Thyroid Gland Surgery

If you’ve recently found out that you’ll be needing surgery for a thyroid issue, you may be feeling overwhelmed by all of the new information you have to learn. Proper education on the thyroid gland and a thorough explanation of the surgical treatment should put you at ease.

Thyroid gland surgery is a generally safe and common procedure that is frequently  performed by health care providers across the globe. 

The thyroid gland is an important endocrine gland that creates hormones for the body. This endocrine gland plays a significant role in the metabolism and overall functioning of the body. Many different thyroid issues can arise and they are fairly common, affecting more than 12% of the U.S. population.

Even given its important role, you can live without your thyroid. Surgery is a safe and common treatment option for certain thyroid issues.

What is the thyroid gland?

The thyroid gland is a butterfly-shaped gland that is at the front of the neck. The thyroid is one of the eight major endocrine glands in the body. Endocrine glands secrete hormones to keep the body functioning properly.

What does the thyroid gland do for the body?

There are two hormones that the thyroid secretes: thyroxine (T4) and triiodothyronine (T3). These hormones are required for the body to function normally.

T4 is also known as thyroxine. It contains four iodine atoms. T3 is also called triiodothyronine and it contains three iodine atoms. Once T4 reaches the cells of the body, it is actually converted to T3. T3 is the “biologically active” hormone that the thyroid produces, influencing the activity of every cell and tissue of the body.

The main job of the thyroid hormones is influencing the metabolism. Thyroid hormones affect the speed at which the body cells work. So, if too many thyroid hormones are secreted (hyperthyroidism) the metabolism will work too fast, leading to symptoms like unexplained weight loss, anxiety, increased heart rate, overactive digestion and restlessness. If too few thyroid hormones are secreted (hypothyroidism) then your metabolism will be slowed, leading to symptoms like weight gain, low energy, low heart rate, constipation and depression.

How do other glands and the thyroid affect each other?

The functioning of the thyroid can be influenced by other glands and hormones. The pituitary gland secretes thyroid stimulating hormone which is a hormone that influences the effect of the thyroid and the number of thyroid hormones that are secreted.

The parathyroid gland is also connected to the thyroid in some ways. The parathyroid sits directly behind the thyroid and secretes parathyroid hormone–a hormone that plays a major role in blood calcium levels. The parathyroid glands are small, delicate glands located just behind the thyroid. For this reason, they can sometimes be damaged or even unintentionally removed during thyroid surgery.

The thyroid and iodine: what’s the connection?

You may have heard that there is a connection between iodine levels and thyroid function. This is because the thyroid utilizes iodine by converting it to thyroid hormones. Low iodine levels can lead to thyroid disorders like goiters and hypothyroidism. Iodine deficiency is actually the most common cause of thyroid disorders worldwide. Iodine deficiency has been greatly reduced in the United States and other developed countries, given that salt has iodine added to it and salt is added to most foods.

Why might I need a thyroidectomy?

There are many thyroid disorders that may require surgery. Some conditions require partial removal of the thyroid while others require the removal of the entire gland. Common thyroid issues that may require surgery include thyroid nodules or goiter and thyroid cancer.

Hyperthyroidism

Hyperthyroidism occurs when the thyroid is overactive. This will lead to an increased metabolic rate and causes symptoms like unexplained weight loss, anxiety, restlessness, rapid heart rate, tremors and insomnia. Hyperthyroidism is sometimes caused by other conditions such as Grave’s disease, thyroiditis and thyroid nodules. Overconsumption of iodine and improper dosage of thyroid medications can also lead to hyperthyroidism. You may be at an increased risk of developing hyperthyroidism if you have a family history of thyroid disease, are deficient in vitamin B12, have type 1 diabetes, are over the age of 60, were recently pregnant, take iodine-containing medications or eat a diet high in iodine. Surgery to remove some or all of the thyroid is an effective treatment for hyperthyroidism when other methods don’t work.

Hypothyroidism

Hypothyroidism is the opposite of hyperthyroidism and occurs when the thyroid is underactive. Signs of hypothyroidism include weight gain, low energy levels, weakness, hair loss, constipation and depression. Typically, the treatment for hypothyroidism is to take thyroid replacement hormones since this condition is caused by too little thyroid hormones being secreted. However, hypothyroidism is sometimes caused by a condition called Hashimoto’s thyroiditis. This condition is an autoimmune condition in which the body attacks the thyroid. In this case, thyroidectomy can be an effective treatment for hypothyroidism.

Goiter

A goiter is a benign or noncancerous enlargement of the thyroid. Goiters are easy to identify, they look like a large ball in the neck. Goiters are typically caused by iodine deficiency. If a goiter is not causing any symptoms then it may not require treatment. Goiters can cause hypothyroidism because they can interfere with the thyroid’s ability to produce its typical hormones. Contrarily, goiters can also cause hyperthyroidism because they can become toxic and begin producing their own thyroid hormones. There are many different treatments for a goiter and they vary depending on the cause of the goiter and any symptoms that may be occurring. Sometimes, removal of all or some of the thyroid is necessary.

Thyroid cancer

There are many different types of thyroid cancer which means there are also many different treatment approaches. Surgery to remove the thyroid is a common approach to treating thyroid cancer since it can help ensure that the cancer does not continue to spread throughout the body. Thyroid cancer may not cause noticeable symptoms at first but if left untreated the cancer can grow and start to cause uncomfortable symptoms like swelling, voice changes and difficulty swallowing.

Thyroid nodules

Thyroid nodules are small lumps that form in the thyroid. Nodules may be identified as being cancerous or noncancerous but sometimes even after completing a biopsy, your doctor may be unable to tell if the nodules are cancerous or not. If the nodules are identified as cancerous or if it is difficult to tell if they are cancerous or not, your doctor may recommend surgery out of caution. It may not be worth the risk of waiting to see if the nodules grow or become cancerous. Some patients are at increased risk of having cancerous nodules, these patients are also good candidates for surgery as well.

What is a thyroidectomy?

If your doctor has recommended thyroid surgery, then you’ve likely heard them talking about a thyroidectomy. Thyroidectomy is the word used to describe the surgical removal of some or all of the thyroid gland. In some situations, you may only need part of your thyroid removed (such as with noncancerous nodules) or you may need to have the entire gland taken out (such as if you have cancer).

Thyroid surgery is an effective treatment for many thyroid conditions. By removing the entire gland, the previous issues can be resolved. Once your thyroid gland has been removed, you’ll need to take thyroid hormone medications for the rest of your life. This is because your body needs the hormones that your thyroid produces and without this gland, your body will have nowhere else to get them. By taking thyroid hormones as medication, your doctor can target the right amount of thyroid hormones so that your body can be balanced out. Most thyroid issues cause some degree of imbalance with thyroid hormones so many patients find that opting for a total or partial thyroidectomy can lead to a great sense of relief.

Before thyroid surgery

To prepare for thyroid surgery, you’ll want to do plenty of research and talk with your doctor about any concerns you have. Your doctor or care team should go over all of the important patient education material regarding your procedure so that you go into it feeling empowered and aware of what to expect.

Before you go in for your surgery, your doctor will order some blood tests and imaging scans. They’ll also want to do a physical exam to get an idea of your physical health. Blood tests will look at current thyroid hormone levels and blood counts. Platelet counts are an important blood level that your doctor will look at since they influence the risk of bleeding following surgery.

You may need to take special medications prior to surgery, such as thyroid medications. This is because the removal of the gland itself can cause a large shift in hormones and your doctor will want to do everything in their power to make this a seamless process.

You’ll also be given guidelines on when to stop eating before surgery. You will probably need to go at least 8 to 12 hours without eating or drinking before surgery.

During thyroid surgery

When it is the day of surgery, you will be given anesthetic medication either through an IV or by having a breathing mask placed over your face. You will quickly fall asleep and then wake back up when the procedure is complete. Once you are asleep, a breathing tube will be placed down your throat for the duration of your surgery.

There are multiple approaches to thyroid surgery. Your doctor may use a traditional approach, endoscopic approach or transoral. A traditional thyroidectomy involves placing a small incision along the neck and removing the thyroid through that. Endoscopic thyroidectomies (a type of endocrine surgery) result in a smaller scar because they utilize a few small incisions and use specialized devices to remove the thyroid that way. Transoral thyroidectomies are a newer method that results in no external scar at all because the thyroid is removed through the mouth.

If you have cancer, then your doctor will also evaluate the surrounding tissues and remove any other tissues or cells where the cancer has spread.

Our expert team of general surgeons at UCF Health are skilled in thyroidectomy surgeries.

After thyroid surgery

Once your surgery is complete, you’ll be moved to a recovery room where you will be monitored for the first hour or so until the anesthesia wears off. Some patients have to stay overnight at the hospital following thyroidectomy while others may be able to go home the same day.

Many people will have some hoarseness or a weak voice following surgery caused by throat irritation from the breathing tube, but this is a temporary symptom. A small percentage of patients will experience permanent voice changes following thyroid surgery but again, this is unlikely.

The pain following thyroid surgery is usually mild. You will likely be able to manage your pain easily with over-the-counter pain medications like ibuprofen. You should be able to quickly get back to your usual daily activities but you will need to wait at least 10 days before doing any heavy lifting or strenuous exercise.

Depending on the type of thyroidectomy you had, you may have a scar from the surgery. Scars can be permanent but will likely fade a bit over time. Surgeons try to be mindful about where they place the scar so that it can be as minimally noticeable as possible.

In the first few days and weeks after surgery, you’ll want to be mindful of any signs of infection, such as new or excessive pain, respiratory distress, redness, swelling or fever. Call your doctor right away if you think your incision site is infected. Some other post-operative risks include bleeding and permanent voice changes.

What are the alternatives to thyroid gland surgery?

Thyroid issues are incredibly common and not every thyroid issue requires surgery. Non-cancerous thyroid nodules, hyperthyroidism and hypothyroidism are fairly common thyroid issues that don’t always require surgery. Many non-severe thyroid issues can be treated with other methods such as medication and radiation. Here are some common approaches to treating thyroid issues without surgery.

Radioactive iodine pills

Radioactive iodine pills are a method for treating thyroid nodules and some types of thyroid cancer. This treatment method destroys toxic thyroid tissue without the need for surgery. The radioactive iodine is absorbed by the thyroid and destroys the tissue once it gets there. This is an effective method for wiping out certain problematic tissues that may exist in the thyroid gland.

There are some risks associated with radioactive iodine therapy and it is not for everyone. Women who are pregnant or nursing cannot undergo radioactive iodine therapy. Radioactive iodine pills can cause damage to the tear ducts and salivary glands. Sometimes, doctors will use radioactive iodine therapy following surgery for thyroid cancer to prevent the cancer from returning.

External beam radiation therapy

External beam radiation is another alternative to thyroid surgery that can help to destroy cancer cells or prevent them from growing. This type of therapy uses high-energy particles, through a focused beam from the outside of the body. External beam radiation is commonly used for medullary thyroid cancer and anaplastic thyroid cancer.

Because radioactive iodine pills are a better option for thyroid cancers that take up iodine, external beam radiation is commonly used for thyroid cancers that do not respond to iodine or that have spread beyond the thyroid. Sometimes, external beam radiation is used in combination with other treatments to prevent cancer from returning.

External beam radiation is sometimes used when cancer does not respond to radioactive iodine. External beam radiation is typically given 5 days per week for multiple weeks at a time. Usually, the setup time takes longer than the treatment itself since your healthcare team will need to take steps to ensure the correct angles for proper dosing. The treatment itself is usually painless.

Maintaining a Healthy Thyroid

Keeping your thyroid health in check really just boils down to doing the best you can to take care of your body as a whole. There are very few directly linked preventative measures for thyroid health but what we do know is that taking certain steps to maintain your overall health can place you at a lower risk of developing thyroid issues that require surgery. 

Some healthy lifestyle measures include:

• Manage stress well. Poorly managed stress can cause excessive release of the hormone cortisol leading to adrenal fatigue. Adrenal fatigue may be linked to hypothyroidism. Keeping your stress well managed can support your overall health as well as that of your thyroid. Some effective stress management techniques include meditation, breathwork and exercise.
• Exercise regularly. Exercise has been found to improve thyroid function so you should try to make regular exercise a priority if you want to keep your thyroid functioning well. Try to exercise three to five times a week to maintain your health.
• Eat a healthy diet. Eating a healthy diet that is low in sugar can help support healthy thyroid function. Keeping your blood sugar balanced is also essential for thyroid health. This means that you’ll want to eat small, regular meals to keep your blood sugar balanced, rather than going long stretches of time without eating and then eating a huge meal. Cruciferous vegetables (like broccoli and cabbage) can even interfere with thyroid function so you’ll want to make sure to eat these vegetables in moderation.
• Go to regular checkups. Seeing your doctor regularly can help you maintain a healthy thyroid. Your doctor can help you remain vigilant about your health by investigating and treating any unusual symptoms (such as significant neck pain as soon as they occur.

Working with the endocrinology team at UCF Health can help you maintain your thyroid health and treat any thyroid issues that do arise. If you’re concerned about your thyroid health, then our team of experts and experienced surgeons are here to help you. Schedule your visit today.