Thyroid Problems and Operative Treatment

The thyroid gland produces hormones and is one of the endocrine glands, placed in the anterior neck just below the voice box and is the source of the hormone thyroxine. The thyroid hormones are secreted into the blood and are important in controlling the metabolism and contribute to the normal function of all the body’s cells. The thyroid gland can produce and store more thyroid hormone than the body needs at any period and so a patient may not need to take thyroid replacement hormone if only a proportion of the thyroid gland is removed.

If the entire thyroid gland is removed then thyroxine replacement tablets will be necessary for the rest of the person’s life. There are four tiny glands attached to the thyroid gland the size of grains of rice and called the parathyroid glands. These produce parathyroid hormone and this hormone regulates the concentration of calcium in the blood. Normal calcium levels are essential for healthy bones and general well-being. The surgeon tries to leave the parathyroid glands in place when the thyroid is operated on but their function can be affected by the operation.

When the surgeons take out the thyroid gland the operation is called thyroidectomy and this can be total, involving the whole gland, or a sub-total or partial removal. Hemithyroidectomy involves removing half the gland and lobectomy a removal of one of the thyroid lobes. Hyperthyroidism, overactivity of the thyroid gland secretions, is the most common reason for this operation although if the thyroid gland enlarges, a condition known as goitre, this may need operation. Goitre can appear unsightly or interfere with breathing or swallowing.

Thyroidectomy will be carried out under a general anaesthetic which means the patient is unconscious during the whole operation. An incision will be made in the neck, often made in the natural skin crease just above the top of the breastbone and always made symmetrically. This helps the incision to heal, leaving a scar which is usually inconspicuous and may become virtually invisible in time. The surgeon may leave a small drain tube in the neck to collect wound fluid and help speed up the healing process, removing it on the first or second day after operation. The stay in hospital will usually be two to four days.

Patients should refrain from eating for six hours before the operation and take clear fluids only up to two hours before the event. A venflon will be placed in the arm and through this the anaesthetic is given to last for the hour or two the operation will take. Some surgeons put stitches under the skin so removal is not necessary, others may use clips or stitches in the skin which are taken out after a few days. Two to four days is the typical hospital stay but this is dependent on how well people are, and on discharge they should be collected by a relative. The level of pain after thyroidectomy varies and typically patients have some around the neck.

It is uncommon to get a wound infection and patients should monitor the wound to check it does not become sore and red, in which case antibiotics will be used. Rarely the wound needs to be re-explored to release pus. There is a one in fifty chance of bleeding occurring into the wound and the haematoma has to be explored and removed in rare cases. It is common to have wound swelling and bruising which is caused by the bleeding under the wound and later by scarring.

Patients will have a vocal chord check before surgery and the surgeon will discuss the specific problems of operating so close to the voice box and its associated nerves. Bruising of the nerves during surgery may stop them working properly and as these nerves control the movements of the vocal chords if they are damaged this can cause hoarseness and weakness in the voice. The voice should recover over a period of a few weeks or months but occasionally a nerve will be permanently damaged but this is rare. Injury to both nerves is very uncommon and very serious as the voice is lost and a tracheotomy tube is placed in the windpipe to allow breathing to occur.

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