Thyroid Surgery

Patient information

What is the Thyroid Gland?

The thyroid gland is a small organ that sits in the front of the neck wrapped around the windpipe (trachea). It consists of two halves (left and right thyroid lobes) joined in the middle by a thin bridge called the isthmus. The normal shape of the thyroid gland resembles a butterfly. The thyroid gland makes thyroid hormones (called T3 and T4) that affect the body’s metabolism and are essential for the body to function normally.

Why might a patient need thyroid surgery?

There are a range of reasons why I might recommend thyroid surgery for your condition. The most common reasons are to treat an overactive thyroid problem (hyperthyroidism), goitre (enlarged thyroid gland), a concerning thyroid nodule or confirmed thyroid cancer.

What type of operation should I expect?

I will explain which operation you are advised to consider and why.

• Hemithyroidectomy. This is removal of one thyroid lobe and the thyroid isthmus. Depending on the reasons for this operation it may be necessary to have the other side of the thyroid gland removed at a second operation.
• Total thyroidectomy. This is removal of the entire thyroid gland leaving no thyroid tissue behind. Sometimes, to protect important structures that run very close to the thyroid gland, I may leave a very tiny amount of thyroid tissue behind. This is called a near total thyroidectomy. The amount of thyroid tissue left behind is so small that for practical purposes the whole of the gland has been removed.

When is lymph node surgery needed?

Lymph nodes drain tissue fluid (or lymph) that is produced by many tissues in the body. Sometimes the lymph nodes in the middle of the neck around the thyroid gland are removed as part of an operation for patients with confirmed thyroid cancer. If cancer is found in the lymph nodes this can affect the type of treatment you might receive after surgery. When these lymph nodes close to the thyroid gland are removed the operation is called a central neck dissection. If you need a central neck dissection it does not usually affect the size of the scar. In rare cases it may be necessary to remove lymph glands from the side of the neck. This is a much larger operation resulting in a longer scar and is called a lateral neck dissection. If you need this type of surgery I will explain it to you in detail and discuss why it is necessary in your case. It is important to note that not all patients with a diagnosis of thyroid cancer will need lymph node surgery. This decision will be based on a number of factors and I will discuss the reasons for my recommendation with you.

What can I expect after the operation?

Most people stay only one night in hospital after thyroid surgery. I will give you a separate information sheet before you go home with instructions about wound care and answers to other common questions. Most patients find that they are tired for about a week after surgery but that the pain is well controlled with the simple painkillers we prescribe. Typically you will be ready to return to work about two weeks after surgery. Before you return to driving you need to be able to turn your neck freely. Be sure to let your vehicle insurance company know that you have had surgery.

What are the possible complications of thyroid surgery?

Complications from this kind of surgery are rare but I will try to ensure that the risks are fully explained to you.

• Voice change. This can occur for a few reasons. It doesn’t happen very often and if it does it usually improves over time. Temporary voice change is due to ‘bruising’ or ‘stretching’ of the voice box nerves and can result in a deeper, hoarser or breathy voice. Damage to the external laryngeal nerve can lead to difficulty shouting or reaching higher notes when singing. Permanent damage to the voice is rare and occurs in about 1:100 operations. Permanent damage to both recurrent laryngeal nerves is extremely rare.
• Thyroid hormone replacement. If you have the whole of your thyroid gland removed you will be prescribed thyroid hormone which you will need to take life-long. It is important that you take the dose you are prescribed. We will check that you are on the correct amount with a simple blood test. For the majority of patients who have had only half of their thyroid removed, thyroid hormone replacement will not be required but I will arrange blood tests to be sure. The chance of needing to take thyroid hormone soon after having had half of your thyroid gland removed is about 10%. The lifetime risk is approximately 20-25%.
• Bleeding. Bleeding into the neck after the operation is uncommon and sometimes needs to be treated with further surgery. The risk of this is about 1%.
• Scar. The scars from thyroid surgery usually heal very well. Rarely the scar can become thick, raised or itchy. Please tell me if you have a tendency to forming this kind of scar. Occasionally some numbness is experienced around the scar but this normally settles with time.
• Low calcium levels. This is normally due to damage to the parathyroid glands which are 4 tiny glands attached to the back of the thyroid. Great care is taken to preserve these glands but they are fragile. Fortunately damage to the parathyroid glands is almost always temporary. You will have your blood calcium level checked after surgery and if it is too low you may be prescribed calcium tablets to treat this. Permanently low calcium occurs in 2-3% of patients and this requires life-long calcium and vitamin D supplements. This risk is a little higher (5-7%) if your surgery is performed for an overactive thyroid or if you have lymph node surgery too.
• Fluid collection. After thyroid surgery, particularly where lymph nodes are removed, there is a small risk of a fluid collection. This normally settles by itself. I will tell you more about this if you are going to have lymph node surgery.
• Thyroid storm. This is an extremely rare complication in modern medical practice. Thyroid storm is a medical emergency and requires immediate treatment. It is caused when excessive amounts of thyroid hormones are released during surgery in patients with hyperthyroidism who have not had the overactive gland brought under control with medication before an operation.
• Risks of the anaesthetic. These will be discussed with you in detail by your anaesthetist. You should ensure that you tell the anaesthetist your full medical history including any problems you or your family may have had with anaesthetics in the past. Feel free to ask them about the specifics of your anaesthetic.