Thyroid Info

What is the Thyroid Gland and What Are Its Functions?

The thyroid gland, resembling a butterfly in shape, is located in the neck, positioned in front of the windpipe just below the Adams Apple. Comprising two halves, known as left and right lobes, it is connected by a central bridge called the isthmus.

In healthy adults, each lobe measures approximately 3-4 cm in height, 1-2 cm in width, and 1-1.5 cm in depth. The adult thyroid gland typically weighs around 25g. Functioning as an essential endocrine organ, the thyroid gland secretes a hormone called Thyroxine, playing a crucial role in regulating the body's metabolism and maintaining overall health.

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Indications for Thyroid Surgery

Thyroid surgery, involving the partial or complete removal of the thyroid gland, may be recommended for the following reasons:

• Increase in the size of the thyroid gland (Goitre):

• Any enlargement of the thyroid, known as a goitre, may necessitate surgery.
• Growth in the thyroid can lead to compression on the windpipe (trachea) or gullet (oesophagus), prompting your surgeon to recommend thyroid surgery.
• Even without pressure on adjacent structures, an enlarged thyroid may cause discomfort or aesthetic concerns, prompting a discussion with your surgeon about the potential benefits and risks of surgery.

• Development of a lump (nodule) in the gland:

• Thyroid nodules, which can be solitary or part of a multi-nodular goitre, may require evaluation through clinical examination, ultrasound, and needle biopsy.
• If your surgeon expresses concerns based on these assessments, surgery may be recommended.
• Additional scans, such as a CT scan, may be necessary to assist in surgical planning.
• The incidence of thyroid nodules increases with age, more common in women than in men.

• Over-active thyroid gland (Hyperthyroidism):

• Hyperthyroidism, characterized by excessive thyroid hormone secretion, presents identifiable symptoms and is diagnosed through physical examination and blood tests. 
• If you're diagnosed with hyperthyroidism, which cannot be treated by non-surgical methods, you would require surgery to remove your thyroid gland. 

What Kind of Thyroid Operation Should I Anticipate?

Here is a general overview of thyroid surgery options. Your surgeon (Mr. Jeddy) will provide detailed explanations regarding the recommended procedure and the reasons behind it.

Thyroid Lobectomy: 

This operation involves the removal of one thyroid lobe along with the thyroid isthmus. Some surgeons may refer to this as a hemithyroidectomy.

Total Thyroidectomy: 

This comprehensive procedure removes the entire thyroid gland, leaving no thyroid tissue behind. Occasionally, for surgical reasons, a very small amount of thyroid tissue may be left behind, known as a near-total thyroidectomy. This is done to safeguard critical structures in close proximity to the thyroid gland in the neck. It's important to note that the residual amount is minimal, and the operation is considered as if the entire gland has been removed.

What to Expect Before Surgery:

If you are on regular medications, including thyroid-related tablets, continue them unless instructed otherwise. 

Patients on blood-thinning tablets (e.g. clopidogrel, warfarin, rivaroxaban, or dabigatran) should inform their surgeon, ensuring control of the conditions these medications address before and after surgery. Patients who are on small dose of aspirin (75mg) do not need to discontinue this before surgery.

You will have a pre-operative assessment, where a nurse will review your case, provide guidance on medication, and arrange necessary tests for anesthesia and thyroid operation.

A pre-surgery examination of your vocal cords is recommended, often conducted through flexible naso-endoscopy. It may be uncomfortable but lasts less than a minute. This will be performed by a ENT specialist. 

Hospital Stay Duration:

Usually, patients are discharged to go home the following day. However some patients may be suitable for same day discharge. 

Wound Care:

Upon discharge, ward staff will offer advice on wound care.

Dressing may be applied, usually removable after 48 hours unless advised otherwise. You can typically bathe or shower 48 hours post-operation, gently patting the wound dry. The wound may appear raised and pink initially, settling over time. Full healing may take months.

Do not apply ointments or bio-oils until you have been seen by Mr. Jeddy at a follow-up clinic.

Recovery and Medication After Thyroidectomy:

Thyroidectomy is generally a low-pain procedure, and pain relief is seldom needed after 72 hours. Avoid driving if on pain medication. Fatigue is normal post-surgery and may persist for up to a month before energy levels fully return. If prescribed thyroid replacement tablets, recovery duration may extend until the correct dose is achieved, assessed through blood tests. Feeling like there's a lump in the throat after surgery is common and diminishes over time.

Driving Considerations:

Before resuming driving, ensure you can make an emergency stop without neck discomfort and comfortably turn your neck. Inform your car insurance provider about the thyroid operation, as different insurers have varied rules on the waiting period after surgery before returning to driving.

Return to Work:

The timing for returning to work depends on the nature of your job and the type of operation. Office-based work may be resumed after one or two weeks, while heavier work might require up to four weeks. Your surgical team will provide specific guidance.

Thyroid Replacement Tablets:

Total Thyroidectomy or Near Total Thyroidectomy:

Patients who undergo complete thyroid removal will need lifelong thyroid tablets. You will be prescribed the tablets upon discharge and ensures the correct dose through clinic blood tests.

Lobectomy (Hemithyroidectomy):

Up to 20% of patients who have half of their thyroid removed, thyroid hormone treatment may be necessary. A blood test is conducted six weeks after the operation (not earlier) to determine if supplementation is required.