Michel Babajanian, MD, FACS
Otolaryngologist & ENT located in Century City, Los Angeles, CA
Thyroid problems can cause an array of health issues for patients. Because the thyroid powers so many systems throughout the body, it is important to have a thorough checkup to ensure everything’s running smoothly. Visit Dr. Michel Babajanian, a board-certified otolaryngologist and ENT practicing in Century City, at the first sign that something is wrong. As a surgical thyroid expert, he’ll help diagnose the problem and set up an individualized treatment plan, which may include surgery.
Thyroid Surgery Q & A
The thyroid gland is one of the endocrine glands of the body, which secretes hormones that have vital regulatory role in metabolism of the body. The thyroid gland is located in the lower midline portion of the neck immediately in front of the voice box and the windpipe. Thyroid gland frequently develops cystic or solid growths within itself that in majority of instances are non-cancerous (benign) and do not require surgical removal. In minority of cases, however, the growth inside the thyroid gland may be malignant and in those cases, the primary treatment is thyroidectomy (removal of the thyroid gland). In those circumstances where the diagnostic tests such as ultrasound or fine needle aspiration biopsy (sampling of a few cells from the growth using small needles under local anesthesia and examining them under the microscope) do not definitively diagnose the growth as malignant or benign, and if malignancy is suspected, partial thyroidectomy is performed, removing only the portion of the thyroid gland containing the suspicious tumor, so further pathology testing and evaluation can be performed on the removed tissue. Every attempt is made to perform minimally invasive surgery through very small and almost invisible incisions when appropriate criteria are met. We also use intraoperative laryngeal nerve monitoring to minimize surgical risks such as vocal cord paralysis. Recovery from thyroid surgery is generally well tolerated and easy. The downtime is quite short ranging around a few days. As thyroid surgeons we work closely with endocrinologists, internists, radiologists and pathologists to coordinate and optimize the care of our patients.
Types Of Thyroid Surgery
Most thyroid conditions such as overactive thyroid (“hyperthyroidism”), underactive thyroid (“hypothyroidism”) and inflammatory thyroid diseases (“thyroiditis”) do not need surgery. However, under certain circumstances a portion or the entire thyroid gland may need to be removed by 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 windpipe (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.For known benign (noncancerous) tumors that are confined to one lobe, only that lobe of the thyroid is removed in an operation called “thyroid lobectomy” or “hemithyroidectomy”. If thyroid cancer is diagnosed definitively, usually a “total thyroidectomy” is the minimum operation during which the entire thyroid gland is removed. In such cases, often times, the lymph nodes around the thyroid, in the center compartment of the neck is also removed surgically in an operation called “central compartment lymph node dissection”.
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, depending on its extent which is unique for every case, may take from 30 minutes for a simple biopsy to several hours for total thyroidectomy and neck lymph node dissection as necessary. Surgery is always performed tailored to the patient’s specific needs and the preoperative diagnostic findings. We firmly believe in patient’s informed and educated participation in the preoperative discussion and decision making regarding surgery. The date of the surgery is scheduled by our office staff by mutual agreement.
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.
Sometimes, as a result of damage to the parathyroid glands and their blood supply, which are located directly on or within the thyroid gland, the patient may develop low blood calcium (hypocalcemia) which is due to reduced production of the parathyroid hormone (hypoparathyroidism). Replacing the calcium deficit corrects the problem and this complication is rarely long-term. Other surgical complications include infections, formation of hematoma (blood under the skin) or seroma (collection of fluid under the skin).
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.
Thyroid Surgery FAQs
CANDIDATES FOR SURGERY:
Most thyroid disorders and conditions do not require surgery. A series of medications are available to treat a variety of thyroid conditions.
Hypothyroidism (underactive thyroid gland) is treated successfully by replacing the hormone deficiency with a synthetic equivalent of the natural thyroid hormone.
Hyperthyroidism (overactive thyroid gland) is also treated with a variety of medications and in some cases, like Grave’s Disease, by radioactive iodine therapy.
In addition, many inflammatory diseases of the thyroid gland, known as thyroiditis, are treated with anti-inflammatory medications, and in most cases remission and cure of the disease is the expected outcome.
Those patients who are referred to Dr. Michel Babajanian for thyroid surgery generally either have a known or suspected malignancy (cancer) of the thyroid gland, or have thyroid nodules or tumors that continue to grow in size despite conservative medical treatment and observation. In cases of known cancer of the thyroid gland, during the same surgery, lymph nodes of different anatomic sites of the neck may need to be removed as well.
In addition, those patients who have progressively enlarging multinodular goiters (abnormally enlarged thyroid glands), which result in compression and difficulty with breathing, swallowing or speech, are also suitable candidates to undergo surgery. Finally, some cases of hyperthyroidism which do not respond to medical and conservative treatment, or if the patient desires to avoid exposure to radioiodine