre) causing symptoms such as difficulty breathing, swallowing, or sleeping lying flat
• an overactive thyroid, caused by a toxic nodule, toxic multinodular goitre, or Graves' disease, that hasn't been controlled with medication or radioactive iodine
• a thyroid nodule that can't be confidently diagnosed as harmless from a needle biopsy alone
• thyroid cancer, which accounts for fewer than 5% of all thyroid nodules found.

What are the benefits of having a thyroidectomy?

Removing an overactive or cancerous thyroid gland, or one that's pressing on your windpipe or gullet, can permanently resolve the underlying problem and relieve symptoms such as breathing or swallowing difficulty. For an uncertain nodule, removing half the gland (a lobectomy) can also provide a clear diagnosis that a needle biopsy alone couldn't give.

Most people go home the day after surgery, and recovery is generally straightforward: most are back to normal activities within around 2 weeks.

Are there different types of surgical approach?

There are three main extents of thyroid surgery:

• A lobectomy: This is also called a hemithyroidectomy, which removes just one side of the gland, and may be enough on its own if only one side is affected, or may be used first to confirm a diagnosis before deciding if further surgery is needed
• A total thyroidectomy: This removes the whole gland, and is usually needed for cancer affecting both sides, more aggressive cancer types, or an overactive gland affecting the whole thyroid
• A subtotal, or near-total, thyroidectomy: This removes one whole lobe, the connecting bridge of tissue, and most of the other lobe, leaving a small amount of thyroid tissue behind that may still produce some of your thyroid hormone.

The operation itself can be done through a single cut low down at the front of the neck (the conventional approach), through a smaller cut with the help of a camera, or occasionally through a less visible route such as the mouth, armpit or hairline; your surgeon will discuss which is suitable for you.

If cancer is suspected, your surgeon may also take samples of, or remove, nearby lymph nodes in your neck during the same operation.

What happens before the operation?

Before your operation:

• You'll usually have an ultrasound scan, and a needle biopsy if you have a nodule, to help plan your surgery
• If you have an overactive thyroid, you may be given medication beforehand to bring your hormone levels under control, since surgery on an overactive thyroid carries extra risks
• You may be asked to have your vocal cords checked beforehand, particularly if you've had neck surgery before – this involves a small camera passed through your nose under local anaesthetic
• You'll be asked about all your medications, including whether to continue or pause any blood thinners
• You'll need to stop eating and drinking for a set period before your operation, as instructed by the hospital
• Stopping smoking, reducing alcohol, staying active and losing excess weight beforehand can all help reduce your risk of complications.

What happens during the procedure?

A typical thyroidectomy involves the following:

1. You're given a general anaesthetic, so you're asleep throughout, and a breathing tube is placed to help control your breathing during the operation
2. Your surgeon makes a cut low down at the front of your neck, usually following a natural skin crease to help the scar heal less visibly
3. The thyroid gland is carefully freed from the surrounding tissue, taking great care to identify and protect the nerves controlling your voice box and the small parathyroid glands that control your blood calcium levels
4. The blood vessels supplying the thyroid are tied off, and the affected part, or the whole gland, is removed
5. Occasionally, a small drainage tube is left in the wound temporarily to prevent fluid building up
6. The wound is closed, usually with dissolvable stitches, clips, or skin glue.

The operation usually takes between 30 minutes and 3 hours, depending on how much of the gland is being removed and how straightforward your particular anatomy is.

What does recovery look like?

After your operation, you'll be closely monitored in a recovery area as you wake up, with regular checks on your breathing, heart rate, blood pressure and wound.

You'll usually stay in hospital overnight and go home the following day, once your care team is happy with your progress.

Most people only need simple painkillers such as paracetamol for discomfort, and eating a soft diet for the first few days can make swallowing more comfortable.

You can shower as normal, patting the wound dry, but it's best to avoid soaking the wound in a bath or swimming for around 2 weeks.

You shouldn't drive for 48 hours after a general anaesthetic, and only once you're pain-free and can turn your head comfortably. Most people feel able to return to work within about 2 weeks, though this depends on how physical your job is.

If you've had your entire thyroid removed, you'll need to take a thyroid hormone replacement tablet (levothyroxine) every day for the rest of your life – this will usually be started before you leave hospital.

A blood test around 6 weeks after your operation checks your thyroid hormone levels, and sometimes your calcium levels too, so your medication dose can be adjusted if needed. If only part of your thyroid was removed, the remaining tissue may make enough hormone on its own, though some people still need replacement tablets.

Your neck scar will usually fade from red and slightly raised to a thin, pale line over 12 to 18 months. Gently massaging it with a simple moisturiser once it's fully healed, from about 2 weeks, can help it settle.

What are the risks and complications?

As with any operation, there are risks to be aware of, including:

• infection, bleeding, or a collection of blood (haematoma) at the wound site, which occasionally needs a return to theatre, since swelling here can press on your windpipe
• temporary changes to your voice or swallowing from irritation to the nerves near the thyroid, affecting around 4 to 6 in 100 people, usually settling within a few days to 6 months
• permanent voice change, affecting around 1 to 2 in 100 people
• temporary low calcium levels, from effects on the small parathyroid glands nearby, causing tingling around your mouth or fingertips; this affects a significant minority of people having a total thyroidectomy and usually settles within a few weeks, though a small number of people need long-term calcium and vitamin D supplements
• very rarely, injury to both of the nerves controlling your voice box, which can block your airway and require an emergency procedure to help you breathe
• the general risks of any operation under general anaesthetic, including blood clots, chest infection, and, rarely, more serious cardiovascular complications.