Thyroid Disorders and Surgery

What Does the Thyroid Do?

The thyroid gland is an endocrine gland that produces hormones to regulate your body’s metabolic rate, heart rate, digestion, sweating, energy consumed, brain development, mood and bone maintenance.

Other endocrine glands include the pituitary, adrenal, and parathyroid glands and specific cells in the pancreas.

Your thyroid gland is in the middle of your lower neck, below the voice box and wraps around the front of the trachea or windpipe. Shaped like a bow tie, it is located just above the collarbones, with two halves joined by a small piece of tissue called the isthmus.

What Is A Thyroid Disorder?

Thyroid disorders are very common and affect millions of Americans.

The most common thyroid problems are:

  • Hyperthyroidism or an overactive thyroid gland which can include Graves’ disease, toxic adenoma or toxic nodular goiter.
  • Hypothyroidism or an underactive thyroid gland which can include Hashimoto’s disease or thyroiditis.
  • Thyroid enlargement due to overactivity which can be caused by Graves’ disease or from under-activity (hypothyroidism). An enlarged thyroid gland is often called a goiter.

Patients with a history of family thyroid cancer or who had radiation therapy to the head or neck as children are more prone to develop thyroid cancer.

What Treatment May Be Recommended?

Hypothyroidism treatment:

  • Thyroid hormone replacement pills

Hyperthyroidism treatment:

  • Medication to block the effects of excessive production of thyroid hormone
  • Radioactive iodine to destroy the thyroid gland
  • Surgical removal of the thyroid gland

Goiters (lumps):

If you have a goiter, the doctor will create a treatment plan after the examination and test results.
Your doctor may recommend:

  • To determine the characteristics of a nodule, the size, the location within the gland is to get an imaging study done. The types of imaging studies are CT or CAT scans, MRIs and ultrasounds.
  • A fine-needle aspiration biopsy is another possible recommendation. It is a safe, relatively painless procedure. A hypodermic needle goes into the lump, where they take tissue fluid samples containing cells. This may have to be done more than once. Sometimes an ultrasound is used to guide the needle. This procedure is painless and has a very few complications after the procedure. This test helps the doctor learn more information about what the lump in your thyroid gland is and may help to determine if it’s benign or a malignant or cancerous thyroid goiter.

How will I know if I need thyroid surgery?

  • When the results from the fine needle aspiration come back as indeterminate, suspicious or suggestive of cancer.
  • If the imaging shows that the nodules have unusual characteristics or if they are getting bigger.
  • If the nodule drastically affects the trachea or windpipe because one or both thyroid lobes are very enlarged.

Some thyroid nodules have been known to reduce in size when the thyroid hormone is administered. However, this treatment (medical suppression therapy) has been an unreliable treatment method.

What is Thyroid Surgery?

Thyroid surgery is where the surgeon removes some or all the thyroid gland. The procedure is performed in the hospital with general anesthesia. Usually the operation removes the lobe of the thyroid gland containing the lump. For an immediate readying, a frozen section may be used to determine if the rest of the thyroid gland should be removed during the surgery.

Depending on the result of the frozen section, the surgeon may not remove any more thyroid tissue, or the surgeon may have to remove the entire thyroid gland, or additional tissue in the neck. The surgeon makes this decision in the operating room depending on findings at the time of surgery.

The surgeon may only remove one lobe and await the final pathology report before deciding if the remaining lobe needs to be removed. It is possible that the definite microscopic answer cannot be determined until after surgery. If a malignancy is identified, your surgeon may need to remove the remaining lobe of the thyroid at a second surgery. If you have specific questions about thyroid surgery, ask your otolaryngologist. They will be happy to answer your questions in detail.

What happens after thyroid surgery?

During the first 24 hours:

There may be a drain (tiny piece of plastic tubing) after surgery, which prevents fluid and blood from building up in the wound. The drain is removed when the fluid accumulation has stabilized which is usually within 24 hours after surgery. Most patients are discharged the same day or the following day.
Complications may include:

  • Bleeding
  • Bleeding under the skin that rarely can cause shortness of breath requiring immediate medical evaluation
  • A hoarse voice
  • Difficulty swallowing
  • Numbness of the skin on the neck
  • Vocal cord paralysis
  • Low blood calcium

Going home after thyroid surgery

After the procedure, if you need to take any medication, your surgeon will discuss this with you before you leave the hospital. The medications may include thyroid hormone replacement, calcium, and or vitamin D replacement.

Some symptoms may not be evident for two or three days after surgery. If you experience any of these symptoms following surgery, call your surgeon or seek immediate medical attention:

  • Numbness or tingling around the lips and hands
  • Increased pain
  • Swelling
  • Fever
  • Discharge from the wound
  • Breathing issues

If malignancy was found, there may be a few weeks delay before thyroid replacement medication is prescribed. A radioactive scan can better detect any remaining microscopic thyroid tissue to help determine if the malignant cells have spread to lymph nodes or other areas.

How Is A Diagnosis Made?

A physical examination and medical history are used to diagnose a thyroid function abnormality or a thyroid mass. Blood tests, imaging studies or fine-needle aspiration may also be required. Your doctor will examine your neck and ask you to lift your chin to make your thyroid gland easier to examine. You may be asked to swallow, which helps to feel the thyroid and any mass in it. The doctor may include the following tests:

  • A hormone test
  • An antibody test
  • Examination of the larynx and vocal cords with a mirror or a fiberoptic telescope
  • An ultrasound exam of your neck and thyroid
  • CT scan or MRI
  • Chest X-ray
  • A radioactive thyroid scan
  • A fine-needle aspiration biopsy

Colorado ENT offers extensive experience in the surgical management of thyroid disorders. Our Otolaryngology physicians have unmatched experience in thyroid surgery. Call (719) 867-7800 to make an appointment today.