Thyroid

The thyroid is a gland located at the front, center, and lower part of the neck. It has a butterfly shape, with a right and a left lobe connected in the middle by what is called the isthmus. The thyroid produces a hormone called thyroxine, which is essential for the body’s metabolism. Located in specific areas on the thyroid are four other small glands called the parathyroids. These secrete parathyroid hormone, which regulates the calcium levels in the blood.

There are three main reasons for thyroid surgery:

1. The appearance of a solitary nodule in the gland that may potentially be thyroid cancer. The only definitive way to clarify the diagnosis is through thyroidectomy, which may be partial or total. If cancer is diagnosed after histological analysis, and depending on the type, further treatment may be required.
2. General enlargement of the gland (either soft or multinodular), which can cause:
   a) Pressure on the trachea and esophagus, leading to breathing and swallowing difficulties.
   b) Suspicion of thyroid cancer.
   c) An unsightly appearance of the neck.
3. Hyperthyroidism that cannot be treated with medication.

The thyroid has significant reserves for the production and secretion of thyroxine. Even after removal of half the gland, replacement is rarely necessary. Thyroxine replacement is required only when the entire gland is removed (total thyroidectomy).

– Blood tests for thyroid hormones and calcium, and detection of possible thyroid antibodies.
– Fine Needle Aspiration (FNA) biopsy, which may help with diagnosis.
– Thyroid ultrasound.

The procedure is done under general anesthesia. A horizontal incision about 5–6 cm is made in the lower mid-neck, where the gland is located. In a partial thyroidectomy, usually only one lobe (left or right) is removed, while in a total thyroidectomy the entire gland is removed. At the end of the surgery, a small plastic drainage tube is temporarily placed, and the wound is closed with absorbable sutures.

Calcium levels are monitored by blood tests the evening of and the day after the surgery. The patient is typically discharged about 24–48 hours after the operation.

In most cases, the operation is complication-free. However, as with any surgery, there are risks such as postoperative infections, bleeding, and anesthesia-related issues. More rarely, the following specific complications may occur:

• Scarring: The incision used for the procedure generally heals almost completely within a year. However, depending on the quality of the skin and the tendency to form scars, it may leave a visible mark.

• Hoarseness: The voice is usually unaffected by the surgery. However, the nerves controlling the vocal cords run just behind the thyroid (one on each side). Thus, there is always a small risk (around 1%) of nerve damage during surgery, regardless of the surgeon’s experience. If only one nerve is affected, hoarseness typically results, which is usually temporary and improves over time. If both nerves are damaged (a risk only in total thyroidectomy), this can lead to paralysis of both vocal cords, potentially affecting breathing. Fortunately, this is extremely rare.

• Calcium issues: The parathyroid glands, which regulate calcium levels in the blood, are very close to the thyroid. Sometimes these glands temporarily stop functioning after surgery, leading to low calcium levels in the blood. This can cause symptoms such as numbness in the hands, feet, and lips. In such cases, calcium and vitamin D supplements are given for a short period.

• Thyroxine replacement: If a total thyroidectomy is performed, lifelong thyroxine replacement in tablet form becomes necessary.

Source: British Thyroid Association (BTA)