The thyroid is a butterfly shaped gland that sits in front of your windpipe and produces the hormone thyroxine – T4. Thyroxine is important for controlling the body’s metabolic rate, which is the rate that 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 through thyroid surgery, you will have to take the hormone thyroxine. Ten percent of patients require thyroxine replacement following removal of half of the thyroid (hemithyroidectomy).
Why do I need a thyroid surgery?
Removal of half or all of your thyroid may be required for the following reasons:
- A needle biopsy has raised the suspicion of thyroid cancer
- 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
- Your thyroid has large nodules making it difficult to swallow or breathe especially on exertion
- Your thyroid is overactive and medication or radioactive iodine can’t control it or is contraindicated on medical grounds or if it is producing side effects
What type of scar will I have?
Professor Sidhu will offer a key hole operation where possible. The neck incision for this is 2-2.5cm. If a key hole operation is not possible the standard neck incision for a total thyroidectomy is 5-7cm depending on the size of the thyroid. A hemithyroidectomy incision is 5cm long. Professor Sidhu will make the incision in an existing crease within the neck wherever possible.
Post-operative care of the wound will assist to reduce the visibility of scarring. Following surgery the wound will be stitched with dissolvable sutures and covered with steristrips. If the tape comes off before your post-operative review it can be replaced with micropore tape which is available at most pharamcies. This can be changed every 2 days with the use of BIO Oil in between dressing changes. The use of the micropore tape for 6 weeks post surgery minimises scar stretching. You can shower as normal.
What can go wrong?
Everyone is naturally worried about having their throat cut when having thyroid surgery. It is not possible for a thyroid surgeon to give a patient a guarantee of no complications. However, after having performed over 5000 operations on the neck, patients can be reassured that risks of problems occurring are small and when they do occur, Professor Sidhu has the expertise to manage them.
Specific Risks of Thyroid Surgery
- Permanent voice change -less than0.5%
- Inability to raise the voice -1-2%
- Permanent total or partial hypoparathyroidism requiring calcium /or vitamin D tablets -<2%
- Bleeding requiring reoperation -<0.5%
- Wound infection -<1%
- Keloid or hypertrophic scar -rare
Following total thyroidectomy patients requires lifelong medication. This is taken in the morning with a 20 minutes before eating. Thyroxine has a long half-life so if you miss a day it won’t affect the efficacy. When half the thyroid is removed there is a 10% chance of requiring medication.
I am a singer or a voice professional and am concerned about voice change following thyroid surgery
Voice change following thyroid surgery occurs due to a number of factors. Most of these resolve within 3 months of surgery (e.g. trauma from a laryngeal tube, post-operative oedema, internal fibrosis, and scar formation). The two most important factors essential to voice preservation are preservation of the function in the recurrent and laryngeal nerves. If the recurrent nerve is paralysed, then the voice is weak, hoarse, and husky. If the external laryngeal nerve does not function then voice projection and pitch is affected.
During thyroid surgery, Professor Sidhu uses a neurostimulator attached to a neuromonitor to test the function in the recurrent and external laryngeal nerves. This minimises the chances of inadvertently injuring these nerves. Following thyroid surgery nerve function can be documented utilising this technology. Please see section on voice change following thyroid surgery.
Thyroid surgery - What you need to know
The thyroid is a butterfly-shaped gland situated at the bottom of your neck. It is responsible for releasing the hormones triiodothyronine (T3) and thyroxine (T4), which control your metabolic rate or how the body consumes energy. The thyroid regulates important body functions such as:
- Heart rate
- Body weight
- Menstrual cycles
- Muscle strength
- Body temperature
- and more
Too much T3 and T4 in the body leads to hyperthyroidism while too low T3 and T4 leads to hypothyroidism.
Undergoing thyroid surgery for thyroidectomy is recommended for patients who are suspected to have thyroid conditions including benign and malignant tumours, enlarged thyroid glands (goiter), and overactive thyroid.
To make an appointment to confirm if you need thyroid gland surgery, you can call Professor Sidhu’s rooms on (02) 9437 1731
Before Thyroid Surgery
What time should I go to hospital?
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. The hospital will notify you of the 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, the day prior to surgery, of the time to arrive on the day of your operation.
Do I need to fast?
Yes, you do. 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.
This includes the following medications:
- Aspirin – 2 weeks
- Plavix or Iscover – 2 weeks
- Warfarin – 5 days
- Herbal medications eg St John’s Wort – 2 weeks
- Factor X inhibitors eg Xarelto -3 days
Professor Sidhu will discuss these medications at the time of consultation.
To gain access to the thyroid gland the neck is tilted backwards. To help relieve soreness and swelling we recommend neck exercises prior to the surgery. Neck exercises booklet can be found here.
Your thyroid surgery is undertaken using a general anaesthetic – you will be asleep for the operation. A local anaesthetic is also used in the neck area 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. Sometimes, by having the neck extended during surgery, patients complain of pain in the back of their neck or head. Neck exercises and physiotherapy 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 minimise skin swelling.
The hospital stay is usually for 1 or 2 nights after thyroid surgery. 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 test results on the first post-operative day.
All patients will be given a sheet to explain what to expect following surgery. If this does not happen, please download here.
The wound is closed with a dissolving suture and the steristrip dressing stays on for 10 days. You can shower as normal. After 10 days, the steristrip can be replaced with a brown micropore tape. This can be changed every 2 days with the use of BIO Oil in between dressing changes. The use of the micropore tape for 6 weeks post surgery minimises scar stretching.
No driving is permitted for 3-4 days following thyroid 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:
- Sensation of difficulty swallowing
- Sensation of tightness in the neck without any obvious neck swelling
- Numbness in the skin above and below the incision
- Throat irritation from the anaesthetic tube
- 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.
Symptoms you do have to worry about
- Delayed neck swelling producing difficulty breathing
- Redness and heat in the wound with a high temperature over 38 degrees
- 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 after your thyroid surgery, please contact Professor Sidhu on his mobile (provided on his business card) and the postoperative instruction sheet or go to your local hospital if you are are country patient.