A thyroidectomy is a surgical procedure to remove all or part of the thyroid – a butterfly-shaped gland located in the front of the neck. The thyroid gland regulates key bodily functions like metabolism, heart rate, and body temperature by releasing a steady supply of thyroid hormones. ENT surgeons perform thyroidectomies to treat various thyroid disorders, and the extent of the surgery depends on the specific condition.
What Conditions Are Treated with Thyroid Surgery?
Thyroidectomy is performed to treat various thyroid disorders. Some common conditions that may necessitate thyroid surgery include:
- Thyroid Nodules - These are lumps or growths that form within the thyroid gland. Thyroid surgery is an option if symptoms are present or if the patient wishes to remove the lump.
- Overactive Thyroid (Hyperthyroidism) - This is a condition where the thyroid gland produces excessive thyroid hormone. Surgery is recommended when other treatments fail, if cancer is a concern, or for those considering pregnancy who want to avoid anti-thyroid medication.
- Thyroid Cancer - This is a type of cancer that develops in the thyroid gland. Thyroid cancer is usually treated with surgical removal of the thyroid.
- Goitres - This is an enlargement of the thyroid gland. Surgery may be recommended if the goitre is large and causes problems with breathing and swallowing, or if cancer is present.
What Are the Types of Thyroid Surgery?
There are several types of thyroid surgery, each tailored to treat specific thyroid conditions. Some of the main types include:
- Total Thyroidectomy - This procedure involves the complete removal of the thyroid gland. It is often performed for patients with conditions like advanced thyroid cancer, large goitres, or hyperthyroidism that do not respond well to other medications.
- Subtotal Thyroidectomy - This surgery removes most of the thyroid gland while leaving a small portion intact. This less common procedure may be considered for certain cases of goitre or hyperthyroidism.
- Thyroid Lobectomy - This refers to the removal of one of the two lobes of the thyroid gland. This procedure is often recommended for patients with smaller, less aggressive thyroid cancers or benign nodules.
- Isthmusectomy - This procedure involves removing only the isthmus, the connecting tissue between the two lobes of the thyroid gland. It is recommended to preserve thyroid function when a small nodule or tumour is found within the isthmus.
What Are the Methods of Thyroid Surgery?
Here are the primary methods of thyroid surgery:
- Open Thyroidectomy - A traditional procedure where the thyroid gland is removed through an incision in the lower mid-neck.
- Transoral Thyroidectomy - A technique that removes the thyroid gland through the mouth, avoiding a visible neck incision.
- Endoscopic Thyroidectomy - A minimally invasive procedure using small neck incisions to insert instruments and a camera for thyroid removal.
- Robotic Thyroid Surgery - A minimally invasive method using a robotic system to remove the thyroid gland through an incision in the armpit, leaving no visible neck scar.
What Happens During a Thyroid Surgery Procedure?
The entire procedure typically takes 1-2 hours or more, depending on the extent of the surgery. Key steps in thyroid surgery include:
- Anaesthesia - General anaesthesia ensures patient comfort and safety during the procedure. It is administered via inhalation or intravenous injection to induce unconsciousness, followed by the insertion of a breathing tube into the trachea to assist with breathing during surgery.
- Incision - The patient will be positioned on their back with their neck extended to provide optimal access to their thyroid gland. The incision location varies by surgery type: in open surgery, a small incision is made in the centre of the neck, usually along a natural skin crease; in transoral surgery, the incision is inside the mouth; while endoscopic and robotic surgeries may use small incisions in the neck, chest, or armpit for surgical instruments.
- Dissection - The surgeon carefully dissects the neck tissue to expose the thyroid gland and its surrounding structures, including the parathyroid glands and recurrent laryngeal nerve, which are protected to reduce the risk of complications. In robotic or endoscopic procedures, tools are inserted through the incisions, often guided by a camera.
- Removal - Depending on the diagnosis, the surgeon may remove the entire thyroid gland or just a portion of it. If the surgery is for thyroid cancer, nearby lymph nodes may also be removed. To minimise the risk of vocal cord damage, surgeons may use specialised equipment such as nerve monitoring devices during the procedure.
- Haemostasis and Closure - Bleeding will be controlled to ensure a clean surgical site and reduce post-surgery complications. Once the surgery is complete, the incision will be closed with sutures or skin glue.
What Happens After Thyroid Surgery?
After the surgery, the patient will be taken to the recovery room where they will be monitored for any signs of bleeding, swelling, or breathing difficulties.
Depending on the extent of the surgery, some patients may be allowed to go home the same day while others may stay overnight for monitoring. Voice tests may be conducted before they get discharged to assess any potential nerve damage.
Surgeons will also provide important post-surgical instructions to support recovery, which may include:
- Incision Care - Keep the incision clean and dry, especially for the first few days.
- Diet - Start with a soft diet to eat more comfortably in the days following the surgery.
- Activity Limitation - Refrain from heavy lifting, bending, or high-impact exercises for at least 10 to 14 days.
- Medication - Take prescribed pain medications and supplements to reduce discomfort and maintain healthy calcium levels.
- Regular Check-ups - Attend regular check-ups to monitor recovery and adjust medication as needed.
What Are the Potential Complications of Thyroid Surgery?
As with any surgery, thyroid surgery carries the potential risks of infection, bleeding, and other complications related to the anatomical structure of the thyroid gland, such as:
- Voice Changes - The recurrent laryngeal nerve, which controls the vocal cords, runs close to the thyroid gland. Damage to this nerve during surgery can lead to voice changes or hoarseness.
- Low Calcium Levels - The parathyroid glands, located near the thyroid, regulate calcium levels. Accidental damage during surgery can lead to temporary or permanent hypoparathyroidism, causing low blood calcium levels.
- Bad Scarring - Some patients are prone to developing hypertrophic or keloid scars which can be prominent, raised, and sometimes, itchy or painful.
However, in the hands of an experienced surgeon and a well-equipped medical facility, the risks are minimised and there will be post-op follow-ups to ensure a smooth recovery.
If you are facing a thyroid condition that may require surgery, consult our ENT surgeon to explore your treatment options. We are committed to providing essential medical services, including thyroid surgery. Contact us today to book a consultation and let us discuss your needs.
