The thyroid is a butterfly shaped gland that sits in front of your windpipe and produces the hormone thyroxine –T4 which is important for controlling the body’s metabolic rate-that is the rate at which every cell in the body functions. A parallel situation is the control switch on a conveyor belt-if the switch is at maximum, the belt moves too quickly and if the switch is at minimum, the belt moves too slowly. Following total removal of your thyroid , you will have to take the hormone thyroxine every day.
Why do I need a thyroid operation?
Removal of half or all of your thyroid is required for the following reasons:
1. A needle biopsy has raised the suspicion of thyroid cancer.
What type of scar will I have?
2. A needle biopsy has shown atypical cells and there is a risk of cancer of between 20-30% based on your age and characteristics of your nodule.
3. Your thyroid has large nodules in it making it difficult to swallow or breathe especially on exertion.
4. Your thyroid is overactive and medication or radioactive iodine can’t control it, are producing side effects or are contraindicated on medical grounds.
A standard neck scar for a total thyroidectomy is 5-7cm depending on the size of the thyroid. A hemithyroidectomy scar is 5cm long. If I can do a keyhole operation through a 2-2.5cm scar, I will offer that.
What can go wrong?
Everyone is naturally worried about having their throat cut. No surgeon can give a patient a guarantee of no complications. However after having performed over 3000 operations on the neck, patients can be reassured that risks of problems occurring are small and when they do occur, I have the expertise to manage them.
Specific Risks of Thyroid Surgery
1. Permanent voice change-0.5%
2. Inability to raise the voice-2-3%
3. Permanent total or partial hypoparathyroidism requiring calcium /or vit D tablets-2-3%
4. Bleeding requiring reoperation-1%
5. Wound Infection -1%
6. Keloid or hypertrophic scar-rare
Following total thyroidectomy every patient requires lifelong medication. This is taken when you first awake with a 20minute interval before breakfast. Thyroxine has a long half life so if you miss a day it doesn’t matter. When half the thyroid is removed there is a 10% chance of requiring medication..
If you are having an operation in the public hospital the hospital will contact you about 1 month prior to surgery and ask you to attend for a preoperative assessment by the hospital anaesthetic team before your operation. The hospital will notify you of what time to arrive on the day of your operation.
In the private hospital setting, your date will be allocated at the time of consultation or soon thereafter and you will be seen by your private anaesthetist prior to or on the day of surgery. The private hospital will notify you of what time to arrive on the day of your operation.
Patients having morning surgery need to be fasted from 12 midnight and patients having afternoon surgery are permitted to have a light breakfast and fast from 0700 hours.
All patients taking a tablet that causes bleeding must stop the tablets prior to surgery.
1. Aspirin-2 weeks
2. Plavix or Iscover-2 weeks
3. Warfarin-5 days
4. Herbal medications eg St John’s Wort-2 weeks
Your operation is undertaken using a general anaesthetic-you will be asleep for the operation. I will use local anaesthetic in the neck to numb the skin for 12-16 hours after surgery . The anaesthetic tube used during surgery can sometimes cause a sore throat afterwards. You will be given tablets for pain relief afterwards. Sometimes by having the neck extended during surgery, patients complain of pain in the back of their neck or head- neck exercises and physiotherapy do help in alleviating this pain.
You will wake up with an ice pack on your neck to be used for the first 12-24 hours to minimize skin swelling.
The hospital stay is usually for 1 or 2 nights.All patients having half a thyroid removed will stay 1 night and 50% of patients having all the thyroid removed will stay 1 night depending on their blood tests.
All patients will be given a sheet to explain what to expect following surgery.If this does not happen please download from this website.
The wound is closed with a dissolving suture and the steristrip dressing stays on for 10 days . You can shower as normal. Following 10 days, the steristrip is replaced with a brown micropore tape. This can be change every 2 days with the use of BIO Oil in between dressing changes. The use of the steristrip for 6 weeks post surgery minimizes scar stretching.
No driving is permitted for 3-4 days following surgery and you can return to work in 1-2 weeks depending on the type of work you do.
A number of symptoms can occur following thyroid surgery which you don’t have to worry about. These are normal and will settle with time. They include:
Symptoms you do have to worry about
1. Sensation of difficulty swallowing.
2. Sensation of tightness in the neck without any obvious neck swelling.
3. Numbness in the skin above and below the incision.
4. Throat irritation from the anaesthetic tube.
5. Intermittent voice change. This can range from true hoarseness of voice all the time to fluctuations in volume and clarity especially towards the end of the day. Recurrent laryngeal nerve injury is usually temporary in 2-3% of people and recovers in a few weeks following surgery.
1. Delayed neck swelling producing difficulty breathing.
2. Redness and heat in the wound with a high temperature over 38 degrees.
3. Tingling in the fingers and toes with cramping in the hands and feet-this is due to a low calcium level. You will be sent home on calcium tablets following a total thyroidectomy to minimize the chance of this happening-please see post operative instructions.
If any of these symptoms occur please contact me on my mobile which is on my card and the postoperative instruction sheet or go to your local hospital if you are from the country.