Thyroid Surgery
Thyroid operations are performed through a collar-shaped incision in the front of the neck, low down. The incision is carefully located with both adequate exposure and the appearance of the final scar in mind. When possible, the incision is made in a fold in the skin so when a year passes it will be hard to see.
We do thyroidectomy under general anesthesia, and the patient usually stays in the hospital for up to two nights.
Depending on the individual problem, a complete or partial (hemi) thyroidectomy may be done. Occasionally, it’s not possible to say before the operation which it will be. Only the necessary operation is ever done.
The operation is standardized and is done commonly. Surgery in the area of the lower neck is a big part of our specialty, so ENT surgeons are very comfortable in this area. The unexpected can happen, and patients need to know some of the possibilities.
The most serious problem is bleeding in the neck after surgery, causing pressure on the airway. We operate under high magnification and are especially careful to stop all bleeding before we close up the operative space. Patients are monitored carefully with this possibility in mind. Sometimes we leave a pressure relief drain overnight just to be sure. This would be removed in 24 to 36 hours.
The nerves to the vocal cords . . . one on each side . . . run very close to the backside of the thyroid gland. They’re not always in the same place in every one. We look for them as we work and use electronic monitoring to help us to avoid damage to them. They are very fragile and damage can occur despite all our precautions. Occasionally, they’re involved in the process which led to the operation in the first place. Loss of one cord leaves a breathy voice and a tendency to choke on liquids. These effects are usually temporary and if they last for more than six to nine months there are ways of restoring voice surgically. This situation is very, very uncommon.
Damage to both vocal cords can result in the cords not opening during breathing. In these cases, it might be necessary to insert an unplanned tracheostomy, a long-term breathing hole below the cords. We’ve had no patients of mine ever require a tracheostomy after a thyroid operation. It’s a risk we work hard to prevent.
Finally, the surgical risks include possible damage to the parathyroid glands. The parathyroids are four peanut-sized glands on the four corners of the thyroid. We work to preserve all four. Any one of the four can do the work of all of them. If we should, by some chance, damage all four, changes in calcium metabolism can occur, and supplemental calcium will be necessary for life. We’ve never yet seen this happen to my patients who have benign diseases.
When the entire thyroid is removed, thyroid replacement medicine will be necessary for life. When this situation is managed with the help of the endocrinologist, there are no long-term problems for the patient besides the need to take a daily dose of thyroid hormone.