Thyroid Surgery: Types, Indications, Risks, and Recovery

What is Thyroid Surgery?

The thyroid gland is a butterfly-shaped gland located in front of the neck. It produces hormones responsible for the body’s metabolism, like managing the heart rate or the number of calories burned by the body. Thyroidectomy or thyroid surgery removes a portion or the entire thyroid gland. 

Indications for Thyroid Surgery

Doctors can perform thyroid surgery or thyroidectomy in the following cases:

• Presence of thyroid nodules: Thyroid nodules are a lump or growth of the thyroid cells in the thyroid gland. Although generally benign or non-cancerous, thyroid nodules can be cancerous or malignant. When the nodules have an increased risk of being cancerous, thyroid surgery can be done to remove them.

• Goiter or non-cancerous enlargement of the thyroid gland: Goiter is an enlarged thyroid gland with or without the presence of thyroid nodules. An enlarged thyroid gland can affect the esophagus or the food pipe, as well as the trachea or windpipe, causing difficulty in breathing and swallowing. Goiter can also be removed by removing half or all of the thyroid gland relieving the obstruction.

• Thyroid cancer: Thyroidectomy is primarily done because of thyroid cancer. Cancer in the thyroid gland may require the removal of a part or the entire thyroid gland.

• Hyperthyroidism or overactive thyroid: Hyperthyroidism can occur when the body produces excessive thyroxin hormone. The doctor can perform a thyroidectomy when the patient has problems taking anti-thyroid drugs or when they do not want radioactive iodine therapy.

Types of Thyroid Surgery

Thyroid surgery can be total, where the entire thyroid gland is removed, or partial, where a part of the gland is removed. 

• Total thyroidectomy: A total or near-total thyroidectomy involves the surgical removal of all or most of the thyroid gland. 

• Partial thyroidectomy: The surgeon can remove a part of the thyroid gland while the remaining takes over the functions of the entire thyroid gland. 

• Thyroid lobectomy (aka hemi-thyroidectomy): The surgeon removes one thyroid lobe. 

• Isthmusectomy: The surgery removes small tumors located in the thyroid tissue between the two lobes in the thyroid gland (thyroid isthmus). 

• Completion thyroidectomy: This is a second surgery to remove the second half of the thyroid gland, typically for cases of thyroid cancer found in the first surgery. 

Thyroid Surgery Risks

Surgical removal of the whole or part of the thyroid glands can have certain risks in addition to general risks of surgery and general anesthesia. 

Temporary or permanent Hypoparathyroidism:

Surgery of the thyroid gland can cause injury of or accidental removal of a portion of the four parathyroid glands located at the back of the thyroid gland. The parathyroid glands produce parathyroid hormone that helps balance calcium and phosphorus in the kidneys and bones. 

Injury to the parathyroid glands can lower the calcium levels in the body, causing hypocalcemia. Hypocalcemia can occur for a few weeks to months following the thyroid surgery and requires calcium supplements.  In rare cases, it can be permanent. 

Patients can have symptoms like: 

• Muscle cramps and twitches

• Tingling and numbness in the hands, feet, or lips 

• Headaches, anxiety, and depression 

Severe calcium deficiency may cause: 

• Arrhythmias or abnormal beating of the heart 

• Heart failures 

• Seizures 

• Breathing difficulties 

Hypothyroidism

When thyroid surgery removes the entire thyroid gland, patients will not have a gland to produce thyroid hormone and will need to take thyroid hormone supplement daily.  Typically, after a partial thyroidectomy, no hormone replacement is necessary, but your doctor will assess your levels. 

Some of the common symptoms of hypothyroidism are: 

• Dry, coarse skin 

• Muscle cramps 

• Feeling cold, especially in the extremities 

• Frequent periods with heavy menstrual flows 

• Excessive or unexplained weight gain

• Constipation 

• Fatigue 

• Depression and difficulty in concentration 

Hoarseness or voice change

Thyroid surgery patients can experience hoarseness or changes in voice following the surgery. This can happen because of irritating or injuring the laryngeal nerves near the thyroid gland. 

While temporary irritation and inflammation of the nerves improve within the first few weeks of the surgery, the change in voice can persist up to six months following the thyroid surgery. 

In rare cases where the surgery damages the laryngeal nerves causing a permanently hoarse voice, an ENT specialist can perform different procedures to improve the voice quality. 

Injury to the recurrent laryngeal nerve

This can cause symptoms like:

• Breathing problems

• Persistent cough when talking

• Aspiration pneumonia where pneumonia is caused when substances from the mouth get into the lungs

Other side effects:

Some of the other side effects noticed in patients after thyroid surgery can be:

• Dysphagia or difficulty with swallowing: They are pretty common and resolve within two weeks following the surgery;

• Neck pain and stiffness: As thyroid surgery requires the neck to be placed in an extended position, the patients can experience neck pain and stiffness following the surgery.

• Infections: Although the risk of infection is present in all surgeries, it is comparatively rare in thyroid surgeries.

Thyroid Surgery Recovery

After thyroid surgery, most patients can return home on the same day after a few hours of observation in the hospital. Before leaving, your doctor will schedule a follow-up appointment, review the medication prescribed and provide instructions to recover at home. 

Patients typically take a leave of 2 weeks from work to recover. They are advised not to lift heavy weights during recovery and avoid straining the neck for up to three weeks following surgery. 

The doctor can prescribe pain medications and medicines to treat the temporary symptoms of sore throat, difficulty swallowing, neck pain, and a hoarse voice. 

Patients of thyroid surgery who require calcium supplements will need to come for a follow-up visit one to two weeks after surgery when the doctor shall decide whether to continue the supplements.  

The doctor will check your thyroid hormone levels through a TSH (Thyroid Stimulating Hormone) test and may recommend hormone replacement therapy six weeks after the surgery. 

When to call the doctor? 

You need to call the doctor immediately if you experience the following symptoms after the thyroid surgery: 

• Swelling and bleeding at the incision site 
• Redness and warmth at the incision area 

• Fever of 101 degrees F or higher 
• Numbness or a tingling sensation in your hands, lips, or face 

Thyroid Surgery at Houston ENT & Allergy

We at Houston ENT & Allergy have served the greater Houston community for over 100 years.

We have board-certified specialists who are passionate about diagnosing, treating, and educating people to prevent ENT issues resulting from thyroid problems, helping them lead a regular life.

If you are currently suffering from thyroid issues or other ENT-related symptoms, schedule an appointment today.