Thyroid & Parathyroid Problems

Thyroid Surgery

There is a confusing array of terms for different thyroid operations. Many thyroid problems may be treated by the removal of half of the thyroid gland, a hemi-thyroidectomy.

More extensive problems are best treated by removal of the whole thyroid gland, a total thyroidectomy, leaving behind the parathyroid glands.  

In the past Grave’s disease was treated by removal of 4/5ths of the thyroid gland the so-called sub-total thyroidectomy.

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The operation is generally carried out under general anaesthesia. After you go to sleep the anaesthetist will place a special breathing tube through your mouth (endotracheal tube) and into your windpipe to help you breathe. Here at MyENTSpecialist all thyroid and parathyroid operations are carried out with the assistance of IONM (intra-operative nerve monitoring) where small electrodes attached to the endotracheal tube monitor the movement of the vocal cords and enable us to make sure the laryngeal nerves are kept safe.

A horizontal incision around 3 cm long is made through the skin. The strap muscles of the neck are separated in the middle and the dissection continues deep to these muscles to free up the thyroid lobe. The parathyroid glands are identified and preserved. After the gland is removed a silicone drain is placed and the wound is closed with dissolving stitches. Sometimes where a thyroid cancer is suspected it is necessary to remove the lymph nodes close to the thyroid, this is called a central neck dissection.  Generally, hemi thyroidectomy is carried out as a day surgery procedure, total thyroidectomy as a one night stay in the hospital. For both, you should be able to return to normal activities after around a week.

Specific complications of thyroidectomy

Like all operations there are some complications that can occur. Thankfully these are very rare. Complications may be:

The nerves that move your vocal cords run along the back of the thyroid gland and are called the recurrent laryngeal nerves. In every thyroid operation we find these nerves and peel the gland away form them. Rarely these nerves can stop working after thyroid surgery resulting in a vocal cord palsy. If this happens to one recurrent laryngeal nerve it results in a weak and breathy voice. Thankfully it is very rare, around 1-2 % of cases. Even if it happens it will most often recover by itself but may take a number of months to do so.  

If both nerves are injured after thyroid surgery it is a disaster as the patient is unable to open the vocal cords to breath.  Insertion of a breathing tube (a tracheostomy) is then required whilst recovery of the vocal cords is awaited. It is however possible to avoid nearly all of these cases by routinely using Intra operative recurrent laryngeal nerve monitoring. After one lobe has been removed A Prof McGuinness uses the nerve monitor  to “test” the nerve and check that it is working properly,  only if he is confident that this is the case will he proceed to the other side of the thyroid gland. All patients having thyroid surgery should have a vocal cord examination before and after their procedure.

Results in paralysis of the crico-thyroid muscle and difficulties changing the pitch of the voice. This is only likely to cause problems in the professional voice user.

This is not really a complication but if we remove the thyroid gland we will need to replace the thyroid hormones. This is readily treated with once daily thyroxine administration.

The parathyroid glands are 4 small glands on the back of the thyroid gland, their job is to control and maintain the amount of calcium in the bloodstream. We need calcium for our muscles and nerves to work properly. Temporary low calcium (hypocalcaemia) is relatively common after total thyroidectomy and affects about 1 in 5 patients. The symptoms of low blood calcium are numbness and tingling in the extremities and around the mouth along with spasms in the fingers and toes. Here at My ENT Specialist we have a policy of giving every patient calcium supplementation after thyroid surgery to prevent these symptoms. Long term low calcium occurs in around 1 in a hundred patients after total thyroidectomy. Chronic problems are treated with oral administration of calcium and vitamin D.

These complications can occur after thyroid surgery but they are quite rare.

Removal of half of the gland is usually a simpler operation than total thyroidectomy. As only half of the thyroid gland is removed there is enough tissue left behind to make hormones so thyroid hormone replacement is generally not needed. Also, for most people there are no risks of hypoparathyroidism and low calcium after this operation and you will not need to take calcium replacement.