What Is Thyroid Surgery?
Thyroid surgery is an operation to remove part or all of the thyroid gland. It is performed in the hospital, and general anesthesia is usually required. Typically, the operation removes the lobe of the thyroid gland containing the lump and possibly the isthmus. A frozen section (immediate microscopic reading) may be used to determine if the rest of the thyroid gland should be removed during the same surgery.
Sometimes, based on the result of the frozen section, the surgeon may decide not to remove any additional thyroid tissue, or proceed to remove the entire thyroid gland, and/or other tissue in the neck. This decision is usually made in the operating room by the surgeon, based on findings at the time of surgery. Your surgeon will discuss these options with you preoperatively.
As an alternative, your surgeon may choose to remove only one lobe and await the final pathology report before deciding if the remaining lobe needs to be removed. There also may be times when the definite microscopic answer cannot be determined until several days after surgery. If a malignancy is identified in this way, your surgeon may recommend that the remaining lobe of the thyroid be removed at a second procedure. If you have specific questions about thyroid surgery, ask your otolaryngologist to answer them in detail.
What Happens After Thyroid Surgery?
During the first 24 hours:
After surgery, you may have a drain (tiny piece of plastic tubing), which prevents fluid and blood from building up in the wound. This is removed after the fluid accumulation has stabilized, usually within 24 hours after surgery. Most patients are discharged later the same day or the next day. Complications are rare but may include:
- Bleeding under the skin that rarely can cause shortness of breath requiring immediate medical evaluation
- A hoarse voice
- Difficulty swallowing
- Numbness of the skin on the neck
- Vocal cord paralysis?
- Low blood calcium
Following the procedure, if it is determined that you need to take any medication, your surgeon will discuss this with you prior to your discharge. Medications may include:
- Thyroid hormone replacement
- Calcium and/or vitamin D replacement
Some symptoms may not become evident for two or three days after surgery. If you experience any of the following, call your surgeon or seek medical attention:
- Numbness and tingling around the lips and hands
- Increasing pain
- Wound discharge
- Shortness of breath
If a malignancy is identified, thyroid replacement medication may be withheld for several weeks. This allows a radioactive scan to better detect any remaining microscopic thyroid tissue, or spread of malignant cells to lymph nodes or other sites in the body.
How Is A Diagnosis Made?
The diagnosis of a thyroid function abnormality or a thyroid mass is made by taking a medical history and a physical examination. In addition, blood tests and imaging studies or fine-needle aspiration may be required. As part of the exam, your doctor will examine your neck and ask you to lift up your chin to make your thyroid gland more prominent. You may be asked to swallow during the examination, which helps to feel the thyroid and any mass in it. Tests your doctor may order include:
- Evaluation of the larynx/vocal cords with a mirror or a fiberoptic telescope
- An ultrasound examination of your neck and thyroid
- Blood tests of thyroid function
- A radioactive thyroid scan
- A fine-needle aspiration biopsy
- A chest X-ray
- A CT or MRI scan
Types of Thyroid Operations
In general, there are three types of thyroid resections:
Total thyroidectomy: removal of the entire thyroid
A total thyroidectomy may be done for a variety of diseases including thyroid cancer, Graves’ disease (See Hyperthyroidism »), multinodular goiter, and substernal goiter, among others. In certain cases, the surgeon may choose to perform a near-total thyroidectomy in which a small piece of thyroid tissue is left behind usually in the area of the parathyroid glands and recurrent laryngeal nerve in order to avoid damaging these structures. After a total thyroidectomy, patients will need to take thyroid hormone replacement pills (one pill a day for the rest of their lives).
Thyroid lobectomy (aka hemithyroidectomy): removal of half of the thyroid
A thyroid lobectomy may be done for a variety of diseases including indeterminate lesions on fine needle biopsy (See Thyroid Nodules Diagnosis and Treatment »), a toxic nodule (See Hyperthyroidism »), substernal goiter, and an enlarging thyroid nodule, among others. In cases of indeterminate lesions, some surgeons refer to a thyroid lobectomy as a diagnostic lobectomy because the main purpose of the operation is to make a diagnosis – cancer or benign thyroid disease. During the operation, the surgeon may send a frozen section biopsy. With a frozen section, the pathologist will look at one or two sections of the thyroid nodule in question while the patient is still in the operating room in order to see if there is a cancer present. If there is a clear-cut cancer, the surgeon will remove the other side of the thyroid as well. Unfortunately, since the pathologist is only able to look at a couple of slices of the nodule, the frozen section biopsy is most often not helpful and typically one has to wait until the final pathology is ready within 7 to 10 business days after the operation. Approximately 70% of patients who have half of a normal thyroid gland left in place will not require thyroid hormone replacement pills. This percent decreases in older women, patients with a personal or family history of Hashimoto’s thyroiditis or hypothyroidism, and patients with a family history of autoimmune disease.
Completion thyroidectomy: removal of any remaining thyroid tissue.
A completion thyroidectomy is usually done after a thyroid lobectomy reveals cancer in the first half of the thyroid but may also be done for multinodular goiter or hyperthyroidism. After a completion thyroidectomy, patients will need to take thyroid hormone replacement pills (one pill a day for the rest of their lives).
The decision as to which thyroid operation to perform depends on a number of factors including the type of disease and the patient’s preferences. It is critical to work with a team of thyroid specialists to choose the right operation for each individual patient.