Thyroidectomy Patient Information

The thyroid gland lies in the lower neck. It is a butterfly-shaped gland whose two lobes lie on either side of the upper trachea (windpipe) just below the larynx (voice box). A thin central portion (the isthmus) lies just over the trachea and connects the two lobes. The thyroid gland produces hormones that control metabolism. Benign or malignant tumors can develop in the thyroid and will present as a lump in the lower neck. Most tumors are benign. Malignant tumors may cause hoarseness, lymph node enlargement, pain at the site of the tumor, or even breathing difficulties.

The nerves to the larynx run close to the thyroid gland. Removal of thyroid tumors requires care to prevent injury to these nerves. There are two nerves on each side of the neck. One, the superior laryngeal nerve approaches the upper end of the thyroid and provides tension to the vocal cords thus allowing higher pitched singing and speaking. The more crucial nerve to speech is the recurrent laryngeal nerve that passes just deep to the thyroid lobe as it courses up from the chest to the larynx. Injury to this nerve causes a paralysis of the vocal cord. The effect of this vocal cord weakness varies considerably between individuals as some patients demonstrate no detectable voice change and others become hoarse. If hoarseness does result, it is usually temporary. Corrective procedures can be performed for either temporary or permanent vocal fold weakness.

The procedure is done under general anesthesia through a transverse incision below the collar line. This incision heals well with minimal scarring and provides safe access to identify the recurrent laryngeal nerves and remove all tumor tissue. Thyroid lobectomy (removal of one half of the gland) takes about 2 hours while total thyroidectomy is a 3-4 hour procedure. The incision is usually closed with nylon sutures that are removed 4-6 days after surgery. A drain is usually placed which is removed in 1-2 days after surgery.

The risks of surgery are in part determined by the anatomy of the tumor. Great care is taken to protect the recurrent laryngeal and superior laryngeal nerves during surgery, and almost all patients have normal function of these nerves following surgery. If present, temporary weakness will usually recover in 3-4 months without the need for any additional therapy. Permanent weakness can also occur, but is very rare if the nerve is visibly intact at the conclusion of the procedure. Occasionally, malignant tumors will be adherent one of these nerves or even surround a nerve. These are cases when sacrifice of the nerve needs to be considered in order to remove all tumor tissue.

If the blood supply to the parathyroid glands is injured at thyroidectomy, there may be a decrease in the calcium level in the blood. This is usually temporary and can be managed with the administration of calcium and vitamin D by mouth. Hypoparathyroidism is rarely encountered when only one lobe of the thyroid is removed.

Wound infections may also occur and can usually be managed in the clinic with antibiotics and minor wound care. Bleeding in the wound is a rare event and may require a return to the operating room for safe management.

Patients leave the hospital with sutures at the wound site. The drain may still be in place at discharge. If a collecting bulb type drain is used, no dressing is required. Once the drain output is less than 15-20 cc/day, the drain can be safely removed in clinic without discomfort. Sutures may be removed on the 4th to 6th day after surgery.

Clean the wound with hydrogen peroxide using a cotton swab twice each day. Apply antibiotic ointment (bacitracin or polysporin) to the wound. If you have a bulb type drain, empty the drain bulb twice each day and record the output. Once the sutures are out, you may wash the wound with soap and water and gently dry the area. The skin around the incision will be numb for several months after surgery. Three weeks after surgery, you may begin to massage the wound using a vitamin E or aloe containing lotion or oil. This will soften the scar over time.

You will be seen in clinic for post-operative visits. Pathology results are usually available 3-5 working days after surgery and can be reviewed in clinic. After suture removal, you will be seen in clinic every 2-4 weeks until healing is complete. Long-term follow-up is determined by the pathology. Patients with benign tumors are typically seen every 3-6 months for two years, then yearly. Patients with malignant tumors are followed every 3 months for two years, then every 6 months for 5 years. In many cases, an endocrinologist will perform long-term follow-up.

Call the office at 202-444-8186 to schedule appointments.

For patients of Dr. Bruce Davidson, his assistant, Sharon Robins may be reached at
202-444-7035 for questions pertaining to surgery or scheduling difficulties. A resident is available by page 24 hours a day at 202-444-7243. If you have a non-emergent matter, please call the office first.

For general questions or information, you may also email us. Please note that we cannot guarantee the confidentiality of this e-mail — for confidential patient questions, please call the phone number listed above.

E-mail contact options are:

Sharon Robins  Syr2@gunet.georgetown.edu
Bruce J. Davidson, MD, FACS davidsob@gunet.georgetown.edu