Thyroidectomy Treatment

A thyroidectomy is a surgical procedure to remove your thyroid gland. Depending on your condition, either half (hemithyroidectomy) or all (total thyroidectomy) of your thyroid is removed. If the entire thyroid is removed, you will need to take daily thyroid hormone (thyroxine) replacement medication following the surgery, usually a tablet or two of thyroxine every day half an hour before breakfast. 

Patients who require thyroid surgery usually have one of more of the following:

1. A big thyroid (goitre), or a thyroid nodule causing symptoms.
2. Thyroid cancer.
3. A nodule that is suspicious for cancer.
4. Hyperthyroidism (an overactive thyroid gland).

Thyroid surgery is done under general anaesthesia (GA) to ensure your comfort. The recurrent laryngeal nerve is monitored throughout the operation. If a total or completion thyroidectomy is performed, a blood test to check the calcium and PTH levels, is done later the same day and the following morning. Most patients undergoing thyroid surgery will stay overnight in hospital and take one to two weeks to recover. Most patients do not find the post-surgery recovery particularly painful but may find it uncomfortable.

An incision is placed in a skin crease on the neck, resulting in a less-visible scar. Usually, after a while, the scar is difficult to see. 

Dr. Francis Hall has performed hundreds of thyroid operations and takes the utmost care to avoid injury to surrounding neck structures during surgery. However, all surgery carries some risk. Complications are very uncommon (about 1-2%). 

Some important complications to be aware of include:

As with any operation, bleeding may occur. However, this is an uncommon complication (1-2%), after thyroid surgery. If bleeding occurs you will need to go back to theatre to have the bleeding controlled.

Two nerves, the recurrent laryngeal nerve, and the external branch of the superior laryngeal nerve, are near the thyroid gland.  If either nerve is injured, the patient will experience some hoarseness of the voice. Dr. Hall is especially careful to protect these nerves during the procedure, and routinely uses recurrent laryngeal nerve monitoring, and the harmonic scalpel, to avoid such complications. 

Four tiny glands called parathyroid glands, are also located near the thyroid gland. Each parathyroid gland is about the size of a grain of rice. The parathyroid glands control the level of calcium in the blood. There is no risk of a low calcium level if only half the thyroid is removed (hemithyroidectomy). If the entire thyroid is removed (total thyroidectomy or completion thyroidectomy) then there is a chance that all four parathyroid glands or their tiny blood vessels could be injured.

Two blood tests are performed during the 24 hours following total thyroidectomy, to check the calcium and parathyroid hormone levels. Some patients may experience low calcium levels (hypocalcaemia) and calcium supplements will be required, usually this is temporary. Patients with a slightly low calcium level may have no symptoms. If the calcium level is very low, patients develop muscle cramps and spasms. Numbness around the mouth and in the fingers may also occur. These symptoms are alleviated with calcium tablets and calcitriol tablets (an active form of vitamin D).

Usually, the pathologist sends a typed signed report to Dr Hall about one to two weeks after the operation. Occasionally it may take the pathologist longer to issue a report either because of the complexity of your case or because of high workloads. Dr Hall will contact you by phone or text once he receives the pathologist’s report. He will advise you what the next step is to manage your condition. 

Dr. Hall and Thyroid Surgery

Dr Hall has performed hundreds of thyroid operations. He routinely uses recurrent laryngeal nerve monitoring and the harmonic scalpel. He attends the monthly regional thyroid multidisciplinary meeting at Middlemore Hospital where patients with thyroid cancer are discussed. He has spoken at national and international meetings, on thyroidectomy and thyroid cancer, and has several articles on thyroid cancer in peer reviewed international journals.