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So, your doctor has recommended thyroid surgery. Don’t worry, you aren’t alone – over 150,000 thyroid surgeries are performed in the U.S. each year. The thyroid is a butterfly-shaped gland in the neck that plays a major role in overall health by excreting some of the body’s most vital hormones. This means that thyroid issues are often more than evident, having a major effect on your day-to-day life.

Resolving thyroid issues sometimes means having surgery. Though this may feel scary, you can rest assured that this surgery may be exactly what you need to get back to feeling like yourself again. Common thyroid issues that often lead to surgery include thyroid cancer, thyroid nodules, goiter and hyperthyroidism.

Why does a patient need thyroid surgery?

There are many reasons why your doctor may have recommended thyroid surgery. Some of the most common reasons include:

  • Thyroid cancer: An overgrowth of cells in the thyroid gland is characteristic of thyroid cancer. The exact cause of thyroid cancer is not known. Treatment for this type of cancer can vary but surgery is one of the most common methods. Other treatment options include hormone therapy, radioactive iodine, radiation and sometimes chemotherapy.
  • Goiter: Goiters are an enlargement of the thyroid gland that appears as a large growth on the front of the neck. Goiters usually occur as a result of iodine deficiency or thyroid inflammation. Smaller goiters that don’t cause symptoms may not require treatment but larger goiters that cause discomfort or difficulty breathing do require surgery.
  • Hyperthyroidism: Also known as an over-active thyroid, hyperthyroidism occurs when the thyroid gland produces too much thyroxine (a hormone that controls your metabolic rate). If you are unable to tolerate other treatments for hyperthyroidism, such as antithyroid drugs and radioactive iodine therapy, then surgery would be the next best option.
  • Nodules: Thyroid nodules are lumps that form within the thyroid gland. When should you worry about these nodules? If the nodules are cancerous, then a thyroidectomy will likely be recommended. In some circumstances, it may be difficult for your doctor to determine if your thyroid nodules are cancerous or not. Thyroidectomy might be recommended in these circumstances.

What is a thyroidectomy?

A thyroidectomy is a procedure that involves the removal of all or some of the thyroid gland. Thyroidectomies can vary, depending on the thyroid condition that warrants surgery. There are a couple of different approaches to thyroidectomy including traditional, scarless and endoscopic.

Risk factors

Thyroidectomies are a common and generally safe procedure but all surgeries carry some risk. Potential risk factors of thyroidectomy include:

  • Bleeding or blood clots
  • Hoarseness and voice box changes
  • Adhesions or scar tissue (potentially leading to future surgery)
  • Damage to the muscle of the esophagus or windpipe
  • Post-operative infection
  • Hypoparathyroidism which can lead to low calcium levels

More often than not, patients undergo thyroid surgery and recover fully with little to no complications. Many people fear the possibility of their voice changing, however, this complication only occurs in about 14.6% to 18.4% of patients. The risk of bleeding after surgery is another common concern amongst patients but is again a rare complication, representing only about 4.2% of cases.

Thyroidectomy

Traditional thyroidectomies involve placing an incision at the base of the neck to remove the thyroid. This can leave the appearance of a scar but your surgeon will do their best to place the incision along a crease-line to make the scar as minimal in appearance as possible.

What to expect before thyroidectomy.

Prior to your thyroidectomy, you’ll likely need to have some blood tests, imaging scans and physical evaluation performed by your doctor. Your blood levels will be checked to look at your existing thyroid hormone levels and other important factors, such as platelet counts. Your platelet count helps your doctor see your risk for excessive bleeding during and after surgery.

You also might have imaging scans performed to look at your thyroid gland prior to surgery. This could include an ultrasound, CT scan or MRI. Your doctor might want to examine your vocal cords by looking in your mouth with a laryngoscope.

For patients who have hyperthyroidism, doctors give thyroid medications to help keep hormone levels balanced during surgery. This helps prevent a drastic shift in hormones when your thyroid is removed.

Your doctor will provide guidelines regarding how long before surgery you should stop eating and drinking. Typically, it is recommended that patients go 8 to 12 hours without eating or drinking before undergoing surgery.

What to expect during thyroidectomy.

During your thyroidectomy, you will be placed under general anesthesia. You will have a breathing tube placed down your throat and you will be hooked up to continuous monitors to make sure that you remain stable throughout the surgery.

Your doctor will place a small incision along your neckline and remove some or all of your thyroid. If you are having a thyroidectomy because of thyroid cancer, then your surgeon may also decide to remove some of the lymph nodes surrounding the thyroid as well.

What to expect after thyroidectomy.

After your surgery is complete, you will be moved to a recovery room where healthcare staff will continue to monitor you. Once the anesthesia has worn off, you will be moved to a hospital room where you will stay overnight for additional monitoring. Some patients may be able to go home the same day of surgery but this depends on the patient’s stability and the surgical method used.

Your voice may feel hoarse after surgery but this doesn’t mean that your vocal chords have sustained permanent damage. Even though that is a potential complication, hoarseness in the voice following surgery could also be related to throat irritation from the breathing tube that was placed during surgery.

Most patients experience minimal pain following thyroidectomy and are able to quickly return home and get back to performing their daily activities. You’ll want to wait at least 10 days before returning to any strenuous activities such as heavy lifting or vigorous exercise.

It could take up to a year for your scar to fade. Applying sunscreen to the scar can help minimize the appearance of it over time.

FAQs

  • Can the operation affect my parathyroids?

The parathyroid glands can be affected by thyroidectomy. The parathyroid is located behind the thyroid gland, at the base of the neck. Sometimes, thyroid surgery can cause permanent damage to the parathyroid gland. The parathyroid produces a hormone that aids in calcium regulation throughout the body, so damage to this gland can cause permanent hypoparathyroidism which leads to long-term calcium deficiencies. There is a 10% risk of parathyroid damage occurring during thyroidectomy.

  • Will I have a scar?

Traditional thyroidectomies are performed by placing an incision in the neck. This thyroidectomy method will result in a scar. Surgeons try to be mindful about the placement of the scar, attempting to place it along a crease line of the neck so that it will blend in more easily. Scar gels and creams can help with minimizing the appearance of the scar as well.

  • Will I need another surgery?

In some cases, a second surgery may be required following thyroid surgery. This tends to occur in patients who have thyroid cancer that returns after surgery. You may also need an additional surgery if you have a partial thyroidectomy (only part of the 

thyroid removed) and your doctor later discovers that you need to have the entire thyroid gland removed.

  • Will I need to take thyroid hormones following thyroid surgery?

If you are going to have your entire thyroid removed, then your body will no longer be able to produce the thyroid hormones that are required. This means that you will have to take synthetic thyroid hormones in order to prevent hypothyroidism and other adrenal disorders. Levothyroxine is one of the most common thyroid hormone medications. It is a synthetic version of the hormones that are naturally produced by the thyroid, helping to regulate the body’s metabolism and energy levels. 

If your doctor has informed you that you’ll only need to have part of your thyroid removed, then it may continue to function normally after surgery. In this circumstance, you will not be required to take thyroid medications after surgery.

  • How painful is thyroid surgery?

Typically, thyroid surgery is not very painful. Most patients don’t even require narcotic pain medications following surgery and can easily manage their neck pain with over-the-counter pain medications like Tylenol. Most patients are able to quickly return to their daily activities and may even be able to go home the same day as surgery.

  • Is thyroidectomy considered major surgery?

Thyroidectomies are minimally invasive and common but some might consider them to be major surgery. This is because it results in the permanent removal of one of the body’s major endocrine glands and it carries some risk of severe complications. One study found that only about 9% of patients who had a thyroidectomy experienced severe complications.

  • What type of doctor diagnoses thyroid issues? 

Thyroid issues are typically diagnosed by endocrinologists — so, it is recommended that patients who struggle with ongoing thyroid issues consult an endocrinologist. If your endocrinologist determines that surgery is needed, an otolaryngologist or general surgeon will be identified and contacted to perform the operation. Your general practice physician may be who you follow up with and who helps to prescribe your thyroid hormone replacement medications. If you have thyroid cancer, you may also have an oncologist on board. 

Conclusion

Making sure that you have educated yourself on what to expect is the best first step to take to help ease stress. Having background knowledge will also help you bring all of the important and necessary questions that you have to your provider’s attention so that you can know exactly what’s going on before you undergo surgery.

If you want to have a successful thyroid surgery, one of the key factors is to rely on a competent team of healthcare providers. UCF Health offers a diverse team of skilled providers who can ensure that your surgery is performed properly with minimal risk for complications. Come see us today.

Sources

https://www.endocrineweb.com/conditions/hyperthyroidism/surgery-hyperthyroidism/should-i-be-scared-of-thyroid-surgery

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/thyroidectomy

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5868671/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2749190/

https://www.surgjournal.com/article/S0039-6060(20)30530-4/fulltext

https://wvgeneralsurgery.com/can-i-eat-or-drink-before-surgery/