Thyroidectomy

If you would like to find out about the treatment of thyroid problems by thyroidectomy, and the cost of such treatment of thyroid problems, the information on these pages will be of interest to you.

Before you have a thyroidectomy to deal with thyroid problems, it may be useful to find out all you can about it. The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things when treating thyroid problems, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making choices regarding your treatment for thyroid problems with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

What is the problem?

Removal of the thyroid gland, called a thyroidectomy, is usually for one or more of the following reasons:

• Your thyroid gland may be too large. A goitre is a common name for this.

• It may have one or more swellings in it.

• It may be pressing on other neck structures.

• It may be overactive.

What is the thyroid gland?

There are 3 types of gland in the body.

• One type makes liquids such as sweat or saliva.

• The second type, lymph glands, are part of your defences against disease. For example, if you have a sore throat, the lymph glands in the neck become swollen to fight off the infection.

• The third type includes the thyroid gland. They make chemicals (hormones) that pass into the bloodstream. The thyroid gland makes the hormone thyroxine, which keeps the body working at the correct speed. Thyroxine contains iodine, which is important in the treatment of some thyroid diseases.

The thyroid gland cells also make a thick liquid called colloid. Colloid stays in the thyroid gland and does not pass into the bloodstream.   

The thyroid gland is H-shaped. It lies just in front of the windpipe, called the trachea in the neck. It is about 3 inches across.

The two nerves to the vocal cords in the voice box, the larynx run up from the chest behind the thyroid. Four pea-sized parathyroid glands lie near the thyroid gland. They make a hormone, which controls the level of calcium in the blood. Calcium is well known for making bones strong. It is also important in other areas, such as making nerves work properly and keeping the lens of the eye healthy.

What has gone wrong?

The most common problem is a colloid build up that is making one or more swellings (colloid cysts) in the gland. This is the most common cause of a neck swelling, called a large goitre. There may some bleeding into a colloid cyst, making the thyroid suddenly a little larger and perhaps uncomfortable.

Tumours can arise in the thyroid, causing swellings. They are mostly single non-malignant tumours, but a few are malignantThe thyroid could be swelling because of inflammation. The most common inflammation is called Hashimoto’s disease. Here, the body is slowly attacking the thyroid tissue.

Sometimes the gland makes too much thyroxine. The body becomes overactive. This causes weight loss, increase in appetite and sweating. The heart beats too fast and can go into failure. The eyes may bulge forward and the eyelids open very wide, to give a staring gaze. If drug treatment does not control the overactive gland, an operation may be needed.

As the gland swells it may cause pressure effects such as:

• Pressure on the windpipe causing shortness of breath

• Pressure on the gullet causing difficulty swallowing

• Pressure on the nerves to the vocal cords causing a hoarseness of the voice

It may also cause an ugly swelling in the front of your neck.

The aims

The aims are to stop the pressure effects of the gland, to remove any tumour, to prevent any tumour in the neck from coming back and to remove overactive thyroid tissue. At the same time, we aim to avoid any damage to the nerves and parathyroid glands. If possible we leave enough thyroid tissue for your needs.

This means removing part or all of the thyroid gland. You will have a general anaesthetic and be completely asleep while it this is done.

The benefits

You will lose the pressure effects. The thyroid will be back to a normal size. Any removed tumour will be examined to see if further treatment is needed. The operation should prevent further problems from cysts.

The effects of an overactive thyroid should disappear, although eye problems may continue and need extra treatment.

Are there any alternatives?

If there are pressure effects due to inflammation of the thyroid, removal of only the central part of the thyroid in front of the windpipe is worth considering.

If bleeding into a cyst is settling down, and it is unlikely to be a tumour, it is reasonable to wait and see if it happens again.

If the thyroid is overactive and has not settled down after a course of drug treatment, then treatment with radioactive iodine is often better than an operation. An operation is usually better for a younger patient than radioactive iodine. The same applies if the over-activity comes from just one part of the thyroid gland, called a hot nodule.

X-ray treatment is better than an operation for only one rare type of tumour, an anaplastic tumour. The other types are better treated with surgery.

What if you do nothing?

There is often some uncertainty about the cause for a thyroid swelling. Scans, tissue sampling by needle and blood tests may not give a clear answer. If you do nothing and the cause remains unclear, you could be missing out on important treatment.

If the thyroid is already pressing on your windpipe, it may get rapidly worse if you leave it. It may block your windpipe and stop your breathing completely.

Author: Mr Michael Edwards FRCSEng FRCSEd. Consultant general surgeon.

© Dumas Ltd 2006

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