The thyroid is a small gland shaped like a butterfly. It’s located in the lower front part of the neck, just below the voice box.
The thyroid produces hormones that the blood carries to every tissue in the body. It helps regulate metabolism — the process by which the body turns food into energy. It also plays a role in keeping the organs functioning properly and helping the body conserve heat.
Sometimes, the thyroid produces too much hormone. It may also develop structural problems, such as swelling and the growth of cysts or nodules. Thyroid surgery may be necessary when these problems occur.
Thyroid surgery involves removing all or a portion of the thyroid gland. A doctor will perform this surgery in a hospital while the patient is under general anesthesia.
The most common reason for thyroid surgery is the presence of nodules or tumors on the thyroid gland. Most nodules are benign, but some can be cancerous or precancerous.
Even benign nodules can cause problems if they grow large enough to obstruct the throat, or if they stimulate the thyroid to overproduce hormones (a condition called hyperthyroidism).
Graves’ disease causes the body to misidentify the thyroid gland as a foreign body and send antibodies to attack it. These antibodies inflame the thyroid, causing hormone overproduction.
Another reason for thyroid surgery is the swelling or enlargement of the thyroid gland. This is referred to as a goiter. Like large nodules, goiters can block the throat and interfere with eating, speaking, and breathing.
There are several different types of thyroid surgery. The most common are lobectomy, subtotal thyroidectomy, and total thyroidectomy.
Sometimes, a nodule, inflammation, or swelling affects only half of the thyroid gland. When this happens, a doctor will remove only one of the two lobes. The part left behind should retain some or all of its function.
A subtotal thyroidectomy removes the thyroid gland but leaves behind a small amount of thyroid tissue. This preserves some thyroid function.
Many individuals who undergo this type of surgery develop hypothyroidism, a condition that occurs when the thyroid doesn’t produce enough hormones. This is treated with daily hormone supplements.
A total thyroidectomy removes the entire thyroid and the thyroid tissue. This surgery is appropriate when nodules, swelling, or inflammation affect the entire thyroid gland, or when cancer is present.
Thyroid surgery takes place in a hospital. It’s important not to eat or drink anything after midnight before your surgery.
When you arrive at the hospital, you’ll check in and then go to a preparation area where you’ll remove your clothes and put on a hospital gown. A nurse will insert an IV in your wrist or your arm to administer fluids and medication.
Before surgery, you’ll meet with your surgeon. They’ll do a quick examination and answer any questions you may have about the procedure. You’ll also meet with the anesthesiologist who will be administering the medicine that makes you sleep throughout the procedure.
When it’s time for surgery, you’ll enter the operating room on a gurney. The anesthesiologist will inject medicine into your IV. The medicine may feel cold or sting as it enters your body, but it will quickly put you into a deep sleep.
The surgeon will make an incision over the thyroid gland and carefully remove all or part of the gland. Because the thyroid is small and surrounded by nerves and glands, the procedure may take 2 hours or more.
You’ll wake up in the recovery room, where the staff will make sure you’re comfortable. They’ll check your vital signs and administer pain medication as needed. When you’re in stable condition, they’ll transfer you to a room where you’ll remain under observation for 24 to 48 hours.
Another type of surgery is called a robotic thyroidectomy. In a robotic thyroidectomy, the surgeon can remove all or part of the thyroid through an axillary incision (via the armpit) or transorally (via the mouth).
You may resume most of your normal activities the day after surgery. However, wait for at least 10 days, or until your doctor gives you permission, to engage in strenuous activities such as high-impact exercise.
Your throat will probably feel sore for several days. You may be able to take an over-the-counter pain medication such as ibuprofen or acetaminophen to relieve the soreness.If these medications don’t provide relief, your doctor may prescribe narcotic pain medication.
After your surgery, you may develop hypothyroidism. If this occurs, your doctor will prescribe some form of levothyroxine to help bring your hormone levels into balance. It may take several adjustments and blood tests to find the best dosage for you.
As with every major surgery, thyroid surgery carries the risk of an adverse reaction to general anesthetic. Other risks include heavy bleeding and infection.
Risks specific to thyroid surgery rarely occur. However, the two most common risks are:
- damage to the recurrent laryngeal nerves (nerves connected to your vocal cords)
- damage to the parathyroid glands (glands that control the level of calcium in your body)
Supplements can treat low levels of calcium (hypocalcemia). Treatment should start as soon as possible. Notify your doctor if you feel nervous or jittery or if your muscles start twitching. These are signs of low calcium.
Of all patients having a thyroidectomy, only a minority will develop hypocalcemia. Of those who develop hypocalcemia,