Description of a Thyroidectomy
A thyroidectomy is a surgery to take out a portion or all of the thyroid gland. The thyroid gland is butterfly-shaped and can be found at the front and bottom of the neck, just below the adam’s apple. The thyroid makes hormones that control all metabolic functions of the body, including heart rate and how fast the body burns calories. Thyroid hormones also regulate the body’s heat production and bone growth. The amount of the thyroid removed during a thyroidectomy depends on why the surgery is needed.
Reasons For a Thyroidectomy (Thyroid Surgery)
A doctor may suggest thyroid surgery as treatment for:
- Benign (Non-cancerous) Thyroid Nodules
- Thyroid Cancer
- Hyperthyroidism (Overactive Thyroid)
Benign (non-cancerous) Thyroid Nodules
Thyroid nodules are also known as thyroid tumors. There are several types, but over 95% of these tumors are non-cancerous or benign. Tests must be done to differentiate between cancerous and non-cancerous nodules. Several types of benign thyroid nodules exist including:
Multinodular Goiter is also known as a non-toxic goiter. Typically, the pituitary gland (in the brain) produces too much thyroid stimulating hormone (TSH) and the thyroid gland becomes enlarged. Thyroid hormone pills may be used to treat the goiter if small enough, but if it becomes too large or does not stop growing after hormone treatment, surgery is needed. Large goiters can put pressure on the trachea (windpipe) or esophagus (food tube), which can be very dangerous and make breathing or eating difficult.
Chronic Thyroiditis (Hashimoto’s Disease) is a slowly progressing inflammation of the thyroid gland. Thyroiditis happens when the body’s immune system turns on itself by killing the cells of the thyroid gland. This causes reduced function of they thyroid gland (hypothyroidism). Chronic thyroiditis is most common among middle-aged women and those with a family history of thyroid disease.
Thyroid Cysts are small or large fluid filled nodules. They can surface without warning and need to be removed surgically if they lead to neck pain or make it difficult to swallow. A cyst that contains both solid parts and fluid is known as a complex nodule.
Benign Follicular Adenomas are nodules that contain follicular cells. Under a microscope, follicular cells have the appearance of a cluster of small circles. If these follicular cells are confined to the nodule, the condition is non-cancerous. The nodule must be removed surgically and microscopically studied to check for cell intrusion into normal thyroid tissue or blood vessels, which indicates cancer.
In the United States, there are 20,000 new cases of thyroid cancer diagnosed each year. Thyroid cancer is 3 times more common in women than in men and most common after 30, but it can be diagnosed at any age. The four types of thyroid cancer tumors are:
Papillary Tumors constitute 78% of all thyroid cancers. They metastasize (spread) most often to the lungs and bones and typically move to the lymph glands in the neck as well. Papillary tumors seldom spread to distant organs.
Follicular (Hurthle cell) Tumors, the second most common thyroid cancer, often metastasizes (spreads) to outlying organs (lungs, bones, brain, liver, bladder, skin) but spreads to lymph glands less often than papillary tumors. Follicular tumors most frequently develop between the age of 40-60, and if treated properly, have a cure rate of 97% or higher.
Medullary Tumors metastasize (spread) to the lymph nodes in early stages. Following surgery, calcitonin hormone levels are evaluated every 4-6 months to look for a recurrence of the disease. If the condition has not spread to the outside of the thyroid gland, the survival rate is 90%. The survival rate is 70% if the condition has spread to the lymph glands in the neck and 20% if the condition has expanded to distant organs.
Anaplastic Cancer is the most rare and threatening form of thyroid cancer. Three years post diagnosis and treatment the survival rate for patients is only 10%. The tumors develop quickly, and over 90% of them metastasize (spread) to the lymph glands in the neck and to distant organs. The age of onset averages 65 years or older, and men are twice as likely as women to develop anaplastic cancer. A tracheotomy (breathing tube placed in the neck) is often necessary, because the tumor obstructs the airway by crushing the trachea (windpipe). This cancer must be identified early to maximize the chance of survival, as it is very low.
Hyperthyroidism (Overactive Thyroid)
Hyperthyroidism is a problem where the thyroid gland yields an overabundance of the hormone thyroxine. Thyroid surgery may be a course of action for patients who are:
Nonresponsive or not properly responsive to antithyroid drugs or radioactive iodine therapy. (Outside of the U.S., surgery is at times implemented as a hyperthyroidism treatment prior to or in place of radioactive iodine.)
Pregnant or want to become pregnant quickly after treatment. In pregnant women, hypothyroidism cannot be regulated with antithyroid drugs but demands prompt treatment.
Children with a health care provider or parent who wants to evade radioactive iodine.
Noncompliant towards or refuse antithyroid medications or radioactive iodine.
Cause and Risk Factors of Thyroid Nodules
- The precise cause for thyroid nodules is not understood, but there are several risk increasing factors for developing nodules, which might require thyroid surgery as a course of treatment:
- Heredity. The likelihood of developing a thyroid nodule increases if a parent or sibling had a thyroid nodule.
- Age. As age increases, the risk of developing thyroid nodules increases.
- Gender. Women develop thyroid nodules more frequently than men.
- Thyroiditis. Patients with chronic inflammation of the thyroid gland are at an increased risk of developing thyroid nodules.
- Radiation exposure to neck or head. A large number of babies, children, and teens were exposed to radiation for treatment of acne and enlarged tonsils in the 1940’s and 1950s. Patients who have undergone these treatments have an increased risk.
- Exposure to nuclear power plant accidents increases the risk.
- Exoposure to radioactive particles discharged into the air during testing for atomic weapons increases the risk.
Signs and Symptoms of Thyroid Nodules
Thyroid nodules rarely cause symptoms, but occasionally a person or family member might visibly notice or feel a lump in the front of the neck. The lump can lead to pain or trouble swallowing. If the lump is a nodule and producing an overabundance of thyroid hormone (TH), the person might experience heat intolerance, palpitations, rapid heart beat, nervousness, insomnia, increased bowel movements, absent periods, fatigue, weight loss, hair loss, or muscle weakness.
Diagnosis of Thyroid Nodules
Physicians commonly discover thyroid nodules during routine physical examinations by noticing an abnormal lump on the front a patient’s neck. To establish a diagnosis, a mixture of physical exams, symptoms, medical history, and tests are used.
A number of blood tests can be used to check thyroid hormones for abnormal levels, and both thyroid tests and pituitary tests are mandatory to pinpoint the thyroid as the problem. Blood tests include:
TSH blood test. This test evaluates levels of a pituitary gland hormone that activates the thyroid gland. The thyroid may not be working sufficiently if the TSH level is increased.
T4 by RIA blood test, T3 by RIA blood test, Thyroid Binding Globulin blood test. These measure other thyroid hormones.
Thyroid Scan. This test determines the amount of iodine the thyroid is able to absorb.
Fine Needle Aspiration Biopsy. This test determines if a nodule is cancerous or benign. A needle is inserted into the thyroid nodule to draw up a sample of cells. These are then inspected under a microscope to determine if the nodule is cancerous. If benign, a doctor may decide to keep an eye on a thyroid nodule to make sure it does not grow or cause symptoms. Thyroid hormones may also be prescribed to subdue gland activity and keep more nodules from forming. If a nodule grows larger, another biopsy might be required.
Thyroid Ultrasound. This test employs painless sound waves to produce an image of the thyroid gland and locate nodules. Ultrasound cannot determine if a nodule is cancerous or benign, but it does show if a nodule is solid or a fluid-filled cyst.
Types of Thyroid Surgery
Total Thyroidectomy. This surgery is the complete removal of the thyroid gland for a patient with thyroid cancer or large benign tumors. Thyroid hormone replacement medication will be required after the entire thyroid is removed.
Thyroid Lobectomy. During this operation, one side (a lobe) of the thyroid gland is removed for patients with only one thyroid nodule. Typically, thyroid hormone therapy is not required after surgery, because the patient’s remaining lobe takes charge of the function of the entire thyroid gland.
Thyroid Lobectomy with Isthmusectomy. This surgery removes one side (a lobe) of the thyroid gland and the thyroid tissue that attaches the two lobes (the isthmus). A larger amount of thyroid tissue is removed than during a lobectomy.
Preparing for Thyroid Surgery
For patients with hyperthyroidism, medications like iodine and potassium solution may be required before surgery to control thyroid function and lower the risk of bleeding.
A doctor will also give particular eating and drinking instructions before surgery to avoid problems with anesthesia.
What to Expect During Thyroid Surgery
A thyroidectomy normally takes several hours. The operation is performed under general anesthesia, so the patient is unconscious the entire time. Depending on the surgical method being used, either a small incision is made in the front of the neck or several small incisions are made under the arm. Then, based on the reason for surgery, either a portion or all of the thyroid gland is removed.
During the operation, an advanced technological tool called Intraoperative Recurrent Laryngeal Nerve Monitoring can be used to avoid causing damage to the laryngeal nerve (voice box nerve), which is near the site of surgery. The muscles of the vocal cords are connected to a computer by electrodes. The laryngeal nerve is constantly monitored, and the technician will notify the surgeon if the nerve is unintentionally disturbed.
What to Expect After Thyroid Surgery
After surgery, the patient will be relocated to a recovery room where he or she will wake up. Once fully conscious, the patient will be moved to a hospital room. There may be a drain under the neck incision, which is typically removed the morning after the operation.
Following a thyroidectomy, a patient may experience short-term neck pain and a weak or hoarse voice. This does not necessarily indicate any permanent damage to the laryngeal nerve, as these symptoms usually subside.
Patients can eat and drink normally after the surgery and most return home after a hospital stay of 24 hours.
A patient should ask their doctor about any activity restrictions. Normally, once a patient has recovered from the thyroid surgery itself, he or she can return to regular activities within a few weeks.
If the entire thyroid is removed (total thyroidectomy), the body can no longer make thyroid hormone, so the patient must take a pill every day that contains and replaces the thyroid hormone theroxine. This will keep the body from experiencing signs and symptoms of hypothyroidism. A doctor will determine the levels of thyroid hormone replacement required by blood tests.
Sometimes temporary calcium supplements are required after a total thyroidectomy if blood calcium levels drop too low (hypocalcemia), but this condition does not typically persist.
Radioactive Iodine is used after surgery to remove any thyroid cells that might be hidden in the body or could not terminated during the thyroidectomy. Four to six weeks following the surgery, a single radioactive iodine pill is taken. Thyroid cells are the only cells with the ability to absorb iodine, so any surviving thyroid cells will absorb the radioactive iodine and be destroyed. Radioactive iodine will not induce hair loss, nausea, or damage any other cells in the body.
Potential Complications of Thyroid Surgery
- Typically thyroidectomy is a safe procedure, but with any surgery risk of potential complications exists. Possible complications include:
- Airway obstruction due to bleeding.
- Permanent hoarse or weak voice due to laryngeal nerve damage.
- Hypoparathyroidism due to damaged parathyroid glands, which can lead to increased levels of phosphorus in the blood as well as:
- Hypocalcemia, unusually low blood calcium levels.
Mayo Clinic. (2011, October 06). Thyroidectomy. Retrieved from
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