Thyroid Surgery
Dr Shaw is an experienced, specialised thyroid surgeon.
When do I need thyroid surgery?
Thyroid surgery is recommended for the following situations:
Malignant nodule (thyroid cancer)
Nodules that are atypical on biopsy (Bethesda 3 and 4) in order to rule out a cancer.
Multinodular goitres which are causing pressure symptoms or cosmetic disturbance
Hyperthyroidism conditions that are not suitable for, or have failed, medical or other therapies – including Grave’s disease, toxic multinodular goiter, toxic adenoma
Extension and growth of the thyroid into the chest (retrosternal extension)
What are the types of thyroid surgery?
Hemithyroidectomy (taking one lobe, or half of the gland)
Partial thyroidectomy or isthmusectomy (only rarely suitable)
Total thyroidectomy with or without central neck dissection (removing all the thyroid gland and sampling the draining lymph nodes in cases of thyroid cancer
Multiple variables such as age, comorbidities, child bearing age, patient preference are considered along with the thyroid pathology and presence of nodules in the rest of the gland to decided what surgery is recommend. Dr Shaw will discuss the options with you in a coherent, respectful and personalised way so you can reach an informed decision.
What are the risks and potential complications of thyroid surgery?
You will require a general anaesthetic which carries risks depending on your overall condition, medical comorbidities and previous reactions to anaesthesia. The neck is generally a clean site but there are small risks of surgical site infections and wound problems as with any surgery.
Risks specific for thyroid surgery include:
Post operative bleeding that may cause swelling in the wound bed around the airway and difficulty breathing. Occasionally a second operation is required to remove clot and alleviate pressure if there is a significant post operative bleed.
Injury to the recurrent laryngeal nerves (RLN). There is a recurrent laryngeal nerve on either side of the neck that supplies the vocal cord of the same side. Permanent damage occurs in 1-2% of cases, and may require further surgery to the vocal cords to mitigate long term effects of an immobile vocal cord. Temporary injury rates are higher and result in a hoarse voice that gradually recovers with time.
Hypoparathyroidism. The parathyroid glands are small glands that secrete parathyroid hormone (PTH) and help regulate the body’s calcium levels. Their locations are somewhat variable but there are usually 2 on each side, all very closely related the thyroid gland. Parathyroid function may be reduced after thyroid surgery; usually only in total thyroidectomy or revision thyroid surgery. Sometimes the blood supply to a parathyroid surgery is impaired from thyroid surgery and the gland is reimplanted at the time of surgery into a muscle where it receives a good blood supply and can recover function.
What to expect after surgery?
A small scar in a neck skin crease
2 nights in hospital for a total thyroidectomy
Frequently a small drain in the neck to prevent blood collecting in the thyroid bed. This is usually removed by the second post operative day.
Thyroid hormone replacement medication (thyroxine) for total thyroidectomy patients and certain hemithyroidectomy patients
Calcium replacement tablets if hypoparathyroidism is present on initial post-operative blood tests
Are there other approaches for thyroid cancer?
Dr Shaw is a member of the Northern Beaches Hospital and Macquarie University Hospital Endocrine Surgery Multidisciplinary Team (MDT). All patients with thyroid cancer and those who require a review of imaging or pathology will be discussed in an MDT meeting by a panel of experts in thyroid cancer from different specialties to give a consensus personalised treatment and follow up recommendations. Certain patients with a higher risk of recurrence may be recommended to have radioactive iodine ablation to treat microscopic residual disease and reduce the risk of it recurring.
Consultation for thyroid pathology
Dr Shaw will take a medical history for symptoms related to thyroid dysfunction and a physical examination of the neck.
An office ultrasound may be performed to look at the thyroid gland or neck structures. A flexible nasoendoscopy may be performed to examine vocal cord function. This is where after a spray of anaesthetic medication in the nose, a 2mm flexible videoscope is inserted via a nostril to inspect the oropharynx and vocal cords. It is usually painless and well tolerated, but we recommend not having hot drinks for 60mins afterwards.
Dr Shaw may recommend additional investigations, scans, or biopsies. He will you in a clear and coherent manner your results and the treatment options. Please ask any questions you may have.