The thyroid gland lies in front of the neck just below the Adam’s apple and is butterfly shaped. The right and left wings (lobes) are joined by a small bridge of thyroid tissue (body) called the isthmus. The two lobes lie on either side of the windpipe. The thyroid gland manufactures hormones, which are chemicals that circulate in the bloodstream and affect the function of the cells and tissues in the body. Thyroid hormones are essential for survival.
What is a goiter
Any enlargement of the thyroid gland is called goitre. When the whole gland is diffusely enlarged it is called a diffuse goitre. If there is a single nodule, it is termed a solitary nodule. The majority of goitres are not cancerous. However, a small proportion of goitres may harbour cancer cells and this is the reason why I recommend investigations for all thyroid swellings (goitre).
Investigation and treatment of thyroid lump
During the initial consultation, we will take a detailed history of your problem and assess you. A needle may be inserted into the lump to collect a sample of cells, this is called fine needle aspiration cytology test (FNAC). These cells are then analyzed under the microscope by the pathologist who will determine the nature of the swelling.
There are other tests, such as a CT scan, MRI scan or nuclear isotope scan which may be required in some cases. Often no treatment may be necessary for the thyroid lump (goitre) and you will be advised to adopt a ‘watch and wait policy’. Alternatively, surgery may be advised. This is commonly undertaken when there is a suspicion of cancer, pressure symptoms, uncontrolled over activity, and cosmetic concerns. The surgery is called thyroidectomy and is discussed briefly below.
There are many different terms used to describe thyroid surgery. Total thyroidectomy implies removal of all the thyroid gland, whereas a hemi-thyroidectomy or lobectomy only part of the gland is removed. You will be advised about the exact procedure you will need based on your problem.
The operation is performed under a general anaesthetic, which means you will be asleep throughout the procedure. A skin cut (incision) is made across the midline in the neck over the gland. This cut is usually placed along a crease line, so when it heals it is barely visible. The required part or the entire gland is removed after making sure all important nerves, blood vessels and parathyroid glands are preserved. At the end of the operation, a drain (plastic tube) is placed through the skin in order to prevent blood collection in the operated area. Some patients may spend 24 hours in the hospital after the operation. The drain is removed within 24-48 hours and the stitches are usually removed after 6 days.
Risks involved in thyroidectomy
In the following section we have briefly discussed some common and serious risks of thyroid surgery. Please note that the chances of any of these complications are small and great care is taken to avoid any risks.
Changes in voice
Nerves called the recurrent laryngeal nerve (RLN) and the superior laryngeal nerve (SLN) that maintain normal function of the voice box (larynx) are in close proximity to the thyroid gland. If these nerves are damaged, you may notice that your voice is hoarse and weak and your singing voice is affected. This occurs as a result of minor bruising of the nerves and usually recovers. Very rarely the damage may be severe, which means the voice will be permanently affected.
Bleeding is generally minimal, self-limiting and requires no action. Rarely, excess bleeding can occur which may lead to neck swelling and occasionally difficulty in breathing. If this is the case, it is necessary to return to the operating theatre to rectify the problem.
Parathyroid – calcium problems
This is applicable to you if you are having a total thyroidectomy. The parathyroid glands that control the level of calcium in the blood lie close to the thyroid gland. If these glands are affected, the calcium levels may fall. As a result, you may experience tingling sensations in your hands, fingers, toes, in your lips or around your nose. If you experience any of these symptoms please inform us immediately.
We monitor the levels of calcium in your blood after the operation and treat you as necessary. Generally speaking, parathyroid glands recover quickly following surgery and you suffer no ill effects. If a quick recovery is not anticipated, you will be sent home on medication to maintain your calcium levels.
Neck and shoulder stiffness
You may feel some discomfort and stiffness around your neck and shoulders. You will be given adequate painkillers to control this effectively and generally the recovery is quick. Regular massaging of the area after stitch removal is also helpful.
Effects of removing the thyroid gland
If the entire thyroid gland is removed you will need to take replacement thyroid hormones in the form of a tablet called thyroxine (T4) everyday for the rest of your life. The amount of thyroxine you need will be monitored based on blood tests and as long as one takes the correct prescribed dose, you will suffer no ill effects. If, on the other hand, only part of the thyroid gland is removed, then generally you do not need to take thyroxine. This is because the part of the thyroid gland that is left behind in your neck will produce enough hormones to meet the demands of the body. Blood tests will be done to confirm this after the operation.