Thyroid surgery

Malignant tumours of the thyroid are surgically removed. Depending on the case, the entire thyroid gland, or only a part of it, will be removed. After surgery, the thyroid hormones are often replaced with medication.

As an organ, the thyroid produces important hormones for the metabolism. Benign or malignant tumours of the thyroid can therefore lead to hyperthyrosis or hypothyrosis of the thyroid gland, and thus upset the metabolism. Benign enlargement of the thyroid, commonly known as goitre, is mainly caused by a lack of iodine. Benign changes do not necessarily require surgery. If these changes are thyroid cancer-related on the other hand, surgery is usually unavoidable.  Radioiodine therapy can be started in certain cases as an alternative to surgery. During this form of therapy, radioactive iodine is taken in capsule form or as a watery solution. Iodine is absorbed solely by the thyroid and results in the destruction of the tumour.

What preparations are carried out before the procedure?

Different examinations are carried out to accurately determine the stage of the disease and the type of tumour before the surgery. They include ultrasound examination, biopsy and scintigraphic scan of the thyroid gland. The thyroid hormones are measured in the blood.

As is standard before all operations, all blood-thinning medication must be discontinued before the surgery. The operation is performed under general anaesthetic. Patients should therefore have an empty stomach for the procedure.

How is the operation performed?

The thyroid consists of two flaps. Depending on the extent and stage of the thyroid cancer, the entire thyroid (total thyroidectomy) or only half of the thyroid (hemithyroidectomy) will be removed. The thyroid gland is carefully exposed with an incision under the larynx. Particular care must be taken with the vocal cord nerve which runs through the thyroid gland. The entire thyroid gland is removed during a total thyroidectomy. During a hemithyroidectomy or partial thyroidectomy, only the diseased tissue is removed and the remainder of the thyroid is retained.

Sometimes the parathyroid gland also has to be removed. This operation is described in the chapter entitled Parathyroid surgery.

After the thyroid has been removed, the surgical wound is closed with a suture.  The examination takes between one and two hours.

What is the success rate of this procedure?

The disease course after removal of the thyroid depends on the type of the tumour and the stage of the disease. The prognosis after removal of the thyroid is particularly good when the cancer is localised in the thyroid itself.

What are the possible complications and risks of this procedure?

As with all surgery, the operation may occasionally lead to infections, nerve damage, post-operative haemorrhaging or blood clots. The risk of temporary paralysis of the vocal cords is around 3%. Approx. 0.5% of those affected are left with permanent paralysis of a nerve or both vocal cords.

What happens after the operation?

The function of the vocal cords is immediately checked after the operation. There is an increased risk of post-operative haemorrhaging after thyroid surgery. Therefore, patients are monitored for at least 24 hours after surgery, and they can usually leave hospital two or three days later. The vocal cord function is tested once more before discharge.

After around four to six weeks, the thyroid hormones and the parathyroid hormones are determined in the blood. Depending on the findings, the hormones must be replaced. After complete removal of the thyroid, the patient must take thyroid hormones for the rest of their life in any case.

Thyroid cancer patients normally require radiotherapy and regular check-up examinations after the surgery.

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