Thyroidectomy

The following information is for patients undergoing an operation to remove the thyroid gland.

Your time in hospital

You will be in the hospital for usually 2-3 days. You will be assessed on the ward the week before your operation. This allows us to make sure that you are fit for an operation, to do a pre-operative blood test and to make a routine check on your vocal cords (this is done by passing a fine telescope down your nose under local anaesthetic). It also allows you to meet the junior doctors and nurses who will be looking after you during your stay on the ward. The anaesthetist, who is the doctor that will put you to sleep for the operation, will also review you. If your thyroid gland has been over-active, you will remain on your usual anti-thyroid medication. After your assessment you will be allowed home and you will then come into the ward on the day of your operation, having fasted (nothing to eat or drink) from midnight the night before.

The operation itself

The operation on the thyroid is done through an 8 cm skin crease incision across the front of the neck. The surgeon will either remove one half of the thyroid (called a thyroid lobectomy) or remove the whole thyroid (called a total thyroidectomy), depending on the abnormality of the thyroid gland. The wound gradually fades away over a period of months and usually ends up hardly being noticed at all.

After your operation

The operation itself normally takes 1-2 hours. Following the operation you are kept in the theatre recovery area for around 3-4 hours and then returned to the ward. When you wake up, there will be a little drain in your neck with a dressing around it, and a drip in your arm. You will be allowed to drink the same night and the following morning the drip and the drain will be removed. You are encouraged to be as active as possible. If your gland has been over-active, then the anti-thyroid medication is stopped. Depending on the type of operation that was done on your thyroid, you may be started on thyroxine therapy - this is a natural hormone that replaces the job of the thyroid gland. Usually on the second day, after your operation, you will be allowed home. There will be one stitch under the skin, which will be removed by your GP’s nurse, five days after the operation. After a few weeks you can massage some cold cream, such as Astral or Nivea, into the wound, to help keep it supple. You are advised to avoid direct sun on your wound for at least six months after your operation.

Your follow-up appointment

You will normally be reviewed in the endocrine outpatient clinic approximately six weeks after your operation, when the surgeon will review you. At this review you will have a blood test to check the function of the thyroid and to go over the results of the pathology of the thyroid gland. Follow-up thereafter will depend on the pathology of the thyroid but most patients will eventually be registered with SAFUR, a computer-organised system that automatically ensures that you get your thyroid blood tests checked by your GP at various intervals for the rest of your life.

Any operation can have potential risks

Any operation can have potential risks, and there are a few risks that you should know about: -

¨ There is about a 1% chance of damage to the nerve that controls your voice-box, which can leave you hoarse. Most patients are a little husky after the operation, but this is caused by having an operation on your neck and having a tube placed down your throat for breathing and usually settles after a few weeks.

¨ There is about a 5% chance of damage to your parathyroid glands. These are four little glands next to your thyroid, which control the blood calcium. We will perform routine blood tests after your operation to make sure that the blood calcium level is normal. If the blood calcium level is low, then we will start you on calcium tablets. The chance of needing calcium tablets at one year after the operation is about 1%.

¨ There is around a 5% chance of an infection in your wound, the vast majority of which can be controlled by an antibiotic.

¨ There is about a 3% chance of significant wound bruising, which causes some swelling of the wound.

¨ You may require to go on thyroxine treatment following surgery, depending on how much of the thyroid is gland is removed. If all or nearly all the gland is removed, then you will need thyroxine therapy on a long-term basis. If you have only half the gland removed (the operation is called a thyroid lobectomy) then the chance of needing thyroxine treatment is about 5%. Some conditions of the thyroid gland may require that you go on thyroxine, but that would be decided on an individual basis. As we have already said, thyroxine is a natural hormone that replaces the function of the thyroid gland, and is not a drug as such.

This information goes some of the way in answering a lot of the most common questions that we get asked by patients undergoing a thyroid operation. However, you may have specific questions about the operation and we will be more than happy to answer your questions when you are admitted to hospital.

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Ó NHS Tayside; 2006; version 1.0

Disclaimer; no liability whatsoever is accepted for information given and all such information, especially with regard to drug usage (UK version provided), must be checked with a person’s health provider.