The thyroid is a butterfly shaped organ located in the neck. It secretes thyroid hormone that plays an important role in metabolism and affects several functions in the body e.g. heart rate, weight, bowel habit. Patients may have an overactive or underactive thyroid that can cause a range of symptoms. This is usually confirmed with a blood test (thyroid function test). The management of an overactive or underactive thyroid is usually performed by an endocrinologist. Referral to an endocrine surgeon usually implies that surgery may be required to address a problem e.g. symptoms from a large goitre or assess a suspicious nodule.
Types of thyroid surgery
Operations on the thyroid involve removal of half (hemithyroidectomy) or the entire gland (total thyroidectomy). The decision on the type of operation is generally determined by the pathology or indication for surgery. If thyroid cancer is proven prior to surgery, then sometimes some of the neck lymph nodes may need to be removed as well (neck dissection).
Risks of thyroid surgery
The operative risks for a hemithyroidectomy and a total thyroidectomy are essentially the same but increased in a total thyroidectomy.
Post operative bleeding
Bleeding can happen in any surgery but can be life threatening in neck surgery. For this reason, I admit patients into a high dependency ward for close observation.
Damage to the recurrent laryngeal nerve (RLN)
This nerve is intimately related to the back of the thyroid gland. It is only a few millimetres wide (width of a paperclip) and can have a variable location. The RLN supplies muscles to the vocal cords and damage can cause a weak/ hoarse voice, difficulty coughing and swallowing. Identifying and protecting the RLN is one of the main focuses of thyroid surgery. The risk of temporary damage/ strain is 6%, and permanent damage is 0.5%.
Damage to the parathyroid glands (see parathyroid surgery)
This is only a major concern when having a total thyroidectomy. These glands are delicate and can be easily stunned/damaged in thyroid surgery due to their shared blood supply and close location to the thyroid gland. If they are damaged, the parathyroid hormone level can drop leading to low calcium levels. This can lead to numbness around the lips and severe muscle cramps. This is usually managed with calcium and vitamin D tablets but may require up to 15 tablets a day, intravenous infusion, and regular blood tests.