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The thyroid gland is a small gland in the neck that resembles a butterfly. It is located in the lower front of the neck. The gland is engaged in the production of hormones, which, in turn, the blood carries to every cell of the body. Hormones regulate metabolic processes – the processes by which the body interprets food into vital energy. It also plays a role in the proper functioning of organs and helps the body retain heat.
Sometimes the thyroid gland produces an excess amount of the hormone. It can also cause structural problems such as swelling and development of cysts or nodules. If these problems occur, thyroid surgery may be required. Thyroid surgery involves removing all or part of the thyroid gland. This procedure is performed by highly qualified specialists in a hospital under local anesthesia.
Indications and contraindications for the operation
The most common reason for thyroid surgery is the presence of nodules or tumors on the thyroid. Most nodules are benign, but some may be cancerous or precancerous. Even benign nodules can cause problems if they grow large enough, cause discomfort, or if they stimulate the thyroid gland to produce large amounts of hormones (a condition called hyperthyroidism).
Surgery can correct such a phenomenon as hyperthyroidism. Hyperthyroidism is the result of an autoimmune disease called Graves’ disease (causes the body to mistakenly identify the thyroid gland as a foreign body and send antibodies to destroy it). These antibodies inflame the organ, causing an overproduction of hormones.
Another reason for surgery is swelling or enlargement of the thyroid gland. This is called a goiter. Like large nodules, goiters can block the throat and interfere with eating, talking, and breathing.
There are contraindications to surgical intervention, including the presence of a benign tumor (a number of additional examinations are carried out and specific drug treatment is selected), the patient’s age is 60+ (the doctor additionally prescribes an examination of the cardiovascular system, since patients of advanced age may not tolerate anesthesia), the presence of severe infectious diseases in the acute phase.
Types of operations
There are several different types of thyroid surgery. The most common are:
- hemithyroidectomy;
- subtotal thyroidectomy;
- total thyroidectomy (resection).
Sometimes a nodule, inflammation, or swelling affects only half of the thyroid gland. When this happens, the doctor will remove only one of the two lobes. The portion left should preserve some or all of the thyroid function.
A subtotal thyroidectomy removes the thyroid gland, but leaves a small amount of thyroid tissue. This retains some of its functionality. Many people who undergo this type of surgery suffer from hypothyroidism, a condition that occurs when the thyroid gland does not produce enough hormones. This condition is easily corrected by daily hormonal supplements.
A total thyroidectomy removes the entire thyroid gland and thyroid tissue. This surgery is appropriate when nodules, swelling, or inflammation affects the entire thyroid gland, or when cancer is present.
Preparation and algorithm of the operation
There are no special preparatory procedures. It is important that there are no contraindications to the operation. The doctor, before prescribing a surgical intervention, without fail outlines a number of examinations, including:
- laryngoscopy of the vocal folds;
- fine-needle aspiration biopsy of existing thyroid nodules;
- Ultrasound of the thyroid gland;
- blood test for the amount of thyroid hormones.
Sometimes genetic studies, thyroid scintigraphy and CT of the chest and neck are prescribed. The patient is placed comfortably on a couch and a general anesthetic is administered. The duration of the procedure may vary depending on various factors: complications during the operation, the characteristics of the patient’s body, the volume of surgical intervention.
The usual duration of the procedure is an hour and a half. The maximum duration of the procedure is four hours.
The skin on the front of the neck is incised (in the region of the collarbone). The procedure is carried out as carefully as possible in order not to accidentally damage the laryngeal nerves (otherwise the patient will lose his voice). After removal of the thyroid gland, all obtained tissues must be sent for a histological type examination in order to exclude the presence of oncological formation.
If the presence of oncology is confirmed, an additional operation is also performed to remove the lymph nodes. After the operation is completed, all incisions on the skin are sutured, processed and sterile dressings are applied to them.
Rehabilitation period
The first day after surgery, the patient spends in bed. In a hospital (provided there are no complications), the operated is up to five days. The patient should refuse to visit baths, saunas, from heavy loads for at least one month. The first two weeks (before the stitches are removed) it is necessary to regularly treat the wound and change the dressings to sterile ones.
If during the recovery period the wound becomes very painful, inflammation, redness, itching, purulent discharge and other uncomfortable sensations begin to be observed, you should urgently contact your doctor. If the recovery period is normal, stitches are removed after 14 days, and after a month it is necessary to visit a doctor for a follow-up examination.