Thyroid Surgery

Anatomy and thyroid surgery

The thyroid is a small, butterfly-shaped gland situated in the neck just below the Adam's apple. In spite of its size, the thyroid has a huge impact on one's hormones, metabolism, emotions, and overall health. The thyroid produces the body's thyroid hormones, primarily thyroxine (T4) and triiodothyronine (T3), which control your metabolism and promote the healthy development of many other systems in the body. In fact, a healthy thyroid keeps your heart, brain, digestive tract, muscles, nerves, and even your skin, hair, and nails in good condition. If you have a thyroid disorder, many or all of these vital body systems can be affected.

Hypothyroidism

If your doctor diagnoses you with hypothyroidism, it simply means your thyroid isn't working as hard as it should. An under-active thyroid doesn't produce enough thyroid hormone that controls body temperature, and regulates the rate at which you burn fat and carbohydrates and produce protein. The result is that your body slows down, and you feel sluggish and less energetic.

Symptoms of hypothyroidism include:

• Chronic fatigue
• Getting cold more easily
• Weight gain
• Pale, dry skin
• Achy muscles or swollen joints
• Constipation
• Depression

If you have any of these symptoms, your doctor can run a blood test to screen your hormone levels. Hypothyroidism is generally treated with drug therapy, and does not require surgery.

Hyperthyroidism

The effects of hyperthyroidism are just the opposite of hypothyroidism. In this case, your thyroid is working too hard and overproducing thyroid hormones, making your body run faster than it should. Hyperthyroidism causes your metabolism to speed up to an abnormal rate, resulting in:

• Rapid and unexplained weight loss
• Overheating and excessive sweating
• A rapid or irregular heartbeat
• Nervousness and irritability
• Feeling jittery and "wired" while also experiencing fatigue and muscle weakness
• Trouble sleeping

Treatment for hyperthyroidism can include medications to slow down the production of thyroid hormone, radioactive iodine to kill the thyroid cells, or surgery to remove the thyroid completely (thyroidectomy).

Nodules and goiter

Sometimes the tissue in the thyroid will begin to grow abnormally, producing solid or fluid-filled lumps known as nodules. The thyroid may develop one or many nodules, which can sometimes be felt from outside the neck. Nodules are usually benign, or non-cancerous, but can sometimes be malignant, or cancerous. If the nodules are cancerous or very large, they will need to be surgically removed.

When the thyroid gland becomes enlarged, it is called a goiter. Although it is generally not uncomfortable, you may notice swelling in your neck, making your collars or necklaces tighter than normal. After a certain point, a goiter can interfere with your breathing and ability to swallow. A goiter may occur if you have hyper- or hypothyroidism; either the thyroid grows in an attempt to make more hormones, or the thyroid cells multiply faster than they need to. If a goiter does not get smaller after hormone treatment, it may need to be surgically removed.

Thyroid surgery

To determine whether a nodule is cancerous or not, your doctor may conduct a fine-needle aspiration biopsy. After numbing the area around your thyroid, your doctor will pass a fine needle into the nodule to remove a small amount of cells, which will be examined under a microscope by a pathologist. If the nodule is found to be cancerous, it will need to be removed.

There are generally three reasons that all or part of your thyroid will need to be surgically removed:

• You have a large goiter or multiple nodules
• You have one or more cancerous nodules
• You have hyperthyroidism that does not respond to hormone or iodine therapy

During surgery, you will be given general anesthesia and IV fluid support so that you sleep comfortably through the entire surgery. The surgeon will then make an incision along the base of the neck, and remove half, most, or all of the thyroid gland. Once the surgery is complete, the surgeon will close the incision with sutures and or surgical glue.

After thyroid surgery

• Most thyroid surgeries are done as an outpatient procedure (at NASA Surgical Center) or most an overnight stay at the hospital (up to 23 hours stay). In the immediate post-up period (or recovery room), you are monitored for bleeding. In the first few days you may be asked to take supplemental calcium to ensure your parathyroid glands are functioning properly.
• You will usually be able to eat and walk around the evening of surgery, but you may still feel a little nauseous from the anesthesia.
• You may experience a sore throat and hoarseness for about a week after surgery, but discomfort is usually minimal.
• Your doctor may ask you not to get your incision wet for a few days following surgery, and you should avoid any strenuous activity for a few weeks.