WHAT IS A THYROID GLAND?
The thyroid gland is an endocrine gland in your neck. It makes two hormones that are secreted into the blood: thyroxine (T4) and triiodothyronine (T3). These hormones are necessary for all the cells in your body to work normally.
Thyroid disorders are very common and tend mainly to occur in women, although anybody - men, teenagers, children and babies, too - can be affected. About one in 20 people has some kind of thyroid disorder, which may be temporary or permanent.
The thyroid gland lies in the front of your neck in a position just below your Adam’s apple. It is made up of two lobes - the right lobe and the left lobe, each about the size of a plum cut in half - and these two lobes are joined by a small bridge of thyroid tissue called the isthmus. The two lobes lie on either side of your wind-pipe.
Surgery is the recommended treatment for several disorders of the thyroid gland.
The operation is performed under a general anaesthetic.
The main types of thyroid surgery are:
- total thyroidectomy (removing all of the thyroid gland)
- lobectomy or hemithyroidectomy (removing half of the thyroid gland)
- near-total thyroidectomy (removing most of the thyroid gland but leaving a little tissue on one side)
- occasionally, isthmusectomy (removal of the central part of the thyroid gland) is performed
The incision is usually made through a lower crease in your neck. Many structures pass through the neck and during the operation the surgeon will take care to identify the various arteries, veins and nerves. Special attention is paid to the nerves that supply your voice box, as well as the blood supply to the parathyroid glands which control your calcium metabolism.
The thyroid gland has a very rich blood supply, and to avoid bleeding, the arteries are carefully tied off before removing the gland. After the part of the thyroid that needs to be removed has been taken out, the wound is closed together with the skin. This can be done with stitches (sutures), clips, strips of sticky tape (steristrips) or glue. If stitches are used, these are removed after a few days. Sometimes soluble stitches are used. Small drainage tubes are sometimes placed in the neck to drain away any extra fluid for the first 24-48 hours.
After the operation
After surgery you may feel a little uncomfortable, but this soon passes. If there are no complications you will be ready to go home after a day or so. If there is significant bleeding within the wound you will need to be taken back to theatre, but this is extremely rare and usually within the first 12 hours.
Most patients will be eating, drinking, and walking around the night of their surgery. Typically, there is not a lot of pain involved with thyroid and parathyroid surgery. Rarely narcotic pain medication will be required, but it will be available to you if needed. Most patients only need acetaminophen (Tylenol) for discomfort. You will stay overnight for observation and be discharged to home usually by 11:00 AM the morning after surgery.
The incision is closed with dissolvable sutures internally and you will not be able to see them. On the outside, the incision will also be closed with either surgical glue or surgical paper tape called steri-strips. A light bandage consisting of a gauze pad and a clear plastic covering will be placed over your incision after surgery. This bandage may be removed 48 hours after you leave the hospital. If you have steri-strips on your incision, leave them in place until they begin to fall off naturally. If they have not fallen off in 7-10 days, you may gently remove them. If glue was used, it will appear as a white crusty white or yellow material covering the incision. You may notice tiny pieces of yellow material on your washcloth when you gently clean your incision.
The incision will be slightly raised and there may be swelling and light bruising at the incision site. This is normal for several weeks after surgery and will resolve over time. You may also feel a sensation of swelling or firmness that will also resolve over time.
It is normal to experience numbness under your chin after surgery, especially around the incision. This will get better over time. However, if you feel numbness and tingling around your mouth or in your fingertips or toes call our office.
You may feel a firm ridge directly over the incision. This is normal and will soften and go away when healing is complete usually in 3-6 months. All incisions are sensitive to sunlight. The ultraviolet light of the sun and tanning booths will darken the scar area in the first year. Always use sunscreen.
You may shower the day after surgery. Try not to get the bandage totally soaked. Once the bandage is off, it is still OK to shower. Still try not to totally saturate the incision. You should not go swimming or soak in a tub or hot tub for at least a week.
You may eat whatever you choose. You may prefer softer foods and liquids initially if you have a sore throat. Advance you diet as you see fit. Some patients experience minor changes in swallowing that improve over time. You may feel there is a lump in your throat when you swallow. This sensation will decrease with time.
This is normal to experience after surgery and will often last up to 5 days after surgery. Lozenges and a softer diet may be helpful until this resolves. You may also feel like you have phlegm in your throat and need to cough. This is due to the irritation of the tube in your windpipe during surgery. It should clear up in 4-5 days.
Your voice may be hoarse or weak at first because the surgery took place near the voice box but usually recovers within weeks. Some patients also notice a change in the pitch of their voices that affects singing. Rarely these changes are permanent.
You may experience stiffness/soreness in your neck, shoulder, or back and may experience tension headaches. These may take a few days or weeks to go away completely. You should not drive until you can comfortably turn your head from side to side. It is a good idea to gently perform neck exercises to help keep it from getting stiff looking side to side, up and down or moving your head in a small circle. You may apply a warm compress or heating pad to your shoulder and back to alleviate stiffness.
What are the risks
In the hands of an experienced thyroid surgeon, thyroid surgery is a safe procedure with few complications. The main risks of thyroid surgery include:
Hoarseness/Voice Change (recurrent laryngeal nerve injury)
There are two sets of nerves near the thyroid gland that help control the vocal cords. These are the recurrent laryngeal nerve and the external branch of the superior laryngeal nerve. Damage to a recurrent laryngeal nerve can cause you to lose your voice or become hoarse. Temporary hoarseness, voice tiring, and weakness can occur when one or more of the nerves are irritated during the operation or because of inflammation that occurs after the surgery. This usually gets better within a few weeks, but can take up to 6 months to resolve. Even in the rare chance of having a permanently hoarse voice, there are things that can be done to improve voice quality. An otolaryngologist or Ear, Nose, & Throat specialist can be very helpful in determining the specific problem and can perform different procedures to help improve voice quality.
Hypocalcemia (low blood calcium levels) may occur after thyroid and parathyroid surgery because the parathyroid glands may not function normally right after surgery and temporary hypocalcemia/hypoparathyroidism is common. The parathyroid glands are four small, delicate glands that measure about the size of a grain of rice. They are located near, or attached to, the thyroid gland and control the blood calcium levels. Each thyroid lobe has two parathyroid glands. After thyroid surgery and before you are discharged home your blood calcium will be checked. You will also be sent home with instructions to take supplemental calcium for the first week or two weeks after thyroid surgery. Hypocalcemia can cause symptoms such as numbness and tingling (especially around the lips and in the hands and feet) as well as muscle cramps. At your first post-operative visit, your blood calcium level will be checked and you may be weaned off the supplemental calcium prescribed after your surgery. Only one half functioning parathyroid gland is needed for calcium control. If all four parathyroid glands were injured or removed during surgery, the blood calcium levels can become lower than normal.
Seromas are fluid collections underneath the skin at an incision site that feel like fullness or swelling. When minor, they get usually disappear within a few weeks. If the seroma is large, it may need to drained by a surgeon.
If a post-operative infection develops, drainage of the infected fluid may be needed and antibiotics may be necessary. The neck is a clean area and generally does not get infected.