Thyroid Surgery (Thyroidectomy)
Thyroidectomy is surgery of the thyroid gland in which some or all of the gland is removed. This surgery should only be performed by a surgeon with specialized training in endocrine surgery of the neck, typically an otolaryngologist. Thyroid surgery is performed through a limited incision low in the central neck, which typically heals quickly with little scarring. In some cases, a small surgical drain may be left in place in the neck wound for one to three days following surgery. This drain is later removed painlessly by the surgeon without the need for anesthesia.
For patients with a relatively low risk of cancer, removal of one side, or lobe, of the thyroid gland is generally adequate to safely treat a thyroid nodule. This procedure is called a hemithyroidectomy or thyroid lobectomy. If the risk of malignancy is high or a nodule is known to be cancerous, a total thyroidectomy is often performed to remove the entire gland.
Thyroid surgery is a delicate procedure because several important structures are present near the thyroid gland that must be protected during the gland’s removal. One such structure is a tiny nerve that controls the movement of the vocal cord, called the recurrent laryngeal nerve. This nerve runs from the brain down to the chest before looping back up into the neck and the larynx (voice box). During its return course up through the neck, this delicate nerve runs directly against the back surface of the thyroid gland. If the nerve is disturbed during the removal of the gland, the result can be temporary (or in some cases even permanent) vocal cord paralysis.
There are two separate nerves, one for each vocal cord, traveling along each side of the neck. Damage to one nerve can cause hoarseness or a weak voice, as well as coughing during swallowing, but this is usually temporary and improves as the nerve heals or the vocal cords adapt to the weakness. However, if both nerves are damaged during surgery, the result can be paralysis of the vocal cords and obstruction of breathing that can be life-threatening without placement of a surgical bypass of the airway, known as a tracheostomy. For this reason, the laryngeal nerve is always monitored with special electrodes during surgery to confirm its location and proper function. If a nerve is not functioning normally after the removal of one side of the thyroid gland, the surgery is aborted until a later date to allow the nerve to recover. This is also why total thyroidectomy is performed only when necessary to remove thyroid cancer.
Parathyroid glands, a group of four tiny glands that rest on the back surface of the thyroid gland (two on each side), are also important structures during thyroid surgery. These glands are critical for controlling the body’s calcium levels, an important electrolyte for nerve and muscle function. During thyroid surgery, the parathyroid glands are identified and preserved whenever possible. Fortunately, only half of one gland is needed to meet the body’s demands for parathyroid hormone production, so the loss or damage of one or even several glands will usually not cause any harm to the patient. During total thyroidectomy, all four parathyroid glands are placed at risk of damage or removal, which increases the risk of prolonged or even permanent hypocalcemia (low blood calcium levels) after surgery. If this occurs, patients may require ongoing calcium and vitamin D replacement as well as close, careful monitoring of their blood calcium levels. This risk further explains why total thyroidectomy is performed only when necessary to remove thyroid cancer.
Despite all these risks, thyroid surgery is generally very safe and successful when performed by a qualified and experienced ENT surgeon. Many patients return home the same day after thyroid surgery without an overnight hospital stay.
After Thyroid Surgery
Patients typically report very little postoperative pain or downtime following thyroidectomy, and healing is usually complete within two weeks. Afterward, your surgeon may want to monitor your calcium levels with blood tests or observe your vocal cord function with an endoscopic exam of the vocal cords, called a laryngoscopy. If a total thyroidectomy is necessary, thyroid hormone replacement pills will be required indefinitely following surgery. Usually, a follow-up visit one to two weeks after surgery is scheduled to inspect the incision and remove any sutures. After that point, thyroid hormone levels are monitored periodically by an endocrinologist or primary care physician to assess the need for thyroid hormone replacement. However, most patients undergoing a thyroid lobectomy will not require any thyroid hormone replacement because the remaining thyroid lobe is usually able to meet the body’s requirements for thyroid hormone production.
The ENT specialists at CornerStone Ear, Nose & Throat have years of experience performing thyroid surgery and helping patients with thyroid nodules. To learn more or to make an appointment, call 704-752-7575.