THYROID SURGERY

Indications:

1. Malignancy/Suspicion of cancer in a thyroid nodule

2. Obstructive symptoms from a large goitre(eg pressure on airway, on nerve to vocal cord- causing hoarse voice)

3. Hyperactive thyroid - not controlled by medications

Procedure

Partial thyroidectomy - removal of half the thyroid gland

Total thyroidectomy - removal of all the thyroid gland

Operation time = 45min to 2 hours depending on the size of the thyroid and complexity of case.

General anaethesia. Transverse neck incision. Blood vessels to the gland will be clipped with metal(titanium) clips and also ligated. A search is carried out for the nerve to the vocal cords and this is traced upwards to behind the thyroid gland(in order to avoid damaging it).

Skin and neck tissues - closed in layers(in midline for strap muscles, then for platysma and then for skin). Dissolvable sutures. Tapes and plastic waterproof dressing to skin

Drain - usually for 1 day.

Post-op Management

If total thyroidectomy, the calcium level would need to be checked. Also need thryoid hormone replacement(with thyroxine) - this is usually started postop although it can wait for a few weeks.

Risks

As with any surgical procedures, there are risks of complications such as:

1. Bleeding - Risk of neck haematoma causing swelling in the throat tissues and blokcage of the airway. This is a rare but serious complication.

2. Wound - scar, swelling/collection(seroma), pain/discomfort swallowing, infection

3. Damage to parathyroid glands(these are the glands that control the calcium level in the blood. There are usually 4 such glands located directly behind the thyroid gland) - may lead to low calcium postop. May need treatement with calcium and vitamin D

4. Damage to the laryngeal nerves(nerve to the vocal cords) : this may be minor and affect one's ability to sing a high pitch(esp for opera singers or those who love to sing in the shower). Or it may cause one's voice to be weak and hoarse.

5. Other complications of surgery or anaesthesia - eg heart attack, blood clot in legs/lung

Summary

Thyroid surgery is a common surgery for the indications listed above. Most patients are happy after their surgery. Occassionally, partial thyroidectomy may lead to the discovery of a thyroid cancer and this may then require another operation to completely remove the rest of the thyroid gland.

It is important to discuss this with your general practitioner and your surgeon.