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What is a thyroidectomy?
A thyroidectomy is the surgical removal of a diseased thyroid gland. Your thyroid gland is located in the front of your neck, below your larynx (voice box). It consists of two lobes, one on each side of your trachea (windpipe). Your thyroid gland plays an important role in regulating your body's metabolism and calcium balance. A thyroidectomy is a treatment for a variety of diseases, disorders and conditions of the thyroid gland.

Types of thyroidectomy -
The types of thyroidectomy procedures include:
• Lobectomy or partial thyroidectomy removes one lobe or only a portion of your thyroid gland.
• Lumpectomy removes only a small portion of your thyroid gland. This procedure is a treatment for small, benign (non-cancerous) thyroid nodules or cysts.
• Sub-total or near-total thyroidectomy removes almost all of your thyroid gland, leaving behind a very small amount of thyroid tissue.
• Total or completion thyroidectomy removes all thyroid tissue. A completion thyroidectomy refers to the removal of any remaining thyroid tissue after you have had a previous lobectomy or partial thyroidectomy.

Other procedures that may be performed
I may perform other procedures in addition to a thyroidectomy. This includes a lymphadenectomy or the removal or biopsy sampling of lymph nodes. I may perform this procedure for confirmed or suspected thyroid cancer.

Why is a thyroidectomy performed?
I may recommend a thyroidectomy to treat a variety of diseases, disorders and conditions of the thyroid.I may only consider a thyroidectomy for you if other treatment options with less risk of complications have been ineffective.

• Benign (non-cancerous) thyroid tumors, nodules or cysts
• Goiter or an enlarged thyroid gland. Surgery may be recommended for a goiter that interferes with breathing and swallowing.
• Hyperthyroidism (overactive thyroid gland) when radioactive iodine and medications are not options
• Thyroid cancer
• Thyrotoxicosis, also called thyroid crisis or thyroid storm, is a sudden worsening of hyperthyroidism that can be life threatening.

How is a thyroidectomy performed?
Your thyroidectomy will be performed in a hospital setting. I will perform a thyroidectomy using one of the following approaches:
• Minimally invasive surgery involves inserting special instruments and an endoscope through a small incision in your neck. An endoscope is a thin, lighted instrument with a small camera. The camera transmits pictures of the inside of your body to a video screen viewed by your surgeon while performing surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less damage to tissues and organs. I will make small incisions instead of a larger one used in open surgery. Surgical tools are threaded around muscles and tissues instead of cutting through or displacing them as in open surgery.
• Open surgery involves making a three to four inch incision in your neck. Open surgery allows to directly view and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.

Types of anesthesia that may be used
We will perform a thyroidectomy using general anesthesia.
• General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain.

What to expect the day of your thyroidectomy?
The day of your surgery, you can generally expect:
• To talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
• To remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
• To talk with the anaesthetist about your medical history and the type of anesthesia you will receive.
• A surgical team member will start an IV.
• The anesthesiologist will start your anesthesia.
• A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
• The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.

What are the risks and potential complications of a thyroidectomy?
As with all surgeries, a thyroidectomy involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
• Anesthesia reaction, such as an allergic reaction and problems with breathing
• Bleeding, which can lead to shock
• Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
• Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of thyroidectomy
Complications of thyroidectomy include:
• Damage to the parathyroid glands causing problems controlling your body’s calcium levels
• Difficulty breathing, which is a rare complication
• Nerve damage, which can lead to permanent hoarseness, coughing, swallowing problems, problems speaking, or other voice changes but it is rare
• Nerve irritation leading to temporary voice changes, hoarseness or weakness.
• Temporary rise in the level of thyroid hormones
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
• Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery
• Informing your doctor if you are nursing or if there is any possibility of pregnancy
• Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
• Taking your medications exactly as directed
• Telling all members of your care team if you have any allergies

How do I prepare for my thyroidectomy?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for a thyroidectomy by:
• Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
• Getting preoperative testing as directed. Testing varies depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, other imaging studies, a fine-needle biopsy, a swallow study, bronchoscopy (windpipe evaluation), flexible laryngoscopy (vocal cord evaluation), blood tests, and other tests as needed.
• Losing excess weight before the surgery through a healthy diet and exercise plan
• Not eating or drinking 6 hrs before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
• Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
• Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. You may also need to take thyroid medications or iodine treatments for a couple of weeks before your thyroidectomy.

What can I expect after my thyroidectomy?
Knowing what to expect can help make your road to recovery after a thyroidectomy as smooth as possible.

How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
You may go home on the same day if you are recovering well and can swallow liquids. A hospital stay of one to two days may be required in some cases. Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Full recovery takes two to four weeks.

Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery .I will treat your pain so you are comfortable and can get the rest you need.

When should I call u doctor?
It is important to keep your follow-up appointments after a thyroidectomy. Call me right away or seek immediate medical care if you have:
• Bleeding
• Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
• Change in alertness, such as passing out, dizziness, unresponsiveness, or confusion
• Chest pain or palpitations
• Hoarseness, coughing, swallowing problems, problems speaking, or other voice changes that are unexpected or last longer than expected.
• Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
• Inability to urinate, pas gas, or have a bowel movement
• Pain that is not controlled by your pain medication
• Sore throat that lasts for more than three weeks
• Swelling of the neck or throat
• Tingling or cramps in the hands, feet or lips
• Unexpected drainage, pus, redness or swelling of your incision

How might a thyroidectomy affect my everyday life?
A thyroidectomy may cure your condition or significantly reduce your symptoms so you can lead an active, normal life. It may also cause changes to your body that affect everyday life. You may need to:
• Avoid strenuous activity for a few weeks after your surgery
• Have any remaining thyroid tissue checked on a regular basis for any signs of cancer recurrence if you had thyroid cancer
• See me on a regular basis 6 monthly to monitor your thyroid hormone levels with lab tests
• Take lifelong thyroid medication to maintain normal levels of thyroid hormones

          Dr. Prashant Manohar kewle © 2014
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