total thyroidectomy header

Information about this procedure is listed under the following headings:

Why do I need this operation?

What are the intended benefits of the surgery?

How is the surgery performed?

What are the potential risks and how great are these risks?

What am I to expect after the operation?

How long will I be off work/school?

Frequently asked Questions

Why do I need this operation?

A total thyroidectomy is the complete removal of the thyroid gland. The thyroid gland is situated in the lower part of the front of the neck (see picture). There are different reasons for performing a total thyroidectomy.

1) Hyperthyroidism - a condition where the thyroid gland is producing too much thyroid hormone.

2) Suspected or Confirmed thyroid cancer.

3) Compression - The thyroid may enlarge to such an extent that surrounding structures are compressed in the neck. These structures may include the trachea (windpipe) or oesophagus (gullet).

4) Cosmetic - an enlarged thyroid may cause a lump on the front of the neck that a patient may consider unsightly.

What are the intended benefits of the surgery?

Simply removing the entire thyroid gland in cases of thyroid cancer may be sufficient to cure the cancer. In those whose major symptom is compression, thyroidectomy will relieve these symptoms. Where the thyroid gland is producing too much thyroid hormone, a total thyroidectomy will prevent any more hormone being produced and proper levels may be controlled with medication.

How is the surgery performed?

A general anaesthetic is administered. A horizontal skin incision (cut) is made in one of the skin creases in the neck. The thyroid gland is reached by dissection and removed. A surgical drain is inserted to allow any blood to drain.

What are the potential risks?

There are many potential risks involved in having a total thyroidectomy and some of these risks are very serious, but it is important to note that these risks are very uncommon.

1) Bleeding - As with any operation, there may be some bleeding from the site of the operation. This is drained using a surgical drain. The amount of bleeding is seldom serious enough to require a return to the operating theatre or a blood transfusion.

2) Scar - The site of the scar (see photograph) following a thyroid operation is low on the neck, and normally shrinks to an extent where is is difficult to see within a few months. If you are from an Afro-Caribbean background, you are at more risk of a keloid scar which may be more unsightly.

3) Damage to recurrent laryngeal nerve - this nerve supplies the vocal cords. If one is damaged during the operation, the result may be a hoarse voice or a weak voice. This may be temporary or permanent. The chance of the nerve being damaged is 1-2%. If both nerves are injured then both vocal cords will be paralysed and the windpipe may become blocked. This may require a tracheostomy. The chance of both nerves being damaged is very small. If the superior laryngeal nerve is injured, there may be difficulty in altering the pitch of your voice. This is seldom permanent.

4) Calcium supplements - the glands that regulate the levels of calcium in the blood are situated near the thyroid gland. These parathyroid glands are very small and may be removed with the thyroid gland during surgery. If they are injured of removed, calcium replacement may be required. 20-30% of thyroidectomy patients will have low calcium levels, some of these patients will require calcium replacement initially, but within 3-4 months, this will fall to around 2% who will require lifelong replacement of calcium.

5) Thyroid hormone replacement - if the entire thyroid gland is removed, you will have to take thyroid hormone replacement tablets for life to supply the body with the hormone that the thyroid was responsible for producing.

What am I to expect after the operation?

The length of stay will depend on how well you progress after the surgery. A drain will be required for at least the first night, and when this has stopped draining, it can be removed, after which it is often possible to go home. Usually this is happens on the second day after the operation. During your stay, blood will be taken to check that the levels of calcium in the blood are normal. If they are not, the doctor will prescribe supplemental calcium. You will be started on thyroid hormone replacement medication.

How long will I be off work / school?

The length of time off work is variable and will vary from one to two weeks depending on how soon you get back to normal following your surgery. A doctor's note will be provided.

Frequently asked Questions

Will the scar be very obvious?

The scar is on the front of the neck, but this often settles to become a barely noticeable white line.

Can anything be done if I have an injury to my recurrent laryngeal nerve?

If the nerve does not recover on its own, there are some simple surgical procedures that may be effective in improving your voice.


Last updated: 23 October 2004