Thyroidectomy

Published by Bupa's Health Information Team, July 2011.

This factsheet is for people who are having a thyroidectomy, or who would like information about it.

A thyroidectomy is an operation to remove all, or part, of the thyroid gland. It's used to treat several conditions, including overactive thyroid (hyperthyroidism).

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About thyroidectomy

Your thyroid gland is found at the base of your neck, in front of your windpipe. It's an endocrine gland, which means that it releases hormones into your bloodstream. Hormones are chemical messengers that help regulate your body's functions. Thyroid hormones work together to control your metabolism (the speed of your body's processes).

A thyroidectomy is an operation to remove all, or part, of your thyroid gland. If all of your thyroid gland is removed, it's called a total thyroidectomy. If only part of it is removed, it's called a partial thyroidectomy, a sub-total thyroidectomy or a lobectomy.

A thyroidectomy is used to treat several conditions, including:

• an overactive thyroid gland (hyperthyroidism) – a condition where your thyroid gland produces and releases excess hormones
• an enlarged thyroid gland (goitre)
• cancer of your thyroid gland
• a cyst or benign (non-cancerous) lump on your thyroid gland

What are the alternatives to thyroidectomy?

An overactive thyroid gland can be treated with medicines. It can also be treated with radioactive iodine, which you take as one dose – either a tablet or a drink – and that works by slowly destroying your thyroid tissue. Radioactive iodine treatment isn’t suitable for pregnant women.

Cancer of the thyroid gland can sometimes be treated with radiotherapy or chemotherapy instead of surgery.

Preparing for thyroidectomy

Your surgeon will explain how to prepare for your thyroidectomy. For example if you smoke, you will be asked to stop, as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

If you have an overactive thyroid gland, you may be given some medicine, such as carbimazole, to take before your operation. This will slow down the production of thyroid hormones. You may also be given some medicine containing iodine to take for 10 to 14 days before your operation. This will reduce the size of your thyroid gland and its blood flow, helping to make the operation easier.

Your surgeon may arrange for you to have your vocal cords checked by another specialist surgeon before the operation. This is because the nerve that controls your vocal cords is at a slight risk of damage during the surgery. Usually, the surgeon will pass a narrow, flexible, tube-like telescopic camera through your nose to look at the movement of your vocal cords.

The operation is usually done under general anaesthesia. This means you will be asleep during the procedure. If you're having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your surgeon's advice.

At the hospital, your nurse may check your heart rate and take a sample of urine and blood to test.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anticlotting medicine called heparin as well as, or instead of, wearing compression stockings.

Your surgeon will discuss with you what will happen before, during and after your thyroidectomy, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to your thyroidectomy. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during a thyroidectomy

Once the anaesthetic has taken effect, your surgeon will make a cut into your lower neck. If you already have a crease in your lower neck, the cut will be made here so any scarring is less prominent. Your surgeon will remove all, or part, of your thyroid gland and close the cut with stitches or surgical clips.

What to expect afterwards

You may need to rest until the effects of the anaesthetic have passed and you may need pain relief to help with any discomfort as the anaesthetic wears off.

When you wake up from the operation you will have a drip providing you with fluids, probably going into a vein in the back of your hand. You may have a catheter to drain urine from your bladder into a bag. You may also have fine tubes running out from the wound. These drain fluid into another bag and are usually removed after a day or two.

You may have some pain and stiffness in your neck. If you're in a lot of pain, let your surgeon or a nurse know and he or she will give you some painkillers.

You can usually go home one or two days after your operation. Sometimes, you may have the operation as a day case. This means that you don't have to stay overnight in the hospital. You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours after your thyroidectomy.

General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon's advice.

If you had surgical clips to close the wounds in your neck, these will be removed before you go home. A nurse will usually remove the stitches in your neck a few days after the operation. If you have dissolvable stitches, the length of time it takes for them to disappear depends on the type of stitches you have. However, for this procedure, they should usually disappear in about two to three weeks, although it can sometimes take longer.

Recovering from a thyroidectomy

It usually takes a few weeks to make a full recovery from a thyroidectomy, but this varies between individuals, so it's important to follow your surgeon's advice. You should be able to carry out your usual activities once you're home, but don't overdo it. Avoid any strenuous activities and lifting for the first few weeks.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

You may find it uncomfortable to swallow for a few days after your operation. It might be helpful to eat soft foods during this time.

If all of your thyroid gland was removed, you may be given hormone replacement medicine to take. This will replace the hormones that your thyroid gland used to make.

Your surgeon or nurse may give you an information sheet about exercises that you can do to help reduce the stiffness in your neck. You will need to do these exercises until you can move your neck as well as you could before the operation.

What are the risks?

As with every procedure, there are some risks associated with a thyroidectomy.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.

You will have a scar after the operation and it may feel a little tight or swollen to begin with. You may also have some pain and stiffness in your neck.

Complications

Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT). We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

The possible complications of a thyroidectomy are listed here.

• The nerve to your voice box (larynx) could be damaged during the operation, giving you a hoarse voice. This will usually get better on its own. For a very small number of people this may be permanent.
• Your parathyroid glands could be damaged during the operation. You will be tested for this the day after your surgery if you have had a total or partial thyroidectomy. If this happens, you may need to take calcium replacement medicine. You may also need to take vitamin D supplements.
• If there is a lot of bleeding, you may need further surgery. This is very rare.
• Your wound may become infected. If your neck becomes increasingly red, swollen or painful, or there is discharge coming from your wound, contact the hospital or your GP. Infections can usually be treated with antibiotics.
• There is a risk you may develop a condition called 'thyroid storm' during or after the surgery. This is when your thyroid glands release excessive amounts of hormones, and may cause your heart to beat irregularly or your heart rate to change. Your body may also overheat. Without treatment it can be fatal, but this is a rare complication and your surgeon will monitor you.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.