Information and support I am Looking for information about treatments About thyroid surgery Surgery Content overview Why is surgery usually performed? Types of operations What questions do I need to ask? Recovery Potential complications Managing hypothyroidism Alternatives to surgery Further information Why is surgery usually performed? Surgery is the recommended treatment for several disorders of the thyroid gland. These include: Large nodules or goitres Recurrent thyroid cysts Hyperthyroidism (Graves’ disease) Thyroid cancer Where the type of nodule is unclear Types of operations Thyroid operations are usually straightforward when performed by an experienced surgeon. The most common types of thyroid surgery are: total thyroidectomy (removing all of the thyroid gland) lobectomy or hemithyroidectomy (removing half of the thyroid gland) near-total thyroidectomy (removing most of the thyroid gland but leaving a little tissue on one side) isthmusectomy (removal of the central part of the thyroid gland) What questions do I need to ask? If you have been advised that surgery is an option to treat your thyroid disorder it is important that your doctor or surgeon explains the purpose of the operation and discusses with you all of the risks involved, no matter how small. There are risks to all surgical procedures and you should not be worried about asking your surgeon what their personal complication rate is. All thyroid surgeons should be entering their data into the UK Register of Endocrine and Thyroid Surgery (UKRETS) database. This is recommended for all thyroid surgeons in England and mandatory for all members of the British Association of Endocrine and Thyroid Surgeons (BAETS). You can find out about surgeon-specific outcomes on the BAETS website. [link when this information is published.] We have prepared a checklist of questions that you may wish to ask. Once you feel you have all the information you need you will be able to give your consent to the operation. Recovery A thyroidectomy is not usually a painful operation but it is normal to feel tired following surgery and it may take up to a month before you feel you have your energy levels back. The recovery process varies between individuals, however, and how you are affected will depend in part on the operation you have had. Potential complications It is important that you understand the potential risks of a thyroidectomy, how likely they are to happen, and in some cases, what steps you can take to avoid them. The most common complications include Voice changes caused by laryngeal nerve damage Low calcium levels caused by damage to parathyroid glands (hypoparathyroidism) It is caused when the parathyroid glands in your neck are inactive or produce too little parathyroid hormone (PTH) which leads to low blood calcium levels or hypocalcaemia. Post-operative bleeding Neck numbness Swallowing difficulties Scar Incomplete removal of tissue Generally not feeling quite right Managing hypothyroidism If you have undergone a total thyroidectomy to treat hyperthyroidism, a thyroid nodule or thyroid cancer, you will need to take thyroxine (levothyroxine) to replace what your body can no longer make. If you have undergone a hemithyroidectomy, you may also need to take levothyroxine if the remaining part of the thyroid cannot produce thyroxine in sufficient quantities. Levothyroxine doses are dependent upon your body weight and blood test results. Most patients require between 100 and 150mcg a day, but the dose can be lower than 50mcg or up to 300mcg a day, depending on your needs. If you have severe hypothyroidism or are at risk of heart problems you can expect your doctor to start cautiously and increase the dose gradually. It can take several months before you feel better and for the thyroid function tests to return to normal or be judged satisfactory by your doctor. During this period you will have regular thyroid function tests, usually every three months, and your dose may need to be adjusted according to the results of the tests. Alternatives to surgery Benign (not cancer ) thyroid nodules are common and usually do not require treatment. If they are causing symptoms, such as pain or pressure, or cosmetic issues, the following are less invasive treatment options (less pain and scarring) that may offer an alternative to surgery and radioiodine therapy (RAI). You should ask your surgeon or doctor to discuss with you whether there are any less invasive options that might be suitable for you. Percutaneous radiofrequency ablation (RFA) therapy for nodules is a technique where radiofrequency energy (an electric current) is used to generate heat to destroy the thyroid nodule cells. RFA is considered in patients for whom high-risk surgery is unsuitable or who wish to avoid having surgery for their benign thyroid nodule. Ethanol ablation This is used as a non-surgical treatment usually for cystic (i.e. pure cyst) or predominantly cystic benign thyroid nodules. This involves draining the cyst of fluid under ultrasound guidance then injecting ethanol immediately back into it. It causes the walls of the cyst to stick together and it stops the cyst from recurring. It can be quite effective in shrinking large cysts. Robotic assisted thyroid surgery is a technique that is offered by the team at Imperial College, London Transoral surgery is a technique where the surgeon accesses the thyroid gland through the patient’s mouth to avoid any visible scarring. This surgery is currently only available outside the UK and is only suitable for certain patients i.e. with small thyroid cancers, thyroid nodules and hyperparathyroidism. The Royal Berkshire Foundation Trust has a team developing expertise in this area. Further information Read our Guide to Thyroid Surgery RCS: Get Well Soon: Recovery after a Thyroidectomy BAETs leaflet explaining the possible consequences of thyroid surgery Parathyroid UK: a patient organisation providing information and support for hypoparathyroidism Less invasive treatment options for benign thyroid nodules Read more about hypothyroidism Please help us help others With your support we can help people to live better with thyroid disease. 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