Thyroidectomy

Thyroid surgery, also called thyroidectomy, is a surgical procedure wherein the thyroid gland or a part of the thyroid gland is removed.

It is done to treat various thyroid disorders like thyroid cancer, hyperthyroidism, thyroid nodule, or a goitre 

Thyroidectomy is used to treat thyroid disorders, such as cancer, a noncancerous enlargement of the thyroid (goitre) and overactive thyroid (hyperthyroidism).

Procedure

Based on your condition, the otolaryngologist (a surgeon who performs thyroid surgery) will take one of the following surgical approaches for your surgery:

1. Hemithyroidectomy (lobectomy thyroidectomy): The surgeon will remove one entire lobe and isthmus in this method. This method is performed for indeterminate nodules.
2. Total thyroidectomy: The surgeon will remove both lobes and isthmus in this method. This method is performed in cases of cancer.

What to expect before thyroidectomy?

1. When it is being performed for the removal of thyroid cancer, the surgeon and the oncologist discuss the need for radiotherapy with the patient.
2. Most patients require hormone replacement for the thyroid hormone after the surgery, so this aspect of post-surgery is discussed with the patient before the surgery.
3. The patient is usually prescribed Levothyroxine for the rest of their life.
4. Basic blood work, physical fitness, chest x-ray, or CT scan are done.
5. Complete medical history is taken, and any medication like blood thinners is stopped a few days before surgery. Patients who might be on antithyroid medication are advised suitably.
6. Pre-anaesthetic check (PAC) is done to assess the patient’s fitness to tolerate anaesthesia. Thyroidectomy is performed under general anaesthesia. 
7. The date for the surgery is decided, and the patient is informed of all the risks and possible complications associated with a thyroidectomy.
8. The patient is generally asked to fast for 6 to 8 hours before surgery.
9. The hospital stay is between 1 to 3 days.

What to expect on the day of thyroidectomy?

1. After being admitted to the hospital for the surgery, the patient and their kin have to sign a consent form explaining in detail the surgery and the associated risks, any complications encountered during surgery, and any adverse outcomes.
2. The patient is made to change into a hospital gown. Any jewellery, dentures, or other items are removed.
3. The patient is shifted from the pre-op area to the operation theatre.

What to expect during thyroidectomy?

1. Thyroidectomy usually takes about 2 hours.
2. The patient lies on their back and is given IV lines to receive medicine and IV fluids before, during, and after the procedure.
3. The surgical site is cleaned with spirit and betadine and then draped with an
4. aseptic cloth.
5. After this, the anaesthetist will administer the general anaesthesia while monitoring the patient carefully. The anaesthetist ensures that the patient is properly anaesthetised before starting the procedure.
6. A breathing tube (intubation) is placed in the patient’s windpipe to help them breathe during the surgery.
7. The patient’s vitals, such as pulse, respiratory rate, blood pressure, etc., are continuously measured during the procedure.
8. An incision is placed in the front of the neck. The thyroid gland is accessed, and the required part or all of it is removed.
9. The incision is closed with sutures. A surgical drain may be placed if required, and a healing dressing is placed over the sutures.
10. The removed gland tissue is sent to pathology for examination.

What to expect after thyroidectomy?

1. Following the surgery, the patient is made conscious again and moved to a recovery room.
2. The patient is monitored for their vitals, any post-surgical complications, and the wearing off of anaesthesia.
3. The most important post-surgical complication to watch out for is bleeding in the neck, which can lead to airway obstruction.
4. The patient is given pain medication as there is pain and tenderness at the incision site. The patient may also be given prophylactic antibiotics.
5. There may be some neck pain, hoarseness, or weakness in the voice. This is short-term and is caused due to a breathing tube being placed in the windpipe during the surgery.
6. Recovery from thyroidectomy usually takes two weeks.
7. Patients are given the following advice: 

                      Wait 48 hours to bathe after surgery.

                    Don’t rub the incision; pat on it gently. Sunscreen can be applied to the incision to minimise the scar. 

                    Avoid heavy lifting or strenuous activity.

                 Any previous medication that was stopped should only be resumed after consulting with the doctor.

              Eat a soft, regular diet.

First follow-up appointment 

1. The first follow-up appointment is after 10-14 days for the removal of sutures.
2. The patient should contact the doctor before that in case of any emergency or complication.

1. Bleeding in the neck is the biggest risk associated with thyroidectomy. It is rare, but patients should watch for signs such as difficulty in breathing, a high squeaky voice, or swelling in the neck that continues to get bigger.
2. Hoarseness of voice after a thyroidectomy is due to injury or handling of the recurrent laryngeal nerve during the surgery. It is also a rare complication and usually temporary; it recovers within 6 months. 
3. Hypocalcemia is due to lower than normal levels of calcium in the blood, and it happens after the thyroid surgery due to the removal of parathyroid glands. Patients experience numbness, tingling, or cramping. Oral calcium is given to correct hypocalcemia.
4. Infection or any sign of infection is a cause of concern and warrants a doctor’s consultation to make sure the recovery is smooth.