Surgery for Hyperthyroidism: Are You a Candidate for a Thyroid Gland Removal?

The thyroid gland is one of the major endocrine glands that make hormones essential for normal functioning of the cells and tissues of the body and secretes them directly into the bloodstream. 

These hormones are Thyroxine (T4) and Triiodothyronine (T3) which influences body cells and tissues and controls the speed of body processes or what is known as the ‘metabolic rate’; and calcitonin that controls calcium levels in the blood. In the absence of a thyroid gland, however, the T3 and T4 hormones could be replaced by medication, while calcitonin may or may not require substitution. 

Hyperthyroidism, and other thyroid disorders

An increase in the production of the T4 and T3 hormones could result in a speeding up of the metabolic rate, making you work faster, and feeling overactive, anxious, craving or hungry for more food than normal, despite losing or even gaining weight rapidly. This condition is called hyperthyroidism. 

Likewise, a decrease in the above hormones could result in tiredness and feeling sluggish; the body processes begin to work slower than the normal rate, resulting in ‘hypothyroidism’. 

Other abnormalities of the thyroid include: 

• A partly enlarged thyroid gland called a nodule
• Goitre, or a thyroid gland that is fully enlarged
• Inflammation of the thyroid, or thyroiditis
• Cancer of the thyroid

When is it necessary to remove the Thyroid gland?

Thyroid disorders and their symptoms are assessed by the doctors using a clinical examination and measures such as:

• Blood tests that can demonstrate the levels of active hormones in the body.
• A test sample of tissue or fluid from the suspected nodule or goitre to check if it is cancerous.
• Ultrasound or CT scans to check for size and location, or any abnormalities so that the surrounding structures and organs, such as the windpipe, are not affected.

Depending on the results of this initial investigation, Hyperthyroidism is generally treated with radioactive iodine or anti-thyroid drugs, failing which, surgery is an option. Complete removal of the thyroid gland, or thyroidectomy, is recommended: 

• In conditions of thyroid cancer
• When the thyroid is enlarged and you are finding it difficult to breathe or swallow food. 
• When an overactive thyroid or hyperthyroidism (also called Graves’ disease) doesn’t improve with medication.
  
  

Sometimes, your doctor may recommend surgery to remove only one half (or a lobe) of the thyroid gland. This process is called a thyroid lobectomy. 

Thyroidectomy: Risks and post-operative care

Prior to a thyroidectomy, your doctor or endocrinologist will think it critical to ensure that your hyperthyroidism conditions are managed well before the actual surgery. This is to eliminate any risk of heart disease and to avoid the release of thyroid hormones into the bloodstream, which can be dangerous at the time of surgery. This may be controlled with the help of beta-blockers, anti-thyroid medication, or elemental (non-radioactive) iodine a week before the operation.

A thyroidectomy surgery will take you about one or two days to recover after which you will be discharged from the hospital. As with any surgical procedure, it is better to be educated or aware of the risks and complications associated with the operation. For example, you may or may not experience some post-operative reactions such as numbness or pain in the neck areas, breathing or swallowing difficulties, and bleeding, or infections. However, the majority of these are rare and can be treated by the doctor. Some other risks include:

1. Thyroid storm: While this is a rare occurrence, a thyroid storm is a medical emergency situation that is caused by lack of appropriate hyperthyroidism management measures before the surgical procedure. As a result, during the thyroidectomy, excessive amounts of active thyroid hormones rush into the bloodstream causing symptoms that include palpitations, fever, changes in mental status, or even coma and very rarely, death. 
   
   
2. Voice changes: Depending on the reasons for undergoing the thyroidectomy (cancerous thyroid, tumour, or a very large goitre), there may be a significant, albeit, temporary change in your voice. This is normal and it may take a few days or months to recover your original voice, which can be important to you if you are a professional performer, orator or singer. 
   
   In very rare cases, there could be damage, injury or bruising to any of the recurrent or superior laryngeal nerves that control the normal functioning of the vocal cords. As these nerves travel close to blood vessels surrounding the thyroid gland, this may result in a temporary or permanent weakening of the voice, although the sound of your voice will remain the same. This means you may find it difficult to talk or shout at a high pitch, the tone of your voice may fluctuate occasionally or you may tire easily from talking too much or singing aloud. 
   
   
3. Low calcium levels: Calcium levels in the bloodstream are maintained by four parathyroid glands – two situated on either side of the neck and attached very close to the thyroid. Despite nil or minimal injury to the parathyroid glands, you could be at risk of low calcium levels called hypoparathyroidism, or hypocalcaemia after your thyroidectomy. However, this can be fully corrected after a course of calcium supplements as prescribed by your doctor.
4. Hypothyroidism: With an absent thyroid gland, you will be advised to take thyroid hormone replacement therapy for the rest of your life. For this, you will be prescribed Thyroxine tablets that are affordable, effective and safe. 

If you think you are a candidate for a thyroidectomy, do discuss with your doctor about the risks you are likely to face owing to other existing health conditions, the precautions you need to take, as well as the benefits and post-operative care you will need after the surgery.