Thyroid Surgery

Thyroidectomy

A total thyroidectomy is an operation to remove all of the thyroid gland.

A thyroid lobectomy is an operation to remove one half (i.e. a lobe) of the thyroid gland.

Both operations are carried out under general anaesthetic and are performed for the following reasons:

  • Removal of a large goitre that is compressing the airway (trachea) or gullet (oesophagus)
  • Treatment for Graves’ disease (overactive thyroid gland)
  • Diagnosis of a thyroid swelling
  • Removal of a recurrent thyroid cyst
  • Treatment of thyroid cancer

What are the risks of surgery?

Most thyroid operations are uncomplicated not associated with any major problems. However all operations carry risks which include postoperative infections, bleeding in the wound and miscellaneous problems due to anaesthesia but these are rare. Some specific complications of thyroid surgery are discussed below.

Scar: The scar will heal as a red line and may appear swollen for a few months after the operation before fading to a thin white line. Rarely, some patients develop a thick exaggerated scar. Regular massage of the scar 2-3 weeks post-op with either ‘E45’ cream or ‘Bio Oil’ helps flatten the scar and improve the appearance.

Voice change: Voice changes are very common following neck surgery; fortunately they barely noticeable in the majority of people. Thyroid surgery may be associated with injury to one or both recurrent laryngeal nerves. These nerves pass behind the thyroid gland and control movement of the vocal cords and injury causes a hoarse, ‘breathy’ voice. Temporary loss of function is not uncommon after thyroid surgery due to bruising of the nerve but this recovers over a few days or weeks. The external laryngeal nerve may also be injured resulting in difficulty with the high notes when singing and reduced ability to project the voice or shout. Careful identification of the nerves reduces these risks to 1-2% for permanent injury and 10% for temporary injury.

Low blood calcium levels: Patients undergoing thyroidectomy can develop low blood calcium if the four parathyroid glands which control the level of calcium in the blood are temporarily bruised by surgery or are accidentally removed. Temporary low blood calcium is very common after total thyroid removal but is easily treated with calcium tablets taken for a week or two post-operatively until calcium levels normalise. In 2-5% of patients this problem is more persistent and requires long-term calcium and/or vitamin D tablets to maintain the blood calcium level.

Thyroid function: If all the thyroid gland is removed lifelong thyroxine replacement is needed. Fortunately this is a once daily medication (tablet) that is easy to adjust. In the case of partial thyroidectomy (thyroid lobectomy) the remaining gland should produce sufficient hormone and this will checked with blood tests.

Bleeding: Bleeding in the neck from thyroid surgery is uncommon (about 1 in 100). If it does occur it may require a further operation to remove the blood clot. This complication is most likely to happen in the first 6-12 hours after surgery.

After your operation

If all the thyroid gland is removed you will require a blood test to measure your calcium level.

Going home

Most patients are discharged 1 day after a total thyroidectomy and thyroid lobectomy.

Should I look out for any problems following discharge?

If your wound is red, hot, swollen or painful you should seek advice from your GP or practice nurse.

Wound care

The wound should be kept dry for 48 hours and it can be left without a dressing.

Follow-up

We will give you an appointment to be seen in the Outpatient Department about 4-6 weeks after your operation. This is an opportunity to discuss any further results or treatment and check your thyroid function with a blood test.