Thyroid Surgery Information
What you should I know about Thyroid Surgery:
Seek Experience: Thyroid surgery should be done by a surgeon who does a large number of these operations and has experience in dealing with all aspects of the disease for which the surgery is being recommended. The surgeon should also be capable of performing lymph node dissections should they prove necessary. At the DMH Thyroid Surgical Institute, Dr. Steven Sobol continues to perform between 100 and 200 of these operations yearly.
The Procedure Itself: Most thyroid surgery may be done on an outpatient basis, although some patients may elect to stay for 1 night. The incision is located in the lower neck and its size will vary based on the size of the thyroid to be removed and the patient’s anatomy; overweight patients and those with very large necks may need larger incisions. The surgery is kept as minimally invasive as possible and the scar is rarely anything to be concerned about, even in young people. There is very little bleeding during the procedure and the patient rarely complains of intense postoperative pain – although this varies from patient to patient. Most patients return to light-normal activity within a couple of days of the operation. A small suction drain is often used for 24 hours which can be easily cared for by most patients or their family. Bathing and showering is permitted on the first day after surgery.
Possible complications surrounding with Thyroid Surgery
As with any surgical procedure, there are risks and these should be discussed with the patient by the thyroid surgeon. The two issues which must be discussed relate to 1) the nerve to the vocal cords (recurrent laryngeal nerve & external laryngeal nerve) and 2) the parathyroid glands.
In most thyroid surgery, one or both of the thyroid lobes will be removed. The surgeon must utilize proper technique to avoid injury to the nerves to the vocal cords. Failure to do so can result in an injury to the nerve and result in paralysis of one or both vocal cords. This leads to a significant alteration in the patient’s voice which may or may not recover. Although there are procedures to improve the voice should this occur, they cannot fully replicate the patient’s previous voice with perfection. Fortunately, in skilled hands, this complication is rare (less than 1%).
Some surgeons use a Nerve Monitor during the operation to enhance nerve identification and assist in determining nerve integrity at the end of the surgical procedure. It is not absolutely necessary to do so in most cases, and in recent studies there has not been any significant improvement in the incidence of nerve injury which can be ascribed to its use routinely. Your surgeon may discuss this with you, but, in general, it is up to the surgeon to decide if he wishes to use a nerve monitor during the surgery.
The parathyroid glands, 4 in number, lie behind the thyroid gland. They share some common blood supply with the thyroid and are quite small ( about 1 cm each). They are very active little glands, producing a hormone called Parathyroid Hormone (PTH) which together with Vitamin D regulates and maintains blood calcium at a normal level.
The surgeon must make an effort to identify and preserve these glands during thyroid gland removal. Failure to do so can result in inadvertent injury or removal of these, and give rise to low blood calcium during the postoperative period and beyond. On the surface, this might seem to be an easy thing to do, but it isn’t always so simple.
First, their location is not always perfectly typical and can vary, and some patients have less than 4 glands. If all four glands are damaged or inadvertently removed, the patient must take large doses of calcium and Vitamin D for life to control their blood calcium levels. Low calcium can cause muscle cramping (tetany), numbness and tingling, and severe muscle weakness. When only one lobe of the thyroid is removed, there is usually no risk of this complication. But when a total thyroid gland removal is deemed necessary, the risk of hypoparathyroidism (low PTH production) and secondary hypocalcemia (low blood calcium) is increased.
The surgeon will monitor the serum calcium after surgery along with the parathyroid hormone level to assist in deciding if the patient needs supplemental calcium and vitamin D. Temporary low calcium levels are not uncommon, as manipulation of the parathyroid glands can result in bruising of the glands and temporary dysfunction. But this will self correct in a few days or weeks in most cases and supplemental calcium and vitamin D need only be taken for a short time.
Other less common complications include bleeding and infection. Immediate postoperative bleeding may require an occasional patient to return to the operating room to remove blood clots which have accumulated under the skin. Routine use of antibiotics is not necessary for thyroid surgery.
Depending on how much thyroid is left behind, the patient may have to take thyroid hormone replacement after removal of the gland. Regulation of this is done by blood tests, as with hypothyroidism (see above).