Introduction

The thyroid gland is located low in the front of the neck (just above the sternum) and has two halves, located to the left and right of the trachea, which are interconnected by a narrower “intermediate piece” located in front of the trachea. At the back of each thyroid half, two other small glands are attached to the thyroid gland: the parathyroid glands, these are usually only half a cm. great, but no less important. The thyroid gland produces a hormone that regulates the metabolism of our entire body, the parathyroid glands regulate the calcium content of our body: the absorption in the intestines and distribution to the blood and to our bones. The purpose of this information is to provide you with generally applicable information about this type of operation. Of course it is possible that in your individual case certain aspects of this document do not apply or that they should be discussed more or additionally with your surgeon. Remember to report to your surgeon all information regarding your general health, as well as any medications you regularly take (especially aspirin and related products, or other medications that may affect clotting). The general anesthetic is best discussed in advance with the physician-anaesthetist

Purpose of the procedure

The thyroid gland is operated on for several possible reasons. Its functioning can be disrupted and can not or insufficiently be adjusted with medication. Even when it is still functioning normally according to blood tests, it can increase strongly in volume and start to exert pressure on surrounding structures, or become aesthetically disturbing. Nodules can grow in the thyroid gland, usually these are benign, sometimes malignant, the distinction between the two is not easy to make “from the outside” so that surgery may be necessary for that reason. The decision to operate is almost always made in consultation with the endocrinologist (or “thyroid specialist”), who also plays an important role in the follow-up after surgery. During thyroid surgery, either one half or both halves of the thyroid gland is removed, sometimes it is also decided to leave a small healthy part of the thyroid gland in place. In other words, what does not happen is that one or a few isolated nodules from the thyroid are surgically removed, for various technical and medical reasons. The parathyroid gland(s) are always removed when they work too strongly, several different diseases can cause this, these are never malignant diseases

Technical aspect of the procedure

The surgeon makes a horizontal incision in the neck, about 2 cm above the upper edge of the sternum, the incision coincides with the natural skin lines so that the later scar is hardly visible. Some superficial structures are incised or moved to the side to access the thyroid gland. This is then loosened all around and removed. There are a few special points to pay attention to: the parathyroid glands are left in place (with thyroid surgery – in the case of parathyroid surgery it is vice versa) and must therefore first be peeled off the thyroid gland; the nerves of the larynx are also close to the thyroid gland and so should also be carefully avoided. The operation ends with the placement of a “drain” in the wound, which prevents the accumulation of exudate and blood in the neck wound, and with the re-closing of the neck wound in several layers.

Immediate consequences of the procedure

Mild neck and/or neck pain and mild temporary hoarseness may occur. Eating, drinking, swallowing and talking can be done almost immediately (but food and drink should be limited for the first few hours after surgery to prevent nausea and vomiting as is the case after any anaesthetic), sitting up and walking around as well. An intravenous line remains in the arm for the first 24 hours, the drain usually remains in place for 48 hours. Even when the parathyroid glands were perfectly respected during thyroid surgery, their functioning can be temporarily disrupted. That is why every patient is given preventive calcium intake after surgery and the calcium level in the blood is checked several times. Discharge typically follows the third day after the procedure. The thyroid hormone in our body has a fairly long "half-life", so that deficiency of it (eg when the thyroid gland has been completely removed) is not quickly noticeable. If necessary, however, thyroid replacement medication is also started after the operation. It is best taken in the morning sober.

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The belated consequences

Wound healing is usually fast. Sutures are removed within a week, support plasters (Steri-Strips) are best left on the wound for an extra week. The neck wound must be healed. Stay strictly dry for 2 weeks. Scars heal best if they are not exposed to bright sunlight in the first months, a scarf or "sun block" is sufficient if you have holiday plans. Long-term follow-up of the thyroid gland function and the regulation of “thyroid substitution” are done in consultation with the general practitioner and endocrinologist. With a correct substitution there are no further consequences of the operation

Serious and/or exceptional complications

Any surgical procedure, even performed under ideal conditions and in the best possible way, can still involve complications. A bruise in the neck may require urgent reoperation, this complication is rare and never occurs after discharge. Permanent hoarseness or even breathlessness due to limited mobility of the vocal cords is very rare and has its specific treatment options.

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