Surgical Procedures  Thyroid Surgery
Extent of Thyroid Surgery
The extent of thyroid surgery performed depends on the specific thyroid condition being treated.
The goal of the surgeon is to treat the condition to the best extent possible, while maintaining the highest quality of life possible.
Surgery should only be recommended if the condition cannot be adequately treated medically, i.e. if cancer is found or suspected, if the airway is obstructed, or if the patient cannot tolerate medication.
Depending on the specific condition, a surgeon may recommend removing only one lobe of the thyroid, or "wing" of the butterfly-shaped gland (this procedure is called a lobectomy).
Removing almost the entire thyroid is called a subtotal thyroidectomy, and removing the entire thyroid is called a total thyroidectomy.
Sometimes the extent of surgery must be determined by the surgeon during surgery when the features of the thyroid disease can be seen directly.
If the thyroid is cancerous, the surgeon may remove the entire gland as well as the lymph nodes close to the thyroid gland to reduce the risk of metastases, or spread of the cancer to other parts of the body.
When surrounding lymph nodes are removed, the operation is called a modified radical neck dissection.
After the operation, this area of the neck is usually numb because the nerves to the skin in this area are purposely severed in order to remove the diseased lymph nodes.
Other than this numbness, there are no long-term effects of having these lymph nodes removed.
In the rare cases when the thyroid cancer is more advanced, both the left and right sides of the neck must be cleared of lymph nodes.
If this is the case, two separate operations are performed about 2 months apart.
This delay is to allow time for healing on one side before beginning the operation on the opposite side.
Performing the lymph node dissection on both sides at the same time could lead to unnecessary swelling (edema) of the head and face if time is not given in between operations to allow for alternate pathways of blood flow to form in order to drain the head and neck area.
More extensive surgery is associated with higher complication rates and thus many surgeons who are inexperienced in thyroid surgery choose to remove less thyroid tissue in order to decrease the risk of complication.
Frequently Asked Questions
If you need thyroid surgery, it is important to know what to expect. The following are some of the most frequently asked questions:
Q: How long will I be hospitalized?
A: Most patients come to the hospital on the morning of their surgery.
Although an overnight bed is automatically reserved for each patient, the majority of patients go home the same day after a 6 hour observation period in the recovery room.
Q: What type of anesthesia will I have?
A: You are given the option of either general anesthesia or local anesthesia.
With local anesthesia your neck area is numbed, mild sedatives may be given to reduce anxiety, and it is as if you are taking a nap during the operation.
Since you will no be completely asleep, you can be in close communication with your surgeon throughout the operation.
With general anesthesia you are completely asleep during the operation and the same local anesthetic is given to your neck area to help eliminate any post-operative discomfort.
Q: Will I have a scar?
A: Yes. All surgery causes scarring, and how the patient heals the scar is very much dependent on the individual.
However, there are some techniques that surgeons use to minimize scarring.
These techniques include: smaller incision size, careful incision placement, and hypoallergenic suture material (to avoid inflammation).
As a general rule, you should not have a noticeable scar after six months.
Q: Will I have pain after the operation?
A: All operations involve some pain and discomfort.
Our goal is to minimize this discomfort.
At the time of operation, your surgeon will give you some numbing medicine which usually lasts about eight hours.
Although you should be able to eat and drink normally, the main complaint is pain with swallowing.
Most patients take Tylenol® or Motrin® to keep them comfortable at home.
Q: When will I know the findings of the surgery?
A: During the operation, your surgeon will consult with the pathologist who will provide a preliminary diagnosis.
However, the final pathology report requires careful study of the surgical specimen.
Therefore, the final report is usually not available until about one week after the operation.
Q: Will I have stitches?
The incision is covered with a clear plastic coating (collodion), which is waterproof so that you can bathe as usual (but do not submerge the incision for 5 days).
Before you are discharged from the hospital, a single suture in the incision will be removed.
The coating will peel off on its own within 3-7 days and a moisturizer can be applied to the wound to improve healing.
Q: Will I have any physical restrictions after my surgery?
A: In general, your activity level depends on the amount of discomfort you experience.
Many patients have resumed golf or tennis within a week after the operation.
Most patients are able to return to work within the first or second week of surgery, and you are able to drive as soon as your head can be turned comfortably.
You should restrain from driving if you are taking narcotics for pain control (this limitation is for driver safety).
You must see your surgeon for a routine follow-up office visit two to three weeks after surgery.
Q: What are the complications unique to thyroid surgery?
A: In about 1 in 100 thyroid operations, the nerves that control the voice are affected by the surgical removal of the thyroid.
When this occurs, the main difficulties are projection of the voice and production of high pitched sounds.
It is usually described as hoarseness, but will not necessarily be considered abnormal by strangers.
Usually, voice changes are temporary, so the voice will return to normal within a few weeks; permanent change is rare.
In about 1 in 300 thyroid operations, the parathyroid glands will not function as a result of surgery.
These are four delicate glands that are located near the thyroid. Since the parathyroid glands control calcium levels, their dysfunction usually results in a lowered calcium level.
Therefore, some patients require calcium supplements on a temporary basis.
If the parathyroids do not function properly, calcium or vitamin D may be needed on a permanent basis.
Both of these possible complications are directly related to the operative experience of the surgeon, and these statistics are based on our own results.
Although the risk of these complications cannot be eliminated entirely, they can certainly be minimized in the hands of an experienced thyroid surgeon.
As with any operation, there is a risk of bleeding.
In the case of thyroid and parathyroid surgery, the risk is 1 in 300 patients (much less than 1%).
Because of this rare chance of bleeding, we keep you in the hospital for 4 to 6 hours after the operation for observation and in certain cases may observe you overnight in the hospital.
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