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Fast Facts

Stop aspirin and other medications causing bleeding one week before surgery.

If you notice swelling in the wound or trouble breathing after surgery tell the nurse immediately.

There’s a small risk of permanent change in voice.

If the whole gland is removed you will need to take a thyroid hormone tablet every day for the rest of your life.

Take two weeks off to recover.

total thyroidectomy

hemithyroidectomy

mitec-thyroid

What is this for? Is it effective?

Thyroidectomy means removing the thyroid gland.

Removing one side of the gland is called hemi-thyroidectomy.

Removing the whole gland is called total thyroidectomy.

Your surgeon and endocrinologist (hormone specialist) will recommend which operation you need.

The thyroid gland makes thyroid hormone. This hormone is essential for many parts of the body to work properly especially the brain and heart.

The thyroid gland may need to be removed if the gland is too large, overactive or contains a nodule that could be cancer:

  • Too large, causing pressure on breathing and swallowing.
  • Over-active, making too much hormone. This is usually treated with medication first. If medication isn’t working, surgery or radio-iodine treatment are the next options.
  • Thyroid nodules (lump) are very common. These can be benign or malignant (cancer). Benign nodules are much more common than malignant nodules.

Tests for thyroid disease:

  • Blood test to check the hormone level.
  • Ultrasound shows the size and shape of the gland and the size and shape of nodules. Each nodule gets a score (TIRADS) and helps the surgeon and radiologist decide if the nodule is more likely to be benign or more likely to be malignant. If the TIRADS score is higher, an FNA is recommended.
  • Ultrasound guided needed sample (FNA) can determine if the nodule is benign or due to cancer. This is like having a blood test, but the needle is placed into the lump to draw out some cells rather than into a vein to draw blood. The pathologist gives the cells a score (Bethesda). A higher score means the lump is more likely to be cancer and surgery will be recommended.
  • CT of the neck and chest if the gland is very large or you have breathing or swallowing pressure symptoms from a large thyroid.

For more information about thyroid disease and treatment see www.thyroid.org

Frequently Asked Questions

What could go wrong? Is there a chance that surgery could make me worse?

There are 3 structures close to the thyroid gland that can be affected by surgery:

  1. Blood vessels,
  2. Nerves to the voice box (larynx). Damage can cause voice change.
  3. Parathyroid glands. These are 4 small glands, 2 on each side, that make parathyroid hormone (PTH). PTH helps regulate calcium levels in your body.  Damage can cause low calcium. A normal calcium level is essential for heart and brain function.

Temporary side effects:   

All thyroid surgery

  • 3:100 people have bleeding into the wound requiring urgent care within a day of surgery. The thyroid gland has lots of blood vessels around it that are sealed during surgery. In the first 24 hours after surgery, one of these blood vessels can bleed, causing sudden swelling in the neck and pressure on breathing. If this happens, you will be taken back to the operating theatre to have the blood vessel sealed again. The nurses will carefully watch for this complication after surgery. Tell the nurse straight away if you notice swelling in the neck.
  • 2:100 people have temporary change in voice that can last up to 3 months.
  • Less than 1:100 people have an infection in the wound and need tablet antibiotics
  • Clots in the legs (deep vein thrombosis DVT) occur rarely with operations lasting longer than 45 minutes. Prevention starts in hospital with TED stockings, compression devices on the calves and injections of medication to prevent clots.

Extra risks with total thyroidectomy

  • 1:10 people having the whole thyroid gland removed have low calcium for 1-2 weeks after surgery. This is treated with calcium and vitamin D tablets until it comes back to normal.
  • Very rarely, if both vocal cords are weak, breathing is difficult and a breathing tube inserted through the skin of the neck is required.

Permanent side effects: 

All thyroid surgery

  • Less than 1:100 people have permanent change in voice. Dr Clancy hasn’t had this complication. There are procedures to help the voice sound stronger but they don’t make the voice sound perfect.
  • For some patients who have half the gland removed, the other half doesn’t make enough hormone and hormone replacement is needed.

Extra risks with total thyroidectomy

  • 1:100 people have permanently low calcium and need to take calcium and vitamin D tablets every day for the rest of their life.
  • All patients who have the whole gland removed will need to take thyroid hormone replacement tablets every day for the rest of their life. Thyroid hormone replacement has no side effects; it is simply replacing what your gland would usually make.
Could I need more surgery or treatment in the future?

If half the gland is removed, the other half may develop disease and need to be removed.

If you have thyroid cancer, you will have extra tests after surgery and may have a two day treatment in hospital with medication called radio-iodine treatment.

What are the alternatives to surgery? Are they appropriate for me?

Over-active thyroid disease (hyperthyroidism) is always treated with medication first. The endocrinologist (hormone specialist) will send you to a surgeon if the medication isn’t working well enough, you have side effects from the medication or the gland is also large and causing breathing problems. Radio-iodine ablation is an alternative non-surgical treatment.

Nodules in the thyroid gland are very common and for most people, they are benign or non-cancerous. If the ultrasound and FNA (needle sample) of the nodule suggest the nodule if benign, surgery isn’t needed. If the tests show the nodule is a cancer or could be a cancer, surgery is needed.

Large glands that aren’t squashing the windpipe (trachea) or causing swallowing problems may not need surgery. An alternative is repeating the ultrasound in 6-12 months to see if the gland is growing.

What if I choose not to have surgery?

For mild disease, it may be ok not to have surgery. For cancer, surgery is recommended.

See should I have surgery for more information.

How should I prepare for surgery?

Stop using any supplements and medications that increase bleeding (like Nurofen) one week before surgery and follow the fasting instructions provided by the hospital. Stop smoking for as long as possible before surgery.

See preparing for surgery for more information.

When will I come into hospital? How long will the operation take? How long will I stay in hospital?

You will come into hospital on the day of surgery. The operation takes 1-4 hours depending on the size and shape of the gland.

After hemithyroidectomy, you’ll go home the next day.

After total thyroidectomy, you will need blood tests 2-3 times a day to check calcium levels. You will go home 2-4 days after surgery depending on calcium levels.

How long will I need off work/school/sport?

Don’t drive, operate dangerous machinery or make major decisions for at least 24 hours after an anaesthetic.

Take two weeks off work, sport and study.

Will I be awake or asleep for the operation? What kind of anaesthetic will I have?

Children and adults always have a general anaesthetic for this procedure.

See anaesthesia for more information.

How will I feel after surgery?

You will have mild pain in the wound. Most people need paracetamol only a few times in the first day after surgery and occasionally a stronger pain reliever. There are dissolvable stitches in the wound in the neck with a white steristrip dressing across the wound.

You will be eating, drinking and walking around normally within 4 hours of the procedure.

1:30 people feel sick or vomit after surgery.

Many patients tell me they feel tired for a few weeks after surgery.

What do I need to do to recover well?

Keep the wound dry and the dressing intact for a week. Don’t rub or apply heat packs. Eat as well as possible to aid healing. Avoid smoking.

Scar massage can improve the cosmetic appearance of the scar. You can start two weeks after surgery and continue every day for up to 6 months. Watch the video on how to do scar massage

When will I see the surgeon?

The surgeon will check on you in the recovery room, on the ward the next day and every day you are in hospital. You’ll have a bedside endoscopy the day after surgery to check the vocal cords and voice.

The surgeon will see you again in the office one week and six weeks after surgery. You will have a blood test to check the thyroid hormone level six weeks after surgery.

What should I do if I need help or advice?

You can ring the surgeon or practice nurse during business hours on 55605411. For non advice outside business hours, ring the nurse at the hospital where you had surgery. For urgent care outside business hours, attend your nearest emergency department.

Click here for information about Dr Clancy’s on call schedule.

Is there any more information specific to my situation?

Your surgeon will take into consideration your work, sports/hobbies, support at home and other health problems as well as past reactions or complications with anaesthesia and surgery.

Your surgeon will answer any specific questions you ask.

After thyroid surgery

You need 24 hours off driving after a general anaesthetic. You shouldn’t drive on any day when you have taken strong pain relievers or when you don’t feel capable of safe driving. Most people take 2 weeks off work and sport to recover after thyroid surgery.

What do I need to do to recover well?

The better you eat, the better you heal, especially fruit and vegetables. Keep the wound dry and the dressing intact until you see the surgeon in one week. Avoid vigorous activity (running, gym, competitive sports) and aim for some exercise like walking on most days.

Scar massage can improve the cosmetic appearance of the scar. You can start two weeks after surgery and continue every day for up to 6 months. Watch the video on how to do scar massage.

If you have had the whole thyroid removed (total thyroidectomy) you will need to take a thyroid hormone tablet every day for the rest of your life.

What is normal? How will I feel after surgery?

It is common to feel sore on the inside of the throat, due to the breathing tube used during surgery. The wound will be mildly painful. You may feel fatigued for a few weeks.

What is not normal?

Contact your surgeon or attend your nearest emergency department if you have:

  • swelling in the neck or difficulty breathing.
  • signs of low calcium: pins and needles in the hands, feet or lips, muscle twitches or cramps or palpitations.
  • vomiting lasting more than a few hours.
  • severe pain not controlled by the prescribed pain medication.
  • fever >38 degrees for more than 24 hours.
When will I see the surgeon?

The surgeon will see you:

  • in the recovery room.
  • on the ward the next morning, including a nasal endoscopy to check the movement of the vocal cords.
  • In the office one week after surgery. You will be given an appointment card today.
  • and again in 6 weeks, with a blood test one day before that visit.
What should I do if I need help or advice?

You can ring the surgeon or practice nurse during business hours on 55605411. For non advice outside business hours, ring the nurse at the hospital where you had surgery. For urgent care outside business hours, attend your nearest emergency department.

Click here for information about Dr Clancy’s on call schedule.

Is there any more information specific to my situation?

If you have had the whole thyroid removed (total thyroidectomy) you will need to take a thyroid hormone tablet every day for the rest of your life.