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Thyroid Surgery

There are a number of reasons that you may be referred to a surgeon for an assessment and opinion regarding your thyroid:

  1. A diagnosis of thyroid cancer after a biopsy (FNA or fine needle aspiration)
  2. A biopsy that was suspicious for abnormal cells or needs specialist opinion
  3. Pressure symptoms in the neck, difficulty swallowing or a cough not explained by other causes
  4. A nodule that continues to grow over time
  5. An overactive thyroid gland or nodule that is not responding to medication
  6. Cosmetic reasons, due to a large goitre or nodule

What is the difference between a hemithyroidectomy and a total thyroidectomy?

A hemithyroidectomy is the removal of half of the thyroid. This is usually done to remove a nodule that is producing too much thyroid hormone, or because a nodule(s) is causing problems because of its size. It may also be done if a biopsy result suggests that there is a risk of cancer in a nodule. In most instances, the remaining part of the thyroid gland is able to produce enough thyroid hormone for your body.

A total thyroidectomy is the removal of the entire thyroid gland. This is usually done for cancer, a large goitre, large nodules on both sides (multinodular goitre) and some autoimmune conditions. Once your thyroid gland is completely removed, you will no longer produce any thyroid hormone. This means you will need to take thyroid hormone replacement tablets indefinitely.

What are the risks of thyroid surgery?

Thyroid surgery is performed under a general anaesthetic. The thyroid gland sits in the front of the neck, so any surgery to the thyroid requires a small (3cm - 6cm) cut in the neck. The size of the cut will vary depending on how big the thyroid is. Dr Lancashire will generally be able to conceal incision lines in any skin folds that you may have.

No surgery is without potential risks or side effects. As a general rule, surgeons who are specifically trained in endocrine surgery have lower complication rates associated with those procedures than surgeons who don’t perform them on a regular basis.

The main risks specific to thyroid surgery are:

  • A small fluid collection under the wound (seroma) (~5%)
  • Bleeding or haematoma (blood clot) (<2%)
  • Damage to the parathyroid glands needing calcium replacement (1-2%)
  • Wound infection (<1%)
  • Permanent voice hoarseness or weakness (<1%)

Dr Lancashire routinely uses a nerve monitor (NIM®) to help confirm and monitor the function of the important nerves that are at risk of injury during thyroid surgery. He will explain what surgery he recommends for your condition, and spend time discussing risks associated with the operation.