Thyroidectomy

The thyroid is a butterfly-shaped gland low in the front of the neck, wrapped around the windpipe, with a lobe on each side joined by a bridge of tissue. Thyroidectomy is the removal of that gland, either one lobe or all of it.

Which of the two you are having is the fact that governs everything afterwards. With one lobe removed, the other usually makes enough hormone on its own and many people need no tablets. With the whole gland removed, your body has no source of thyroid hormone and you will take a daily tablet of thyroxine for life, adjusted by blood tests until the dose is right.

Two structures sit immediately behind the gland and define the delicacy of the operation. The nerves that move the vocal cords run up the back of each lobe, and the four parathyroid glands, each the size of a grain of rice and responsible for controlling calcium, sit on its rear surface. Your surgeon identifies and protects all of them as the gland is lifted away.

This is an Inpatient operation under general anaesthetic. You are admitted the day before or on the morning of surgery, having not eaten for six hours, and you are fully asleep with a tube in your windpipe throughout.

Your surgeon makes a cut of four to six centimetres in a natural crease low in the front of the neck, so the scar sits where a necklace would and fades into the crease over a year. The muscles in front of the gland are separated in the midline instead of being cut. The gland is then freed, the nerves and the parathyroids identified, the blood supply sealed and the tissue removed.

Removing one lobe takes about ninety minutes and the whole gland two to three hours. A fine drain is sometimes left in the wound overnight. The skin is usually closed with a dissolvable stitch under the surface or with clips.

You spend one to two nights in hospital, and your voice and your calcium are checked before you go home.

Expect a sore throat from the breathing tube for two to three days, a stiff neck, and difficulty looking up or turning quickly for about a fortnight. Swallowing feels tight for the first week. Simple painkillers cover it.

Most people are back at desk work in one to two weeks and at physical work in three to four. Driving resumes once you can turn your head fully and comfortably to check a blind spot, usually at one to two weeks. Avoid heavy lifting for three weeks.

The voice often tires quickly for the first few weeks even when the nerves are entirely intact, and singers and teachers notice this most. It settles in most people by six to twelve weeks.

Blood tests are the part that continues. After removal of the whole gland, thyroxine starts straight away and the dose is checked at about six weeks and then adjusted until stable, and after removal of one lobe the level is checked at a few months to see whether the remaining lobe is coping. Massage the scar with a plain moisturiser once it has healed.