Why do people need their thyroid gland removed (thyroidectomy)?
Without a doubt, the most common reason a person needs part or all of his/her thyroid removed is due to is a worrisome mass/nodule. Many times these have been biopsied with a small needle (fine needle aspiration -or- FNA) and the nodule has been found to be abnormal. It may have been found to be a cancer, a nodule highly suspicious for cancer or inconclusive and in need of further testing. In these instances surgery is usually the next step.
In some cases a person may need his/her thyroid removed due to its extreme size (goiter), nodules that are benign but otherwise causing bothersome symptoms (due to their size or over-functioning) or as a treatment for difficult-to-control hyperthyroidism.
What kinds of surgeries are available?
There are three basic kinds of thyroid surgery:
- Removal of one half of the thyroid (lobectomy),
- Removal of almost all of the thyroid (sub-total thyroidectomy), where only a small amount of thyroid is left behind,
- Removal of all of the thyroid (total thyroidectomy).
Which surgery is the right one for your circumstances will be determined after a consultation with your surgeon. When the surgery is being done for cancer, it will frequently also involve removal of lymph nodes in the areas around the thyroid gland.
Most thyroid surgery is accomplished through a small incision on your lower neck. However, new techniques are being developed, some with the help of a robot, that allow for the incision to be hidden in your axilla (arm pit) or along the back of your neck.
What are the risks of thyroid surgery?
Aside from the usual risks of any surgery, there are three main risks associated with thyroid surgery, all of which are thankfully uncommon.
- Injury to the nerves (recurrent laryngeal and superior laryngeal nerves) that control your vocal cords. These course right behind the thyroid gland. This could result in hoarseness, inability to sing high notes and in unusual and extreme cases, difficulty with breathing.
- Injury to your parathyroid glands, which are responsible for regulating calcium levels in your body. This can result in temporary or permanent problems with low calcium levels.
- Bleeding, which is a rare but serious problem in this area because it can cause difficultly with breathing due to the fact that your trachea (windpipe) lies right below your thyroid gland and significant bleeding can compress the trachea.
What do I need to do to prepare for surgery?
Depending on your age and other health issues, you may need very little further workup or you might be asked to complete blood tests, EKGs, etc, to be sure you are safe for surgery. Of course, everyone must stop eating or drinking after midnight the day before the surgery so you are sure to have an empty stomach during the surgery.
Depending on the reason for surgery (certain kinds of cancers) and/or your family history, you may need a more extensive workup to look for other kinds of tumors that can be found in certain conditions. If you have some preexisting hoarseness in your voice, you may need to have a formal evaluation of your vocal cords prior to any thyroid surgery.
What can I expect the day of surgery?
You will present to the preoperative check-in several hours before the surgery. Any remaining hospital paperwork will be completed, an IV will be started and you will see your surgeon, the operating room staff and anesthesiologist. The length of the surgery can vary greatly depending on why it is being done. It can last as little as one hour to several hours. From the operating room you will be transported to the recovery room where you will be watch closely after the surgery. Once you are stable and fully awake, you will most likely be moved to a regular hospital room and if all goes well, discharged the next day.
In general, the incision used for a thyroidectomy is not terribly painful and any discomfort is usually effectively treated with mild oral narcotics. You may experience a sore throat that should subside fairly quickly. Your diet is generally unrestricted.
What is life like after thyroid surgery?
Once you are home, normal activities can be resumed. In general, most surgeons allow showers to resume 24 hours after surgery and prefer that you participate in no strenuous activities for 10-14 days. However, please be sure to ask about and follow your surgeon’s particular restrictions carefully and keep any requested follow up appointments.
Once fully recovered from surgery, you should be able to live life without any restrictions. Depending on your surgery, you may need to take thyroid hormones to replace the thyroid function you lost. This is particularly true if you underwent a subtotal or total thyroidectomy. If you will need radioactive iodine after the surgery (see Thyroid Cancer pamphlet) you will likely not start thyroid replacement until after you have completed this treatment.