Thyroidectomy in KPHB, Hyderabad

The tests come first: an ultrasound of the neck, a needle test of the lump (nodule), and thyroid blood tests. Where possible, they are done before the visit. Then most of the decision can be made in one visit. The operation is done while you are fully asleep (general anaesthetic). It is done through a crease in the lower neck and takes one and a half to three hours. It needs a larger operating room team and a stay of one to two nights. That stay is arranged at an associated hospital, and you are told which at the first visit. You go home with a small dressing. Stitches or clips are managed at follow-up in the first week. Desk work at one to two weeks. Where the whole gland was removed, blood tests afterwards set the dose of thyroid tablets.

• A nodule with worrying features on ultrasound or on a needle test (biopsy)
• Thyroid cancer that is proven or suspected
• A large swollen gland (goitre) causing pressure: trouble swallowing, tightness, breathlessness lying flat, or a gland growing down behind the breastbone
• An overactive thyroid not controlled by medicine or radioactive iodine, or where those are not suitable
• A nodule that keeps growing, or a fluid-filled lump (cyst) that fills up again after it is drained with a needle
• Worry about the look of a clearly enlarged gland, in some cases

Most thyroid nodules are not cancer (benign), and most never need surgery. Being told you have a nodule is not being told you need an operation. A scan and a needle test usually settle it.

Thyroid surgery is only as good as the tests done before it. All of the following come before a date is booked:

• Thyroid blood tests (TSH, T3, T4). An overactive gland is brought under control before you are put to sleep.
• An ultrasound of the neck. It grades the risk of the nodule in a set way, and it checks the glands (lymph nodes) in the neck.
• A fine needle test (FNAC), usually guided by ultrasound. This is the test that decides the operation. It is done before surgery, not instead of it.
• A camera check of the voice box (laryngoscopy) to see how the vocal cords move. If a cord is already not moving, that is vital to know. Recording normal cords beforehand protects both patient and surgeon.
• Calcium and vitamin D levels.
• A CT of the neck and chest where the gland reaches down behind the breastbone, or where cancer is suspected.

Sometimes a hormone specialist (endocrinologist) needs to be involved, before or after the operation. That is arranged as part of the plan.

The cut runs across a natural skin crease at the lower front of the neck. It heals into that crease and settles into a fine line over months. The gland is separated from the windpipe. The nerve that moves the vocal cord on each side is found and kept safe along its whole length. The parathyroid glands, each about the size of a grain of rice, are found and left with their blood supply intact. The gland’s blood vessels are sealed and cut with a harmonic scalpel. It uses vibration, not spreading heat, to close them. So there are fewer ties in the wound, and less bleeding to manage.

Hemithyroidectomy removes one lobe. Most patients keep normal thyroid function afterwards. Total thyroidectomy removes the whole gland. You then need thyroid hormone tablets for life: one tablet each morning, adjusted by blood tests. Once the dose is settled, this is a small thing, not a large one.

One and a half to three hours. A drain is sometimes left in overnight. The stay is usually one to two nights. A standard cut is used, and the reasons are explained at the first visit.

First 24 hours. A sore throat from the breathing tube, and neck discomfort when you move. A hoarse or tired voice, which is usually swelling, not nerve injury. Calcium is checked by blood test. Tingling around the mouth or in the fingertips must be reported straight away.

Week one. The dressing and stitches or clips are managed at follow-up. Sleep propped up. The neck feels tight when you look up. The voice tires quickly by evening.

Weeks two to six. Most people are back to desk work in one to two weeks. Heavy lifting waits. Massage the scar once it has healed. Keep it out of the sun for several months. That does more for how it looks in the end than anything put on it.

Ongoing. Blood tests to set the thyroid hormone dose after a total thyroidectomy. Follow-up goes on where the diagnosis was cancer.

• Voice change from injury to the nerve that moves the vocal cord. The nerve runs right behind the gland. A weak voice for a while is not rare after thyroid surgery. It usually recovers over weeks to months. Permanent injury is uncommon, and it leaves a weak, breathy voice that lasts. Injury on both sides is rare, and it is a serious breathing problem. The nerve is found and traced in every operation. How the vocal cords move is checked before surgery, so any change is measured against a starting point.
• Low calcium, when the parathyroid glands are disturbed. Common for a short time after a total thyroidectomy. It causes tingling in the fingers and around the mouth. It is treated with calcium and vitamin D. Low calcium for life, needing supplements for life, happens in a small share of people. Keeping each gland with its blood supply is the guard.
• Bleeding into the neck. Uncommon, and the reason you are watched overnight. Blood collecting in the neck can press on the airway, and it needs treatment at once.
• Thyroid hormone tablets for life after a total thyroidectomy. This one is certain, not a risk, and you agree to it before the operation.
• The scar. A fine line in a skin crease in most people. Thicker or raised scars happen, above all in people prone to thick raised scars (keloid).
• A change to the higher notes of the voice, from injury to a smaller nerve above the gland. This matters most to singers.
• Wound infection or a collection of fluid, uncommon.
• A final lab report on the gland (histology) that differs from the needle test. Now and then this leads to advice to have more surgery.