Thyroid Disease & Surgery

The thyroid gland, located in the neck just below the larynx, regulates the body’s energy levels, releasing hormones to regulate metabolism. Thyroid hormones influence virtually every system in the body, regulating the rate at which organs function, as well as the body’s consumption of oxygen and production of heat. When hyperthyroidism, the production of too much thyroid hormone, occurs, and cannot be adequately controlled with medication or other treatment, thyroid surgery is necessary.

Reasons for Thyroid Surgery

Thyroid surgery is used to treat a variety of thyroid conditions such as thyroid cancer, thyroid nodules, or Graves’ disease, an immune disorder that results in hyperactivity of the gland. When the thyroid gland produces too much thyroid hormone for any reason, the condition is called hyperthyroidism. Hyperthyroidism results in the speeding up of the body’s metabolism. This increased metabolic rate can have serious medical consequences, resulting in any or all of the following symptoms:

  • Goiter, enlargement of the thyroid gland
  • Rapid heartbeat
  • Unexplained weight loss
  • Diarrhea or frequent bowel movements
  • Irritability, anxiety
  • Intolerance to heat
  • Visual problems
  • Menstrual irregularities
  • Infertility

Surgery is rarely necessary to treat hyperthyroidism unless there is either a suspicion of cancer, a benign nodule that has grown large enough to interfere with swallowing or breathing, a cyst on the gland that refills after drainage, or if hyperthyroidism treatment with medication or radioactive iodine alone is not effective. Another reason for surgery is pregnancy, since it may not be safe for a pregnant woman to take the necessary medications or treatment.

Thyroid Surgery Procedures

There are several types of thyroid surgery, all involving partial or total removal of the gland. Which surgery is performed depends on the reasons for the procedure. The types of surgery for thyroid disease include:

  • Biopsy, removal of a tissue sample for microscopic examination
  • Lumpectomy, removal of a small diseased part of the thyroid gland
  • Lobectomy, removal of one lobe and the isthmus which connects the lobes
  • Subtotal Thyroidectomy, removal of one lobe, the isthmus, and part of the second lobe
  • Total Thyroidectomy, removal of the entire gland and the surrounding lymph nodes

Depending on several factors, especially how extensive the necessary procedure will be, the operation may be performed traditionally or with a minimally invasive video-assisted, sometimes robotic, procedure. The patient will have a breathing tube in the throat during surgery and a drain may remain in the neck for 12 hours after the procedure. The length of the surgery depends on how much needs to accomplished. Minimal operations may be performed outpatient, while for more complex surgeries the patient may be hospitalized for a night or two.

Recovery from Thyroid Surgery

After the operation, the patient’s throat will be sore due to the breathing tube inserted during surgery. While most patients are able to return to their normal activities in one day or several, depending on the extent of the surgery, strenuous activities, such as heavy lifting or vigorous sports, must be avoided for at least 10 days after the operation.

Most thyroid surgeries are very successful, but the majority of patients develop hypothyroidism as a consequence of the procedure. This will require ongoing treatment with hormone therapy, but is not usually problematic. The patient may also need follow-up treatment with radioactive iodine to shrink thyroid tissue either because hyperactivity of the gland continues to be an issue or in order to stem the growth of a thyroid cancer.

Parathyroid Disease & Surgery

The parathyroid glands are four small glands located behind the thyroid that regulate the calcium level in the blood. By controlling the amount of calcium in the body, the parathyroid glands control the strength and density of the bones, as well as other systemic functions. The most common reason for a parathyroidectomy, during which one or more of the parathyroid glands is removed, is the presence of a small benign tumor, known as an adenoma. The adenoma causes an overproduction of parathyroid hormone (PTH), resulting in hyperparathyroidism, an imbalance that can cause uncomfortable and serious symptoms.

The Parathyroidectomy Procedure

The surgery is performed and may take between 1 and 3 hours depending on its complexity.  Typically a small incision is made in the lower central neck.  Preoperative testing guides the surgeon to the likely location.

Even if the surgery is extensive, some parathyroid tissue is left in place to maintain normal function of the glands’ function and prevent hypoparathyroidism (decreased parathyroid activity and thus low calcium levels).   Most patients can now have this surgery as an outpatient and go home the same day.

While once a parathyroidectomy required a long incision, this surgery can now be performed with a much smaller incision.  Following removal of the suspect parathyroid gland, the patients blood is drawn for what is called “Rapid PTH” level.  Based off of reserarch we know that an appropriate drop in abnormal PTH (parathyroid hormone) level confirms the suspect gland has been removed.

Recovery from Parathyroidectomy

Recovery from a parathyroidectomy is typically uneventful. Most of the time, patients return home the same day as the procedure. Patients may experience numbness or tingling around the mouth for a day or two, the result of a low blood calcium level. After taking calcium supplements regularly, this symptom will abate, but they are limited soft foods for the first 24 hours after surgery. While they can resume normal activities within a day or two, they may not fully heal for up to 3 weeks.

After having had a parathyroidectomy, patients must have routine blood tests to check their calcium levels. In a certain percentage of cases, further surgery may be required at a later date.