Thyroid Conditions

Thyroid Surgery

Thyroid surgery may be required for a number of different reasons. One is to remove nodules with malignancy or malignant potential within the thyroid. Another is to remove the entire gland due to hyperfunction (overactivity). Finally the thyroid gland may need to be removed due to a large multinodular goitre (multiple large nodules causing enlargement of the thyroid gland) causing pressure or compression symptoms (difficulty swallowing, changes in breathing).

Thyroid Nodules

Thyroid nodules can be benign, indeterminate or malignant.

A FNA (fine needle aspiration) biopsy is usually required to diagnose the type of thyroid nodule.

All biopsy may be recommended for a Thyroid nodule due to the size or Ultrasound features. An FNA allows a sample of cells from the thyroid nodule to be collected and examined under the microscope. A report is then issued with a category which ranges from benign to malignant in nature.

Hyperfunctioning Thyroid (Grave’s disease)

Graves disease is an autoimmune disease that affects the thyroid. The disease process results in the thyroid gland becoming enlarged and overactive. It may also be associated with some changes in the eyes and potential visual change.

Grave’s disease can be treated with medication or Radioactive Iodine therapy however in some circumstances surgery is the treatment of choice.

The operation requires removal of the entire gland. Post-operatively there is then the need for replacement of thyroid hormone with life-long thyroxine medication. The advantage of surgery is that the Graves will be effectively ‘cured’. There will be no further need to take antithyroid medication.

Surgery is the preferred choice of management when the gland is very big and causing compression of structures, and also when there are eye signs present.

Thyroid Cancer

Thyroid cancer is usually a very slow growing cancer with an excellent prognosis. It tends to occur in younger patients and usually presents as a lump in the neck or thyroid.

There are four main types of thyroid cancer:

Papillary Thyroid Cancer (PTC)

  • Most common.

  • Usually younger patients.

  • Often multifocal.

  • Can spread to lymph nodes.

  • Excellent prognosis.

Follicular thyroid cancer (FTC)

  • Usually older patients than PTC.

  • Common.

  • Can spread via the blood.

  • Good prognosis.

Medullary

  • Uncommon.

  • Often associated with genetic endocrine disorders (MEN syndrome).

  • Poor prognosis (if not treated early and inadequate excision)

Anaplastic

  • Extremely rare.

  • Extremely dangerous.

  • Survival often < 12 months.

Thyroid cancer is usually diagnosed with an FNA (eg. Papillary Thyroid Cancer), which results in the need for a Total Thyroidectomy (complete excision of the gland). However, on some occasions the FNA may reveal indeterminate results which may indicate a possible but not definite cancer. This will often lead to the need for a hemithyroidectomy (half of the thyroid to be removed) containing the nodule in question. This will enable a formal histological diagnosis to be gained. On some occasions this may result in the need for a subsequent second operation to remove the remaining side of the thyroid if the nodule is cancerous.

Thyroidectomy

Thyroid operations are performed under a general anaesthetic. Patients will usually stay 1-2 nights post-operatively.
During your surgical consultation Dr Geere will discuss the particular operation which is required for your surgical diagnosis. She will discuss the potential risks and complications of the surgery.

Once you are under general anaesthesia a skin incision is made in the skin crease of the neck. The size of the incision is dependent on the size of the thyroid and also whether there is to be lymph node excision. This is usually between 4-6cm.


Particular attention is placed on the blood supply to the Thyroid when the vessels are ligated and divided to reduce the risk of post-op bleeding complications.

Also attention to small glands called the Parathyroid glands which are located very close to or within the Thyroid gland is made. These glands are important to maintain the calcium levels in the body. If these are damaged then a patient may require temporary or permanent calcium replacement. Patient’s will require a blood test to check the calcium level in the blood if they are undergoing a Total Thyroidectomy.

During the operation attention will also be placed on the identification of the Recurrent Laryngeal Nerve which controls the voice box. There is a nerve located on each side of the neck behind the thyroid gland. During the surgery a Nerve Monitor will be used to confirm an intact nerve signal once the Nerve has been visually identified. There may be a stretch injury to the nerve during a thyroid operation (especially in a large goitre removal). This may result in a temporary weakening of the voice, swallow and cough. Very rarely (<1%) there may be a permanent voice change.

Other potential risks/complications which will be discussed include bleeding, infection, scarring and pain.