Healthy Living

When Is Thyroid Surgery Necessary?

When Is Thyroid Surgery Necessary?

Key Takeaways

  • Thyroid surgery or removal is generally not advised for the treatment of hypothyroidism.
  • Hypothyroidism caused by Hashimoto's disease is the only condition that shows improvement in symptoms after thyroid surgery.
  • The most commonly used medicine for the treatment of hypothyroidism is levothyroxine, which is a synthetic form of T4 or tetraiodothyronine.

Overview of Thyroidectomy

Hypothyroidism, as the name indicates, refers to an underactive form of the thyroid gland. It means that the thyroid gland fails to produce a sufficient amount of thyroid hormones in the body. The removal of the thyroid gland will further reduce the production of hormones, affecting the metabolic rate. Hence, thyroid surgery or removal is generally not advised for this condition.

In some rare cases where hypothyroidism is associated with the immune system disorder, Hashimoto’s disease, a complete removal of the thyroid glands was found to improve the symptoms caused by hypothyroidism. Many patients reported an improvement in fatigue, which is the most common symptom of hypothyroidism. However, the decision to have a thyroid removal surgery will purely depend on the doctor’s recommendation.

How do you treat hypothyroidism?

The most common and effective treatment for this condition is taking a pill of levothyroxine (thyroid hormone) to compensate for the low hormone amounts in the blood. It is a synthetic form of the thyroid hormone, the dosage of which is based on the patient’s requirement.

The dose of medication is adjusted after periodic re-evaluation. The evaluations will continue until a suitable maintenance dosage is obtained. Patients may have a relief from the symptoms within a few months. A complete relief is achieved only when the correct dosage is taken. In most of the cases, this hormone treatment therapy will have to be continued for life.

In some special cases, a combination therapy of T4 and T3 hormones, which are the two major thyroid hormones, is given for treatment. Some medications may have an interaction with synthetic hormone medications, and hence, one should inform his/her doctor about the other medications before starting on the synthetic thyroid hormones.

Pregnant women may need an increased dose of the hormones to meet the demand. It is important to get the correct diagnosis before starting the treatment.

The optimum dosage of the hormones is the mainstay of the treatment, and to decide on that, one may need to frequently undergo examinations and blood tests. Once decided, the maintenance dose can be continued, unless and until told by the physician.   

When is thyroid removal suggested?

Thyroid removal is suggested in the following cases:

  • Cancer of the thyroid glands – it is one of the most common causes for thyroid removal. In this case, the glands may be removed partially or entirely as a treatment option.
  • Thyroid nodules these are big nodules that are non-cancerous but can affect the breathing and swallowing of people who suffer from hypothyroidism. These nodules are also removed by surgery.
  • Hyperthyroidism in this condition, the thyroid gland makes more hormones than what the body needs. Thyroid removal is one of the options to treat the condition.
  • Non-cancerous enlargement of the thyroid – in conditions like goiter, where the thyroid gland is abnormally enlarged, surgery is the best choice.

Does thyroid surgery cause hypothyroidism?

Thyroid removal is a common cause of hypothyroidism. Total thyroidectomy, or the complete removal of the thyroid glands, definitely results in hypothyroidism. Thyroid lobectomy or the partial removal of the thyroid glands results in hypothyroid conditions in around 30% to 50% of the patients. Radioactive thyroid ablation and anti-thyroid medications may also result in hypothyroidism. Patients who have undergone half thyroidectomy may require a thyroid pill after the surgery. For those who had a complete thyroid removal, lifelong hormone replacement therapy is needed.

Different Types of Thyroidectomy

Thyroid surgery has different types, but the most commonly performed are the following:

  • Open thyroid biopsy  - In this procedure, a surgeon secures a part of the thyroid tissue and removes it for further evaluation or tests. There will be a need for the patient to be admitted to a hospital since this procedure requires general anesthesia. This type of biopsy is commonly performed to know what causes the growth in the patient’s thyroid gland. Thyroid excisional biopsy may be recommended if fine needle aspiration is not enough for the diagnosis of the disease.
  • Lobectomy – this procedure is performed in cases where the nodule or swelling only affects half of the thyroid gland. Thus, the surgeon will only remove half of the gland, leaving the remaining functional lobe.
  • Partial thyroidectomy – also referred as subtotal thyroidectomy. It is a surgical operation wherein the surgeon preserves the function of the thyroid gland by not completely removing the gland. What the surgeon does is to leave a small part of the gland to retain some of the thyroid gland’s functions. Most patients who have undergone partial thyroidectomy experience hypothyroidism, wherein the thyroid gland fails to produce the ideal levels of hormones for the body. However, when hypothyroidism happens, the patient will be treated by a daily dosage of hormonal supplements.
  • Total thyroidectomy – refers to the complete removal of the entire thyroid gland and its tissues. If cancer is suspected or present, this type of thyroid surgery is usually suggested. This procedure is also done if the whole thyroid gland is affected by inflammation and nodules.

Surgery Risks

Thyroidectomy also has risk factors involved since the procedure is a major surgery that needs the administration of general anesthesia. When the patient is under general anesthesia, he or she will not feel any pain and be put to sleep.

The general risk factors include:

  • Difficulty in breathing due to medicine sensitivity
  • Infection
  • Loss of blood
  • Vocal cord nerve damage
  • Parathyroid gland trauma that leads to a decrease of the body’s calcium level in the blood
  • Blockage or narrowing of the airway passages
  • Sudden increased levels of thyroid hormones during surgery
  • Hyperthyroidism – characterized by an increased level of thyroid hormones

What to Expect in a Thyroidectomy Procedure

Before your scheduled surgery:

  • Imaging tests such as CT scan and ultrasound may be requested by your doctor to aid in his diagnosis. These tests can help find out the exact location of anomalous growths in the thyroid.
  • Fine needle aspiration can also be performed by your doctor to check whether the thyroid growth is cancerous or not.
  • Your doctor may also assess the functioning of the vocal folds in your larynx.
  • Iodine treatments may be prescribed 14 days prior to your surgery.
  • Your doctor may also advise you to refrain from taking anticoagulant medications such as warfarin, ibuprofen, naproxen, and aspirin. These types of medicines are called blood thinners, which make blood harder to form clots.
  • If you are a smoker, you are also advised to stop smoking to prepare your body for the upcoming surgery.
  • If you are taking alternative medicine or herbal supplements, it is better to discuss them with your physician before undergoing surgery.

On your scheduled surgery:

  • Specific instructions by your doctor should be followed, especially the time when you should stop eating or drinking.
  • Any type of medicines ordered by your doctor or medical health provider must be taken with a minimal amount of water.
  • Ensure that you know your surgery’s scheduled date and time.

What to Expect After Your Thyroid Surgery

After a thyroidectomy, recovery depends on the patient’s health situation. Some may be discharged a day after their operation, while others, although rarely happens, stay for a longer time in the hospital. Before discharge, the patient will be assessed if he or she can already drink fluids. Moreover, if a total thyroidectomy was performed, blood tests will be done to check the patient’s level of calcium.

Normally, pain can be felt after your operation. Your doctor will advise you about pain management and may prescribe pain relievers for you to take home. A full recovery from a major surgery such as thyroidectomy takes about a month.

Prognosis After Surgery

An excellent surgical outcome of thyroidectomy is generally observed. However, if the patient has undergone a total thyroidectomy or the complete removal of the thyroid gland, he or she may constantly need a thyroid hormone replacement therapy.