Thyroidectomy

Definition

Thyroidectomy is the surgical removal of all or part of the thyroid gland. This gland is in the neck. It produces hormones that regulate metabolism. The surgery may be a:

  • Total or near-total thyroidectomy—all of the thyroid is removed
  • Thyroid lobectomy or partial thyroidectomy—removal of only a part of the right or left lobe and/or center of the thyroid
The Thyroid Gland
The Thyroid
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Reasons for Procedure

All or part of the thyroid gland may be surgically removed for any of the following reasons:

  • Overactive thyroid, known as hyperthyroidism , due to Graves disease or an over-functioning nodule
  • Enlarged thyroid, known as a goiter, causing significant symptoms because of its size
  • Thyroid nodule(s) that are suspicious or cause concern for thyroid cancer
  • Thyroid cancer

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Damage to the parathyroid gland, which controls calcium metabolism, which could lead to nerve and heart problems
  • Scarring
  • Bleeding
  • Infection
  • Low blood calcium—usually temporary
  • Voice changes due to damage to nerves leading to the voice box—rare
  • Thyrotoxic crisis, which is a sudden excessive release of thyroid hormone at toxic levels—very rare

Some factors that may increase the risk of complications include:

Some factors that may increase the risk of complications include:

  • Severe hyperthyroidism
  • Large goiter
  • Obesity
  • Smoking
  • Alcoholism
  • Poor nutrition
  • Long-term illness such as diabetes

What to Expect

Prior to Procedure

Your doctor may do the following:

  • Physical exam
  • Laboratory and/or imaging tests to assess thyroid function and anatomy, such as:
    • Ultrasound
    • MRI scan
    • Thyroid hormone testing
    • Anti-thyroid medicine to suppress thyroid activity in patients with hyperthyroidism
    • Thyroid scan

Leading up to your procedure:

  • Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.
  • Do not eat or drink anything after midnight the night before the procedure.
  • Arrange for transportation to and from the hospital.

Anesthesia

General anesthesia will be used. You will be asleep.

Description of Procedure

An incision will be made in the front of the neck. Bleeding vessels will be clamped and tied off. All or part of the thyroid gland will be cut away from other tissues in the neck. Care will be taken to avoid injury to other nearby glands and nerves. Bleeding is controlled with special tools that compress and seal the ends of the vessels. The incision will be closed. The edges of skin will be stitched together. A drain will often be left in overnight. It will help drain any extra fluids.

The thyroid may be removed to treat thyroid cancer. In this case, lymph nodes in the area may also be removed. This will test if the cancer has spread.

In some cases, the doctor may be able to remove the thyroid using endoscopic surgery. This involves making small incisions, instead of a large incision in the neck. This is becoming more common.

How Long Will It Take?

About 2-4 hours

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay

The usual length of stay is one day. Your doctor may choose to keep you longer if complications arise.

Post-procedure Care

At the Hospital

  • There will be discomfort in your neck for several days. The pain can be treated with medication.
  • In some cases, you may have a hoarse voice for a few days.
  • Depending on how much of the thyroid is removed, you may need to take replacement thyroid hormone.
  • In some cases of thyroid cancer, you may need radioactive iodine treatments. This is called remnant ablation.

At Home

When you return home, do the following to help ensure a smooth recovery:

  • Keep the incision clean and dry.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • Do not get the incision wet until your doctor allows. If it does get wet, dry it right away.
  • Do not apply make-up, lotion, or cream to the incision area.
  • Perform neck exercises as instructed by your doctor.
  • Take all medications as prescribed by your doctor.
  • Be sure to follow your doctor's instructions.

Call Your Doctor

It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:

  • Numbness or tingling around the lips or extremities
  • Twitching or muscle spasms
  • Excessive and progressive fatigue
  • Difficulty swallowing, talking, or breathing
  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Persistent nausea and/or vomiting that you cannot control with the medications you were given
  • Cough, shortness of breath, or chest pain
  • Pain that you cannot control with the medications you were given

In case of an emergency, call for medical help right away.

Revisions

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