Thyroid and Parathyroid Surgery

Surgery for thyroid and parathyroid problems deals with both non-cancerous and cancerous issues in the thyroid and parathyroid glands. The thyroid gland is butterfly-shaped in the middle of the neck. It produces thyroid hormone that regulates the metabolism of the body. A tumor may form in the thyroid gland due to the over-division of the normal cells in the gland.

Parathyroid glands are four rice grain-sized glands on each side of the neck. They produce a parathyroid hormone that regulates calcium levels in the blood.

If you’re being checked for a thyroid or parathyroid issue, your doctor will ask questions about your health, examine your neck, and do a ultrasSometimes, they might also do a fine needle biopsy to get tissue from nodules for more information on how to treat. the issue.

Surgery Options for Thyroid and Parathyroid Conditions

Surgery is a common approach for addressing issues related to the thyroid and parathyroid glands. The specific surgery options depend on the nature of the condition. Here are common surgical interventions:

1.   Thyroidectomy:

Description: Removal of all or part of the thyroid gland.

Indications: Thyroid cancer, large goitres, hyperthyroidism, or suspicious nodules.

Types:

Total thyroidectomy: removal of the entire thyroid.

Total thyroidectomy may be done for a variety of diseases, including thyroid cancer, Graves’s disease, multinodular goiter, and substernal goiter, among others. After a total thyroidectomy, patients will need to take thyroid hormone replacement pills (one pill a day for the rest of their lives).

Thyroid lobectomy (aka hemithyroidectomy): removal of half of the thyroid.

A thyroid lobectomy may be done for a variety of diseases, including indeterminate lesions on fine needle biopsy, substernalgoiter, and an enlarging thyroid nodule, among others.

Completion thyroidectomy: removal of any remaining thyroid tissue.

A completion thyroidectomy is usually done after a thyroid lobectomy reveals cancer in the first half of the thyroid but may also be done for multinodular goiter or hyperthyroidism.

2.             Parathyroidectomy:

Description: Removal of one or more parathyroid glands.

Indications: Hyperparathyroidism due to benign tumors (adenomas) or overactivity of the parathyroid glands.

Types: Focused parathyroidectomy (removal of the affected gland) or subtotal/total parathyroidectomy (removal of multiple glands).

3.             Minimally Invasive Surgery:

Description: Utilizes smaller incisions and specialized instruments for reduced scarring and quicker recovery.

Indications: Small thyroid nodules or parathyroid adenomas suitable for a less invasive approach.

Types: Endoscopic thyroidectomy or minimally invasive parathyroidectomy.

4.             Robotic-Assisted Surgery:

Description: Uses robotic technology to enhance precision and allow for intricate movements during surgery.

Indications: Complex thyroid or parathyroid cases requiring enhanced dexterity.

Types: Robotic thyroidectomy or robotic-assisted parathyroidectomy.

5.             Neck Dissection:

Description: Removal of lymph nodes in the neck to check for cancer spread.

Indications: Thyroid cancer cases where lymph node involvement is suspected.

Types: Central neck dissection or lateral neck dissection.

Surgery options are tailored to the specific diagnosis and individual patient factors. The choice of procedure is a collaborative decision between the patient and the healthcare team, considering the nature of the condition, potential risks, and desired outcomes.

What happens during thyroidectomy and parathyroidectomy?

The procedure can be performed using various methods, such as traditional, minimally invasive, or scarless techniques (with an incision made inside the mouth instead of the neck). If a neck incision is necessary, it will be strategically placed to minimize visible scarring, often in a natural crease. Your surgeon will discuss the options with you and provide details about the procedure on the day of surgery.

During your surgery:

• Anesthesia will be administered for your comfort.
• Depending on the chosen surgical approach, a small incision will be made in your neck or mouth to locate the parathyroid glands.
• The affected parathyroid glands will be removed.
• The incision will be closed with sutures.
• The entire procedure typically lasts about one hour.

What to expect after thyroid and parathyroid surgery)?

After the procedure, you can usually return home the same day or the following day. In case of total thyroidectomy and neck dissection, you might stay in the hospital for 2-3 days. You can resume regular eating and drinking, but sticking to soft foods for a day or two is advisable if you have a sore throat. Walking is encouraged, but communicate until your surgeon gives clearance.

Depending on your situation, you may need temporary calcium supplements to boost blood calcium levels while your remaining parathyroid glands adjust and recover.

Risks of Thyroid Surgery

In the hands of an experienced thyroid surgeon, thyroid surgery is a safe procedure with few complications. The following possible complications are directly related to the surgeon’s operative experience, and as such, these risks ar,,e low in the hands of a head-neck and thyroid surgeon. However, it is essential to communicate these risks to the patient before surgery to alleviate any stress. These include but are not limited to

bleeding in the neck:

With modern techniques, the risk of bleeding is low1%.

Hoarseness (Recurrent laryngeal nerve injury):

Two nerves, the recurrent laryngeal nerves, run just behind the thyroid. These nerves control the vocal cords. If one of these nerves is injured, the voice may become hoarse. Temporary hoarseness usually improves within a few weeks but can take up to 6 months to resolve. Even in the rare chance of having a permanently hoarse voice, some things can be done to improve or fix the voice.

Hypocalcemia (Hypoparathyroidism):

Hypocalcemia can cause symptoms such as numbness and tingling (especially around the lips and in the hands and feet), cramping, and even “locking” of the hands and feet.

How should I prepare for thyroid/parathyroid surgery ?

Preparing for surgery involves understanding specific guidelines tailored to your case. To ensure you’re well-prepared, consider asking your healthcare provider the following questions before your scheduled procedure:

• Fasting Instructions: Inquire whether fasting is necessary on the morning of the surgery. Your provider will guide you on when to stop eating and drinking before the procedure.
• Medication, Vitamins, and Supplements: Seek clarification on whether you should take your regular medications, vitamins, and supplements before the surgery. Your provider will provide guidance on any adjustments needed.