Thyroid Surgery Information

 
 

The Basics

Thyroid surgery is a very common operation.

There are many reasons why one may require it.
These include:

An enlarged thyroid gland

A hyperactive thyroid gland

A growth or tumor of the thyroid gland


           

      A large goiter on the left, windpipe (trachea) pushed to right


A large goiter of right thyroid lobe

Enlarged thyroid glands are often called “goiters”.  Most goiters can often be managed conservatively with medication. However, when “goiters” do not respond to medication, surgery may be required. Sometimes they are removed because of the appearance of a large lump in the neck. Surgery is performed on goiters that get so large they cause symptoms, such as difficulty breathing or swallowing. Goiters may require partial (1/2) or total removal of the thyroid gland. (partial or total thyroidectomy)

   




The trachea (windpipe) is pushed over to the right by a large goiter in this

x-ray. (White arrow points to trachea)


   



Hyperactive thyroid glands or Graves disease (hyperthyroidism) sometimes require surgery. Usually they are managed with medication and/or radioactive iodine. However, in some patients these options are not successful requiring total removal of the thyroid gland.

  Tumors or Lumps of the Thyroid Gland can be either benign or malignant (cancer). Sometimes the diagnosis can not be made with Fine Needle Aspiration. If the mass is “equivocal” meaning the pathologists is unsure or if the Fine Needle aspirate suggests cancer surgery is required. Surgery may also be required for thyroid cysts which keep recurring.

   At surgery the amount of thyroid removed is often dependent on the diagnosis. Most malignant thyroid tumors (thyroid cancers) require removal of the entire thyroid gland. Benign thyroid tumors, cysts and some goiters may only require removal of half of the thyroid gland. 


Where is the surgery performed?

The operation is performed in the Hospital operating room. Most patients are admitted the day of surgery and go home either that evening or the following morning.


What type of anesthesia is used?

The operation is usually performed under general anesthesia (you are asleep). Some surgeons do the operation with the patient awake and with light sedation and local anesthesia. The safety of either approach is equal, however many surgeons prefer to perform the procedure under general anesthesia as it gives the surgeon more options during the operation. Some of these may be related to access to other parts of the neck or upper chest. This may be hard to do under awake/sedation anesthesia. General anesthesia gives the surgeon more control, and that enables the surgeon to achieve the goals of the procedure in a more expedient way.


Where is the neck cut?

The standard incision is in the lower neck about 2 to 3 inches above the collar bone. It is in the middle of the neck, a symmetrical “cut”– equidistant from both sides.  If the patient has a prominent crease in their neck, most surgeons will try to put the incision (cut) there.

The length of the incision depends on the size of the thyroid that needs to be removed. Usually it is no more then the size between the two large muscles that run up and down the neck. Sometimes it may be a bit larger if the patient has a goiter (a very enlarged thyroid gland). Trying to remove a large thyroid through a very small incision can lead to bruising, which may lead to poor healing and scaring. If there is a prior scar from previous thyroid surgery that site will usually be used for the incision.


Are there stitches and when do they come out?


Most stitches dissolve on their own in your body. There is one long stitch called a “pull-out” type which comes out five days to a week after surgery in the office. Surgical tape is placed on the wound and is changed during the first office visit after surgery.




                        Post-operative thyroidectomy scars


Are drains used?

A small plastic drain may be placed at the time
of surgery and is removed before discharge from
the hospital.


The risks of thyroid surgery

The main risks of thyroid surgery are:

Anesthetic risk

Bleeding after surgery

Injury to the nerves that work your vocal cords

Low blood calcium level


What to expect after thyroid surgery

You will usually wake up in the recovery room  You will have some pain in your throat and neck. You may have to go to the bathroom. The nurses in the recovery room will take care of your every need. They will administer fluids and pain medicines, and perform any other functions that are required for your post-operative care. You will be able to talk and will be able to start oral intake when you are fully awake. You will be followed closely by the surgical team. If you have had your entire thyroid removed blood will be drawn to follow your blood calcium level and replace it if it is too low. Patients who have Total Thyroidectomy performed may need to stay overnight. Most patients can be discharged 6 to 8 hours after surgery. Once you are discharged from the recovery room you will be placed into a step-down or out-take unit where you will be able to get out of bed, eat and converse with members of your family. There will be a large bandage around your neck which will be removed before your discharge. If you have a drain present it will be removed before your discharge. You will be sent home with a waterproof dressing that will allow you to shower. The surgical team will give you prescriptions for pain, and sometimes, antibiotics as well as thyroid hormone replacement.

You will usually see your surgeon 4 to 7 days after your surgery for suture removal, dressing change and wound inspection. You will usually see your endocrinologist or primary care physician one week after surgery. Your medications may be adjusted at that time. If indicated, planning for radioactive iodine therapy will be initiated.


Helpful links for more information


Thyroid Cancer                       


National Cancer Institute



AmericanThyroid Association 

   







@ 2007 A Komisar, MD, All rights reserved



 
 

This web site has been constructed for your benefit by

Arnold Komisar, MD, FACS.

1421 Third Avenue

New York, New York 10028

212-861-8888

212-472-3086 (Fax)

axk2@aol.com