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PatientInformationLeafletT1

ThyroidOperationsinAdults

RecurrentLaryngealnerve‘Voicenerve’

Thyroidgland

Parathyroidglands

Clavicle‘Collarbone’

Sternum‘Breastbone’

SuperiorLaryngealnerve

Larynx’Adam’sapple’

Whatisthethyroidglandandwhatdoesitdo?

Thethyroidglandisasmallorganthatsitsintheneckinfrontofthewindpipe

(trachea),belowtheAdamsApple.Itconsistsoftwohalves(leftandright

thyroidlobes)joinedbyacentralbridge(thyroidisthmus)anditsshape

resemblesabutterfly.Inhealthyadultseachlobe,leftandright,measures

around3-4cminheight,1-2cminwidthand1-1.5cmindepth.Anadultthyroid

glandweighsaround15-25g.Thethyroidglandsecretesthyroidhormones

(calledT3andT4)thataffectthebody’smetabolismandarevitalforthebodyto

functionnormally.

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ReasonswhypatientsmayneedthyroidsurgeryThyroidsurgeryinvolvesremovingpartorallofthethyroidgland,andmaybe

performedforthefollowingreasons

• Increaseinthesizeofthethyroidgland

- Anyincreaseinsizeofathyroidgland,fromanycause,iscalleda

goitre

- Growthofthethyroidglandmaycausecompressiononthe

windpipe(trachea)orthegullet(oesophagus).Inthisscenario

yoursurgeonmayrecommendthyroidsurgery

- Evenintheabsenceofpressurefromagoitreonneighbouring

structures,thepresenceofanenlargedthyroidglandcan

occasionallycausediscomfortoritsappearancemaybetroubling

topatients.Inthisscenariopatientsshoulddiscussthebenefits

andrisksofsurgerywiththeirsurgeon.

• Developmentofalump(nodule)inthegland

- Nodulesinthethyroidglandmayconsistofone(solitarynodule)

ormore(multi-nodulargoitre)lumps

- Nodulesarecommonlyassessedbyclinicalexamination,

ultrasoundexamination,needlebiopsyorallthreetests

- Ifyoursurgeonisconcernedaboutthefindingsfromoneormore

oftheseteststheymayrecommendsurgery

- Occasionallyotherscanse.g.aCTscan,mayalsobenecessaryto

helpyoursurgeonplananoperation

- Thyroidnodulesarecommonandcanbefoundinupto6%of

womenand2%ofmen.Theolderyouare,themorelikelyyouare

todevelopathyroidnodule

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• Over-activethyroidgland

- Anover-activethyroidglandsecretestoomuchthyroidhormone.

Thisiscalledhyperthyroidism(orthyrotoxicosis)andresultsina

well-recognisedpatternofsymptoms.Itisdiagnosedbyaphysical

examinationandbloodtests.

WhattypeofthyroidoperationshouldIexpect?

Thefollowingisageneraloverviewofthyroidsurgeryoperations.Yoursurgeon

willexplainwhichoneyouareadvisedtoconsiderandwhy.

• Thyroidlobectomy-thisremovesonethyroidlobeandalsothethyroid

isthmus.Somesurgeonsmaycallthisahemithyroidectomy.

• Totalthyroidectomy-thisremovesallthethyroidgland,leavingno

thyroidtissuebehind.Occasionally,forsurgicalreasons,yoursurgeon

mayleaveaverytinyamountofthyroidtissuebehind.Thisiscalleda

neartotalthyroidectomyandisdonetoprotectimportantstructuresthat

runveryclosetothethyroidglandintheneck.Theamountleftbehindis

sosmallthat,practically,youmayconsiderthatthewholeofthegland

hasbeenremoved.

• Subtotalthyroidectomy-thisisahistoricoperationthatisnotnowadays

recommended.Inthisprocedure,surgeonsusedtoleavebehinda

thumbnailsizedremnantofeachthyroidlobe.Itresultsinan

unacceptablerateofrecurrenceofsymptomsandhasfallenoutoffavour.

Whatislymphnodesurgeryandwhenisitneeded?

Lymphnodesdrainanaturalfluidcalledlymphthatisproducedbymanytissues

inthebody.Inpatientswhohaveadiagnosisofthyroidcancer,thelymphnodes

aroundthethyroidglandaresometimesremovedaspartofthecancer

operation.Ifcancerisfoundinthelymphnodesthiscanaffectthetypeofon-

goingtreatmentyoureceiveaftersurgery.

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Sometimesonlythelymphnodesclosetothethyroidglandareremoved.This

operationiscalledacentralneckdissectionasthelymphglandsinthecentreof

theneckareremoved.Performingacentralneckdissectiondoesnotusually

affectthesizeofthescar.

Sometimesitisnecessarytoremovelymphglandsfromthesideoftheneck.This

isamuchlargeroperationresultinginalongerscarandiscalledalateralneck

dissection.Ifyouneedthistypeofsurgery,yoursurgeonwillexplainittoyouin

detailanddiscusswhyitisnecessaryinyourcase.

Note:notallpatientswithadiagnosisofthyroidcancerwillneedlymphnode

surgery.Yoursurgicalteamwillmakethisdecisionbasedonanumberoffactors

whichwillbediscussedwithyou.

Lymphnodesurgerycancarryanincreasedriskofcomplications.Theseare

discussedinourleafletPotentialComplicationsofThyroidSurgerywhichcanbe

foundonourwebsite(www.baets.org.uk).

Whatwillhappenpriortosurgery?Ifyouareonregularmedicationsyoushouldcontinuethese(includingany

thyroidrelatedtablets)unlessadvisedotherwise.

Somesurgeonsmayaskyoutostoptakingmedicinessuchasaspirin,

dipyridamole(Persantine)orclopidogrel(Plavix)inthedaysleadinguptoyour

operation.Ifyouareonanyofthesetablets,discussthiswithyoursurgeon.

Patientsonblood-thinningtablets(suchaswarfarin,rivaroxabanordabigatran)

shouldinformtheirsurgeonasitisimportantthattheconditionstheseareused

totreatarecontrolledbeforeandaftersurgery.

Manyhospitalshaveapre-operativeassessmentclinicwhereyouwillbe

reviewedbyanurseinpreparationforyourforthcomingoperation.Theywillbe

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abletoadviseifyouhaveanyqueriesrelatingtoyourmedicationsleadingupto

yoursurgery.Theywillarrangeforyoutohaveanyteststhatarenecessaryfor

youranaestheticandthyroidoperation.

Itmaybesuggestedthatyouhaveaflexiblenasendoscopybeforeyoursurgery.

Thistestinvolvespassingasmall,narrowflexibletubewithacamerawithinit

throughyournoseintoyourupperairpassagestoallowinspectionofyourvocal

cords.Itmaybealittleuncomfortablebutshouldnothurtandlastsonlyacouple

ofminutes.Flexiblenasendoscopydoesnotinvolvegeneralanaesthetic.This

testmaybecarriedoutbyyoursurgeoninclinicorbyacolleaguewithinthe

hospital.Somesurgeonsmayalsorequestarepeattestfollowingyoursurgery.

HowlongwillIbeinhospital?

Thisdependsverymuchontheexactdiagnosisandtheoperationbeing

performed.Somesurgeonsmayperformcertainthyroidoperationsasdaycase

procedures,buttypically,patientsstayinhospitalovernightandaredischarged

thedayfollowingsurgery.Insomeinstancesyoumaystayinhospitalforlonger.

Yoursurgeonwilladviseyou.

Careofyourwound

Whenyouaredischargedfromhospitalyoucanexpecttobegivenadviceabout

careofyourwoundfromthewardstaff.Thewoundmaybecoveredbya

dressingandthiscanusuallyberemovedafter48hoursunlessyouaretold

otherwise.Youwillusuallybeabletotakeabathorshower48hoursafteryour

operation.Gentlypatyourwounddryratherthanrubit.

Yourwoundmaybeslightlyraisedandpinkorredinthedaysfollowingsurgery.

Thiswillsettleovertimeasitheals.Eventuallythewoundshouldbecomeflat

andpalebutthismaytakeseveralmonths.

Unlesssuggestedbyyourmedicalteam,itisnotadvisabletorubanyointments

orbio-oilsontothewoundimmediatelyafteryoursurgerybeforethewoundhas

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hadchancetoheal.Itisbesttowaituntilyouhavebeenseeninthepost-

operativeclinicanddiscusswithyoursurgeonifyouwishtousesuchproducts.

HowsoonwillIrecover?

Itisnormaltofeeltiredfollowingthyroidsurgeryanditmaytakeuptoamonth

beforeyoufeelyouhaveyourenergylevelsback.Insomecases,ifyouare

prescribedthyroidreplacementtablets,recoverymaytakelongerbeforeyou

reachthecorrectdoseofthyroidmedicine.Yourmedicalteamwillcarryout

bloodteststoassessthis.

Followingathyroidectomy,somepatientsfeelasthoughthereisalumpintheir

throatastheyswallow.Thisiscommonandwilldisappearintime.

Beforeresumingdrivingyouneedtoensurethatyoucanmakeanemergency

stopwithouthurtingyourneck.Youalsoneedtobeabletocomfortablyturn

yournecktolookaroundasyoudrive,forexample,whenyouchangelanes.You

shouldinformyourcarinsurancecompanythatyouhavehadathyroid

operationasdifferentinsurersmayhavetheirownrulesabouthowlongyou

shouldwaitafteranoperationbeforeyoureturntodriving.

Yourreturntoworkdependsonthetypeofworkyoudoandtheoperationyou

havehad.Youmaybeabletoreturntooffice-basedworkaftertwotothree

weeksandheavierworkafterfourweeks.Yoursurgicalteamwilladviseyou.

WillIneedThyroidreplacementtabletsaftermyoperation?

Thisdependsonwhichoperationyouhavehadperformed.

Patientswhohaveallthethyroidglandremoved(totalthyroidectomyornear

totalthyroidectomy)willneedthyroidtabletspostoperativelyandthiswillbe

lifelong.Yoursurgicalormedicalteamwillstartthetabletsupondischarge

followingyourthyroidoperationandthencheckthatyouareonthecorrectdose

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byperformingbloodtestsintheclinic.Occasionallythesebloodtestsare

performedandcheckedbyyourGP.

Patientswhohavehalfofthethyroidglandremoved(lobectomy,alsocalleda

hemithyroidectomy)mayormaynotneedthyroidtabletspostoperatively.Your

surgicalteamwillperformbloodtestsperformed1to6monthsfollowingyour

operationtocheckwhetheryourequirethyroidtabletsornot.

Whatarethepossiblecomplicationsofthyroidsurgery?

Complicationsofthyroidsurgeryareuncommon.Thevastmajorityofpatients

havestraightforwardsurgeryandaredischargedthefollowingdaywithoutany

complications.Yoursurgeonwilldiscussthebenefitsandpotential

complicationsofsurgerywithyouindetail.Pleasefeelfreetoaskanyquestions

thatareonyourmind.

BAETShaveproduceapatientinformationleaflet,PotentialConsequencesof

ThyroidSurgery,whichcanbefoundonourwebsite(www.baets.org.uk).

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TheBritishAssociationofEndocrine&ThyroidSurgeonsareindebtedtothefollowingpatient

organisationswhohavehelpedintheproductionofthisleaflet

TheBritishThyroidFoundation

TheBritishThyroidFoundationisacharitydedicatedtosupportingpeoplewiththyroid

disordersandhelpingtheirfamiliesandpeoplearoundthemtounderstandthecondition.

Forsupportandmoreinformationaboutthyroiddisorderspleasevisit:

www.btf-thyroid.org

TheButterflyThyroidCancerTrust

TheButterflyThyroidCancerTrustisthefirstnationalcharityintheUKdedicatedsolelytothe

supportofpatientswithThyroidCancer.

Forfurtherinformationpleasevisit:

www.butterfly.org.uk

Disclaimer

Theadviceinthisleafletisbelievedtobetrueandaccurateatthetimeofgoingtopress.

Ultimately,theresponsibilityforobtaininginformedconsentfromyouforasurgicalprocedure

lieswithyoursurgicalteamandnotwiththeBritishAssociationofEndocrine&Thyroid

Surgeons(BAETS).

BAETScannotacceptanylegalresponsibilityforthecontentsofthisleafletwhichisproducedin

goodfaith.