Thyroid Surgery
Dr. Chris Hobbs is an experienced thyroid specialist and surgeon who treats patients with thyroid lumps and other thyroid diseases. Thyroid nodules are common in Singapore and the incidence of thyroid cancer is increasing.
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What is the thyroid gland?
The thyroid gland is an endocrine gland that makes hormones which are released into the bloodstream. These hormones affect cells and tissues in other parts of the body and help them to function normally. Where is the thyroid gland?
The thyroid gland is at the base of the throat. It is made up of two lobes (each about half the size of a plum). The two lobes lie on either side of your windpipe, with the gland lying just below your Adam’s apple. What does the thyroid gland do?
The thyroid gland produces two main hormones that are released into the bloodstream:
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The position of the thyroid gland in the neck
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What do the thyroid hormones do?
Thyroid hormones (T3 and T4) help to control the speed of body processes – your metabolic rate. If too much of the thyroid hormones is released, your body works faster than normal, and you have ‘hyperthyroidism’. This would make you feel overactive and anxious, hungrier than usual, and you would lose weight. However, if too little of the thyroid hormones is produced, your body works slower than normal, and you have ‘hypothyroidism’. In that case, you would feel tired and sluggish, and put on weight easily.
Thyroid hormones (T3 and T4) help to control the speed of body processes – your metabolic rate. If too much of the thyroid hormones is released, your body works faster than normal, and you have ‘hyperthyroidism’. This would make you feel overactive and anxious, hungrier than usual, and you would lose weight. However, if too little of the thyroid hormones is produced, your body works slower than normal, and you have ‘hypothyroidism’. In that case, you would feel tired and sluggish, and put on weight easily.
Thyroid cancer
Most cancers of the thyroid gland are very slow growing, and it may be many years before the symptoms become obvious. Are all thyroid cancers the same? No, there are different types:
Papillary carcinoma – this is the most common thyroid cancer. It is more common in younger people, particularly women.
Follicular carcinoma – this is less common and tends to occur in slightly older people than those with papillary cancer.
Medullary carcinoma – this is a rare cancer, which is sometimes hereditary (i.e. it is passed down through a family from one generation to the next).
Most thyroid cancers are very treatable and curable, but it is possible that they will recur, especially in the very young and very old. This can occur at any stage, but recurrences can be treated successfully, so lifelong follow-up is most important.
Most cancers of the thyroid gland are very slow growing, and it may be many years before the symptoms become obvious. Are all thyroid cancers the same? No, there are different types:
Papillary carcinoma – this is the most common thyroid cancer. It is more common in younger people, particularly women.
Follicular carcinoma – this is less common and tends to occur in slightly older people than those with papillary cancer.
Medullary carcinoma – this is a rare cancer, which is sometimes hereditary (i.e. it is passed down through a family from one generation to the next).
Most thyroid cancers are very treatable and curable, but it is possible that they will recur, especially in the very young and very old. This can occur at any stage, but recurrences can be treated successfully, so lifelong follow-up is most important.
What is the cause of thyroid cancer?
The cause of thyroid cancer is unknown, but exposure to radiation is known to increase the risk of getting thyroid cancer. For example, after the Chernobyl accident, many more children in the area got thyroid cancer. Similarly, it has been found in people who had external radiotherapy to the neck 10 or 20 years earlier. Research into the causes of thyroid cancer is ongoing. Very occasionally papillary cancer is hereditary, and medullary cancer is quite often hereditary.
The cause of thyroid cancer is unknown, but exposure to radiation is known to increase the risk of getting thyroid cancer. For example, after the Chernobyl accident, many more children in the area got thyroid cancer. Similarly, it has been found in people who had external radiotherapy to the neck 10 or 20 years earlier. Research into the causes of thyroid cancer is ongoing. Very occasionally papillary cancer is hereditary, and medullary cancer is quite often hereditary.
What are the reasons for thyroidectomy?
- Cancer or suspected cancer
- Thyrotoxicosis (overactive thyroid or hyperthyroidism)
- Poor cosmesis (e.g. a large lump that other people can see)
- Obstructive symptoms (e.g. pressing on the throat, windpipe or food pipe).
Types of thyroidectomy
Hemithyroidectomy - removal of one side of the thyroid gland plus the middle part (isthmus).
Total thyroidectomy - removal of both sides of the thyroid gland plus the middle part.
Completion thyroidectomy - conversion of a hemithyroidectomy into a total thyroidectomy, either during the same operation or later.
The standard approach is to remove the thyroid gland through a cut made at the front of the neck. Other methods exist in order to avoid a scar in the neck. These include transoral, endoscopic, robotic, and minimally invasive video assisted thyroid surgery (MIVAT). Please discuss with Dr. Chris if you would like to consider one of these methods.
Hemithyroidectomy - removal of one side of the thyroid gland plus the middle part (isthmus).
Total thyroidectomy - removal of both sides of the thyroid gland plus the middle part.
Completion thyroidectomy - conversion of a hemithyroidectomy into a total thyroidectomy, either during the same operation or later.
The standard approach is to remove the thyroid gland through a cut made at the front of the neck. Other methods exist in order to avoid a scar in the neck. These include transoral, endoscopic, robotic, and minimally invasive video assisted thyroid surgery (MIVAT). Please discuss with Dr. Chris if you would like to consider one of these methods.
What investigations may be carried out prior to surgery?
Blood tests: These provide some information regarding the function of the gland.
Ultrasound: This test uses sound waves to determine the structure of the thyroid gland.
Fine needle aspiration: A fine needle is used to obtain a sample of cells from the gland. These are examined under the microscope in the laboratory.
Laryngeal Assessment: A small telescope is used to assess the function of the vocal cords, prior to any surgery.
These are all available in Dr. Chris Hobbs’ Clinic
Blood tests: These provide some information regarding the function of the gland.
Ultrasound: This test uses sound waves to determine the structure of the thyroid gland.
Fine needle aspiration: A fine needle is used to obtain a sample of cells from the gland. These are examined under the microscope in the laboratory.
Laryngeal Assessment: A small telescope is used to assess the function of the vocal cords, prior to any surgery.
These are all available in Dr. Chris Hobbs’ Clinic
What will happen after my operation?
Most patients stay 1-2 nights in hospital. A drain is usually placed in the neck after the surgery. This will need to be removed before you can go home. Patients who undergo total thyroidectomy will also need to have their calcium levels check before discharge. Patients can resume normal daily activities the day after the surgery, however It is advisable to wait for at least 2 weeks before performing strenuous activities, such as heavy lifting or sports. Patients may experience some pain for a few days after the surgery; usually mild analgesics such as paracetamol will be sufficient to control it.
Most patients stay 1-2 nights in hospital. A drain is usually placed in the neck after the surgery. This will need to be removed before you can go home. Patients who undergo total thyroidectomy will also need to have their calcium levels check before discharge. Patients can resume normal daily activities the day after the surgery, however It is advisable to wait for at least 2 weeks before performing strenuous activities, such as heavy lifting or sports. Patients may experience some pain for a few days after the surgery; usually mild analgesics such as paracetamol will be sufficient to control it.
What are the potential complications of surgery?
Bleeding: Blood can accumulate beneath the skin. This occurs in less than 1% of patients. Due to the location of the thyroid, pressure from bleeding can cause breathing difficulties. It may be necessary to relieve this pressure by opening the wound.
Voice changes: Nerves that control your voice box run very close to the thyroid. There is a slight risk (less than 2%) of injury to this nerve, leading to hoarseness. This is usually a temporary effect with a rapid resolution.
Low Calcium: The parathyroid glands control calcium levels in the blood; they lie at the four corners of the thyroid gland. Every effort is made to preserve them; however, they may be traumatised by the operation and take some time to return to normal function. Calcium supplements may be required if the levels are low.
Infection: This is rare (less than 0.5%) and easily treated with antibiotics.
Hypothyroidism: This occurs if the entire thyroid is removed, long-term replacement is required. If only part of the thyroid is removed this is less common.
Bleeding: Blood can accumulate beneath the skin. This occurs in less than 1% of patients. Due to the location of the thyroid, pressure from bleeding can cause breathing difficulties. It may be necessary to relieve this pressure by opening the wound.
Voice changes: Nerves that control your voice box run very close to the thyroid. There is a slight risk (less than 2%) of injury to this nerve, leading to hoarseness. This is usually a temporary effect with a rapid resolution.
Low Calcium: The parathyroid glands control calcium levels in the blood; they lie at the four corners of the thyroid gland. Every effort is made to preserve them; however, they may be traumatised by the operation and take some time to return to normal function. Calcium supplements may be required if the levels are low.
Infection: This is rare (less than 0.5%) and easily treated with antibiotics.
Hypothyroidism: This occurs if the entire thyroid is removed, long-term replacement is required. If only part of the thyroid is removed this is less common.
