Thyroidectomy

A thyroidectomy is the medical name for removal of some or the entire thyroid gland. The thyroid gland sits at the bottom the neck and in front of the windpipe and produces several hormones which includes thyroxine.

The role of the thyroid gland in the endocrine system

The thyroid gland forms part of the endocrine system –a network of glands within the body which each release a type of hormone into the body. These hormones include growth hormone, dopamine and adrenaline.

These hormones enable the body to function on a day to day level. For example, the thyroid gland produces throxine (T4) and triiodothyronine (T3) which controls the metabolism, body temperature and heart rate.

So, the thyroid gland performs a vital role within the body.

Reasons for thyroidectomy

The thyroid gland can experience problems which require surgical intervention. These include:

• Cancer of the thyroid
• Goitre (enlarged thyroid)
• Benign (non-cancerous) lump on the thyroid
• Overactive thyroid
• Obstruction within the thyroid which is causing breathing difficulties.

An overactive thyroid –known as ‘hyperthyroidism’occurs when the thyroid gland produces an excess of hormones which causes the metabolism to speed up. This is usually treated with medication, for example beta blockers, but severe cases will require surgery.

There are two types of thyroidectomy:

• Partial thyroidectomy: removes a part of the thyroid gland
• Total thyroidectomy: remove the entire thyroid gland

Before you are considered for surgery you will undergo a series of blood tests to determine the amount of hormones, produced by your thyroid, in your blood.

You may also have an ultrasound scan if you have an enlarged thyroid as a result of goitre, or the presence of a tumour. Another diagnostic test is a biopsy in which a small sample of tissue is removed from your thyroid for laboratory analysis.

How is thyroidectomy performed?

If you are having surgery to treat an overactive thyroid then you will be given medication before your operation to slow the production of hormones from the thyroid gland.

You may be given medicine, which contains iodine, to take a couple of weeks before surgery. This medicine will reduce the size of the thyroid gland which will help the surgeon during the procedure.

The surgery itself is performed under a general anaesthetic and takes around 2 hours to complete.

The surgeon will make an incision in your neck, around the crease at the base before removing part or the entire thyroid gland. The incision is then closed with stitches or surgical clips.

After the thyroidectomy

You will be taken to a recovery room where your progress will be carefully monitored. Medical staff will keep a close eye on you and once they are satisfied with your condition you will be returned to your room.

You will be on a drip and will also have a drain (a type of tube) running from your surgical wound. This removes any excess fluid or bleeding. You may also have a catheter fitted.

These will be removed within 24 hours of your operation.

Your neck will feel stiff and sore but you will be given painkillers to deal with this.

You will stay in hospital for a day or two at the most.

On the day of your discharge arrange for someone to pick you and drive you home. Ask someone in advance of your surgery so that it is one less thing to worry about. It is a good idea to ask that person if they will stay with you the first 24 hours as you will feel tired, dizzy and slightly groggy after having a general anaesthesia.

Do not operate any machinery or perform any tasks which require a high degree of concentration during this time. Do not sign any legal documents. Wait for at least 48 hours before doing so.

Recovery from thyroidectomy

Take things easy once you arrive back home. You can return to your normal routine but do not overdo it. Avoid any heavy lifting or carrying and rest when you need to.

Take painkillers if you need to. The hospital will have provided you with painkillers for you to take during this time. Follow any instructions given and if you are not sure then ask for advice from your GP.

You may find it difficult to eat for the first few days so stick with foods which are soft and easy to digest. Good examples are soups, fruit smoothies, yoghurts and ice cream. Drink plenty of liquids to prevent dehydration.

If you had a total thyroidectomy (entire thyroid gland removed) then you will have been given a hormone replacement medicine at the hospital. This medicine is designed to replace the hormones that the thyroid gland normally produces.

Your wound may have been closed with dissolvable stitches or the normal non-dissolvable type.

Dissolvable stitches will disappear after a few weeks.

But if you have the normal type or clips then you will have to return to the hospital for them to be removed. This can be done as part of a follow up appointment.

Risks of thyroidectomy

This is an often performed, safe procedure which is also very effective. However, like any surgical procedure there are risks although these are small.

These include:

• Infection
• Poor reaction to the anaesthesia
• Pain and stiffness in your neck
• Excessive bleeding
• Blood clot in the leg (deep vein thrombosis)
• Damaged nerve within your larynx (usually temporary)

Your surgeon will explain these to you before surgery so that you can make an informed decision.