The thyroid gland is an endocrine gland which produces hormones. It is situated in the front of the neck just below the Adam’s apple and produces the hormone thyroxine. Thyroxine is released into the bloodstream where it controls our metabolism and is responsible for the normal working of every cell of the body. The thyroid gland has the capacity to produce and store more thyroxine that the body requires at any one time so if only part of the thyroid gland is removed it is usually unnecessary to have thyroid replacement after the operation.

If the entire thyroid gland is removed then thyroxine replacement tablets will be necessary for the rest of the person’s life. There are four tiny glands attached to the thyroid gland the size of grains of rice and called the parathyroid glands. These produce parathyroid hormone and this hormone regulates the concentration of calcium in the blood. Normal calcium levels are essential for healthy bones and general well-being. The surgeon tries to leave the parathyroid glands in place when the thyroid is operated on but their function can be affected by the operation.

The excision of the thyroid gland is called thyroidectomy and the surgeons either remove the whole gland (total), partial (sub-total) or a hemithyroidectomy or removal of a lobe of the gland (lobectomy). Thyroidectomy is performed for several reasons with hyperthyroidism being the commonest, which means overactivity of the thyroid. An enlargement of the thyroid gland, known as goitre, can cause compression of the gullet or windpipe, may look unpleasant or interfere with swallowing or breathing. Removal of goitre is a typical thyroid operation.

Patients are maintained in an unconscious state during the thyroidectomy by a general anaesthetic and monitored by an anaesthetist. The surgeon makes a neck incision using the normal creases in the neck just above the breastbone and the cuts are typically made symmetrically. The incisions heal well and the scar that remains afterwards becomes so inconspicuous that eventually it becomes almost invisible. A small drain tube in the neck can ensure that fluid does not collect in the wound which enhances wound healing and the tubes are removed in a day or so. The typical hospital stay is two to four days.

Before the operation patients should fast for six hours, taking just clear fluids until about two hours before the operation. A venflon in the arm is the portal through which the anaesthetist administers the anaesthetic to keep the patient under for the one to hours the operation will last. Stitches under the skin can be used to close the wound and these do not need removal, with other surgeons placing clips or skin stitches which do need removal, usually after two to three days. Patients stay in the hospital differs with how well they are and mostly varies between two and four days. Pain levels after the operation are very variable but settle quickly and many patients have some neck discomfort.

Infection in the wound is a risk although it is uncommon, so if the wound becomes red and sore antibiotics may be needed and if pus comes from the wound it may need to be opened up to release the infection. Bleeding into the wound is again uncommon in about one in fifty and in rare cases a re-operation is needed to remove the blood clot. Bruising and swelling are common around the wound, caused by the fluid and blood under the wound and later on by scar formation.

Patients will have a vocal chord check before surgery and the surgeon will discuss the specific problems of operating so close to the voice box and its associated nerves. Bruising of the nerves during surgery may stop them working properly and as these nerves control the movements of the vocal chords if they are damaged this can cause hoarseness and weakness in the voice. The voice should recover over a period of a few weeks or months but occasionally a nerve will be permanently damaged but this is rare. Injury to both nerves is very uncommon and very serious as the voice is lost and a tracheotomy tube is placed in the windpipe to allow breathing to occur.