What is a thyroidectomy?
Thyroidectomy is the surgical removal of all or a portion of the thyroid gland. It is most commonly performed because of a tumor or nodule within the thyroid gland. Typically, a fine needle aspiration biopsy has been performed to aid in preoperative planning. An ultrasound by the performing surgeon provides a roadmap and is part of a comprehensive pre-operative work up. Even if you have had a prior ultrasound, there’s no replacement for the information learned from an ultrasound in an expert surgeon’s hands.
How is thyroidectomy performed?
Thyroidectomy is performed under general anesthesia as an outpatient procedure in most cases where only half the thyroid is to be removed. In most cases where the entire thyroid is removed, an overnight hospital stay would be expected. In some cases, total thyroidectomy may be performed safely as an outpatient. Every case is different so talk over your options with your surgeon.
Isn’t Staying In The Hospital Better?
While sometimes there are good reasons to keep patients overnight, generally outpatient operations are preferred. First, there is a safety factor – hospital acquired infections usually only occur in patients spending the night or several days. Infection risks are decreased with shorter stays and especially with no overnight stay. Second, patients generally sleep better in their own beds without the distractions and interruptions of a typical hospital stay. No nurse will wake you up take your vitals at 4 am if you’re at home! Good sleep is important for your body to make a quick and uneventful recovery. This is usually better in the familiar environment of home. Finally, there’s a huge cost difference and outpatient surgery doesn’t waste valuable healthcare dollars.
How long will surgery take?
Most hemi-thyroidectomies take 40-50 minutes in my hands. A total thyroidectomy is generally 1-2 hours, depending on the complexity. If more involved surgery, like central compartment neck dissection for cancer is needed, this adds to the operative time. While meticulous surgical technique and experience lead to shorter operative times, I will take as much time as needed to ensure the best outcome for each individual patient.
What are the risks associated with thyroidectomy?
The major concern of this procedure is in preserving the laryngeal nerves and parathyroid glands. The laryngeal nerves control the muscles for the voice box. During thyroidectomy these nerves are monitored with a computer and meticulous dissection is performed to preserve them. Despite all precautions, permanent or temporary injury can occur. Most often, weakness of a nerve is a temporary condition. In some instances, especially cancer, the disease process itself can irreversibly injure these nerves. Rates of injury are reported in the scientific literature anywhere from 5% for experienced, high volume surgeons to over 20% for low volume surgeons who perform thyroidectomy on an occasional basis. In my experience, permanent injury rate is less than 1% in my 20+ year experience.
Parathyroid glands sit just on the backside of the thyroid gland and regulate calcium levels in the body by the production of parathyroid hormone (PTH). During surgery these glands can be removed, damaged or shocked – leading to a drop in PTH levels. A PTH level that is too low will lead to low calcium levels in the blood. Temporary or permanent problems can occur requiring treatment – usually with a combination of vitamin D and oral calcium. Protecting and preserving these important parathyroid glands is one of the challenges of thyroid surgery. Like nerve injury, rates of parathyroid injury are relative to the experience and volume of the surgeon performing the case.
Other risks include those which are common to any operation. Infection, bleeding and the risks of anesthesia would fall in this category. Because the neck, and thyroid in particular, have a very rich blood supply – infection is rarely seen. In the few cases I’ve seen, the patient’s blood sugar is usually out of control from poor diabetes management. So, diabetics need proper control to avoid this unusual complication. Hematoma, or bleeding in the surgical site, is rare but accounts for the third most common complication of thyroidectomy. This presents as a rapid swelling in the operated area and if this is suspected, the surgeon should be notified immediately!
Are there alternatives to surgery?
There are no non-surgical interventions for thyroid cancer which even come close to the success rate of surgery. Radioactive iodine is an additional therapy that may be used, but never as a substitute for patients that can have surgery. In cases of high-grade cancer, radiation therapy may be employed as additional treatment but not as a primary treatment. In cases of low-grade cancer and benign tumors surgical excision is usually the only treatment needed.
After Surgery
Will I Be in Pain?
Post-operative pain is usually mild to moderate and readily controlled with medications. Most patients will have been off their pain medicine for several days by the time we remove the stitches one week later. Because we usually don’t have to cut any major muscle, recovery is quite rapid. Discomfort when swallowing is common but improves quickly after surgery. Rarely does this limit a patient’s ability to eat and drink. Most throat soreness is a result of the breathing tube used during the operation.