Description

You will have general anesthesia (asleep and pain-free) for this surgery. Rarely, the surgery may be done with local anesthesia and medicine to relax you. You will be awake but pain-free.

Your surgeon may do the procedure through a surgical cut in your neck.

• Your surgeon will make a 3-inch to 4-inch cut in the middle of your neck, right on top of the thyroid gland. Then the surgeon will remove all or part of the gland.
• The surgery can also be done using a smaller surgical cut that is less than 2 inches long.
• Your surgeon will be very careful not to damage the blood vessels and nerves in your neck.
• Your surgeon may place a small tube (catheter) into the area to help drain blood and other fluids that build up. The drain will be removed in 1 or 2 days.
• Surgery to remove your whole thyroid may take up to 4 hours. It may take less time if only part of the thyroid is removed.

Why the Procedure is Performed

Your doctor may recommend thyroid removal if you have:

• A small thyroid growth (nodule or cyst)
• A thyroid gland that is so overactive it is dangerous (thyrotoxicosis)
• Cancer of the thyroid
• Noncancerous (benign) tumors of the thyroid that are causing symptoms
• Thyroid swelling (nontoxic goiter) that makes it hard for you to breathe or swallow

You may also have surgery if you have an overactive thyroid gland and do not want to have radioactive iodine treatment, or you cannot be treated with antithyroid medicines.

Risks

Risks from any anesthesia include:

• Reactions to medicines
• Breathing problems

Risks from any surgery include:

• Bleeding
• Infection

Risks for thyroid removal include:

• Injury to the nerves in your vocal cords and larynx. You may have problems reaching high notes when you sing, hoarseness, coughing, swallowing problems, or problems speaking. These problems may be mild or severe.
• Difficulty breathing. This is very rare. It almost always goes away several weeks or months after surgery.
• Bleeding and possible airway obstruction
• A sharp rise in thyroid hormone levels (only around the time of surgery)
• Injury to the parathyroid glands (small glands near the thyroid) or to their blood supply. This can cause temporary low levels of calcium in your blood (hypocalcemia).
• Too much release of thyroid hormone (thyroid storm). If you have an overactive thyroid gland, you will be treated with medicine.

Before the Procedure

You may need to have tests that show exactly where the abnormal thyroid growth is located. This will help the surgeon find the growth during surgery. You may have a CT scan, ultrasound, or other special imaging tests.

Your doctor may also do a fine needle aspiration to find out if the growth is noncancerous or cancerous. Before surgery, your vocal cord function should be checked.

You may also need thyroid medicine or iodine treatments 1 - 2 weeks before your surgery.

Before surgery, an anesthesiologist will review your medical history and decide what type of anesthesia to use. The anesthesiologist is a doctor who will give you the medicines that will make you sleepy and keep you pain-free during surgery. The anesthesiologist will also monitor you during surgery.

Fill any prescriptions for pain medicine and calcium you will need after surgery.

Several days to a week before surgery, you may be asked to stop taking drugs that make it harder for your blood to clot. These include drugs such as:

• Aspirin
• Clopidogrel (Plavix)
• Ibuprofen (Advil, Motrin)
• Naproxen (Aleve, Naprosyn)
• Warfarin (Coumadin)

You will probably be asked to stop eating or drinking at least 6 hours before surgery.

Ask your doctor which medicines you should still take the day of surgery.

If you smoke, try to stop. Your recovery time will be shorter if you do not smoke. Ask your doctor or nurse for help.

Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

You will probably go home the day after surgery. In rare cases, patients may spend up to 3 days in the hospital. You must be able to swallow liquids before you can go home.

Your doctor will probably check the calcium level in your blood after surgery. This is done more often when the whole thyroid gland is removed.

You may have some minor pain after surgery. Most patients are able to get up and walk on the day after surgery. It should take about 3 - 4 weeks for you to fully recover. Avoid the sun while the surgical cut is healing to prevent the skin from getting darker.

Outlook (Prognosis)

The outcome of this surgery is usually excellent. Most people will need to take thyroid hormone pills (thyroid hormone replacement) for the rest of their lives if the whole gland has been removed.

Alternative Names

Total thyroidectomy; Partial thyroidectomy; Thyroidectomy; Subtotal thyroidectomy

References

Hanks JB, Salomone LJ. Thyroid. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. St. Louis, Mo: WB Saunders; 2008:chap 36.

Lai SY, Mandel SJ, Weber RS. Management of thyroid neoplasms. In: Flint PW, Haughey BH, Lund VJ, Niparko JK, Richardson MA, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa: Mosby Elsevier;2010:chap 124.

Update Date: 5/6/2012

Reviewed by: Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.