Bechara Y. Ghorayeb, MD, PA
Otolaryngology - Head & Neck Surgery
1140 Business Center Drive, Suite 560, Houston, Texas 77043
Thyroidectomy is an operation in which one or both lobes of the thyroid gland are removed. The most common indications for thyroidectomy include a large mass in the thyroid gland, difficulties with breathing related to a thyroid mass, difficulties with swallowing, suspected or proven cancer of the thyroid gland and hyperthyroidism (overproduction of the thyroid hormone). The need for thyroidectomy based on your history, the results of a physical examination and tests. The procedure is usually done under general anesthesia. The extent of surgery (removal of one or both lobes) may sometimes be determined in the course of surgery after microscopic examination of tissue removed during the surgery.
After surgery it is very common to have difficulty in swallowing. Occasionally, swallowing may even be a little painful. This pain usually resolves within 24 to 72 hours. Bleeding or infection are also possible short term complications. Although rare in thyroid surgery, some patients may develop a thick scar or keloid.
Two complications specific to thyroid surgery are hypocalcemia and vocal cord weakness or paralysis.
Hypocalcemia, or low blood levels of calcium, may occur after complete removal of both thyroid lobes. This condition is caused by injury or interference with the blood supply of four tiny glands called parathyroid glands, which are located within or very close to the thyroid gland. Hypocalcemia is usually temporary, but sometimes may require calcium supplements if sufficiently pronounced. Fortunately, permanent hypocalcemia is rare. Vocal cord weakness or paralysis may be caused by swelling, stretching, or injury to the recurrent laryngeal nerve which passes very close to the thyroid gland. Temporary hoarseness may result. Again, this is an uncommon, usually temporary complication. Permanent vocal cord paralysis is rare.
Frozen section and final diagnosis: During surgery, the specimen removed is examined by the pathologist who performs frozen sections. In the majority of cases, the pathologist is able to distinguish between benign and malignant lesions. In a very small percentage of patients,however, the frozen section may not identify a small cancer which is picked up on permanent sections, a few days later. When this happens, the patient may have to return to surgery for removal of the remaining thyroid tissue and sometimes lymph node dissection.
Depending on the final histologic (microscopic examination) diagnosis of the gland removed, and on the blood tests, continuous follow-up by the endocrinologist and / or surgeon may be indicated for replacement of the thyroid hormone. Following total thyroidectomy, patients have to take replacement thyroid hormone for the rest of their life.
Patients with Graves' Disease / Thyrotoxicosis could develop a thyroid storm. This is a serious condition that is associated with untreated or undertreated hyperthyroidism. During a thyroid storm, an individual's heart rate, blood pressure and body temperature could soar to dangerously high levels.
In very rare circumstances, airway obstruction may occur and a tracheotomy may become necessary to gain access to the airway. This is an extremely rare life saving measure and every effort would be taken to avoid it.
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