Thyroidectomy Surgery in Delhi, India

Thyroidectomy can be classified into two types based on the amount of the thyroid gland that needs to be removed. 

These types are:

1. Partial thyroidectomy
2. Total thyroidectomy

Thyroidectomy is indicated to remove a large goitre or nodule or for thyroid cancer or an overactive gland which cannot be treated with medications. Conditions that may require thyroidectomy include:

• Thyroid cancer: This is the most common reason for thyroidectomy.
• Benign enlargement of the thyroid (goitre): Removing all or part of the thyroid gland is needed for a large goitre if it is causing any difficulty in breathing or swallowing.
• Overactive thyroid (hyperthyroidism): The condition is termed hyperthyroidism when the thyroid gland produces an excess of thyroid hormones. Thyroidectomy may be an option if the patient is not a candidate for radioactive iodine therapy or if the patient is not responding to anti-thyroid drugs or has been on medications for a long duration without going into remission.
• Indeterminate or suspicious thyroid nodules: In some cases, it is a challenge to classify thyroid nodules as benign or malignant on the basis of fine needle biopsy. Thyroidectomy is advised if the nodules show an increased risk of turning malignant.

Doctors record the patient's medical history and family history and perform a physical examination before the procedure.

The doctor enquires in detail about the patient's medical history and records questions such as:

• Existing medical conditions or any recent ailments, such as a heart condition or blood clots
• Medications or supplements are taken, such as aspirin, iron supplements, herbal supplements, ibuprofen, naproxen sodium, or blood thinners
• Allergic to any substances

Doctors may advise certain tests before the procedure. These may include:

• Fine Needle Biopsy

  A thyroid fine needle biopsy is a procedure to diagnose whether the nodule is cancerous or benign. This helps formulate the correct treatment plan. The method involves numbing the biopsy site, after which a thin gauge needle is inserted to obtain a sample for testing. The patient can return to work the same day.

• Thyroid Scanning

  A thyroid scan gives an image of the thyroid gland taken after a low dose of a radioactive isotope that has been injected or swallowed. It (radioactive isotope) is typically taken up by the thyroid cells. The scan provides information on whether the whole gland or a specific nodule is hyper-functioning.

• Ultrasonography

  In this procedure, high-frequency sound waves pass through the skin and are reflected in the machine to create detailed thyroid images. Tiny nodules with a width of 2-3mm can be seen through ultrasonography. It helps distinguish thyroid cysts from solid nodules. It can be used as a lead during fine needle biopsy for aspirating the thyroid nodules.

• Blood tests may be advised to assess thyroid hormone levels.

Before the procedure

Thyroidectomy is performed under general anesthesia. During the procedure, monitors are placed on the body to check vital signs such as blood pressure, heart rate, pulse, and blood oxygen.

During the procedure

Incisions in the center of the neck in the skin crease are made so that the scar is less visible. Then, the gland is accessed and removed. If the surgery is being carried out for thyroid cancer, the lymph nodes are examined and may be removed. The procedure lasts for about one to two hours. However, the time taken to complete the surgery may vary depending on the extent of the disease.

The different approaches to thyroidectomy are:

Conventional thyroidectomy: An incision in the center of the neck is made to access the thyroid gland.

Endoscopic thyroidectomy: Smaller incisions in the neck are made. Using an endoscope, surgical instruments and a small video camera are inserted through the small incisions. This camera guides the surgeon through the procedure.

It is a must to follow the instructions given by the doctor before the procedure. Some of these include:

• At the consultation visit for the surgery, ask doctors any questions that bother you. The doctor gives the post-operative instructions to follow. A consent form for the surgery is signed at this appointment.
• The medical history is reviewed, and the doctor enquires about allergies or pre-existing medical conditions. The doctor may advise some blood tests before the procedure.
• Inform the doctor about any ongoing healthcare supplements or prescribed medications being taken.
• The doctor may stop certain medications, such as blood thinners and NSAIDs, before the operation.
• Avoid smoking and drinking since they interfere with the surgical procedure.
• Jewelry, metallic objects, or any other objects that may interfere with the surgery are removed.
• Empty the bladder before the procedure.
• Follow fasting for 12 to 8 hours before the surgery to avoid the side
• effects of anaesthesia.
• Wear loose, comfortable clothing to the scheduled appointment.

Thyroidectomy is typically a safe procedure but carries certain risks of complications. Some of them include the following:

• Bleeding
• Infection
• Low parathyroid hormone levels (hypoparathyroidism)
• Airway obstruction because of bleeding
• Permanent hoarseness or weakness in voice due to injury to the recurrent laryngeal nerve
• If there is thyroid cancer, you might require additional therapy (radioactive iodine treatment).

• The patient is immediately moved to the recovery room after the surgery, where their vital signs are monitored, and then moved to the normal room.
• Some people require the placement of a drain to prevent fluid accumulation. The drain is removed the next morning after surgery.
• People experience pain and neck stiffness due to swelling and hoarseness or weakness in the voice.
• However, short-term symptoms may occur due to irritation from the breathing tube inserted during surgery.
• Eating and drinking will be as usual.
• Some surgeries require a stay at the hospital, while others can return home the same day.
• Regular activities can be resumed within a week.
• Strenuous exercises and heavy lifting should be avoided for at least 14 to 20 days.
• The scar will fade with time.

Reviewed by Dr. Anshu Alok, Senior Consultant, Endocrinology & Diabetes on 31-Oct-2022.

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