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Operation Treatment for Thyroid Problems

The thyroid gland produces hormones and is one of the endocrine glands, placed in the anterior neck just below the voice box and is the source of the hormone thyroxine. The thyroid hormones are secreted into the blood and are important in controlling the metabolism and contribute to the normal function of all the body's cells. The thyroid gland can produce and store more thyroid hormone than the body needs at any period and so a patient may not need to take thyroid replacement hormone if only a proportion of the thyroid gland is removed.

Thyroid hormone replacement tablets will be necessary for the rest of a person's life if the whole thyroid gland is removed. The parathyroid glands are four very small glands about as big as grains of rice and attached to the thyroid. Parathyroid hormone is secreted by these glands which are involved in the regulation of calcium concentration in the blood. It is essential to have normal calcium in the blood for a healthy skeleton and general health. Surgeons try not to remove the parathyroid glands during the operation but gland function can be compromised.

When the surgeons take out the thyroid gland the operation is called thyroidectomy and this can be total, involving the whole gland, or a sub-total or partial removal. Hemithyroidectomy involves removing half the gland and lobectomy a removal of one of the thyroid lobes. Hyperthyroidism, overactivity of the thyroid gland secretions, is the most common reason for this operation although if the thyroid gland enlarges, a condition known as goitre, this may need operation. Goitre can appear unsightly or interfere with breathing or swallowing.

A general anaesthetic is used to carry out the thyroidectomy operation so the patient is unconscious during the entire procedure. The incision is made in the neck, mostly in the natural crease of the skin just above the sternum and is made on both sides at the same time. The incision heals well in these cases, gradually becoming inconspicuous and eventually almost disappears completely. A small tube may be placed in the neck to act as a drain to collect any fluid from the wound. This helps the process of healing and the drain is removed in the first day or so after operations. Two to four days in hospital is the typical stay.

Before the operation patients should fast for six hours, taking just clear fluids until about two hours before the operation. A venflon in the arm is the portal through which the anaesthetist administers the anaesthetic to keep the patient under for the one to hours the operation will last. Stitches under the skin can be used to close the wound and these do not need removal, with other surgeons placing clips or skin stitches which do need removal, usually after two to three days. Patients stay in the hospital differs with how well they are and mostly varies between two and four days. Pain levels after the operation are very variable but settle quickly and many patients have some neck discomfort.

There are various post-operative risks and many of them are rare. Infection can occur in the wound and if it develops redness and soreness then antibiotic treatment is prescribed. Wound reopening and exploration to remove any accumulated pus is also rarely required. Bleeding in the wound can occur, leading to a haematoma which necessitates wound exploration and washing out, with a one in fifty chance of this occurring. Patients will have some bruising and also swelling around the wound area caused by the bleeding under the wound.

A check of the vocal chords will be performed on all patients before surgery and operating very close to the larynx and the nerves which supply it is discussed with the patient. The nerves can lose partial function if they are bruised during surgery and weakness and hoarseness of the voice can be affected as the nerves control vocal chord movements. It may take months for the voice to recover and in rare, severe cases the nerve can be permanently altered. It is very rare for both nerves to be affected and a serious complication as the ability to speak is lost and a tracheotomy in the trachea is necessary to maintain breathing.


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