Types of Thyroid Surgery
Thyroid surgery is usually recommended if there is suspicion or diagnosis of cancer, the thyroid gland is so enlarged (“goiter”) that causes compression of the food pipe (esophagus) causing difficulty swallowing or if it causes compression and displacement of the wind pipe (trachea) resulting in difficulty breathing, or if a benign (noncancerous) thyroid cyst or solid nodule is very large and cannot be drained with a needle or shrunk with medication.
In addition, some times in inflammatory diseases of thyroid that does not respond to antithyroid medications or the patient is reluctant to undergo radioiodine therapy (nuclear radiation to the thyroid gland) such as in Grave’s Disease, thyroid surgery is indicated and recommended as an alternative treatment.
The extent and the type of thyroid surgery vary a great deal and are dictated by the type of the thyroid condition and the extent of the disease.
In case of thyroid cancer that has spread (metastasized) to the lymph nodes of the neck lateral to the thyroid around the jugular veins, a “modified neck lymph node dissection” is indicated in order to remove all the disease bearing lymph nodes. By doing so, chances of recurrence and persistence of thyroid cancer is significantly reduced.
In other times, when there are multiple nodules on both sides of the thyroid, but they are not malignant (cancerous) a “subtotal thyroidectomy” is performed which removes most of the thyroid tissue from both sides leaving a small but normal thyroid tissue behind.
Thyroid surgery is most of the time performed under general anesthesia with the plan to stay overnight after surgery. You may need to stay one or two nights after surgery at the hospital for routine post surgical observation and recovery. You will be directly under Dr. Babajanian’s care. Your care will be also monitored, from the medical standpoint, by your primary care physician, either the internist or the endocrinologist. The medical/surgical team will follow you closely during your stay at the hospital.
You can expect to have a sore throat on swallowing after surgery which generally resolves fully within 1-3 days after surgery. The amount of pain is generally mild to moderate and you will be able to talk and swallow and walk around in the evening of surgery. We encourage early mobilization after surgery to minimize postoperative complications and particularly since thyroid surgery is not debilitating and recovery from it is generally fast.
After discharge from the hospital we will continue to be available to you directly at all times until you return to our office for your postoperative first visit usually one week after surgery. Most of the time there are no sutures to remove, and if there is a superficial skin suture, it will be removed at that time. By that time, you can expect to return to full activities including resumption of athletic and outdoor activities and return to work.
Thyroid surgery in most cases is quite successful to cure the disease both in benign and malignant cases of thyroid tumors. The extent of surgery and the success rate of cure, as well as incidence of potential complications, depend on the extent of the disease and the extent of the performed surgery. More extensive surgery is performed in more advanced cases. In a minority of very advanced cases of thyroid cancer, cure may not be achievable. In other cases of thyroid cancer, after surgery, you may need to take radioiodine treatment for further improvement of cure and prevention of recurrence. This treatment is given under the supervision of your endocrinologist who will coordinate his care with the Nuclear Medicine physician. After total thyroidectomy you will need to take a thyroid hormone in the form of a tablet to replace your body’s need for that vital hormone. Patients generally do well after thyroid surgery on the replacement medication, rapidly stabilizing the amount of the medication needed. There are no significant long term problems associated with thyroid surgery.
Risks & Complications
Thyroid surgery generally is a safe procedure with low rate of complications. The nerves controlling your voice and swallowing can be damaged during thyroid surgery resulting in temporary or permanent hoarseness, or a change in voice and swallowing. To reduce this risk, we often utilize a nerve monitoring endotracheal tube for anesthesia which simultaneously allows us to monitor any movement of the laryngeal muscles during the surgery.
Nerve monitoring is particularly helpful in revision thyroid surgery and in surgical procedures involving extensive thyroid cancer or large goiters when there is higher risk to the laryngeal nerves.
In addition, bleeding may occur after surgery which may result in acute respiratory distress necessitating rapid return to the operating room.
The surgical scar after thyroid surgery is generally small, and relatively invisible. Particularly with minimally invasive thyroid surgery, gentle handling of the surrounding normal tissues and strict adherence to proper surgical technique, the scar after thyroid surgery has improved dramatically over time. The scars are rarely disfiguring.