Thyroid and parathyroid surgery

What is Thyroid Surgery?

Thyroidectomy is the term used to describe the removal of the thyroid gland through an incision in the skin in the lower part of the neck.

This option may be considered and discussed with you for several reasons:

- If you have a large goitre (enlarged thyroid gland)
- If you have an over active thyroid gland and there are reasons why radioactive iodine cannot be used
- If you have an over active thyroid gland and you have problems taking thyroid tablets (Carbimazole or Propylthiouracil) to control the condition
- In preference to other treatment options

What does this involve?

You will be admitted on the day of the procedure and you would normally stay in hospital for one to two days.

The most common operation performed is called a total thyroidectomy, meaning that all of the thyroid gland is removed by the surgeon through an incision made along one of the natural skin creases in your neck.

When will I recover?

The operation has an excellent success rate, with all patients being cured of their overactive thyroid gland as all of the thyroid gland is removed.

A drainage tube is sometimes left in the neck wound for a day after to allow any fluid to clear. Very rarely patients have to return to theatre from the ward to control bleeding from the operation site.

You will be started immediately after the operation on thyroid hormone tablets (thyroxine) to ensure that your blood levels of the thyroid hormones remain normal. This will be checked with blood tests before or at the post operative clinic visits. The results of these tests will allow the dose of thyroxine medication to be tailored to your specific requirements.

Once the condition is stable everybody who has had treatment for an overactive thyroid gland needs some form of long-term follow-up. This usually involves regular thyroid function blood test every year which is usually done through your GP.

What risks should I know about?

All operations carry some element of risks although a thyroidectomy is a regularly performed and generally safe procedure.

You will have a scar from the incision but your surgeon will ensure that with time the scar is barely noticeable. Rarely patients develop a prominent scar or a keloid scar.

The nerves to the voice box (larynx) lie behind the thyroid gland and can occasionally be damaged resulting in a weakening of your voice or hoarseness. This is usually a temporary problem but uncommonly it may be a permanent change in less than 1% of patients. More commonly a nerve to the cricothyroid muscle may be damaged. This affects the pitch of the voice and may interfere with singing. If on only one side then the other side may compensate and the voice does improve.

The parathyroid glands, which control another chemical in the bloodstream (calcium) also lie behind the thyroid and there is a small possibility that these may be damaged by the operation. In the unlikely event that this occurs you may need to take calcium and vitamin D supplements. About 10% of patients require temporary supplements and less commonly replacement is required for life.

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