Procedures: Thyroidectomy

Thyroidectomy is a surgical procedure involving removal of some or all of the thyroid gland. This page focuses on the post-operative aspects of thyroidectomy.

Total versus partial thyroidectomy

A total thyroidectomy is removal of all possible thyroid tissue, which includes the left lobe, the right lobe, and the isthmus to the extent that thyroid tissue can be seen and felt. Realistically, some microscopic rests of thyroid tissue remain behind even with skilled and meticulous surgical technique in a total thyroidectomy.

Partial thyroidectomy is removal of part of the thyroid gland. Typically when either the left or the right lobe is removed, the isthmus is removed with it.

If needed, thyroidectomy may be combined with removing lymph nodes from areas of the neck specifically chosen for a given situation.

Will thyroid hormone supplementation be necessary after thyroidectomy?

Levothyroxine (Synthroid) is a synthetic molecule identical to the T4 thyroid hormone made by the thyroid gland, and is available in pill, liquid, or I.V. form, and typically taken once a day.

If a person requires thyroid supplementation prior to thyroid surgery, then they will also require thyroid supplementation after thyroid surgery, albeit possibly at a higher dose. Thyroid hormone supplementation is necessary in all patients who have undergone total thyroidectomy. Thyroid hormone supplementation may be necessary for people who have undergone partial thyroidectomy, depending on whether the remaining portion of the thyroid gland can produce enough thyroid hormone to meet the body’s needs. About half of patients who have undergone a thyroid lobectomy (leaving one lobe intact) need thyroid hormone supplementation. In cases where thyroid surgery is performed for thyroid cancer, the ideal amount of circulating thyroid hormone is a little higher, and so about 3/4 of patients who have undergone thyroid lobectomy for cancer are given thyroid supplementation.

Will a person have voice problems after thyroidectomy?

Change in voice is a known risk of thyroid surgery. In fact, when voices are analyzed with sensitive instruments before and after thyroid surgery, most people demonstrate some change in their voice, even if most of them have vocal changes that are otherwise not noticeable to the casual observer. Voice changes that are easily noticed after surgery may be temporary or permanent. Examples of causes of temporary voice changes include swelling of the vocal cords from use of the breathing tube during surgery (which lasts about a week) and partial injury to one or more of the laryngeal nerves. Injury to the left or right superior laryngeal nerve can cause loss of one’s high pitched voice. Injury to the left or right recurrent laryngeal nerve can cause a weak and breathy voice. These nerves sometimes recover from a partial injury or, other times, the opposite vocal cord may compensate such that the voice returns to normal even if one vocal cord does not move well. Permanent and noticeable voice problems after thyroid surgery are reported to happen about 2% of the time.

Will a person have low parathyroid function (hypoparathyroidism) after thyroidectomy?

Low parathyroid function is a risk of thyroid surgery when both sides of the thyroid have been removed. If one side of the thyroid has never undergone removal or surgical exploration, then the two parathyroid glands on that side reliably produce a normal amount of parathyroid hormone for the body.

If both sides of the thyroid have been operated upon, whether in one setting or cumulatively (for example, right thyroid surgery followed at a later date by left thyroid surgery), then low parathyroid function (hypoparathyroidism) may occur. Temporary hypoparathyroidism may occur in roughly one quarter to one third of such cases. Permanent hypoparathyroidism is reported to occur in about 2% of thyroidectomies in which both lobes of the thyroid have undergone surgery.

How long does a person stay in the hospital after thyroidectomy?

Depending on the extent of surgery and a patient’s risk factors, a patient may be discharged to home on the day of surgery or stay in the hospital for one or more days. If there are no problems, such as low calcium, after surgery, patients are commonly discharged to home the morning after surgery.

Is a drain used after thyroid surgery?

At the surgeon’s discretion, a drain may be placed at the time of surgery as a safety measure to minimize the risk of blood and other fluid from collecting in the surgical space. Drains are often removed at about three days after surgery.

What eating and drinking restrictions follow thyroidectomy?

Swallowing is usually somewhat uncomfortable for a few days after surgery, but not intolerable. Patients are able to eat and drink as they wish following thyroid surgery.

What does a thyroidectomy scar look like?

Generally, a mature (fully healed) thyroidectomy scar is a subtle horizontal line low in the neck, measuring about 2-3 inches (5-8 cm). The healing process evolves over time. For the first couple of weeks after surgery, the incision maybe raised and red. The redness usually persists for several months before fading to a thin white line.

What does thyroid surgery look like?

Here is a photograph nearing the end of a left hemithyroidectomy and isthmusectomy procedure: