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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. 1 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 2 • 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. 3 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 4 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 5 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 6 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). 7 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. 8