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Ear, Nose, and Throat

Thyroid Surgery

Thyroid operations are used for patients who have a variety of thyroid conditions, including both cancerous and benign (non-cancerous) thyroid nodules, large thyroid glands (goiters), and overactive thyroid glands. There are several thyroid operations that a surgeon may perform, including: 1) biopsy or lumpectomy – removing a small part of the thyroid gland; 2) lobectomy – removing half of the thyroid gland; 3) removing nearly all of the thyroid gland (subtotal thyroidectomy – leaving a small amount of thyroid tissue bilaterally or near-total thyroidectomy – leaving about one gram of thyroid tissue on one side); or 4) total thyroidectomy, which removes all identifiable thyroid tissue. There are specific indications for each of these operations.

As with any surgical procedure, there are risks and these should be discussed with the patient by the thyroid surgeon. The two issues which must be discussed relate to 1) the nerve to the vocal cords (recurrent laryngeal nerve & external laryngeal nerve) and 2) the parathyroid glands.

In most thyroid surgery, one or both of the thyroid lobes will be removed. The surgeon must utilize proper technique to avoid injury to the nerves to the vocal cords. One of the risks of thyroid surgery is temporary or even permanent weakness of the vocal cords which results in hoarseness. Fortunately, in skilled hands, this complication is rare (less than 1%).

The parathyroid glands, 4 in number, lie behind the thyroid gland. They share some common blood supply with the thyroid and are quite small (about 1 cm each). They are very active little glands, producing a hormone called Parathyroid Hormone (PTH) which together with Vitamin D regulates and maintains blood calcium at a normal level.

Depending on how much of the thyroid gland is removed, the operation will take between 1.5 and 3 hours including anesthesia time. The procedure is performed under general anesthesia. The incision is located in the lower neck and its size will vary based on the size of the thyroid to be removed and the patient’s anatomy; overweight patients and those with very large necks may need larger incisions. The surgery is kept as minimally invasive as possible and the scar is rarely anything to be concerned about, even in young people. There is very little bleeding during the procedure and the patient rarely complains of intense postoperative pain – although this varies from patient to patient. A small drain is often used for 24 hours and patients may either go home the same day or be observed overnight. If the entire thyroid gland is removed, blood calcium levels are checked postoperatively to make sure they are stable before the patient is discharged home. Again, depending on how much of the thyroid gland is removed, patients may need to take thyroid hormone replacement after surgery.

Once the patient is discharged home, light activity is recommended. Avoid heavy lifting and strenuous exercise for one week. Avoid ibuprofen, aspirin, or other medications that can increase the risk of bleeding. Bathing and showering is permitted on the first day after surgery, although it is recommended to keep the incision dry for about 48 hours. It is normal to have a sore throat and some pain around the incision after thyroidectomy. Staying on a soft diet for a few days after surgery will help. Postoperative appointments are usually made for one week after the operation.

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