THYROID SURGERY

The thyroid gland is shaped like a butterfly and located over the windpipe (or trachea) in the front, lower part of the neck. It has two parts (right and left) connected in the middle of the neck by a region of the thyroid known as the isthmus. The thyroid gland produces a hormone that is important for metabolism and regulates a number of bodily functions.

Depending on the indications for thyroid surgery, one half or the entire thyroid gland may need to be removed. If the whole thyroid is removed, after surgery you will need to take regular medication in the form of thyroid hormone replacement.

Thyroid surgery may be required for a number of reasons, such as when:

  • biopsy of a thyroid lump has identified abnormal or cancer cells,
  • the thyroid gland is enlarged (i.e. goitre) and causing pressure symptoms
  • such as choking and difficulty swallowing, or there are cosmetic concerns,
  • the thyroid gland is overactive (i.e. producing too much thyroid hormone),

  and following consultation with your GP and endocrinologist at New Victoria Hospital, you have chosen surgery as definitive treatment for this condition.

THE PROCEDURE

Thyroid surgery is usually performed under a general anaesthetic and takes one to two hours depending on complexity. Most patients will only require a small (2 to 4 cm) central incision in the lower part of the neck. The thyroid gland is carefully dissected from surrounding structures such as the recurrent laryngeal nerve and parathyroid glands.

The recurrent laryngeal nerve controls movement of the vocal cords, whose function is important for speaking, swallowing, and breathing. The rate of permanent recurrent laryngeal nerve injury is very low (less than 1%), but if it does occur you may experience short or long-term voice change, and less commonly, swallowing or breathing problems. Thyroid surgery at the New Victoria Hospital is performed using the latest nerve monitoring equipment that aids identification and preservation of the recurrent laryngeal nerve, with the aim of reducing the risk of nerve damage.

Due to the potential impact of thyroid surgery on vocal cord function, it is recommended that your surgeon confirms mobility of the vocal cords prior to the operation, by examining the larynx with a small flexible endoscope. This quick and painless procedure is usually performed at the time of your initial outpatient consultation.

The parathyroid glands are four tiny structures, normally about the size of a grain of rice, closely positioned to the back of the thyroid gland. The parathyroid glands make a hormone (parathyroid hormone) that controls calcium levels in the blood. There are usually two parathyroid glands on each side of the neck and close attention is paid by New Victoria Hospital's thyroid surgeons during surgery to prevent the parathyroid glands from inadvertently being removed.

The neck incision is usually closed with absorbable stitches that do not require removal, and a small drain is placed in the neck at the end of surgery to collect any excess tissue fluid or blood.

FOLLOWING THYROID SURGERY

Most patients usually require only a single overnight stay in hospital after their thyroid surgery. You are closely monitored on the ward by our nursing staff and allowed to eat and drink as soon as you have recovered sufficiently from the general anaesthetic. Early mobilisation is also encouraged.

If the whole thyroid gland is removed, blood tests to check calcium levels and parathyroid gland function are performed within the first 6 to 12 hours of surgery, and oral calcium supplements may be started in the interim to minimise the symptoms associated with low blood calcium.

Most neck drains are removed the day after surgery, and then patients are discharged home with appropriate analgesia. You will require one to two weeks off work.

Outpatient follow-up takes place 11 to 14 days after surgery, at which the result from pathological analysis of the thyroid is discussed, vocal cord function is confirmed following examination of the larynx with a small flexible endoscope, and the neck wound is also checked for appropriate healing.  

To enquire about our specialist private thyroid surgey, call 020 8949 9000 or use our enquiry form.