Thyroid & Parathyroid Surgery
The thyroid and parathyroid are small glands at the front of your neck that produce and release hormones through the bloodstream. Certain conditions may cause problems that require surgery to remove part or all your thyroid or parathyroid. This includes non-cancerous conditions including multinodular goitre, overactive thyroid disease and some cancers.
About thyroid surgery
Hormones produced by the thyroid help regulate your metabolism, including how quickly our bodies use and store energy. When the thyroid produces too much or too little of these hormones, it can make you feel unwell in different ways. Most thyroid conditions requiring surgery relate to nodules on the thyroid, which are either cancerous or non-cancerous. In most cases, your thyroid functions normally despite the presence of these nodules.
A thyroidectomy is surgery to remove the thyroid gland. It may be performed as a total thyroidectomy (to remove the whole thyroid gland) or a hemithyroidectomy (to remove one side of your thyroid only) depending on your condition.
Why do I need a thyroidectomy?
A thyroidectomy may be considered as part of treatment for conditions including:
Thyroid nodules
These are abnormal growths of thyroid cells that form a lump or nodule. They are extremely common, especially as we get older, and mostly non-cancerous (90-95% of thyroid nodules are benign). Often they do not cause any symptoms and are discovered during a scan for something else. Some people with large nodules or multiple nodules notice difficult with swallowing, neck or throat tightness or a bulge in their neck that they can see.
Thyroid cancer
A rare and usually highly treatable form of cancer that develops when thyroid cells divide in an abnormal way. The four main types of thyroid cancer are papillary, follicular, medullary and anaplastic. Removing part or all of the thyroid gland is usually the first stage of treatment.
Overactive thyroid disease (hyperthyroidism)
Hyperthyroidism is when your body makes too much thyroid hormone. It can develop in several ways and require different types of treatment. Common causes include a diffusely enlarged thyroid that secretes too much thyroid hormone (Graves’ disease) and thyroid nodules that increase their activity (toxic nodules).
Whether you need an operation to remove your thyroid depends on your individual diagnosis and symptoms. In some cases, a goitre may grow large enough to cause difficulty with breathing and swallowing; or you may develop a hoarse voice if a cancerous thyroid nodule invades the nerve that controls the vocal cords. In thyroid cancer, half or all of the thyroid may be removed along with lymph nodes in the neck. Further treatment in the form of radiation tablets may be required to minimise the risk of cancer coming back.
Planning for thyroid surgery
As a head and neck surgeon, Dr Wykes is highly skilled at protecting the important structures in the neck that surround these important glands. He performs conventional thyroidectomy using an appropriate incision in the centre of your neck in one of your natural skin creases to directly access your thyroid gland. This incision is often small and heals well in a crease of skin in your neck. All thyroid surgery is performed under general anaesthetic.
You may need to take medications after your surgery, especially if you had your whole thyroid gland removed. Generally, you’ll start taking thyroid hormone medication the day after surgery. You may also need to take calcium medication for a period of time following surgery. Thyroid cancer often requires additional treatment to reduce the risk of cancer reoccurring, for example, radioactive iodine therapy after the operation.
About parathyroid surgery
The parathyroid glands are located behind the thyroid gland in the neck. They produce and release parathyroid hormones to help control the level of calcium, an essential mineral in the body. Problems can arise when the parathyroid is overactive (hyperparathyroidism), underactive (hypoparathyroidism) or affected by cancerous and non-cancerous tumours that need to be surgically removed.
How the parathyroid glands work
There are four parathyroid glands that work to control the levels of calcium, phosphorus and magnesium in the body. Parathyroid hormone regulates these levels by influencing the rate of bone breakdown, which is needed to maintain and grow healthy bones, and acts on the kidneys to stimulate important kidney functions associated with calcium and vitamin D metabolism.
Why do I need a parathyroidectomy?
Surgery to remove one or more parathyroid glands is called a parathyroidectomy. This is usually only recommended if you develop an overactive single or multiple parathyroid gland.
A problem with the parathyroid gland usually leads to symptoms elsewhere in the body due to the higher levels of calcium in the blood. Common symptoms include tiredness, nausea, kidney stones and pain in your bones. You may also suffer from osteoporosis as a result of an overactive parathyroid. This can be confirmed by tests organised by your GP. The most common conditions affecting the parathyroid include:
Parathyroid adenoma – a benign tumour on one of your parathyroid glands.
Parathyroid hyperplasia – when all four parathyroid glands become enlarged.
Secondary or tertiary Hyperparathyroidism – when your body is making and releasing too much parathyroid hormone, usually due to chronic kidney disease or chronic vitamin D deficiency.
Types of parathyroid surgery
Parathyroid surgery can be minimally invasive, using a small 2cm incision. All parathyroid surgery is performed under general anaesthetic and you will have either:
Minimally invasive parathyroidectomy – if you have a single overactive parathyroid gland, only this gland will be removed using a small incision in your neck if it can be accurately located on scans prior to surgery.
4 gland exploration – to explore different possible locations of an enlarged parathyroid, if it cannot be accurately located by a scan prior to surgery.
Total parathyroidectomy – where all four parathyroid glands are overactive, usually three and a half of the glands are removed, leaving some remaining parathyroid tissue in your body to help control calcium levels. This is usually only done in patients with chronic kidney disease.
Your calcium level will need close monitoring after surgery to ensure that it returns to normal and does not drop too low.
What is the recovery like after thyroid or parathyroid surgery?
Most people stay in hospital for 1-2 days after thyroid or parathyroid surgery.
As a head and neck surgeon, Dr Wykes is highly skilled at protecting the important structures in the neck that surround the parathyroid glands. While both thyroidectomy and parathyroidectomy are safe operations, there are some specific risks due to the location of these glands close to your voice box.
Dr Wykes will explain the surgery and any risks thoroughly during your consultation.