Thyroidectomy is the removal of all or part of your thyroid gland. Your 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.
Thyroidectomy is used to treat thyroid disorders, such as cancer, noncancerous enlargement of the thyroid (goiter) and overactive thyroid (hyperthyroidism).
How much of your thyroid gland is removed during thyroidectomy depends on the reason for surgery. If only a portion is removed (partial thyroidectomy), your thyroid may be able to function normally after surgery. If your entire thyroid is removed (total thyroidectomy), you need daily treatment with thyroid hormone to replace your thyroid’s natural function.
Why it’s done
A thyroidectomy may be recommended for conditions such as:
- Thyroid cancer. Cancer is the most common reason for thyroidectomy. If you have thyroid cancer, removing most, if not all, of your thyroid will likely be a treatment option.
- Noncancerous enlargement of the thyroid (goiter). Removing all or part of your thyroid gland is an option if you have a large goiter that is uncomfortable or causes difficulty breathing or swallowing or, in some cases, if the goiter is causing hyperthyroidism.
- Overactive thyroid (hyperthyroidism). Hyperthyroidism is a condition in which your thyroid gland produces too much of the hormone thyroxine. If you have problems with anti-thyroid drugs and don’t want radioactive iodine therapy, thyroidectomy may be an option.
- Indeterminate or suspicious thyroid nodules. Some thyroid nodules can’t be identified as cancerous or noncancerous after testing a sample from a needle biopsy. Doctors may recommend that people with these nodules have thyroidectomy if the nodules have an increased risk of being cancerous.
What does the thyroid gland do?
The thyroid, located at the base of your neck, makes a hormone that is sent into your bloodstream. The thyroid hormone controls the speed of your metabolism. The thyroid gland makes this hormone from iodine. Iodine is absorbed from the foods we eat.
The pituitary gland (located in your brain) controls how much thyroid hormone to make. It does this by making thyroid stimulating hormone (TSH). TSH tells the thyroid gland to make more or less thyroid hormone.
What problems can occur with the thyroid gland?
Hypothyroidism: An under-active thyroid is called hypothyroidism. The thyroid produces less thyroxine. This makes the pituitary gland send more TSH into the bloodstream to get the thyroid gland to make more hormone.
Common symptoms of hypothyroidism include:
- Weight gain
- Feeling cold
- Dry skin, hair, and nails
- Feeling tired
Hyperthyroidism: An over-active thyroid is called hyperthyroidism. The thyroid gland makes too much thyroid hormone. The pituitary gland decreases the amount of TSH in the blood.
Common symptoms of hyperthyroidism include:
- Heat intolerance
- Feeling jittery or irritable
- Fast heart rate
- Losing weight without dieting
- Muscle weakness, fatigue
Nodules: Thyroid nodules can be either solid or cystic (fluid filled). Most of the time, your thyroid works normally if you have nodules. Most nodules are not cancerous. However, your doctor might take a sample of the cells in the nodule. This is called a fine needle aspiration. This sample will be examined to make sure there are no cancer cells.
Goiter: This is an enlargement of the thyroid gland. You might feel swelling or enlargement in the neck. It can become larger because your thyroid is trying to make more thyroid hormone. Also, in hyperthyroidism the cells grow faster, which causes the thyroid to grow and make more thyroid hormone than the body needs.
Risks
Thyroidectomy is generally a safe procedure. But as with any surgery, thyroidectomy carries a risk of complications.
Potential complications include:
- Bleeding.
- Infection.
- Low parathyroid hormone levels (hypoparathyroidism) caused by surgical damage or removal of the parathyroid glands. These glands are located behind your thyroid and regulate blood calcium. Hypoparathyroidism can cause numbness, tingling or cramping due to low blood-calcium levels.
- Airway obstruction caused by bleeding.
- Permanent hoarse or weak voice due to nerve damage.
How you prepare
Food and medications
If you have hyperthyroidism, your doctor may prescribe medication — such as an iodine and potassium solution — to regulate your thyroid function and decrease the risk of bleeding.
You may need to avoid eating and drinking for a certain period of time before surgery, as well, to avoid anesthesia complications. Your doctor will provide specific instructions.
Other precautions
Before your scheduled surgery, ask a friend or loved one to help you home after the procedure. Be sure to leave jewelry and valuables at home.
What you can expect
Before the procedure
Surgeons typically perform thyroidectomy during general anesthesia, so you won’t be conscious during the procedure. The anesthesiologist or anesthetist gives you an anesthetic medication as a gas — to breathe through a mask — or injects a liquid medication into a vein. A breathing tube will then be placed in your trachea to assist breathing throughout the procedure.
The surgical team places several monitors on your body to help make sure that your heart rate, blood pressure and blood oxygen remain at safe levels throughout the procedure. These monitors include a blood pressure cuff on your arm and heart-monitor leads attached to your chest.
During the procedure
Once you’re unconscious, the surgeon makes an incision low in the center of your neck. It can often be placed in a skin crease where it will be difficult to see after the incision heals. All or part of the thyroid gland is then removed, depending on the reason for the surgery.
If you’re having thyroidectomy as a result of thyroid cancer, the surgeon may also examine and remove lymph nodes around your thyroid. Thyroidectomy usually takes one to two hours. It may take more or less time, depending on the extent of the surgery needed.
There are several approaches to thyroidectomy, including:
- Conventional thyroidectomy.This approach involves making an incision in the center of your neck to directly access your thyroid gland. The majority of people will likely be candidates for this procedure.
- Transoral thyroidectomy. This approach avoids a neck incision by using an incision inside the mouth.
- Endoscopic thyroidectomy. This approach uses smaller incisions in the neck. Surgical instruments and a small video camera are inserted through the incisions. The camera guides your surgeon through the procedure.
After the procedure
After surgery, you’re moved to a recovery room where the health care team monitors your recovery from the surgery and anesthesia. Once you’re fully conscious, you’ll be moved to a hospital room.
Some people may need to have a drain placed under the incision in the neck. This drain is usually removed the morning after surgery.
After thyroidectomy, a few people may experience neck pain and a hoarse or weak voice. This doesn’t necessarily mean there’s permanent damage to the nerve that controls the vocal cords. These symptoms are often temporary and may be due to irritation from the breathing tube (endotracheal tube) that’s inserted into the windpipe (trachea) during surgery, or as a result of nerve irritation caused by the surgery.
You’ll be able to eat and drink as usual after surgery. Depending on the type of surgery you had, you may be able to go home the day of your procedure or your doctor may recommend you stay overnight in the hospital.
When you go home, you can usually return to your regular activities. Wait at least 10 days to two weeks before doing anything vigorous, such as heavy lifting or strenuous sports.
It takes up to a year for the scar from surgery to fade. Your doctor may recommend using sunscreen to help minimize the scar from being noticeable.
Results
The long-term effects of thyroidectomy depend on how much of the thyroid is removed.
Partial thyroidectomy
If only part of your thyroid is removed, the remaining portion typically takes over the function of the entire thyroid gland, and you might not need thyroid hormone therapy.
Complete thyroidectomy
If your entire thyroid is removed, your body can’t make thyroid hormone and without replacement you’ll develop signs and symptoms of underactive thyroid (hypothyroidism). As a result, you’ll need to take a pill every day that contains the synthetic thyroid hormone levothyroxine (Levoxyl, Synthroid, Unithroid).
This hormone replacement is identical to the hormone normally made by your thyroid gland and performs all of the same functions. Your doctor will determine the amount of thyroid hormone replacement you need based on blood tests.