Surgery of the Thyroid Gland

As an experienced endocrine surgeon, Dr Murugappan offers hemithyroidectomy, total thyroidectomy, and neck node dissection operations.

A hemithyroidectomy involves removal of one lobe of the thyroid, either the right or left side. In this operation, an incision is made across the front of the neck and the neck muscles are pushed aside to gain access to the thyroid gland. The half of the thyroid gland is carefully dissected from its blood supply and adjacent structures before being removed from the neck.

When performing a hemithyroidectomy, delicate care and attention is paid to the surrounding structures in the neck. Of particular importance are the parathyroid glands and the recurrent laryngeal nerve.

The parathyroid glands are a set of four glands located on the back surface of the thyroid gland. These glands are responsible for the control of the body’s calcium levels, and damage or removal of these glands may result in low levels of calcium in the blood stream.

The recurrent laryngeal nerve is the primary nerve responsible for control of the vocal cords. Damage to this nerve may result in vocal cord paralysis, causing voice hoarseness or weakness if one side is affected, or even breathing difficulties if both sides are affected.

A total thyroidectomy involves the same steps as in a hemithyroidectomy but repeated for the other side. This can typically be performed through the same size incision.  All patients undergoing a total thyroidectomy will need to take lifelong thyroid hormone supplementation. In addition, total thyroidectomy does carry increased risk as both sides are explored and therefore both recurrent laryngeal nerves and all four parathyroid glands are at risk.

Care is taken in every operation to ensure that both nerves and all parathyroid glands are located and preserved to minimise the risk of loss or damage or these structures.

Will I need a hemithyroidectomy or a total thyroidectomy?

Whether a patient undergoes a hemithyroidectomy or a total thyroidectomy is entirely dependant on their reason for surgery. For example, in the case of a single nodule with a low cancer risk, it may be reasonable to undergo a hemithyroidectomy. If, however, the suspicion for cancer is high then a total thyroidectomy is warranted to ensure complete resection of the tumour.

Node Dissection

If you have a confirmed diagnosis of thyroid cancer or the suspicion of thyroid cancer is high, it may be recommended that you undergo a node dissection. This involves the removal of lymph nodes from one or more areas of the neck. The purpose of this operation is to assess whether the cancer has spread to the lymph nodes and to remove any diseased nodes to limit further spread. Dr Murugappan will discuss node dissection with you if it is applicable to your case.

Hospital Stay

• All thyroid operations require a general anaesthetic, breathing tube placement, and the minimum of an overnight stay in hospital.
• After the operation is over, you will wake up in the recovery area and then be transferred to the ward.
• Occasionally, patients with other health risks or with very large thyroid glands may be admitted to a High Dependency or an Intensive Care Unit for closer observation.

How you will feel

• After waking from your anaesthetic it is very common to have a stiff, sore neck. This is from a combination of your neck positioning during surgery, the operation itself, and the tube placed in your airway to assist your breathing during the operation.
• In most cases, after you are sufficiently awake following your anaesthetic, you will be able to eat a full diet.
• Some people do feel nauseous or even vomit after an anaesthetic. If this is the case for you, rest assured that we can give you some medication to assist and that this feeling will improve as you recover from your anaesthetic.

Wound Care

• Your incision will be stitched with dissolvable sutures, meaning that you will not need to get any sutures removed. Your wound will also be covered with a simple dressing. We ask that you keep your dressing in place until your next outpatient appointment with Dr Murugappan.
• In all cases, Dr Murugappan will endeavour to make the incision within an existing neck crease as this will result in the best cosmetic outcome. It is normal to experience some swelling around the incision site which will continue to improve in the days and weeks following surgery.
• With any incision there is always a risk of bruising and scarring. A minority of patients may be prone to excessive scarring (keloid scarring).
• In the case of difficult or extensive dissection, it is possible that a drain may be placed in the operative site. This is a precautionary measure used to alleviate pressure in the unlikely event of any bleeding after the operation. If you have a drain placed, it will be removed following surgery before you are discharged from the hospital.

Thyroid Hormone Replacement

• A normal level of thyroid hormone is essential for normal bodily function. For this reason, every patient who has a total thyroidectomy needs to take lifelong thyroid hormone replacement, starting the day after surgery.
• The amount of hormone required is different for every individual, and you will initially need to have regular blood tests to determine whether the amount of supplement you are taking is right for you.
• If you have a hemithyroidectomy, you will need to have a blood test performed post-surgery to ensure that your remaining thyroid gland is producing enough thyroid hormone for your body. In most cases, patients who have had a hemithyroidectomy will not need thyroid hormone supplementation.

Calcium Levels

• The parathyroid glands are four small glands located in the neck behind the thyroid gland. Their role is to regulate calcium levels in the bloodstream. Because the parathyroid glands are located very closely to the thyroid gland they are at risk of damage or removal during a thyroid operation.
• Following your operation, your calcium levels will be checked to ensure that your parathyroid glands are still in working order.
• Occasionally, patients may need calcium supplementation while affected glands recover from the operation. Rarely, due to loss or permanent damage of the parathyroid glands, a patient may need to take lifelong calcium and vitamin D supplementation.

Voice Changes

• Most patients following thyroid surgery will wake up with either a normal or slightly hoarse voice due to the breathing tube used while asleep. A small percentage of patients may experience longer-term voice hoarseness due to damage to the recurrent laryngeal nerve, a nerve which helps to control the vocal cords.
• Temporary voice hoarseness may be caused by bruising and manipulation of the nerve during the operation. This typically resolves over a few weeks to months.
• With all thyroid surgery there is a risk of permanent damage to the nerve resulting in permanent voice hoarseness. If this occurs to the nerve on both sides of the neck, airway obstruction may result. The risk of permanent recurrent laryngeal nerve damage during thyroid operation is less than 1%. This risk increases in the case of thyroiditis, repeat neck operation, or neck dissection.

Operative Success and Results

• In every thyroid operation, the removed tissue is sent to a pathologist to be examined. In your follow-up appointment, Dr Murugappan will discuss your results with you and options for further treatment if needed.

Risks and Complications

Many of the risks of thyroid surgery are discussed above. These include;

• Swelling
• Bruising, scarring
• Neck stiffness/soreness
• Wound infection
• Bleeding
• Recurrent Laryngeal Nerve Injury resulting in voice hoarseness or weakness
• Need for calcium and vitamin D supplementation