Thyroidectomy

A thyroidectomy is a surgery to remove all (total thyroidectomy) or part (partial thyroidectomy) of your thyroid gland — a butterfly-shaped organ in your neck.

Thyroidectomy is a surgical treatment for thyroid cancer and certain thyroid conditions, including:

• Thyroid nodules: A thyroid nodule is a growth of cells in your thyroid gland. Thyroid nodules are usually noncancerous, but they can be cancerous. Sometimes, thyroid nodules can produce excess thyroid hormone.
• Goiter: A goiter is an enlarged thyroid gland with or without thyroid nodules. If it grows large enough, it can put pressure on your trachea or esophagus and make it difficult to breathe and/or swallow.
• Hyperthyroidism: This is a condition where your thyroid creates and releases more thyroid hormone than you need. It has several causes, and surgery is one of the treatment options for it.

Types of thyroidectomies

There are two main types of thyroidectomies: total and partial.

• A total thyroidectomy is the removal of all or most of your thyroid.
• A partial thyroidectomy — also called a hemithyroidectomy or lobectomy — is the removal of the right or left lobe of your thyroid.

The type of thyroidectomy you need depends on the reason for the surgery. You, your endocrinologist and your surgeon will determine the best surgery plan for you.

When would I need thyroid surgery?

Your healthcare provider may recommend thyroidectomy for any of the following reasons:

• You have a nodule (growth) on your thyroid that might be thyroid cancer
• You have thyroid cancer
• You have a large nodule or goiter that’s compressing your trachea or esophagus, making it difficult to breathe or swallow
• You have a nodule or goiter that’s releasing excess thyroid hormone

What questions should I ask my healthcare provider?

If your endocrinologist recommends thyroidectomy, it may be helpful to ask your endocrinologist and/or surgeon the following questions:

• Why do I need a thyroidectomy?
• Are there other treatments for my condition?
• What are the risks of a thyroidectomy?
• How much of my thyroid gland needs to be removed?
• Will I need thyroid hormone replacement therapy after the procedure?

How do I prepare for a thyroid surgery?

Your endocrinologist and surgeon will give you specific instructions to prepare for your thyroidectomy.

Depending on your reason for needing a thyroidectomy, in the weeks before your procedure:

• You may need imaging tests, most commonly a thyroid ultrasound, to pinpoint exactly where the abnormal thyroid growth is
• Your provider may perform a fine needle aspiration (a type of needle biopsy) to find out if the growth is cancerous (if you have a nodule)
• Your provider may check your vocal cord function
• You may need medicine to manage high thyroid hormone levels
• Your provider may recommend you quit smoking (if you smoke)

At least one week before surgery:

• Talk to your healthcare provider about all the medications you take — both prescription and non-prescription (this includes herbs and supplements) —and ask them which medicines you should still take on the day of surgery
• Your provider may ask you to temporarily stop taking blood thinners (only stop taking them if they tell you to)

You’ll need to fast (not eat or drink anything except water) for several hours before your procedure. Your provider will give you specific instructions about fasting.

What happens during a thyroidectomy?

Before your surgery, an anesthesiologist will give you general anesthesia to relax your muscles, prevent pain and make you fall asleep. Your healthcare team will also place a breathing tube down your throat for the procedure.

Your surgeon can access your thyroid a few ways:

• Through a standard cut (incision) in your neck (conventional method)
• Through a smaller incision with the help of a camera (minimally invasive video-assisted thyroidectomy or MIVAT)
• Through your mouth, armpit, shoulder blade, breast or ear (these are scarless or hidden incision methods)
• Through your sternum or breastbone (only in very rare cases when a goiter extends low into the chest cavity)

During surgery for a thyroid cancer diagnosis, your surgeon may sample the lymph nodes around your thyroid gland. A pathologist will check the lymph node sample during surgery for evidence of thyroid cancer. If they find cancerous cells, your surgeon may also remove nearby lymph nodes in your neck.

Once your surgeon is done, they’ll close the incision with dissolvable stitches and place glue over the skin.

Surgery to remove your whole thyroid typically takes one to three hours. It may take less time if your surgeon removes only part of your thyroid.

What are the possible complications of a thyroidectomy?

A thyroidectomy is generally very safe, but it’s a major surgery. Complications are uncommon, but the possible risks of thyroidectomy include:

• Excessive bleeding that blocks your airway and makes it hard to breathe
• Injury that leads to vocal cord paralysis and a hoarse voice
• Damage to your parathyroid glands, which can cause hypoparathyroidism (low parathyroid hormone levels) and lead to low calcium levels in your blood

While these complications are rare, they’re more likely to happen if:

• You have an invasive tumor and/or the cancer has spread to nearby lymph nodes in your neck
• You’re having a second thyroid surgery
• You have a very large goiter

What happens after a thyroidectomy?

Once you recover from anesthesia and are fully awake, you’ll be able to have something light to eat and drink. You’ll likely spend the night in the hospital so your healthcare provider can monitor you.

Your throat may be sore due to the breathing tube your healthcare team placed during the surgery.

You may need to take daily thyroid hormone (levothyroxine) pills to replace the lost thyroid hormone your thyroid naturally made. Your healthcare provider will discuss this with you before surgery. If your entire thyroid is removed, your surgeon will likely prescribe oral calcium supplements for several weeks to prevent low blood calcium levels.

What is the recovery time for a thyroidectomy?

Before you go home, your provider will give you instructions on how to care for your incision. They’ll let you know the types of complications to look out for in the coming days. It should take about two to three weeks for you to fully recover. You should wait at least one to two weeks before returning to vigorous activities, like exercising and heavy lifting.

You’ll most likely have a small scar on the front of your neck after the surgery. Most scars are between 1 inch and 2.5 inches long. The exact size depends on how large your thyroid was. The scar can take between 12 and 18 months to heal. It will start out as dark, then gradually lighten. It may also be raised or appear puffy for several months before smoothing out. Your surgeon can give you specific instructions on how to care for your scar.

When should I call my healthcare provider?

Call your healthcare provider if you experience any of the following after a thyroidectomy:

• Swelling, bleeding or oozing pus at the incision site
• Fever of 101 degrees Fahrenheit (38 degrees Celsius) or higher
• Numbness or tingling in your face, hands or lips