Thyroidectomy

What is a thyroidectomy?

A thyroidectomy is the general name of any surgery to remove part or all of the thyroid gland. Other specific types of thyroid surgery are¹:

• lobectomy or hemithyroidectomy – when half of the thyroid is removed
• near-total thyroidectomy – when most of the thyroid is removed but some tissue is left
• isthmusectomy – when the central part of the thyroid called the isthmus is removed

 Why is it done?

 This type of surgery is carried out for a number of reasons, including:

• hyperthyroidism (an overactive thyroid)
• a large goitre that interferes with swallowing or breathing, and treatment is not effective (possibly caused by Hashimoto’s disease)
• recurring thyroid cysts
• thyroid cancer
• suspicious nodules that cannot be identified with a biopsy

How much of the thyroid is removed depends on the underlying condition, and other treatment may be recommended before, alongside or after surgery.¹

What happens during a thyroidectomy?

The time it takes depends on the type of surgery, but all thyroidectomies are performed under general anaesthetic.²

Some patients need to take iodine or potassium medication to help regulate the thyroid and decrease the chance of bleeding.³  You will probably need to avoid eating and drinking before the operation to prevent vomiting.⁴

There are three ways for surgeons to get to the thyroid:^5,6

1. Conventional thyroidectomy – where they make a small cut (incision) in the front of the neck to look at the thyroid. They make the cut in a place where the scar will be less visible
2. Endoscopic thyroidectomy – where they insert a small camera and surgical tools through a smaller cut in the neck
3. Transoral thyroidectomy – where they get to the thyroid through a small cut in the mouth

Surgeons try to leave as much of the thyroid as possible to keep it functioning but relieve any symptoms.⁷ In some cases of thyroid cancer, nearby lymph glands are removed during surgery too as a precaution or if cancer has spread.⁶

As with most surgeries, there are risks of complications, such as bleeding, infection and nerve damage, but this is estimated to be 1 to 2 in 100.⁷

If vocal cord nerves are damaged, there’s a 5% chance of hoarseness for up to six months and a 1% chance that it’s permanent.⁸

Sometimes the small glands behind the thyroid, called parathyroid glands, can be damaged. They regulate calcium in the body, and damage may mean taking calcium supplements. Usual symptoms of this are tingling in the hands, fingers or around the mouth after surgery.²

Some people need a drain to get rid of fluid after surgery and patients are generally advised to not put any strain on their neck for two weeks. There may be a small scar on the neck once the stitches are removed or have dissolved.^2,6  This may be red and thick for a few months and can take from 6 months to a year to heal properly.²

Thyroid Storm

Thyroid surgery is usually safe and surgeons take special care around the nerves, veins and arteries.² However, an extremely rare complication is called a thyroid storm. This is due to excessive amounts of thyroid hormones being released during the operation and can be caused by people with hyperthyroidism not receiving appropriate medication before their operation. The symptoms are:

• fever
• weakness
• palpitations
• changes in mental status
• coma

Death from thyroid storm is 20-30% of people but it is to be stressed that this is extremely rare.²

Testing after the operation

It is usual to have a thyroid function test after surgery to see if you need any levothyroxine. If you had a total thyroidectomy you will be given levothyroxine soon after your operation and will need to take this for life.²

People with thyroid cancer often have a course of radioactive iodine treatment or radiotherapy after surgery. This is to remove rogue cancer cells that might be left.⁹

Prognosis

What happens after a thyroidectomy depends on how much of the thyroid gland is removed. When only part of it is removed, it may continue to function as normal without medication but it may not. Regular thyroid function tests may need to be done, especially if you start to get symptoms of hypothyroidism.

Hypothyroidism can occur immediately after a thyroidectomy but only for a short while or it can occur several months afterwards depending on the amount of thyroid tissue that was removed. It is estimated that 1 in 5 people will develop hypothyroidism after partial thyroidectomy.^10,11

For more support check out our online community:
http://www.healthunlocked.com/thyroiduk

Guidance

2016 – Oxford University Trust NHS Foundation Trust: Thyroidectomy – an operation to remove all or part of the thyroid gland – Information for patients
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10335220/

2015 – The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4739132/

2014 – NICE Guidance: Minimally invasive video-assisted thyroidectomy – Interventional procedures guidance [IPG499]
https://www.nice.org.uk/Guidance/IPG499