Thyroidectomy

What is it?
Thyroid is a butterfly-shaped gland located at the base of your neck. It produces hormones that regulate every aspect of your metabolism, from your heart rate to how quickly you burn calories. It is about 3 inches across. It makes the hormone thyroxine. Thyroxine passes into the blood stream to keep the body active. If the gland makes too much thyroxine, the body gets overactive and the heart can be strained. If the gland swells, it presses on the windpipe and other parts of the neck. It may cause an ugly swelling in the front of your neck. When this happens, the gland, or parts of it, needs to be removed.

The Surgery
The operation will be performed under general anaesthetic which means that you will be put to sleep. You will be unconscious and you will not feel pain during the operation. A cut is made across the front of your neck. Some or the entire thyroid is taken out. Usually enough thyroid is left to supply your needs for thyroxine. If your entire thyroid is removed (total thyroidectomy), you need daily treatment with thyroid hormone to replace your thyroid's natural function. Great care is taken to avoid damaging the nerves that control your voice. The surgeon also avoids the nearby glands (parathyroid glands) that control your blood calcium salts. The cut in the skin is closed so that it heals with a barely visible scar. At least 4 days hospitalization is necessary.

Any Alternatives
If left untreated, the thyroid problem will remain. For an overactive gland, drug treatment will not work very well, or may cause a bad reaction in you. Pressure effects are likely to get worse. Any swelling will get more unsightly. When the thyroid, or parts of it, is removed, they are sent for examination under the microscope to make sure that they don’t harbour a cancerous tumour. If you don’t have the operation, the possibility of a missed tumour remains. Drawing fluid out of a swelling gives relief only for a week or two. X-ray and laser treatment do not work.

Before the operation
Stop smoking and reduce the weight if you are overweight. (See Healthy Living). If you know that you have problems with your blood pressure, heart, or lungs, consult your physician and ask him to check that these are under control. Check the hospital's advice about taking the Pill or hormone replacement therapy (HRT). Check you have a relative or friend who can come with you to the hospital, take you home, and look after you for the first week after the operation. Sort out any tablets, medicines, inhalers that you are using. Keep them in their original boxes and packets. Bring them to the hospital with you.

On the ward, you may be checked for past illnesses and may have special tests to make sure that you are well prepared and that you can have the operation as safely as possible. Please tell the doctors and nurses of any allergies to tablets, medicines or dressings. You will have the operation explained to you and will be asked to fill in an operation consent form. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks.

After - In Hospital
The wound may be mildly to moderately uncomfortable and you may have discomfort in your neck. Swallowing may be difficult. You will be given injections or pills for the pain. After three days you may experience less pain. The wound will have a dressing which may show some staining with old blood in the first 24 hours. A thin plastic drain tube is placed in the area where the thyroid used to be to drain any residual blood or other fluid from the area of the operation. The drain is removed when it stops draining - usually after 48 hours. There may be some purple bruising around the wound which spreads downwards by gravity and fades to a yellow colour after two to three days. This is expected and you should not be worried about it. There may be some swelling of the surrounding skin which also improves after about two to three days.

The wound is usually closed with stitches under the skin. These stitches dissolve over time and result in a very neat scar. Sometimes, the skin can be closed with metal clips or stitches which are removed three days after the operation and are replaced with small pieces of sticky paper tape to allow a better cosmetic result for the wound. Regardless of the way the wound is closed, you can wash it 7 to 10 days after the operation. If you have pieces of sticky paper tape on the wound they will peel off when you start washing. Soap and tap water are entirely adequate. Salted water is not necessary. You can wash or bathe the rest of your body normally. You will be given details about a check-up and the results of the tests two weeks after the operation.

There may be some swelling of the surrounding skin which also improves in 2 to 3 days. After 7 to 10 days, slight crusts on the wound will fall off. The cellulose varnish will peel off and can be assisted with nail varnish remover. Occasionally minor match head sized blebs form on the wound line. These settle down after discharging a blob of yellow fluid for a day or so. You can wash the wound area as soon as the dressing has been removed. Soap and tap water are entirely adequate. Salted water is not necessary. The nurses will talk to you about your home arrangements so that a proper time for you to leave hospital can be arranged. Some hospitals arrange a check up about one month after leaving hospital. Others leave check-ups to the General Practitioner. The nurses will advise about sick notes, certificates etc. You may need to see the Hematology specialist after your operation. This will be arranged.