Thyroid Surgery

January 2018 Thyroid Awareness Month!

The thyroid gland is located in the lower neck and is an organ that regulates your metabolism by secreting thyroid hormone.

  • Excess thyroid hormone may cause symptoms such as nervousness, anxiety, hyperactivity, weight loss, perspiration, heat intolerance, and palpitations.
  • Inadequate thyroid hormone may cause symptoms such as fatigue, loss of energy, weight gain, dry skin, hair loss, cold intolerance, constipation, and depression.
    It is a single organ with a right and left lobe connected by an isthmus. It sits right below the voice box and wraps around the windpipe.
parathyroid gland location

Certain conditions of the thyroid gland require surgery treatment.

The indications for Total Thyroidectomy (removal of all thyroid tissue) include:

  • Thyroid gland enlargement (Goiter) that is causing compressive symptoms in the throat such as difficulty breathing, swallowing, or hoarseness
  • Thyroid cancer
  • Patients with Graves ’ disease or hyperthyroidism that are refractory to medical therapy.

Indications for Thyroid Lobectomy (removal of one lobe) is generally done because a definitive diagnosis has not been obtained:

  • Thyroid nodule concerning for follicular tumors (Follicular cancers cannot be determined by Fine Needle Aspiration)
  • Thyroid nodule with biopsy results that are repeatedly “atypia of uncertain significance”
  • Thyroid nodules that are very large despite negative biopsy results (Large tumors have greater chance of false negatives)

If your thyroid gland is completely removed, you will have to take thyroid hormone replacement medication. If your thyroid gland is partially removed, the remaining gland may be able to produce enough thyroid hormone so that you do not require additional hormone replacement.

If you have surgery for thyroid cancer, you may also be referred for additional radioactive iodine therapy depending on the stage of your cancer. You may also require additional surgery at the time of thyroidectomy to remove affected lymph nodes.

How is surgery done?

Surgery is done under general anesthesia through an incision in the central part of the neck. Your surgeon will attempt to place the incision in the best aesthetic location, often in a natural skin crease to hide the incision. The nerves that go to the voice box (recurrent laryngeal nerve) are located behind the thyroid gland. It is very important that these nerves are identified and preserved to allow normal function (speaking, swallowing, and breathing). Your surgeon will use a Nerve Integrity Monitor to monitor the activity of the nerve during surgery. In addition, the parathyroid glands are located behind the thyroid gland and share the same blood supply. These glands are identified and preserved. However since the blood supply is often shared with the thyroid gland, occasional transient decreased function of the parathyroid gland (hypoparathyroidism) can occur. This can result with low calcium levels in the blood and symptoms such as numbness around the lips and fingertips, and muscle cramps. Cardiac arrhythmias may also occur if the calcium levels get too low. Once the thyroid gland or lobe is removed, the incision is closed. For a total thyroidectomy, you will likely be monitored in the hospital to monitor your blood calcium levels. Your surgeon will also decide if a drain is needed to prevent fluid and blood accumulation in the neck. For a thyroid lobectomy, calcium monitoring is not needed and your surgeon may decide to discharge you home the same day.


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