Thyroid surgery for the removal of the thyroid gland

The most common indications for thyroid surgery are diffuse enlargement of the gland (goiter), localized enlargement of part of the gland (nodule) and thyroid tumors. There are also other much less frequent indications.

As for other operations, every patient undergoing thyroidectomy should be evaluated preoperatively with a complete medical history and physical examination. Any patient who has had a change in voice, or who has had previous neck surgery should have a pre-operative evaluation of the vocal cords called a laryngoscopy.

What are the risks of thyroid surgery?

The most important risks of thyroid surgery include: bleeding, recurrent laryngeal nerve damage that can cause permanent hoarseness, and damage to the parathyroid glands that control calcium levels in the body, causing hypoparathyroidism. In general, the risk of any complications should be less than 2%. However, the risk of complications discussed with the patient should be that of the individual surgeon, not the risk quoted in the literature.

How do you proceed with thyroid surgery?

Patients should discuss with the ENT specialist which type of thyroid operation is to be performed, hemithyroidectomy or total thyroidectomy, and the reason why it is recommended. Total thyroidectomy is the method of choice for the treatment of patients with multiple benign nodules and/or large goiters. For patients with unilateral nodules, hemithyroidectomy is the treatment of choice, provided that the patient is informed that if the anatomopathological result of the surgical specimen is that of a tumor, the other thyroid lobe must be removed. In some medical centers, a biopsy is performed during the operation so that if the diagnosis is that of tumor, the surgical treatment is completed with a total thyroidectomy. The indication for intraoperative biopsy depends on the pathology department of the center where the surgery is performed, and nowadays its use is not recommended due to the high number of false negatives. For patients with hyperthyroidism due to Graves’ disease, total thyroidectomy should be performed. In any case, subtotal thyroidectomy should not be performed in Graves’ disease or in multinodular goiters.

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The surgery usually takes two to three hours. A surgical drain may be left in place depending on the surgeon’s custom and how aggressive the surgery was. Most patients undergoing thyroid surgery remain hospitalized for two to three days. Activities requiring significant physical exertion should be avoided for ten days.

What is the recovery process for thyroid surgery?

In the case of a total thyroidectomy, the patient must take the hormone produced by this gland (thyroxine) for the rest of his or her life, although, in general, thyroid hormone levels normalize in a few months. Thyroid hormone can also be used as suppressive therapy to prevent the growth of thyroid tissue that may have remained after incomplete surgery and in some cases of thyroid tumor.

Thyroid hormone is easy to take. Since it remains in the body for a long period of time, it can be administered only once a day. The best time to take thyroid hormone is first thing in the morning on an empty stomach. It is very important that thyroid hormone and TSH (thyroid stimulating hormone) levels are checked periodically so that the dose can be adjusted if necessary.

With some frequency the patient may present a state of hypocalcemia secondary to the manipulation of the parathyroid glands or to their involuntary or non-involuntary removal during thyroidectomy. In the first situation, the hypocalcemia will be transient and the patient will have to take calcium associated with vitamin D for some time until blood calcium levels normalize. In the second situation, the hypocalcemia will be irreversible and the patient will have to take calcium, vitamin D and parathyroid hormone permanently.