Thyroidectomy

Thyroidectomy is a surgical procedure to remove all or part of the thyroid gland, a butterfly-shaped organ in your neck that controls your metabolism. This operation may be necessary for conditions like thyroid cancer, large goiters that make breathing or swallowing difficult, or an overactive thyroid that doesn’t respond to other treatments.

Table of contents

• What Is Thyroidectomy?
• The Thyroid Gland and Its Function
• Why Would You Need a Thyroidectomy?
• Types of Thyroidectomy
• Preparing for Your Surgery
• What Happens During the Procedure
• Recovery After Thyroidectomy
• Possible Complications
• Living After Thyroidectomy

What Is Thyroidectomy?

Thyroidectomy is the surgical removal of all or part of your thyroid gland^[1]. The thyroid gland is a butterfly-shaped organ located at the front of your neck, sitting at the base of the neck^[1]. This gland makes hormones that control every part of your metabolism, which includes your heart rate and how quickly you burn calories^[1].

Healthcare providers perform thyroidectomy to treat various thyroid disorders, including cancer, noncancerous enlargement of the thyroid, and overactive thyroid conditions^[1]. The surgery can be performed using various techniques, including open or minimally invasive approaches^[2].

The Thyroid Gland and Its Function

The thyroid gland is shaped like a butterfly and consists of two lobes connected by a small bridge called the isthmus^[7]. It wraps around your windpipe and is located below your Adam’s apple^[6]. The thyroid uses iodine from your diet to make the hormone thyroxine, which controls your body’s metabolism including heart rate, temperature, and growth^[6].

The thyroid gland receives a lot of blood from two main sources: the superior and inferior thyroid arteries^[7]. Near the thyroid are important structures including the parathyroid glands, which control calcium levels in the body, and the recurrent laryngeal nerves, which control the vocal cords^[7].

Why Would You Need a Thyroidectomy?

Your doctor may recommend thyroidectomy if you have several specific conditions^[1]:

• Thyroid cancer: This is the most common reason for thyroidectomy. If you have thyroid cancer, removing most or all of your thyroid will likely be a treatment option^[1].
• Noncancerous enlargement of the thyroid (goiter): A large goiter may be uncomfortable or make it hard to breathe or swallow. Removing all or part of your thyroid gland may be necessary, especially if the goiter is causing your thyroid to be overactive^[1].
• Overactive thyroid (hyperthyroidism): In hyperthyroidism, your thyroid gland produces too much of the hormone thyroxine. Thyroidectomy may be an option if you have problems with anti-thyroid drugs or if you don’t want radioactive iodine therapy^[1].
• Suspicious thyroid nodules: Some thyroid nodules might be evaluated through surgery to determine if they are cancerous^[1].

Thyroidectomy is also indicated for various conditions, including benign disorders such as multinodular goiter, toxic adenomas, and thyroiditis, as well as malignant conditions including differentiated thyroid carcinoma and anaplastic thyroid carcinoma^[2].

Types of Thyroidectomy

There are two main types of thyroidectomy procedures^[2][9]:

Total thyroidectomy refers to the complete removal of the thyroid gland^[2]. This is the most common procedure for thyroid cancer^[4].

Partial thyroidectomy includes procedures where only part of the thyroid is removed^[2]. This can also be called a hemithyroidectomy or lobectomy, which is the removal of the right or left lobe of your thyroid^[9].

How much of your thyroid gland is removed during thyroidectomy depends on the reason for the surgery. If you need only part of your thyroid removed, your thyroid may work normally after surgery. If you need your entire thyroid removed, you will need daily treatment with thyroid hormone to replace your thyroid’s natural function^[1].

The decision regarding whether to perform a thyroid lobectomy or total thyroidectomy depends on various factors, including the size, location, and characteristics of the thyroid tissue^[2].

Preparing for Your Surgery

Before undergoing thyroidectomy, patients must have their thyroid function evaluated to assess for hyperthyroidism or hypothyroidism, which could influence how the surgery is managed^[2].

A thyroid ultrasound typically serves as the initial imaging test to evaluate the thyroid gland, allowing doctors to identify structural abnormalities^[2]. If suspicious nodules or growths are detected, targeted fine-needle aspiration biopsies may be performed to determine the characteristics of these areas and whether they might be cancerous^[2].

Your doctor will usually arrange scans and blood tests to measure the level of thyroid hormone^[6]. If you have a growth on your thyroid, your doctor may take a biopsy using a fine needle to help diagnose your condition^[6].

Your doctor will tell you what you need to do to prepare for surgery. You will be asked to fast (not to eat) before your surgery^[6]. You may also need to stop taking certain types of medicine. In the week leading up to your thyroidectomy, it’s best to avoid alcohol and tobacco use^[16].

What Happens During the Procedure

Thyroidectomies are usually done under general anesthetic, which means you will be asleep during the surgery^[6]. An anesthesiologist will give you general anesthesia to relax your muscles, prevent pain, and make you fall asleep^[9].

Your surgeon will make a cut in the front of your neck, typically 2 to 3 centimeters above your collar bone^[6]. The surgery is done through a 1 to 2 inch incision that is placed in one of the skin creases of the neck, just above the collarbones^[5]. The size of the incision is kept as small as possible for the best cosmetic result, and the incision for a thyroid lobectomy and total thyroidectomy are the same size^[5].

During the surgery, your surgeon will divide your muscles so they can reach your thyroid gland. The crucial parts of the surgery include exposing the thyroid gland, identifying and protecting the parathyroid glands, and identifying and protecting the nerve to the vocal cord^[5]. They will be very careful not to damage the nerves to your voice box or your parathyroid glands^[6].

During surgery, you may also have some lymph nodes (glands) in your neck removed if your cancer has or might have spread to them^[15]. After your surgeon removes your thyroid gland, your wound is stitched to close it up^[6].

You may leave the hospital with stitches in the cut (incision) the doctor made. You may still have a tube called a drain in your neck, which your doctor will take out a few days after your surgery^[18].

Recovery After Thyroidectomy

After surgery, the back of your neck may be more uncomfortable than the front due to where your head is positioned during surgery^[17]. You will probably be able to go home the same day or the next day^[6][13].

After the wound has healed, the scar may feel firm. It will soften and begin to fade within a few months^[17]. After a few weeks, any stiffness in your neck and shoulder should be much better^[17]. You should be able to go back to all the things you were doing before your thyroid operation within a few weeks^[17].

Managing Pain and Discomfort

You may have some pain and soreness in your neck at first, especially when you swallow. Your voice may be a little hoarse for the first week^[13]. For most people, these problems get better within 3 to 4 months, but it can take as long as a year^[18].

Your surgeon may have prescribed a narcotic pain medicine, or you may take over-the-counter pain medicine such as ibuprofen or acetaminophen^[13]. You may put a cold compress on your surgical cut for 15 minutes at a time to ease pain and swelling^[13].

Eating and Drinking

After your operation, your neck is likely to be swollen and may feel hard and numb. While your neck is sore, you may find that you need to eat foods that are soft and easy to swallow^[17]. If it is painful to swallow, start out with cold drinks, flavored ice pops, and ice cream. Next, try soft foods like pudding, yogurt, canned or cooked fruit, scrambled eggs, and mashed potatoes^[18].

Make sure that you eat slowly and have plenty to drink during and after meals. Liquids can help to soften your food and make it easier to swallow^[17]. Long, slow cooking softens meat and vegetables, and you can finely chop meat and vegetables in a food processor before or after cooking^[17].

Wound Care

Look out for swelling and signs of infection, such as the wound oozing or feeling red and hot^[17]. To help prevent any infection once you are at home, it is important to leave your dressings in place until you’re told to remove them, keep your neck wound clean and dry until it’s completely healed, and avoid knocking or putting pressure on your wound^[6].

If the incision was covered with skin glue or surgical tape strips, you may shower with soap the day after surgery and pat the area dry^[13]. Cover your incision with clothing or very strong sunscreen when you are in the sun for the first year after surgery to help make your scar less visible^[13].

Activity Recommendations

Rest when you feel tired. Getting enough sleep will help you recover. When you lie down, put two or three pillows under your head to keep it raised^[18]. Try to walk each day, starting by walking a little more than you did the day before^[18].

Avoid strenuous physical activity and lifting heavy objects for 3 weeks after surgery or until your doctor says it is okay^[18]. Do not over-extend your neck backwards for 2 weeks after surgery^[18]. Do not drive if you are taking narcotic pain medicines^[13].

Possible Complications

While thyroidectomy generally has favorable outcomes, complications can occur^[2]. Vocal cord injury and calcium problems are among the most common complications^[16]. The most important potential complications include:

Hypoparathyroidism: This occurs when the parathyroid glands (which sit behind your thyroid and manage your body’s calcium levels) are accidentally damaged during surgery^[6][2]. This could lead to low calcium levels and symptoms related to that. Your doctor may prescribe calcium to prevent problems after surgery from low calcium^[13]. Not having enough calcium can cause symptoms such as tingling around your mouth or in your hands and feet^[18].

Nerve injury: Damage to the recurrent laryngeal nerve (a nerve that controls the vocal cords) can cause voice changes^[2]. Your voice probably will be hoarse, and you may have trouble talking after surgery^[18]. In some cases, this surgery causes permanent problems with chewing, speaking, or swallowing^[18].

Postoperative bleeding: Severe bleeding might need another surgery to control^[7].

Tell your doctor straight away if your neck starts to become red, swollen or more painful, or you have a high temperature (fever), or you have oozing from the wound. You may have an infection and need a course of antibiotics^[17].

The importance of meticulous surgical technique and thorough preoperative assessment cannot be overstated to minimize these complications^[2].

Living After Thyroidectomy

Thyroid Hormone Replacement

If you’ve had surgery to remove your thyroid, you usually need to take hormone tablets to replace the hormones your thyroid made^[15]. The thyroid hormones are thyroxine (T4) and liothyronine (T3)^[17]. You need one of these hormones to keep your body metabolism working properly.

If you need your entire thyroid removed (total thyroidectomy), you need daily treatment with thyroid hormone to replace your thyroid’s natural function^[1]. It can also help stop the cancer coming back^[15]. You may also need to take hormone tablets if you’ve had part of your thyroid removed^[15].

You will need to take this every day for the rest of your life^[7]. Once the surgery is done, it is crucial to recheck the function of any remaining thyroid tissue^[7]. You will have regular check-ups during and after any treatments, which may also include tests and scans^[1].

See your healthcare provider for regular blood tests and to go over your symptoms. Your provider may change the dosage of your hormone medicine based on your blood tests and symptoms^[13].

Long-Term Diet Considerations

You can eat whatever you like after surgery^[13]. While some people promote various types of “thyroid diets,” there is little scientific evidence to support the benefits of following a specific thyroid diet. Instead, follow a balanced whole-food diet low in simple carbohydrates and refined sugars^[22].

It is important to eat a nutritious diet to help with healing^[17]. Build your diet around dark leafy greens, fresh seafood, lean meats, low-fat dairy or dairy alternatives, and low-sugar fruit^[22].

Soy products and certain other foods may interfere with some thyroid hormone replacement medications. Talk to your doctor or pharmacist about potential interactions. If you consume soy products, don’t eat them close to the same time as you take your medication^[22]. Avoid taking your thyroid medication at the same time as walnuts, cottonseed meal, soybean flour, iron supplements, or calcium supplements^[22].

Follow-Up Care

You will probably see your surgeon in about 2 weeks after surgery. If you have stitches or a drain, your surgeon will remove them^[13]. You may need long-term care from an endocrinologist, which is a doctor who treats problems with glands and hormones^[13].

If you had thyroid cancer, you may need to have radioactive iodine treatment soon after surgery^[13]. You may not start thyroid hormone replacement right away, especially if you had thyroid cancer^[13].

After any operation, you need time for your body to recover and your wound to heal. Most people recover in a few weeks, but the recovery time may take longer for some people^[17]. This all-around approach to managing your thyroid removal surgery is very important to ensure the best results and maintain your long-term health and wellbeing^[7].