Thyroid surgery
The thyroid is a small, butterfly-shaped gland that sits in the lower part of the front of the neck. The thyroid plays an important part in the body’s functions. It produces hormones that circulate throughout the body, regulating a person’s temperature and metabolism. It also supports the heart and digestive system and helps maintain muscle control and bone health. In some people, thyroid function is impaired.
Surgery is the recommended treatment for several disorders of the thyroid gland. A doctor may recommend thyroid gland removal for many reasons. These may include one of the following:
- Large thyroid or multi-nodular goitre (a goitre is an enlarged thyroid gland) causing obstructive symptoms of breathing or swallowing difficulties
- Solitary nodule thyroid adenoma (a benign tumour)
- Thyroid cancer
- Graves’ disease (hyperthyroidism or thyrotoxicosis)
- Recurrent thyroid cyst
Types of thyroid surgery
Thyroid surgery is divided into four categories. Types of thyroid surgery include:
- total thyroidectomy (removing all of the thyroid gland)
- lobectomy or hemithyroidectomy (removing half of the thyroid gland)
- near-total thyroidectomy (removing most of the thyroid gland but leaving a little tissue on one side)
- Total thyroidectomy ; this involves removing the entire thyroid gland
The importance of hormone therapy after thyroid surgery
If your thyroid has been removed (thyroidectomy), your body can no longer make the thyroid hormone it needs. You will need to take thyroid hormone (levothyroxine) pills to replace the natural hormone and help maintain normal metabolism and possibly lower your risk of the cancer coming back. Levothyroxine is known worldwide as the most common and least effective drug for controlling hypothyroidism.
Without thyroid hormone, your body cannot function properly, which may result in poor growth, lack of energy, excessive tiredness, constipation, weight gain, hair loss, dry, thick skin, increased sensitivity to cold, joint and muscle pain, heavy or irregular menstrual periods, and depression. When taken correctly, levothyroxine reverses these symptoms.
How to take levothyroxine tablets after thyroid surgery
your doctor will arrange for blood tests to check your thyroid function about six to eight weeks after the operation. If you have a total thyroidectomy you will need to take levothyroxine tablets for the rest of your life immediately after surgery to replace the thyroxine that was produced by your thyroid gland. An appropriate dose of levothyroxine should result in normal levels of thyroid stimulating hormone (TSH) and thyroid hormones in the blood and varies from patient to patient. After surgery, the initial levothyroxine dose is often prescribed based on the patient’s body weight. The dose is then be adjusted 6 to 8 weeks later, based on the blood test result. Administration of the optimal dose of levothyroxine (LT4) is crucial to restore euthyroidism after total thyroidectomy. An insufficient or excessive dosage may result in hypothyroidism or thyrotoxicosis.
If you have a lobectomy or hemithyroidectomy you may develop hypothyroidism (under-active thyroid) if the amount of gland left is unable to maintain normal thyroid function. About one in five of patients who have part of their thyroid removed will need to take a small amount of levothyroxine to top up the thyroxine produced by the remaining thyroid gland.
Some important points
- Thyroid surgery should be performed by an experienced thyroid surgeon
- You will be asked for your informed consent. Don’t hesitate to ask any questions beforehand
- Alert medical staff immediately if you have any tingling in your hands, fingers or face after surgery. You may need calcium supplements
- The scar is usually hardly noticeable after six months to a year
- After thyroid surgery you should have a thyroid function blood test approximately once a year
- If you notice any symptoms of hypothyroidism such as lethargy, weight gain, or mood changes, you should see your doctor and ask for a blood test
- The main complications of thyroid surgery are voice problems and low calcium. These are usually temporary but in a small number of cases may be permanent
- Alternatives to thyroid surgery for hyperthyroidism are antithyroid drug therapy or radioactive iodine treatment
- If you have questions or concerns about your thyroid disorder, you should talk to your doctor or specialist as they will be best placed to advise you.
References
https://www.btf-thyroid.org/thyroid-surgery
https://www.medicalnewstoday.com/articles/323369#outlook
https://www.frontiersin.org/articles/10.3389/fendo.2020.626268/full
https://medlineplus.gov/druginfo/meds/a682461.html
