Mr ENYI OFO
Consultant ENT, Head & Neck, Thyroid and Parathyroid Surgeon
BSc (Hons) MBBS (Lond) DO-HNS FRCS (ORL-NHS) PhD
WHAT IS THE THYROID GLAND?
The thyroid gland is a butterfly-shaped gland usually located in the lower front aspect of the neck.
The thyroid gland is responsible for making the thyroid hormones Thyroxine (T4) and Tri-iodothyronine (T3), which are secreted into the blood and carried to every tissue in the body. T4 and T3 help the body regulate metabolism, use energy, stay warm, and keeps the brain, heart, muscles, and other body organs working normally.
REASONS WHY THYROID SURGERY MAY BE REQUIRED ARE:
A thyroid lump is suspected to be cancerous after a fine needle aspiration biopsy.
A diagnosis of thyroid cancer has been made.
Presence of a thyroid nodule or an enlarged thyroid (goitre), that is causing local obstructive symptoms such as difficulty breathing from compression of the trachea, difficulty swallowing, or an obvious unsightly lump in the neck.
Thyroid nodule or goitre that is causing excessive production and release of thyroid hormone in the body
Recurrent thyroid cyst
Thyroid surgery is broadly divided into three possible operations:
Removal of the entire thyroid gland (Total Thyroidectomy)
Removal of one half of the thyroid gland (Hemi or Partial Thyroidectomy)
Removal of the central portion (isthmus) of the thyroid (Isthmusectomy)
How much of the thyroid gland is removed depends on the underlying condition, and you will discuss this with your consultant thyroid surgeon or endocrinologist. Removal of thyroid nodules alone (especially in suspected or confirmed thyroid cancer) is not recommended for a number of reasons, and one example is that further surgery will be more difficult and prone to complications, due to the internal scarring that invariably happens after any surgery.
The operation is usually safe, and performed under a general anaesthetic, during which a small incision is made in the neck along natural skin crease lines. The thyroid is carefully isolated and removed, whilst ensuring there is no damage to important nerves and the parathyroid glands. A temporary drain is sometimes left in the neck to prevent blood clotting below the skin, and this is easily removed in most patients the morning after surgery.
Hospital discharge following your thyroid surgery is usually 1 or 2 days after a total thyroidectomy, or the following day after a partial or hemithyroidectomy.
COMPLICATIONS OF THYROID SURGERY
As with all surgery, complications although rare can arise and may include the following;
· Voice change
· Neck scar issues
· Surgical site Infection
· Nerve damage
· Parathyroid gland damage and low blood calcium levels
Mr Ofo is an experienced, high-volume thyroid surgeon, performing over 120 thyroid and parathyroid operations each year. Consequently, his complication rates are very low. He also routinely uses specialised nerve monitoring equipment during thyroid surgery to help reduce the risk of accidental damage to the nerve of the voicebox.
AFTER THE PROCEDURE
Following a partial or hemithyroidectomy you do not require any blood tests prior to discharge from hospital. Most patients go home the following day after surgery, and only require pain relieving medication to be used on a regular basis for one to two weeks after the operation. Your blood thyroid levels will need to be checked by your GP or endocrinologist 6 to 8 weeks after surgery, or sooner if you are experiencing symptoms of hypothyroidism.
If the whole of your thyroid gland has been removed, you will require lifelong replacement of thyroid hormone (thyroxine) in the form of a tablet taken on a daily basis. This will be started prior to leaving hospital if you were not already on it, and the levels adjusted in consultation with your GP or endocrinologist over a period of weeks.
Following a total thyroidectomy, you will also have your blood calcium and parathyroid hormone levels checked to ensure that your parathyroid glands are functioning normally. It may take the parathyroid glands sometime to recover fully after thyroid surgery, even in situations when they have been carefully preserved, consequently you may also need to take oral calcium and vitamin D supplements for a period of time following a total thyroidectomy.
RETURNING HOME POST SURGERY
Thyroid surgery is a major operation therefore, you should rest for at least 2 to 3 days when you return home. Most patients are able to return to work 1 to 2 weeks after surgery, but this will vary depending on the type of work you do. It is normal to feel tired for the first few weeks.
The surgical incision site should be kept dry for at least the first 3 days, and it can be left alone for up to two weeks underneath a sterile waterproof dressing. You are most likely to have dissolvable stitches which do not need to be removed. When your neck incision is healed after the first 1 to 2 weeks it can be gently massaged regularly at least twice a day with a cream (e.g. vitamin E cream) to soften the scarring.
You may be asked to have a blood test either at your follow up appointment or with your GP, this is to check whether your parathyroid glands have been affected by the operation.
If there are any concerns about the neck scar or if it becomes red, hot, swollen or painful, you should seek medical advice.
You can drive as soon as you are physically able to and are not impaired by pain medication.