Thyroid/ Parathyroid Surgery
The most common surgeries we perform include:
• Removal of one half of the thyroid (lobectomy)
• Removal of all of the thyroid (total thyroidectomy)
• Lymph node removal for cancer (central or lateral neck dissection)
• Minimally-invasive parathyroid surgery
• Re-operative thyroid, parathyroid and lymph node removal surgery
• “Scarless” transoral endoscopic thyroid and parathyroid surgery, vestibular approach (TOETS-VA)
•Laparoscopic and open adrenalectomy
We also offer in-office ultrasound-guided thyroid and lymph node biopsies, general surgery procedures, and management for patients with rare endocrine tumors.
Why do people need part (lobectomy) or all (thyroidectomy) of their thyroid removed?
The most common reason a person needs part or all of their thyroid removed is due to a worrisome mass or nodule in the thyroid. These can be sampled/biopsied with a small needle (fine needle aspiration-FNA) to determine the risk of cancer. If the needle sample is suspicious, surgery is usually the next step.
In some cases, a person may need their thyroid removed due to large size
(goiter), nodules that are benign but bothersome (due to their size or hormone overproduction/hyperthyroidism) or as treatment for difficult-to-control hypothyroidism.
Why do people need their parathyroid glands removed?
Parathyroid surgery is done when one or more of the parathyroid glands have become enlarged and are making too much parathyroid hormone (PTH). Too much PTH leads to high blood calcium levels known as hypercalcemia. This is most commonly caused by a single nodule/benign parathyroid growth known as a parathyroid adenoma.
Sometimes, enlargement occurs in all four parathyroid glands, known as
parathyroid hyperplasia or multigland disease. This may require removal of multiple glands to reduce the overall amount of parathyroid tissue and hormones.
What are the risks of thyroid/parathyroid surgery?
In addition to the usual risks of any surgery, there are three main risks associated with thyroid/parathyroid surgery, all of which are rather uncommon.
1. Injury to the nerves (recurrent laryngeal and superior laryngeal nerves) that control
the vocal cords. These nerves course right behind the thyroid gland and between the parathyroid glands. Injury to these nerves can result in hoarsesness, inability to sing or reduced pitch range, difficulty swallowing, and in rare cases, difficulty breathing or requirement of a tracheostomy tube.
2. Injury to your parathyroid glands, which are responsible for regulating calcium levels in the body. This can result in temporary or permanent problems with low calcium requiring lifelong calcium supplementation. In parathyroid surgeries, it is also possible to not find one or more abnormal parathyroid glands and have persistent elevations in calcium/PTH.
3. Bleeding. This is a rare but serious problem because it can cause difficulty with
breathing as the windpipe (trachea) is beneath (deep) to the thyroid gland and
significant bleeding can compress the trachea.
What do I need to do to prepare for surgery?
Blood tests and imaging are generally required to help diagnose your condition and plan a safe surgery.
Depending on your age and other health issues, you may need very little additional workup or you may be asked to complete additional tests/appointments to make sure you are safe for surgery. If you are seeing other specialists (such as a heart or lung doctor) you will likely need to consult with them prior to scheduling surgery.
Depending on your reason for surgery, symptoms, size of thyroid nodules/parathyroids, concern for cancer or previous surgeries, you may be
required to have a formal evaluation of your vocal cords prior to surgery.
What can I expect the day of surgery?
For most patients, you are required to stop eating 8 hours prior to surgery, but allowed clear liquids until 4 hours prior to surgery. You will be given specific recommendations about preoperative diet and medication adjustments at your appointment.
We ask our patients to arrive at the Surgical
Registration 2-3 hours prior to surgery to complete paperwork, start your IV, see your
surgeon, and meet and speak with the Anesthesiologist and operating room staff. The length of surgery depends on the type or surgery planned. Your surgeon will let you know the anticipated length of surgery. After surgery, you will be transported to the Recovery Room where you will be monitored as you recover from anesthesia.
Depending on the type of surgery, your other medical conditions, and any other safety concerns, you may be asked to stay overnight or be allowed to go home the same day.
You may have a headache, fatigue and a sore throat that should subside a few days after surgery. Pain after thyroid/parathyroid surgery is usually minmial and most patients are generally able to manage their pain with over-the-counter medications (such as Tylenol, Ibuprofen) and application of ice packs.
What is life like after thyroid/parathyroid surgery?
Once you are home, most normal activities can be resumed. We restrict lifting over 20
pounds for 2 weeks after surgery. In general, you can shower 24 hours after surgery. Light exercise and driving are allowed as soon as 24 hours after surgery for most patients.
We do not generally restrict diet after surgery. We do anticipate that you will have a sore throat for a few days and may choose to adjust your own diet accordingly. Temporary changes in voice and swallowing are also expected and resolve in time most patients.
Once recovered from surgery (usually 1-2 weeks), you may return to normal activities without any restrictions. Depending on your surgery, you may need to take thyroid hormones or extra calcium.
You will need follow-up with your Primary Care Provider or Endocrinologist after surgery and on-going management.