Thyroid surgery — known as thyroidectomy — is performed in a number of situations:
- To treat thyroid cancer
- To remove an enlarged thyroid — known as goiter — that is cosmetically unsightly or is affecting swallowing or breathing
- To remove a thyroid that has large or multiple nodules that are cosmetically unsightly, or are affecting swallowing or breathing
- During the second trimester of pregnancy, when a woman who is hyperthyroid is not responding sufficiently to antithyroid drugs, when the antithyroid drugs are having an adverse effect on her fetus, or when a woman has an adverse reaction to those antithyroid drugs
- When hyperthyroidism is not responding or being sufficiently controlled by antithyroid drugs or radioactive iodine (RAI) ablation
- When a woman of childbearing age does not want RAI due to the six- to 12-month waiting period after RAI before it’s considered safe to get pregnant
Types of thyroid surgery
There are two key types of thyroid surgery:
Total or full thyroidectomy: A total thyroidectomy is the most commonly performed type of thyroid surgery. A total thyroidectomy is performed as a treatment for thyroid cancer, and in some cases, to remove an enlarged or multinodular thyroid that is cosmetically unsightly, or interfering with breathing and swallowing. Less commonly, a full thyroidectomy is performed as a treatment for Graves’ disease and hyperthyroidism. After a total thyroidectomy, you will require lifelong thyroid hormone replacement medication.
Subtotal or partial thyroidectomy: In a subtotal or partial thyroidectomy, only part of the thyroid gland is removed. Frequently, one of the two lobes (halves) of the thyroid is removed, and this is known as a lobectomy. A subtotal or partial thyroidectomy may be done to remove benign nodules or small cancerous thyroid nodules that are not aggressive. Because some thyroid tissue remains, a minority of patients don't require thyroid medication after this surgery.
Thyroid surgical methods
Traditional thyroid surgery involves an incision in the neck, which is then closed with sutures, staples, or both.
A small number of thyroid surgeons perform what is known as transaxillary surgery, meaning that the incision is through the underarm area. The surgery is typically performed with the assistance of a surgical robot. The benefits of this surgery are that there is no visible neck scar, your risk of laryngeal nerve damage is reduced, the surgery is considered less painful, and you may heal more quickly than with a neck incision.
A small percentage of surgeons perform endoscopic thyroid surgery, which involves two, one-inch incisions. A camera is inserted through one incision, and a scalpel device is inserted through the second incision. This surgery results in smaller, less visible scars.
Most thyroid surgery is performed while you are under general anesthesia. In some cases, however, local anesthesia may be an option. Typically, you will be given a drug to sedate you, along with a numbing medication, followed by local anesthesia to block any pain or sensation in the area undergoing surgery.
Outpatient or inpatient surgery
Most thyroid surgeries are performed on an inpatient basis. You will check in to the hospital or surgical center and, barring any additional complications, a typical stay for your recuperation is from two to five days before you are discharged. A longer stay is required if your surgery requires a post-operative drain.
After surgery, you will be monitored for post-surgical complications, which can include bleeding, damage to your laryngeal nerve, or parathyroid damage that can cause low calcium levels; a condition known as hypocalcemia. There are some situations where inpatient thyroid surgery is strongly recommended, including:
- Having other health conditions
- Advanced age
- Large nodules, lesions, or a complicated surgery
In some cases, outpatient surgery may be an option. In that situation, you will have your surgery, recuperate at the hospital or surgery center, and be released within 24 hours to further recuperate at home. If you have outpatient thyroid surgery, your physician should provide detailed instructions regarding potential complications, specifically, the signs and symptoms of hypocalcemia, and guidelines on how to take calcium and vitamin D to prevent or minimize this complication.
Some studies have shown that outpatient surgery is as safe as inpatient thyroid surgery. Other studies, however, have shown an increased risk for bleeding-related complications and higher mortality rates for patients who are not hospitalized for at least one night after surgery.
While the issue remains controversial, at present, many researchers and experts don’t routinely recommend outpatient thyroid surgery. When it is performed, experts recommend that patients remain in the hospital at least six hours for observation, remain near the hospital for at least 24 hours after surgery, and should take calcium and vitamin D to prevent hypocalcemia.
About your thyroid surgery
Prior to surgery, your surgeon should discuss with you pre-operative instructions, including supplements and drugs to take or discontinue, and guidelines regarding eating and drinking prior to the surgery.
Most thyroid surgeries are straightforward, and you can expect the surgery to last from 30 minutes to two hours, depending on the extent of the surgery. If you have thyroid cancer and a neck dissection is needed to remove potentially cancerous lymph nodes, the surgery will take more time.
For a traditional thyroid surgery, after you receive general anesthesia, an endotracheal tube is inserted to aid in breathing. Then, an incision of up to five inches is made across the base of your neck. Experienced thyroid surgeons choose a spot in a fold of your neck so the resulting scar is less noticeable. The muscle and skin in your neck are pulled out of the way so the surgeon can work on the thyroid, removing all or part of the gland.
After your surgery, if you are considered outpatient, you will usually be monitored and then released within 24 hours. If you are inpatient, you will be monitored for up to five days. Before you are released from the hospital, your incision will typically be covered with a protective waterproof bandage or glue so you can shower or bathe.
If there are issues with bleeding, or your thyroid as particularly large, prior to closing your incision your surgeon may insert a surgical drain to prevent fluid buildup. If you are inpatient, the drain will be removed before you are discharged. If you are outpatient, you will need to return to the surgeon for removal of the drain within several days of your surgery.
Columbia University’s New York Thyroid Surgery Center has a helpful PDF Guide to Thyroid Surgery, available for download.
Post-operative side effects and complications
There are some side effects you may experience after thyroid surgery, including neck pain or stiffness, hoarseness in the voice, and pain or sensitivity in the throat and when swallowing. If you are intubated during surgery, you are more likely to have a temporary sore throat after the tube is removed following surgery.
More significant complications include:
- Hypocalcemia (low calcium levels) — symptoms include muscle spasms, muscle cramps, headaches, numbness and tingling in the hands and feet, and numbness and tingling in the lips or mouth
- Damage to the laryngeal nerve — symptoms include hoarseness and laryngitis
The importance of an experienced thyroid surgeon
According to [recent research, more than 12 percent of patients develop post-operative thyroid surgery-related complications, including hypocalcemia, and laryngeal nerve damage.
The risk of post-operative complications correlates directly with the level of experience of your surgeon. High-volume surgeons — defined as those who have performed more than 1,000 thyroid surgeries in their career — have a significantly lower rate of post-surgical complications. The factors that contribute to the highest level of complication rates include:
- Low-volume surgeons (less experience with thyroid surgery)
- Low-volume hospitals and surgery centers (with less experience in thyroid surgery)
- Patients over 65
- Patients who have other health conditions
- Patients with advanced thyroid cancers
Two helpful resources to find high-volume, experienced thyroid surgeons include:
- The American Association of Endocrine Surgeons
- Columbia University’s New York Thyroid Surgery Center
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