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Hyperthyroidism

What About Surgery As A Treatment For Hyperthyroidism?

Last updated on:
21/04/2013

Contributing Author: Guy Slowik FRCS

Surgical treatment for hyperthyroidism involves removal of almost all of the thyroid gland. The remaining part of the gland is not able to produce excessive amounts of thyroid hormone. This surgical procedure is known as a near total thyroidectomy. Surgical treatment is less common than in the past.

There are important points to know about surgery for hyperthyroidism:

  • It brings rapid, permanent control of hyperthyroidism. Preparation before surgery with anti-thyroid drugs is advised; this may require several months.
  • Almost all patients develop hypothyroidism following surgery.
  • As with other surgical procedures, there are the usual risks of:
    • General anesthesia
    • Bleeding
    • Nerve damage
    • Wound infection
    • Other type of infection
    • Other complications

Need To Know:

If any of the following factors are present, surgery is more likely to be recommended:

  • A very large thyroid.
  • A nodular thyroid of any size that does not demonstrate much iodine uptake on RAIU scanning. This finding eliminates radioiodine as a choice for therapy.
  • A thyroid nodule that may be cancerous.
  • Moderate to severe hyperthyroidism in a child or a pregnant woman.

Preparation for surgery

The surgical procedure

Possible complications of surgery

Medical care after surgery

Preparation For Surgery

It is most important to have thyroid hormone levels under control before surgery. Achieving control of the hyperthyroidism before surgery avoids the risk of a "thyroid storm." This condition, also known as a hyperthyroid crisis, is due to a failure of the body to tolerate hyperthyroidism in response to a stress, such as surgery.

  • Preoperative, hormonal control is usually obtained with an anti-thyroid drug, which partially blocks release of previously manufactured thyroid hormone from the overactive thyroid gland.
  • In addition, a few drops of an iodine solution are often taken daily for 10 to 15 days before surgery. These drops may decrease the size and number of blood vessels within the thyroid gland, thereby decreasing the risk for excess bleeding and other complications.

The Surgical Procedure

The operative procedure to treat hyperthyroidism is known as a near total thyroidectomy

  • It is performed under general anesthesia.
  • The surgeon makes an incision in the skin lines across the front of the neck and carefully exposes the thyroid gland.
  • Precautions are taken to identify, isolate, and protect important structures in the area of the thyroid gland. Two are particularly important:
    1. The laryngeal nerve, which is vital for the proper function of the larynx or voice box, is carefully identified and protected from trauma during this procedure.
    2. The four small parathyroid glands, which are embedded in thyroid tissue and produce a hormone necessary for maintenance of blood calcium levels, are also identified and preserved.
  • Most of the thyroid gland is removed.
  • The surgeon usually leaves about 3 to 8 grams, which is less the 0.3 ounces of thyroid tissue.
  • The procedure generally takes several hours.
  • The incision usually heals well and is usually not even noticeable.

Possible Complications Of Surgery

Thyroidectomy is considered safe, with a complication rate for injury to the laryngeal nerves or parathyroid glands of less than two percent. The rate of complications is lowest when an experienced surgeon performs the procedure.

Damage to one or more of the laryngeal nerves may result in changes of voice quality and tone. Damage to the parathyroid glands may cause problems with calcium balance.

Development of hypothyroidism or to a low level of circulating thyroid hormone is not considered a complication of the procedure, since it almost always occurs after surgery.

  • The likelihood of hypothyroidism depends on how much thyroid tissue is removed during surgery.
  • The likelihood of hypothyroidism depends on the underlying cause of the hyperthyroidism such as Graves' disease or nodular thyroid disease.
  • The risk for hypothyroidism is probably lower for individuals with nodular thyroid disease because the remaining tissue is likely to be normal.
  • In individuals with Graves' disease, the need to take enough tissue to make the risk of recurrence low normally results in hypothyroidism after surgery.

Medical Care After Surgery

Following surgery, patients are likely to remain in the hospital for one ot two days. After leaving the hospital, two types of follow-up are required. The individual needs to:

  • Make a follow-up appointment with the surgeon to ensure that recovery is complete.
  • Make an appointment with the endocrinologist to make sure that thyroid hormone levels decrease to normal and remain there.

If hypothyroidism develops, medical follow-up is important to make sure that an adequate thyroid hormone level is maintained with appropriate, ongoing thyroid hormone supplementation.

Need To Know:

It is extremely important that people with hyperthyroid eye disease make sure that their thyroid levels remain normal after treatment for hyperthyroidism. Smokers must make every effort to quit. A smoking-essation program involving nicotine replacement therapy or a support group is usually helpful.

For more information on how to stop smoking, go to Smoking: How To Stop.

How-To Information:

Long-term planning may involve various physicians, including a primary care physician, endocrinologist (specialist in disease of the glands), ophthalmologist (eye specialist), surgeon, or specialist in nuclear medicine. An individual with eye disease benefits when one physician, usually the endocrinologist, assumes responsibility for the collaboration among doctors. This is most likely to prevent a fragmented approach to treatment. In this way, doctors are able to coordinate treatment plans and implementation.

For further infromation about how to stop smoking, go to Smoking: How To Stop.

 

 
 
 

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From Andrew Maynard - Chair of the University of Michigan Department of Environmental Health Sciences, with help from David Faulkner - 2013 Master of Public Health graduate.