Thyroid Surgery

Why is thyroid 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) 

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 shy in 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 

We have prepared a checklist of questions which 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 should not be a particularly 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. How you are affected will depend in part on the operation you have had.  

For more details about what to expect and some suggestions about what may help you, please see the following resources: 

Royal College of Surgeons: thyroidectomy information

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 the following: 

• 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 in turn 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 

For an explanation of the possible consequences of thyroid surgery please see BAETS leaflet 

For information and support about hypoparathyroidism, help is available from Parathyroid UK 

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.

Read our guide to living better with hypothyroidism

See our hypothyroidism resources

Alternatives to surgery 

In the UK there are currently few alternatives to the traditional surgical route available.  

• 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.

• 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.  

• Ultrasound-guided Percutaneous Microwave Ablation for the treatment of benign thyroid nodules 

  In this procedure, a thin wire is inserted into the nodule under local anaesthetic. Ultrasound is used to guide it into position. It sends out microwaves that heat the nodule to destroy it (ablation). The aim is to shrink the nodule to relieve symptoms and improve appearance.

  Some nodules are better suited to microwave ablation than others, this depends on many factors including size, location, the appearance of nodules, and the symptoms being treated. Careful assessment is required as some nodules are adjacent to the carotid artery or laryngeal nerve and there is a very small risk of stroke or damage to the voice box

  This procedure is now approved by the National Institute for Health and Care Excellence (NICE). It is a still very new technique and is currently being performed by the interventional radiology department at the Princess Royal Hospital, part of King’s College Hospital NHS Trust, London and at the Queen Alexandra Hospital, Portsmouth. To find out more, prospective patients can contact the hospitals directly:

  Princess Royal University Hospital,  01689 863000  ask for the interventional radiology department.

  Queen Alexandra Hospital, Portsmouth, consultant interventional radiologist [email protected]

  Read more about microwave ablation 

Further resources

Watch the BTF thyroid surgery webinar

Watch the BTF webinar on hyperthyroidism and surgery for Graves' disease

Watch the BTF webinar on thyroid cancer surgery, diagnosis and management