Thyroid Surgery
What is the Thyroid Gland
​
The thyroid gland is located at the front of the neck just below the larynx (or voice box).
​
It is butterfly-shaped and consists of two lobes located either side of the trachea (windpipe).
​
A normal thyroid gland is not usually visible at the front of the neck or able to be felt if finger pressure is applied to the neck.
The thyroid gland produces a range of hormones that regulate the body’s metabolic rate controlling breathing, heart rate, muscle strength, body temperature, digestive function, brain development, bone maintenance and many more functions.
Patients may have an overactive or underactive thyroid that can cause a range of symptoms. This is usually confirmed with a blood test (thyroid function test). The management of an overactive or underactive thyroid is usually performed by an endocrinologist. Referral to an endocrine surgeon usually implies that surgery may be required to address a problem e.g. symptoms from a large goitre or assess a suspicious nodule.
​
Types of thyroid surgery
Operations on the thyroid involve removal of half (hemithyroidectomy) or the entire gland (total thyroidectomy). The decision on the type of operation is generally determined by the pathology or indication for surgery. If thyroid cancer is proven prior to surgery, then sometimes some of the neck lymph nodes may need to be removed as well (neck dissection).
​
Thyroid surgery – Potential risks and complications
All surgeries carry risks and potential complications. Thyroid surgery risks may include:
​
Post operative bleeding
Bleeding can happen in any surgery but can be life threatening in neck surgery. For this reason, patients are sent post-op to a high dependency/ICU ward for close observation.
​
Damage to the recurrent laryngeal nerve (RLN)
This nerve is intimately related to the back of the thyroid gland. The RLN supplies muscles to the vocal cords and damage can cause a weak/ hoarse voice, difficulty coughing and swallowing. Identifying and protecting the RLN is one of the main focuses of thyroid surgery. The risk of temporary damage/ strain is 6%, and permanent damage is 0.5%.
Damage to the parathyroid glands (see parathyroid surgery)
This is only a major concern when having a total thyroidectomy. These glands are delicate and can be easily stunned/damaged in thyroid surgery due to their shared blood supply and close location to the thyroid gland. If they are damaged, the parathyroid hormone level can drop leading to low calcium levels. This can lead to numbness around the lips and severe muscle cramps. This is usually managed with calcium and vitamin D tablets but in severe cases may require an intravenous infusion, and regular blood tests.