THYROIDECTOMY

Summary

The thyroid is a butterfly-shaped gland at the base of your neck. This gland regulates the metabolism by secreting hormones. When diseases affect the thyroid, its size or activity may become abnormal, causing too much or too little thyroid hormone to be made. This causes havoc with the body leading to weight gain or weight loss, fatigue, heat or cold intolerance, irritability and increased heart rate.

A thyroidectomy is a surgical procedure done to remove the thyroid gland. It is often done as treatment for thyroid cancer, a non-cancerous enlargement of the thyroid (goitre) or nodules on the thyroid gland. It is also used for the treatment of an overactive thyroid (hyperthyroidism) particularly for pregnant women and young children or hyperthyroidism that doesn’t respond to non-surgical treatment methods, i.e. anti-thyroid drugs or radioactive iodine.

How much of your thyroid gland is removed during thyroidectomy depends on the reason for surgery. In some cases the entire gland is removed, other times only half of the thyroid gland or only the lobes of the gland need to be removed.

Reasons for thyroid surgery

  • Treatment for thyroid cancer
  • To remove an enlarged thyroid (goitre)
  • To remove multiple suspicious thyroid nodules
  • As treatment for an overactive thyroid (hyperthyroidism) when non-surgical treatments have not been effective

Types

1Total Thyroidectomy
A total thyroidectomy is done to remove the entire thyroid gland. It is often done for thyroid cancer, particularly aggressive cancers, such as medullary or anaplastic thyroid cancer. A total thyroidectomy is also used for enlarged thyroid glands (known as a goitre) or as a treatment for Graves disease and overactive thyroid (hyperthyroidism).

The entire thyroid is usually removed laparoscopically when possible. This involves small incisions in the front of the neck. Through these tiny holes, a laparoscope is inserted. This tool is fitted with a camera to allow Dr Kavin to visualise the thyroid gland properly. Through other small incisions, tools are inserted to dissect the gland and remove it.

When done for thyroid cancer, the nearby lymph nodes may also be removed to prevent cancer from spreading.
2Subtotal/Partial Thyroidectomy
A subtotal or partial thyroidectomy is the removal of only half of the thyroid gland. This is usually done for small and non-aggressive cancers of the thyroid such as follicular or papillary cancer, contained to one side of the gland. When a subtotal or partial thyroidectomy is performed, typically, surgeons perform a bilateral subtotal thyroidectomy which leaves from 1 to 5 grams on each side/lobe of the thyroid. A Harley Dunhill procedure is also popular, in which there's a total lobectomy on one side, and a subtotal on the other, leaving 4 to 5 grams of thyroid tissue remaining.
3Thyroid Lobectomy
This involves the removal of only a single lobe of the thyroid, about one-quarter of the gland. This is often done when the when a diagnosis of cancer is not known. Once a final diagnosis is found, a total thyroidectomy may be done if needed.

The issue of a subtotal/partial, vs total thyroidectomy is controversial. Some surgeons prefer to perform a partial thyroidectomy whenever possible, believing that they will leave behind enough thyroid tissue to prevent hypothyroidism. (A total thyroidectomy has nearly a 100 per cent chance of causing hypothyroidism).

The risk of hypothyroidism with subtotal thyroidectomy is, however, quite high, and some experts say that more than 70 per cent of patients receiving a subtotal thyroidectomy will become hypothyroid. Since one of the main reasons for subtotal thyroidectomy is to prevent hypothyroidism, and that goal is achieved in only a minority of cases, experts increasingly believe that there is no added benefit to subtotal thyroidectomy, and are more routinely recommending a total thyroidectomy.

Preparation:

In most cases, surgery of the thyroid is not highly complicated and usually takes no more than two hours. Removal of half of the thyroid takes 45 minutes to an hour, so if the entire gland is being removed, the surgery will last about an hour and a half.

Check with your surgeon about medications you are taking, and what you should/shouldn't take in the days prior to surgery.

You will be asked to check into the hospital the morning of your surgery. Typically, your surgeon will ask that you refrain from eating or drinking after midnight the night before surgery.

Recovery:

You can expect a sore, hoarse throat after surgery. You may also have neck pain and difficulty chewing and swallowing for a few days. You will have a drain placed in the incisions to drain excess fluid. This will remain in place for 24 hours. You may be discharged after a night of observation in the hospital. Depending on the extent of the operation, patients may need to take the drug levothyroxine, an oral synthetic thyroid hormone.

Risks:

In the hands of an experienced thyroid surgeon, thyroid surgery is a safe procedure with few complications.

The main risks of thyroid surgery include:

  1. Bleeding in the neck:

As with any operation, there is always a chance of bleeding. The average blood loss for this operation is less than a tablespoon, and the chance of needing a blood transfusion is extremely rare. However, bleeding in the neck is potentially life-threatening because as the blood pools, it can push on the windpipe or trachea, causing difficulty breathing. Fortunately, in the hands of New York Thyroid Center surgeons, the risk of bleeding is less than 1%. Due to this rare risk of bleeding, patients are observed for 6 hours by our highly trained recovery room staff. If there is no sign of bleeding and the patient feels well, he or she may go home. Once at home, patients and their friends/family should watch for signs such as difficulty breathing, a high squeaky voice, swelling in the neck that continues to get bigger, and a feeling that something bad is happening. If any of these symptoms happen, the patient should call 911 first and then their surgeon.

  1. Hoarseness (Recurrent laryngeal nerve injury):

There are two nerves called the recurrent laryngeal nerves that run just behind the thyroid. These nerve control the vocal cords. If one of these nerves is injured, the voice may become hoarse. The chance of having temporary hoarseness is 3%, and the chance of having permanent hoarseness is less than 1%. Temporary hoarseness usually gets better within a few weeks but can take up to 6 months to resolve. Even in the rare chance of having a permanently hoarse voice, there are things that can be done to improve or fix the voice.

  1. Hypocalcemia (Hypoparathyroidism):

The parathyroid glands are 4 small, delicate glands each the size of a grain of rice that sits behind the thyroid and controls the blood calcium levels. If all 4 glands are injured or removed during the operation, the blood calcium levels can become lower than normal called hypocalcemia. Hypocalcemia can cause symptoms such as numbness and tingling (especially around the lips and in the hands and feet) as well as cramping and even "locking" of the hands and feet. The risk of having a temporarily low blood calcium level is about 5%, and the risk of having a permanently low blood calcium level is less than 1%. It is important to note that numbness and tingling may be caused by something other than a parathyroid problem. If a patient has symptoms caused by low blood calcium, the surgeon may prescribe extra calcium and a vitamin D supplement.

Other risks of thyroid surgery include wound infections and seromas. Wound infections happen in about 1 out of 2000 operations (far less than 1%), and because of this low risk, the routine use of antibiotics is not needed. A seroma is a collection of fluid under the incision. Seromas happen rarely and usually disappear within a few weeks.

Hospital

Operating from the new state-of-the-art, multi-disciplinary facility equipped with only the most advanced medical technology,

Equipment

As one of only two such robots in the Western Cape, Dr Kavin operates from a hospital boasting Robotic Surgery capabilities,

Technique

As a surgeon with adept skill in minimally invasive techniques, Dr Kavin opts for laparoscopic keyhole surgery whenever possible.

Expertise

Dr Bruce Kavin is a General Surgeon with particular expertise in Endocrine, Colorectal and Gastrointestinal Surgery and Surgical Oncology.

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