Guide To A Thyroidectomy

The thyroid gland is located at the base of the neck. It is responsible for making hormones that regulate heart rate, blood pressure, body temperature, and metabolism. Two examples of these hormones are thyroxine and triiodothyronine. When making hormones, the thyroid relies on iodine, a mineral present in iodized salt and certain foods. However, several conditions can affect the thyroid gland's function.

Thankfully, a thyroidectomy can be quite helpful when individuals are experiencing thyroid problems. This surgery can act as a treatment for thyroid cancer. In addition, some patients may need it as a hyperthyroidism treatment when thyroid medications have not worked. A thyroidectomy may act as a goiter treatment for some patients as well. Of course, patients must understand how this procedure works first.

When A Thyroidectomy Is Performed

Most thyroidectomies are performed to treat thyroid cancer. However, the procedure may be considered for patients with less serious thyroid conditions if medications and other therapies have not worked. For example, patients with an overactive thyroid, also called hyperthyroidism, can benefit from this procedure. Specifically, they may need a thyroidectomy if they have not responded to anti-thyroid medication.

The procedure may also be helpful for patients who cannot undergo radioactive iodine therapy. A thyroidectomy could be appropriate for individuals with an enlarged thyroid (goiter) that is causing discomfort, breathing difficulties, or trouble swallowing. Patients with thyroid nodules usually have a needle biopsy to determine if the nodules are cancerous. If the biopsy results are inconclusive, this procedure may be necessary if there is a high likelihood that the nodules may be malignant.

How The Procedure Works

A thyroidectomy is performed with general anesthesia. It typically takes one to two hours to complete. When it is done in cases of thyroid cancer, the surgeon may need to remove some of the lymph nodes around the thyroid. The conventional form of the procedure involves surgeons making an incision at the center of the neck to access and remove the thyroid. The surgeon will attempt to make the incision in a skin crease so that any scarring will be easily hidden.

With an endoscopic thyroidectomy, several smaller incisions are made in the neck. Surgical instruments and cameras are inserted into the incisions, and the camera provides visual guidance for the surgical team. The newest approach to this procedure is a transoral thyroidectomy. In this method, the surgeon does not need to make any incisions in the patient's neck. Instead, incisions are made inside the mouth, and there is no scarring. The surgeon will choose the safest and most appropriate surgical method for the patient's condition.

How To Prepare

The patient will have several consultations with the surgical team before their thyroidectomy. During these appointments, the patient can ask any questions they may have about the surgery. The patient must give the surgeon a complete list of all prescription medicines, over-the-counter drugs, vitamins, minerals, and herbal supplements that they currently take. Certain medications, including blood thinners, may need to be discontinued a few days before the operation. However, the surgeon will discuss this with the patient.

The surgeon will also need to know if the patient has any allergies. Since this procedure requires general anesthesia, the patient will need to refrain from eating or drinking after midnight on the night before their surgery. This procedure may be performed on an outpatient or inpatient basis, depending on the patient's overall health and reason for the operation. A friend or family member must take the patient home after.

Risks And Side Effects

Thyroidectomies are very safe. However, all surgeries carry some risks. Since this procedure requires general anesthesia, there is a small risk of complications due to the anesthesia. There are risks of infection and bleeding as well. The patient may be given antibiotics before or after the operation to reduce these risks. The surgeon will take steps to minimize bleeding during the surgery. In addition, the anesthesiologist will constantly monitor the patient for possible anesthesia-related issues during the procedure. Significant bleeding could obstruct the patient's airway.

After the surgery, patients may have low parathyroid hormone levels. This can happen if the parathyroid glands were removed or damaged during the procedure. Low levels of these hormones could reduce the amount of calcium in the patient's blood. This may lead to tingling, numbness, or cramping. If the patient's nerves are damaged due to the thyroidectomy, their voice may be weak or hoarse. This complication could be temporary or permanent.

Recovery And Results

Immediately after the thyroidectomy, the patient will be moved to a recovery room. Doctors and nurses will monitor their vital signs here. If this procedure is done on an outpatient basis, the patient will be discharged once they are fully awake and able to urinate. When this procedure is performed as an inpatient operation, the patient will be moved to a hospital room once they are fully conscious. Patients can eat and drink normally during their recovery. After returning home, the patient should wait ten to fourteen days before doing any strenuous exercise or heavy lifting. It is safe to return to other daily activities. Patients should ask their surgical team if they are unsure if a particular activity is safe to do as they recover. If certain medications were discontinued before surgery, the patient should also ask the surgical team about when it is appropriate to restart these.

For surgeries that involve neck incisions, it may take up to one year before the scars fade. The surgeon may advise the patient to apply sunscreen each day to minimize the visibility of the scar. Patients may want to ask about other skin creams and treatments that could help the scarring heal too. In a partial thyroidectomy, the remaining part of the thyroid may produce sufficient amounts of thyroid hormones. Thus, patients may not need to use synthetic thyroid hormones. However, when a complete thyroidectomy is performed, patients will need to take levothyroxine every day for the rest of their lives. Levothyroxine is a synthetic thyroid hormone that carries out the functions that the thyroid gland would normally complete. Blood tests will be used to determine the appropriate dose.