When do I require thyroid surgery?
Thyroid surgery is advised in patients with the following problems
- Thyroid nodule where the FNAC (needle test) shows cancer (Bethesda 6) or suspicious of cancer (Bethesda 5).
- Thyroid nodule where the FNAC shows follicular neoplasm (Bethesda 4) or atypia of undetermined significance (Bethesda 3).
- Large thyroid nodule more than 4cm in size, or a large swelling compressing the windpipe or food pipe
- Large thyroid swelling which is cosmetically disfiguring
- Hyperthyroidism uncontrolled by medication or radioactive iodine, or in patients where these treatments produce side effects.
- Retrosternal goitres (swellings extending into the chest).
What are the types of thyroid surgery?
Surgery of the thyroid can be
- Hemithyroidectomy/lobectomy
- Total thyroidectomy
- Scarless thyroidectomy or minimally invasive thyroidectomy
The type of surgery performed will depend on the reason for surgery, as well as on the condition of the surrounding thyroid.
———drawing —– thyroid anatomy with parathyroid, trachea, RLN
The different types of thyroid surgery are
- Thyroid Lobectomy/ hemithyroidectomy
It is a smaller procedure where the side of the thyroid containing the nodule is removed. It is done in patients with benign (non-cancerous) nodules or indeterminate nodules involving only one lobe. It is also indicated for patients diagnosed with a thyroid nodule producing excess of thyroid hormones (toxic adenoma).
Normal thyroid gland Right thyroid nodule Right lobectomy
- Total thyroidectomy
In this operation the whole of the thyroid gland is removed. This is the treatment of choice for thyroid cancer. It is also indicated when more than one nodule is present (multinodulargoiter) or when the whole thyroid gland is enlarged( diffuse goiter). The thyroid gland is usually removed via an incision in the lower part of the neck. Thyroidectomy can also be performed through recently developed scarless techniques……LINK TO SCARLESS THYROIDECTOMY…..
When should I go for total removal of my thyroid gland (Total thyroidectomy)?
Total removal or near total removal of the thyroid gland is needed in
- When you have thyroid cancer >1cm
- Nodules in both lobes of thyroid (multinodular goitre)
- Graves’ disease
- Prophylactic thyroidectomy for medullary carcinoma of thyroid
How should I prepare for thyroid surgery?
You will usually be asked to come to the hospital on the morning of surgery. You may need to be fasting from 12 midnight.
How is thyroid surgery performed?
You will be given general anaesthesia to make you fall asleep and minimise pain. Thyroid surgery is then performed via a 4-6cm incision in the front of the neck. Incision is placed over the skin fold to minimize the scar. The thyroid gland is then carefully dissected out and removed. The surgeon should take care to identify and preserve adjacent structures like the parathyroid glands (maintain calcium levels in the blood) and the recurrent laryngeal nerves (voice nerves).
What are the risks associated with thyroid surgery?
Thyroid surgery is generally a safe surgery with minimal complication rates. Risk of complications also depends on the surgeons skill and experience. Some complications which may occur are bleeding (1 to 2%), infection (rare), hoarseness of voice (1 to 3%), low calcium levels.
What will my scar look like after surgery?
Slight bruising or swelling may be seen surrounding the scar immediately after surgery. The scar will then turn pink and harden over the next few weeks as the incision heals. The scar is at its thickest at 3 to 4 weeks, and gradually becomes smaller and less visible over the next 3 months. Complete healing may take up to 6 to 8 months. Try to avoid any undue strain on your neck for at least 2 weeks following surgery.
The surgeon will make the incision along a natural skin crease and also make the incision as small as possible in order to camouflage the scar.
A large proportion of patients, do not have a noticeable scar 6-8 months after surgery.
Thyroidectomy scar
After 3 month After 6 months
Thyroidectomy + neck dissection scar
After 1 month After 6 months
I have a single benign nodule, will my entire gland be removed?
If you have a single nodule we do nodulectomy/hemithyroidectomy and send it for frozen biopsy (intra-operative quick biopsy). This report will come in 20 minutes and if it is benign (non-cancerous) the rest of the thyroid will be left behind. If it comes as cancerous than the opposite lobe of the thyroid is also removed to facilitate further treatment.
I underwent hemi-thyroidectomy/nodulectomy, do I have to take thyroid tablets?
We will check your thyroid hormone levels 4 weeks after the surgery. In 80-90% of patients the opposite lobe will compensate the thyroid function. The remaining 10-20% may need thyroid medicine supplementation. But if you were taking thyroid medicine (thyroxine) before surgery, you will have to continue the medications.
Will I have any problems if my entire thyroid is removed?
If your entire thyroid is removed, you will have to take lifelong thyroid (thyroxine) medications. Thyroxine is normally produced by the thyroid gland. These medications have no side effects and it will totally take care of the function of thyroid gland.
How should this thyroxine (thyroxin, eltroxin or thyronorm) be taken?
This tablet has to be taken in the fasting state soon after you get up .
Give a minimum gap of half an hour before you eat your morning breakfast, tea, coffee etc.
I forgot to take one days tablet, what shall I do, will it affect my body?
There is no adverse effect to missing one dose of this medication. Please take two tablets together whenever you remember that you missed a dose. Fortunately the thyroxine hormone has a half life of 7 days and will act till seven days. But make it a habit to take the tablet, as the first thing you do as soon as you get up.
Will I need Calcium medication after thyroid surgery?
We check parathyroid hormone levels after total thyroidectomy and if the parathyroid hormone levels are >15pg/ml and you are asymptomatic; you won’t need any calcium supplements.
A parathyroid hormone level of<15pg/ml will mean that parathyroid function is less than normal. You will have to take calcium supplements, most likely for few weeks to months. Very rarely <1% will have to take it for a longer period.
We don’t give routine prophylactic calcium supplementation.
Will I have voice change after thyroidectomy?
An expert thyroid surgeon is one who performs at least 100 thyroidectomies per year. The rate of voice change is < 1% for surgeries done by expert surgeons. Even if voice change does occur, it is likely to be temporary and will become normal in 1 to 3 months.
When will the patient be admitted?
Patient can come in morning at 8am on the day of surgery to the admission block in Apollo health city Jubilee hills for admission.
For how long does the patient have to stay in the hospital after surgery?
Usually the patient will be discharged in 1 or 2 days. Occasionally the calcium levels may become very low after surgery, and some patients may need to stay in hospital for 3 to 4 days in order to normalise calcium levels.
When can I talk and Eat after thyroid surgery?
Yes you can talk and eat on the same day after your surgery. There is no restriction on your diet or voice.
What is scarless thyroidectomy?
It a technique in which the thyroid gland is removed through a small incision in the lower lip. The gland is dissected out using micro-surgical instruments (endoscopes). This incision completely heals after 3 months with no visible scar.