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Thyroidectomy

 

What type of surgical procedure is a thyroidectomy?

A thyroidectomy may refer to either a total thyroidectomy or a thyroid lobectomy. These are operations to remove all of the thyroid gland or only half of it.

The thyroid gland closely resembles a butterfly with its wings outspread. Your thyroid is small and lies at the base of your neck, in front of the (windpipe/Trachea). Although small, the thyroid gland plays a critical role in the metabolic process by secreting essential hormones that control your metabolism, weight, body temperature, heart rate and neurological function.

A thyroidectomy is a commonly performed procedure for the treatment of thyroid cancer and certain non-cancerous thyroid conditions. Depending on disease severity and symptoms, Dr Toma will advise you and can either remove half or all of your thyroid gland.

Why is the surgery performed?

Dr Toma performs a thyroidectomy to treat a benign condition such as an enlarged thyroid gland (goitre), a hyperactive thyroid that causes hyperthyroidism and cancer of the thyroid.

The operation can act as a large “biopsy” when a lobectomy is performed – removing half of the thyroid gland – in order to assess whether it is affected by cancer or not. This is due to the vascular supply of the gland and certain difficulties in laboratory assessment, especially for Follicular thyroid cancer.

Thyroid cancer is categorised according to the following types:

  • Papillary thyroid cancer makes up eighty per cent of all thyroid cancer. Papillary thyroid cancer travels slowly to other regions of the body, including the lymph nodes in the neck. Generally, this form of cancer responds well to treatment.
  • Follicular thyroid cancer comprises fifteen per cent of thyroid cancer and can metastasise to the bones and lungs. It is more aggressive than Papillary but still a potentially curable disease entity.
  • Medullary thyroid cancer is rare and typically arises as a result of a genetic mutation.
  • Anaplastic thyroid cancer is the most challenging type of thyroid cancer for doctors to treat. This form of thyroid cancer is aggressive and spreads fast to surrounding tissue.

How does Dr Toma perform a thyroidectomy?

Typically, Dr Toma removes the thyroid gland should he find cancer affecting the gland, thyroid nodules that could be cancerous or goitre that have compressive symptoms or cosmetic concerns.

He performs the procedure with the patient asleep - under general anaesthetic and with the trachea secured with a ventilatory (endotracheal) tube. Dr Toma utilises a cosmetically favourable incision to reach the thyroid gland, although large goitres or Anaplastic thyroid cancer require larger incisions. Depending on the indication and pre-operative discussion with you, he may excise half of the gland (lobectomy) or the whole gland (total thyroidectomy).

In addition, Dr Toma can remove lymph nodes near the gland in the setting of cancer. The surgical samples are sent to the laboratory for further analysis, and you may need further surgery depending on the findings – Dr Toma undertakes to discuss this with you along the way.

FAQ

1What are the signs of advanced thyroid cancer?
Advanced thyroid cancer has a wide spectrum of signs and symptoms. A large goitre might lead to compression on your trachea/oesophagus. You can experience the following:
  • Lump in the front of the neck
  • Lethargy
  • Poor appetite
  • Unexplained weight loss
  • Difficulty breathing (when lying flat especially)
  • Difficulty swallowing
2What typically suggests that my thyroid is cancerous?
Certain symptoms, which include the following, could indicate thyroid cancer:
  • Neck swelling
  • Swollen lymph glands in the neck
  • Voice hoarseness
  • Persistent sore throat that does not dissipate
  • Trouble swallowing
3What can I expect before a thyroidectomy?
Dr Toma will consult and take the history from you first; he then performs an examination of your neck and endocrine system. Typically, Dr Toma will perform blood work to check your thyroid hormone levels and may refer you for a neck ultrasound. Depending on these findings, a small needle biopsy may be performed by Dr Toma or a radiologist. Someone from the hospital will call you to inform you when you should arrive before the procedure. Usually, all patients are requested to be there at least two hours before the scheduled surgery. On the day of the procedure, you should wear comfortable clothing and shoes. Please be advised to leave all valuables at home. Due to the general anaesthetic, it is important that you do not eat or drink on the morning of the surgery/as directed by Dr Toma. Certain medications CAN be taken but seek guidance from your doctor.
4Why does Dr Toma not simply perform a full thyroidectomy every time?
Thyroid surgery, although usually safe, is not without its risks or complications. There are important nerves on both sides of the thyroid gland which affect the voice and closure of the windpipe (trachea). Furthermore, there are tiny associated Parathyroid glands which help your body metabolise calcium. By operating on ONE side, the risks of complications from these structures are far reduced. However, operating on both sides may put them all at risk. Therefore, Dr Toma endeavours to perform the least invasive surgery that can cure your problem. It is important that surgery be performed on both sides in certain cases. Dr Toma will guide you through this process and wishes to make sure you understand your diagnosis and the best approach throughout.
5What does a Fine Needle Aspiration (FNA) entail?
Fine needle aspiration is a diagnostic procedure using a tiny (usually 24G) needle to sample cells from the thyroid gland for assessment. This is done to try to diagnose cancer. Dr Toma uses numbing spray/cream on the skin and then passes the needle into the thyroid gland. It may be necessary for a radiologist to perform the procedure for you under the guidance of an ultrasound machine, where nodules are very tiny.
 

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