Prior to Procedure

• Physical exam
• Laboratory and/or imaging tests such as CT scan [9] , isotope scan, and/or ultrasound [10] to assess thyroid function and anatomy
• Thyroid medication to suppress thyroid activity in patients with hyperthyroidism
• Iodine treatments for 10 to 15 days before surgery
• Fine needle aspiration biopsy [11] to determine if a tumor or nodule is cancerous (in some cases)

During Procedure

• Anesthesia
• Breathing tube (intubation)
• Horizontal incision in the front of your neck, usually above the top of the sternum (breastbone)

Anesthesia

General [12] anesthesia is used fo rthis procedure.

Description of the Procedure

A horizontal incision is made in the front of the neck. The skin is pulled away from the incision and held back with retractors or stitches. Bleeding vessels are clamped and tied off. The surgeon separates muscles [13], blood vessels, and nerves in the neck to access the thyroid gland. All or part of the thyroid gland is cut away from its attachment to other tissues in the neck and removed. Care is taken to avoid injury to the parathyroid glands (tiiny glands behind the thyroid that regulate calcium metabolism in the body) and nerves that control your vocal cords. Bleeding is controlled with instruments that compress, constrict, and cauterize the ends of blood vessels. The incision is closed and the edges of skin are stitched together.

When this gland is removed to treat thyroid cancer [14], lymph nodes in the area may also be removed in case the cancer [14] has metastasized.

When only a small thyroid nodule or cyst needs to be removed, the procedure may be performed with a tiny scope (endoscopic thyroidectomy). Several tiny keyhole incisions are made (instead of the larger traditional open thyroidectomy incision), and a fiberoptic scope is inserted to allow the surgeon to view the area. Miniature surgical instruments are inserted through the other openings to perform the procedure. Endoscopic thyroidectomy leaves smaller scars, and often requires a shorter period of recuperation. Endoscopic thyroidectomy cannot be performed to treat thyroid cancer [14], goiter, or larger nodules.

After Procedure

• You will have stitches or staples in the front of your neck.
• There will be discomfort in your neck for several days which can be treated with pain [15] medication.
• In some cases, you may have a slightly hoarse voice for a few days.
• You may need to take thyroid medication (in many cases, including all cases of total thyroidectomy) to compensate for loss of thyroid function.
• In some cases of thyroid cancer [14], you may need radioactive iodine treatments.

How Long Will It Take?

The procedure typically takes about 2 hours.

Will It Hurt?

Anesthesia prevents pain [15] during the procedure, but pain [15] after the procedure is common.

Possible Complications

• Infection
• Bleeding
• Scarring
• Voice changes due to damage to nerves leading to the voice box (rare)
• Damage to the parathyroid gland, which controls calcium metabolism
• Thyrotoxic crisis (sudden excessive production of thyroid hormone at toxic levels) (very rare)

Average Hospital Stay

1 to 3 days

Postoperative Care

• Keep the incision clean and dry.
• Do not get the incision wet for 5 to 7 days, if it does get wet, dry it immediately.
• Do not apply make-up, lotion, or cream to the incision area.
• Perform neck exercises [16] as instructed by your doctor.
• Take all medications as prescribed by your doctor.