Surgery and Thyroid

When is surgery on the thyroid required?

1. Thyroid Cancer – Thyroid cancer is a definite indication for surgery. In most of the cases, the entire gland is removed.
2. Goitre that is not cancer – A goitre causing pressure effect like difficulty in swallowing, breathing difficulty or hoarseness of the voice are also indications for surgery.
3. Hyperthyroidism – As we have mentioned before overactive thyroid because of multinodular goitre or adenoma will require definitive treatment after initial stabilization of medical treatment. Here definitive therapy means surgery or radioiodine therapy.

When medical treatment for Graves’ disease is not successful or patient not tolerating/reacting to medications surgery is the treatment other than radioiodine.

Similar situation in pregnancy surgery is a must as in pregnancy you can not give radioiodine.

What are the types of surgery?

1. Total thyroidectomy: Total Thyroidectomy means complete removal of the thyroid. This is performed for thyroid cancer.
2. Subtotal thyroidectomy: This is done for people with hyperthyroidism where 7/8^th of the gland is removed. This is done with the idea that the leftover gland will produce enough thyroid hormone and you will not become hypothyroid.  Subtotal thyroidectomy was also done for goitre which is not cancer.
3. Lobectomy: Only the lobe involved is removed, mainly for a small tumour localized in one side of the thyroid gland.

How is the surgery done?

Surgery is performed under general anaesthesia. Skin incision in the neck is made, the parathyroid glands and nerve of the vocal cord are identified and preserved and the affected portion of the thyroid gland is removed. You may not be able to eat or drink anything for the first twenty-four hours or so.

You need to stay in the hospital for a period of three to five days and may need a week or so to recuperate at home.

What are the complications after Thyroid surgery?

Other than some complications that can happen after any Surgery, we are mainly concerned about two.

First, injury to the nerve of the voice box called recurrent laryngeal nerve and the second, removal of the parathyroid glands which will cause low calcium level.

These are serious issues but the good news is that with the advancement of surgical techniques and improvements in anaesthesia we are seeing these less and less nowadays.

There is a chance that the remaining thyroid tissue is not good enough to produce normal amount of thyroid hormone, so you might be on thyroxine replacement for a long time.

When I have a choice between Thyroid surgery and Radioiodine, which one to choose?

This choice is given for Hyperthyroidism. The advantages of radioiodine are outpatient treatment, cheaper, can be repeated after 6 months if the first dose does not work.

We do not expect the size of the goitre to reduce very much after radioiodine, this is a big advantage for surgery if the size of the gland is bothering.

Better to keep in mind that a scar would remain after surgery. Complication of surgery as has been mentioned is a possibility although they are rare now. In pregnancy radioiodine is not to be given.