What is the Thyroid gland?
Your thyroid gland is one of the endocrine glands, which make hormones to regulate physiological functions in your body. The thyroid gland manufactures thyroid hormone, which regulates the rate at which your body carries on its necessary functions. Other endocrine glands are the
parathyroid glands, the pituitary, the adrenal glands, the pancreas, the testes, and the ovaries.
|Thyroid gland, front view
||Thyroid gland, side view
The thyroid gland is located in the middle of the lower neck, below the Adam's apple and just above your clavicles (collarbones). It is shaped like a "bow tie" or “butterfly” having two halves (lobes): a right lobe and a left lobe joined by an "isthmus". You can't always feel a normal thyroid gland.
Thyroid diseases are very common and can be broadly divided into the following categories:
- Overproduction of thyroid hormone (hyperthyroidism)
- Underproduction of thyroid hormone (hypothyroidism)
- Benign (noncancerous) thyroid diseases with normal thyroid hormone production e.g. goitre a diffusely enlarged thyroid gland and multinodular goitre (MNG)
- Thyroid cancer
The diagnosis of a thyroid abnormality in function or a thyroid mass is made by taking a medical history, a physical examination and performing one or more tests if indicated. Tests may include:
- An ultrasound examination of your neck and thyroid
- Blood tests of thyroid function
- A radioactive thyroid scan
- A fine needle aspiration biopsy (A needle is passed into the lump and samples of tissues are taken for analysis)
- A chest X-ray
- A CT or MRI scan
Indications for Thyroid surgery
Most thyroid lumps are benign and most thyroid diseases are treated medically.
- Suspected or proven Thyroid cancer
- When enlargement causes unacceptable cosmetic appearance
- When enlargement causes breathing or swallowing difficulties
- When other forms of medical treatment are inadequate.
Thyroidectomy is a surgical procedure in which all or part of the thyroid gland is removed. It is performed under general anaesthesia. There are various types of thyroidectomy such as:
- Hemithyroidectomy — One thyroid lobe is removed.
- Total thyroidectomy — The entire thyroid gland is removed.
The surgeon makes an incision in the front of the lower neck where a tight-fitting necklace would rest. He locates and takes care not to injure the parathyroid glands and the recurrent laryngeal nerves (nerves which lie very near to the thyroid gland and serve the larynx or the voice box), while freeing the thyroid gland from these surrounding structures.
The blood supply to the portion of the thyroid gland that is to be removed is tied off, and then all or part of the gland is removed. The total amount of thyroid gland removed depends upon the thyroid disease being treated. A drain (a soft plastic tube that drains fluid out of the area) may be placed before the incision is closed. The incision is usually closed with sutures (stitches). A dressing may be placed over the incision and the drain, if one is used.
In most cases, surgery of the thyroid is not highly complicated, and usually takes no more than two hours.
Sometimes a frozen section (an immediate microscopic reading) may be used to determine if the rest of the thyroid gland should be removed. Depending on the result of the frozen section, the surgeon may decide to stop and remove no more thyroid tissue, or proceed to remove the entire thyroid gland. Your surgeon will discuss these options with you if this investigation is indicated.
Complications of Thyroid surgery
- Bleeding- The risk of bleeding is slim and in many cases is very mild. However in some cases this may be severe, requiring return to the operating theatre to stop the bleeding. Rarely is a blood transfusion required.
- Infection- As with any surgery when there is a “cut or wound”, there is a potential but slim risk for infection.
- Damage to the recurrent laryngeal nerve(s) — These nerves pass very close to the thyroid gland and supply the vocal cords. Therefore swelling, stretching, or injury to the recurrent laryngeal nerve can lead to vocal cord immobility and can produce a hoarse or husky voice. This complication is uncommon and usually is a temporary.
In rare cases, if both vocal cords are paralysed, the opening of the throat may be obstructed, causing breathing problems. Therefore a tracheotomy may be required. A tracheostomy is an opening surgically created through the neck into the trachea (windpipe). A tube is placed through this opening to provide a safer airway, to breath through.
- Scar- The neck wound is in the skin crease line and usually heals very well with minimal scarring and good cosmetic result. Rarely patients develop a thick scar or keloid. Numbness or altered sensation of the neck skin can be expected.
- Thyroid hormone (Thyroxine) replacement therapy- Patients who have thyroid surgery may be required to take lifelong thyroid medication to replace thyroid hormones after surgery. This will depend on how much functioning thyroid gland remains, and on the type of the thyroid disease.
- Calcium replacement therapy- About 1% of patients develop low blood levels of calcium (hypocalcaemia), after complete removal of both thyroid lobes.
There are four tiny pea sized parathyroid glands , which are located behind the thyroid gland. They regulate the balance of calcium in the body. Sometimes these parathyroid glands are difficult to find or even hidden within the thyroid gland. Therefore some may be damaged or removed inadvertently. Hypocalcaemia is usually temporary, but sometimes may require calcium supplements if sufficiently pronounced. Permanent hypocalcaemia is fortunately rare.
- Further Thyroid surgery- In suspected however unproven cases of thyroid cancer only one of the Thyroid lobes is removed. If the final histological (microscopic examination) diagnosis of the gland removed is proved to be cancerous, the remaining Thyroid gland must be removed.
Expectation and advice following Thyroid surgery
- After surgery, you may have a drain (a tiny piece of plastic tubing), which prevents fluid from building up in the wound. This is removed when drainage is minimal, usually in 24-48 hours after the surgery.
- You may have some discomfort and/or pain with swallowing. This is usually resolved within 24 to 72 hours.
- You will usually be discharged home, two to three days after the surgery.
- Suture is removed approximately 7 days after surgery.
- The level of calcium in the body may be monitored during the first 24 hours after the operation by obtaining a blood sample. You may also require to have your thyroxine level (thyroid hormone) monitored when you attend the outpatient clinic.
- Depending on the final histological (microscopic examination) diagnosis of the gland removed, continuous follow-up and further treatments by your endocrinologist and/or surgeon may be indicated.
- If you have a thyroid cancer, radioactive iodine treatment taken as a capsule, will destroy any remaining cancer cells following the surgery.
- If you take aspirin, please discuss this with your doctor, as you may need to avoid taking aspirin for a few days prior and after the operation. Aspirin can potentially increase the risk of bleeding.
- Two weeks off work/ school is strongly recommended. A sick-note will be provided.
- Tanning is discouraged for 6 months after surgery.
In case of Emergency...
Whilst every effort has been made to ensure that the information
contained on this website is accurate you should always discuss the
risks, limitations and complications of your specific operation with
the relevant surgeon.
Mr Behrad Elmiyeh MRCS DO-HNS