Download Patient Information Leaflet T1 – Thyroid Operations in Adults

PatientInformationLeafletT1
ThyroidOperationsinAdults
SuperiorLaryngealnerve
Larynx
’Adam’sapple’
Thyroidgland
Parathyroidglands
RecurrentLaryngealnerve
‘Voicenerve’
Clavicle
‘Collarbone’
Sternum
‘Breastbone’
Whatisthethyroidglandandwhatdoesitdo?
Thethyroidglandisasmallorganthatsitsintheneckinfrontofthewindpipe
(trachea),belowtheAdamsApple.Itconsistsoftwohalves(leftandright
thyroidlobes)joinedbyacentralbridge(thyroidisthmus)anditsshape
resemblesabutterfly.Inhealthyadultseachlobe,leftandright,measures
around3-4cminheight,1-2cminwidthand1-1.5cmindepth.Anadultthyroid
glandweighsaround15-25g.Thethyroidglandsecretesthyroidhormones
(calledT3andT4)thataffectthebody’smetabolismandarevitalforthebodyto
functionnormally.
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Reasonswhypatientsmayneedthyroidsurgery
Thyroidsurgeryinvolvesremovingpartorallofthethyroidgland,andmaybe
performedforthefollowingreasons
•
Increaseinthesizeofthethyroidgland
-
Anyincreaseinsizeofathyroidgland,fromanycause,iscalleda
goitre
-
Growthofthethyroidglandmaycausecompressiononthe
windpipe(trachea)orthegullet(oesophagus).Inthisscenario
yoursurgeonmayrecommendthyroidsurgery
-
Evenintheabsenceofpressurefromagoitreonneighbouring
structures,thepresenceofanenlargedthyroidglandcan
occasionallycausediscomfortoritsappearancemaybetroubling
topatients.Inthisscenariopatientsshoulddiscussthebenefits
andrisksofsurgerywiththeirsurgeon. •
Developmentofalump(nodule)inthegland
-
Nodulesinthethyroidglandmayconsistofone(solitarynodule)
ormore(multi-nodulargoitre)lumps
-
Nodulesarecommonlyassessedbyclinicalexamination,
ultrasoundexamination,needlebiopsyorallthreetests
-
Ifyoursurgeonisconcernedaboutthefindingsfromoneormore
oftheseteststheymayrecommendsurgery
-
Occasionallyotherscanse.g.aCTscan,mayalsobenecessaryto
helpyoursurgeonplananoperation
-
Thyroidnodulesarecommonandcanbefoundinupto6%of
womenand2%ofmen.Theolderyouare,themorelikelyyouare
todevelopathyroidnodule
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•
Over-activethyroidgland
-
Anover-activethyroidglandsecretestoomuchthyroidhormone.
Thisiscalledhyperthyroidism(orthyrotoxicosis)andresultsina
well-recognisedpatternofsymptoms.Itisdiagnosedbyaphysical
examinationandbloodtests.
WhattypeofthyroidoperationshouldIexpect?
Thefollowingisageneraloverviewofthyroidsurgeryoperations.Yoursurgeon
willexplainwhichoneyouareadvisedtoconsiderandwhy.
•
Thyroidlobectomy-thisremovesonethyroidlobeandalsothethyroid
isthmus.Somesurgeonsmaycallthisahemithyroidectomy.
•
Totalthyroidectomy-thisremovesallthethyroidgland,leavingno
thyroidtissuebehind.Occasionally,forsurgicalreasons,yoursurgeon
mayleaveaverytinyamountofthyroidtissuebehind.Thisiscalleda
neartotalthyroidectomyandisdonetoprotectimportantstructuresthat
runveryclosetothethyroidglandintheneck.Theamountleftbehindis
sosmallthat,practically,youmayconsiderthatthewholeofthegland
hasbeenremoved.
•
Subtotalthyroidectomy-thisisahistoricoperationthatisnotnowadays
recommended.Inthisprocedure,surgeonsusedtoleavebehinda
thumbnailsizedremnantofeachthyroidlobe.Itresultsinan
unacceptablerateofrecurrenceofsymptomsandhasfallenoutoffavour.
Whatislymphnodesurgeryandwhenisitneeded?
Lymphnodesdrainanaturalfluidcalledlymphthatisproducedbymanytissues
inthebody.Inpatientswhohaveadiagnosisofthyroidcancer,thelymphnodes
aroundthethyroidglandaresometimesremovedaspartofthecancer
operation.Ifcancerisfoundinthelymphnodesthiscanaffectthetypeofongoingtreatmentyoureceiveaftersurgery.
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Sometimesonlythelymphnodesclosetothethyroidglandareremoved.This
operationiscalledacentralneckdissectionasthelymphglandsinthecentreof
theneckareremoved.Performingacentralneckdissectiondoesnotusually
affectthesizeofthescar.
Sometimesitisnecessarytoremovelymphglandsfromthesideoftheneck.This
isamuchlargeroperationresultinginalongerscarandiscalledalateralneck
dissection.Ifyouneedthistypeofsurgery,yoursurgeonwillexplainittoyouin
detailanddiscusswhyitisnecessaryinyourcase.
Note:notallpatientswithadiagnosisofthyroidcancerwillneedlymphnode
surgery.Yoursurgicalteamwillmakethisdecisionbasedonanumberoffactors
whichwillbediscussedwithyou.
Lymphnodesurgerycancarryanincreasedriskofcomplications.Theseare
discussedinourleafletPotentialComplicationsofThyroidSurgerywhichcanbe
foundonourwebsite(www.baets.org.uk).
Whatwillhappenpriortosurgery?
Ifyouareonregularmedicationsyoushouldcontinuethese(includingany
thyroidrelatedtablets)unlessadvisedotherwise.
Somesurgeonsmayaskyoutostoptakingmedicinessuchasaspirin,
dipyridamole(Persantine)orclopidogrel(Plavix)inthedaysleadinguptoyour
operation.Ifyouareonanyofthesetablets,discussthiswithyoursurgeon.
Patientsonblood-thinningtablets(suchaswarfarin,rivaroxabanordabigatran)
shouldinformtheirsurgeonasitisimportantthattheconditionstheseareused
totreatarecontrolledbeforeandaftersurgery.
Manyhospitalshaveapre-operativeassessmentclinicwhereyouwillbe
reviewedbyanurseinpreparationforyourforthcomingoperation.Theywillbe
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abletoadviseifyouhaveanyqueriesrelatingtoyourmedicationsleadingupto
yoursurgery.Theywillarrangeforyoutohaveanyteststhatarenecessaryfor
youranaestheticandthyroidoperation.
Itmaybesuggestedthatyouhaveaflexiblenasendoscopybeforeyoursurgery.
Thistestinvolvespassingasmall,narrowflexibletubewithacamerawithinit
throughyournoseintoyourupperairpassagestoallowinspectionofyourvocal
cords.Itmaybealittleuncomfortablebutshouldnothurtandlastsonlyacouple
ofminutes.Flexiblenasendoscopydoesnotinvolvegeneralanaesthetic.This
testmaybecarriedoutbyyoursurgeoninclinicorbyacolleaguewithinthe
hospital.Somesurgeonsmayalsorequestarepeattestfollowingyoursurgery.
HowlongwillIbeinhospital?
Thisdependsverymuchontheexactdiagnosisandtheoperationbeing
performed.Somesurgeonsmayperformcertainthyroidoperationsasdaycase
procedures,buttypically,patientsstayinhospitalovernightandaredischarged
thedayfollowingsurgery.Insomeinstancesyoumaystayinhospitalforlonger.
Yoursurgeonwilladviseyou.
Careofyourwound
Whenyouaredischargedfromhospitalyoucanexpecttobegivenadviceabout
careofyourwoundfromthewardstaff.Thewoundmaybecoveredbya
dressingandthiscanusuallyberemovedafter48hoursunlessyouaretold
otherwise.Youwillusuallybeabletotakeabathorshower48hoursafteryour
operation.Gentlypatyourwounddryratherthanrubit.
Yourwoundmaybeslightlyraisedandpinkorredinthedaysfollowingsurgery.
Thiswillsettleovertimeasitheals.Eventuallythewoundshouldbecomeflat
andpalebutthismaytakeseveralmonths.
Unlesssuggestedbyyourmedicalteam,itisnotadvisabletorubanyointments
orbio-oilsontothewoundimmediatelyafteryoursurgerybeforethewoundhas
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hadchancetoheal.Itisbesttowaituntilyouhavebeenseeninthepostoperativeclinicanddiscusswithyoursurgeonifyouwishtousesuchproducts.
HowsoonwillIrecover?
Itisnormaltofeeltiredfollowingthyroidsurgeryanditmaytakeuptoamonth
beforeyoufeelyouhaveyourenergylevelsback.Insomecases,ifyouare
prescribedthyroidreplacementtablets,recoverymaytakelongerbeforeyou
reachthecorrectdoseofthyroidmedicine.Yourmedicalteamwillcarryout
bloodteststoassessthis.
Followingathyroidectomy,somepatientsfeelasthoughthereisalumpintheir
throatastheyswallow.Thisiscommonandwilldisappearintime.
Beforeresumingdrivingyouneedtoensurethatyoucanmakeanemergency
stopwithouthurtingyourneck.Youalsoneedtobeabletocomfortablyturn
yournecktolookaroundasyoudrive,forexample,whenyouchangelanes.You
shouldinformyourcarinsurancecompanythatyouhavehadathyroid
operationasdifferentinsurersmayhavetheirownrulesabouthowlongyou
shouldwaitafteranoperationbeforeyoureturntodriving.
Yourreturntoworkdependsonthetypeofworkyoudoandtheoperationyou
havehad.Youmaybeabletoreturntooffice-basedworkaftertwotothree
weeksandheavierworkafterfourweeks.Yoursurgicalteamwilladviseyou.
WillIneedThyroidreplacementtabletsaftermyoperation?
Thisdependsonwhichoperationyouhavehadperformed.
Patientswhohaveallthethyroidglandremoved(totalthyroidectomyornear
totalthyroidectomy)willneedthyroidtabletspostoperativelyandthiswillbe
lifelong.Yoursurgicalormedicalteamwillstartthetabletsupondischarge
followingyourthyroidoperationandthencheckthatyouareonthecorrectdose
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byperformingbloodtestsintheclinic.Occasionallythesebloodtestsare
performedandcheckedbyyourGP.
Patientswhohavehalfofthethyroidglandremoved(lobectomy,alsocalleda
hemithyroidectomy)mayormaynotneedthyroidtabletspostoperatively.Your
surgicalteamwillperformbloodtestsperformed1to6monthsfollowingyour
operationtocheckwhetheryourequirethyroidtabletsornot.
Whatarethepossiblecomplicationsofthyroidsurgery?
Complicationsofthyroidsurgeryareuncommon.Thevastmajorityofpatients
havestraightforwardsurgeryandaredischargedthefollowingdaywithoutany
complications.Yoursurgeonwilldiscussthebenefitsandpotential
complicationsofsurgerywithyouindetail.Pleasefeelfreetoaskanyquestions
thatareonyourmind.
BAETShaveproduceapatientinformationleaflet,PotentialConsequencesof
ThyroidSurgery,whichcanbefoundonourwebsite(www.baets.org.uk).
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TheBritishAssociationofEndocrine&ThyroidSurgeonsareindebtedtothefollowingpatient
organisationswhohavehelpedintheproductionofthisleaflet
TheBritishThyroidFoundation
TheBritishThyroidFoundationisacharitydedicatedtosupportingpeoplewiththyroid
disordersandhelpingtheirfamiliesandpeoplearoundthemtounderstandthecondition.
Forsupportandmoreinformationaboutthyroiddisorderspleasevisit:
www.btf-thyroid.org
TheButterflyThyroidCancerTrust
TheButterflyThyroidCancerTrustisthefirstnationalcharityintheUKdedicatedsolelytothe
supportofpatientswithThyroidCancer.
Forfurtherinformationpleasevisit:
www.butterfly.org.uk
Disclaimer
Theadviceinthisleafletisbelievedtobetrueandaccurateatthetimeofgoingtopress.
Ultimately,theresponsibilityforobtaininginformedconsentfromyouforasurgicalprocedure
lieswithyoursurgicalteamandnotwiththeBritishAssociationofEndocrine&Thyroid
Surgeons(BAETS).
BAETScannotacceptanylegalresponsibilityforthecontentsofthisleafletwhichisproducedin
goodfaith.
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