Surgery on the thyroid is performed for over activity (hyperthyroid), increasing size (goitre) or for tumour (to exclude cancer). Surgery can remove a lump (lumpectomy) or half the thyroid (hemi-thyroidectomy) or total thyroid gland (thyroidectomy). In some cases a very small portion of the thyroid is left behind.

Diagnosis of thyroid problems depends on blood tests, ultrasound scans, CT scan, needle biopsies, and physical examination.

Hyper activity of the thyroid is usually treated medically. There are some instances though where this does not work and the role of surgery would need to be discussed with the physician and surgeon. If the thyroid enlarges removal may be necessary for cosmetic reasons but also for pressure effects especially if the thyroid grows down in to the chest. Removal of tumours may be necessary if it is not possible to prove by other means that the abnormal area is not a cancer. Removal of half the thyroid may be necessary for the pathologist to make the diagnosis. If malignancy is confirmed in most instances removal of the remainder of the thyroid becomes necessary.

The nerve that controls the vocal cords travels up between the thyroid and the trachea (wind pipe). This nerve is at risk during this surgery. In most instances the damage is temporary, due to the pressure being placed on the nerve at the time. Damage to the nerve can be a possible complication leading to a temporary loss of speech.

Para-thyroids are glands which usually sit at the back of the thyroid. These glands control the level of calcium in the blood. They need to be sought and left in place during thyroid operations. Sometimes calcium replacement is needed after thyroid operations. Bleeding after surgery is an uncommon problem.

If the entire thyroid is removed then replacement of the thyroid hormone will be needed for the rest of the patient's life. Regular blood tests are undertaken to ensure that this replacement level is adequate.

More information about the procedure is contained in the RACS patient education pamphlet.

Picture courtesy of RACS and MI-tec Publishing. The complete patient education pamphlet is available from your surgeon.