Thyroid gland removal
Thyroid gland removal
Thyroid gland removal is surgery to remove all or part of the thyroid gland. Your thyroid gland is a butterfly-shaped gland that lies over your trachea. This is the tube that carries air into and out of your lungs. Your thyroid is just below your voice box.
Total thyroidectomy; Partial thyroidectomy; Thyroidectomy; Subtotal thyroidectomy
Depending on the reason you are having your thyroid gland removed, the type of thyroidectomy you have may be:
- Total thyroidectomy, which removes the entire gland.
- Subtotal or partial thyroidectomy, which removes part of the thyroid gland.
You will have general anesthesia (asleep and pain-free) for this surgery. In rare cases, the surgery is done with local anesthesia and medicine to relax you. You will be awake but pain-free.
During the procedure:
- The surgeon makes a 3- to 4-inch cut in the middle of your neck, right on top of the thyroid gland. Or, the surgeon makes a smaller cut less than 2 inches long.
- All or part of the gland is removed through the cut.
- The surgeon is careful not to damage the blood vessels and nerves in your neck.
- A small tube (catheter) may be placed into the area to help drain blood and other fluids that build up. The drain will be removed in 1 or 2 days.
- The cuts are closed with sutures (stitches).
Surgery to remove your whole thyroid may take up to 4 hours. It may take less time if only part of the thyroid is removed.
Why the Procedure Is Performed
Your doctor may recommend thyroid removal if you have:
- A small thyroid growth (nodule or cyst)
- A thyroid gland that is so overactive it is dangerous (thyrotoxicosis)
- Cancer of the thyroid
- Noncancerous (benign) tumors of the thyroid that are causing symptoms
- Thyroid swelling (nontoxic goiter) that makes it hard for you to breathe or swallow
You may also have surgery if you have an overactive thyroid gland and do not want to have radioactive iodine treatment, or you cannot be treated with antithyroid medicines.
Risks of any anesthesia include:
- Reactions to medicines
- Breathing problems
Risks of thyroidectomy:
- Injury to the nerves in your vocal cords and larynx. You may have problems reaching high notes when you sing, hoarseness, weakness of your voice, coughing, swallowing problems, or problems speaking. These problems may be mild or severe.
- Difficulty breathing. This is very rare. It almost always goes away several weeks or months after surgery.
- Bleeding and possible airway obstruction
- A sharp rise in thyroid hormone levels (only around the time of surgery)
- Injury to the parathyroid glands (small glands near the thyroid) or to their blood supply. This can cause temporary low level of calcium in your blood (hypocalcemia).
- Too much thyroid hormone (thyroid storm). If you have an overactive thyroid gland, you will be treated with medicine.
Before the Procedure
You may need to have tests that show exactly where the abnormal thyroid growth is located. This will help the surgeon find the growth during surgery. You may have a CT scan, ultrasound, or other imaging tests.
Your doctor may also do a fine needle aspiration to find out if the growth is noncancerous or cancerous. Before surgery, your vocal cord function should be checked.
You may also need thyroid medicine or iodine treatments 1 to 2 weeks before your surgery.
Before surgery, an anesthesiologist will review your medical history and decide what type of anesthesia to use. The anesthesiologist is a doctor who will give you the medicines that will make you sleepy and keep you pain-free during surgery. The anesthesiologist will also monitor you during surgery.
Fill any prescriptions for pain medicine and calcium you will need after surgery.
Several days to a week before surgery, you may be asked to stop taking medicines that make it harder for your blood to clot. These include:
- Clopidogrel (Plavix)
- Ibuprofen (Advil, Motrin)
- Naproxen (Aleve, Naprosyn)
- Warfarin (Coumadin)
You will probably be asked to stop eating or drinking at least 6 hours before surgery.
Ask your doctor which medicines you should still take the day of surgery.
If you smoke, try to stop. Your recovery time will be shorter if you do not smoke. Ask your doctor or nurse for help.
Your doctor or nurse will tell you when to arrive at the hospital. Be sure to arrive on time.
After the Procedure
You will probably go home the day after surgery. In rare cases, patients spend up to 3 days in the hospital. You must be able to swallow liquids before you can go home.
Your doctor will probably check the calcium level in your blood after surgery. This is done more often when the whole thyroid gland is removed.
You may have some minor pain after surgery. Most patients are able to get up and walk on the day after surgery. It should take about 3 to 4 weeks for you to fully recover. Avoid the sun while the surgical cut is healing to prevent the skin from getting darker.
Outcome of this surgery is usually excellent. Most people need to take thyroid hormone pills (thyroid hormone replacement) for the rest of their lives when the whole gland is removed.
Smith PW, Salomone LJ, Hanks JB. Thyroid. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, Pa: Elsevier Saunders; 2012:chap 38.
Lai SY, Mandel SJ, Weber RS. Management of thyroid neoplasms. In: Flint PW, Haughey BH, Lund VJ, et al., eds. Cummings Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Elsevier Mosby; 2010:chap 124.
Reviewed by:John A. Daller, MD, PhD., Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.
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