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Thyroid Surgery: Preparation, Implementation, and Risk of Side Effects

Thyroid surgery is a procedure for removing part or all of the thyroid, which is a gland shaped like a butterfly in the neck that produces hormones that regulate metabolism, growth, and temperature. Even though it plays an important role as one of the treatments for thyroid disorders, thyroid surgery still has side effects.

Thyroid surgery is generally performed in severe thyroid diseases, such as thyroid cancer, or goiters that have caused interference with swallowing or breathing. Besides, thyroid surgery is also used when drugs or other methods of treatment are unsuccessful.

However, thyroid surgery cannot always be applied to all patients with thyroid disease. Patients with severe and uncontrolled hyperthyroidism, or patients who are pregnant are some of the conditions that are not recommended for this operation.

Based on the part of the gland removed, thyroid surgery is divided into 3 types, namely:




Thyroid lobectomy

In this operation, a part or half of the thyroid gland will be removed. Usually this method is done to remove a tumor or a small thyroid enlargement.

Total thyroidectomy

This type of thyroid surgery is done by removing the entire thyroid gland.

Thyroid biopsy

Surgery to remove part of the thyroid tissue, for further examination in the laboratory. Thyroid biopsy is done to determine whether the thyroid tumor is benign or malignant.

Read Also : Thyroid Nodules: Symptoms, Causes, and Treatment

Preparation Before Thyroid Surgery

A few days before the surgery is done, the doctor will first evaluate the patient's overall health condition. This evaluation can be in the form of physical and supporting examinations, such as blood tests, X-rays, and ECGs.

In addition to ascertaining the condition of the patient, the results of the preoperative evaluation also determine the type of anesthesia that will be used in surgery and which parts of the thyroid need to be removed.

There are several things that need to be considered when undergoing preparations before surgery, namely:

  • All types of thyroid surgery use anesthesia. If you have a history of allergy to the anesthetic that will be used, the patient is required to notify the doctor during the preoperative examination.
  • Patients also need to tell their doctor if they are using supplements, herbal products, or certain medicines. Drugs that are being used are feared to cause drug interactions with anesthesia, and cause dangerous side effects when the surgery takes place or after.
  • Avoid cigarettes and alcoholic beverages, at least 2 weeks before the operation takes place.
  • The doctor will determine when the patient starts fasting. Patients are usually instructed to fast a few hours before surgery, to reduce the risk of complications due to the use of anesthesia.

Thyroid Surgery Procedure

Some time before the surgery begins, the doctor will re-examine the patient's condition. This aims to ensure patient readiness for surgery.

After the condition is declared ready, the patient will then be escorted to the operating room. In the operating room, the doctor will provide anesthesia, either through an injection or breathing mask. During surgery, the patient's vital signs including blood pressure and oxygen levels in the blood will continue to be evaluated through the monitor.

When the patient begins to become anesthetized, the anesthetist will provide an breathing apparatus through a special hose (endotracheal tube) that is inserted into the throat, to help the patient breathe during surgery.

After that, the surgeon will clean the area to be slashed (the area under the neck) using antiseptic fluid. The size of the incision is not always the same for each patient, depending on the part of the thyroid gland removed and the thyroid surgery method used.

The following are 3 thyroid surgery methods that can be used to remove the thyroid gland:

Conventional operation

This method requires an incision of approximately 5-12 cm in the middle of the neck, so that the doctor can directly access the problematic thyroid gland and remove it.

Endoscopic surgery

This method of operation uses a special device called an endoscope, in the form of a hose with a small camera at the end, to lift the thyroid gland. The advantage is that the incisions needed for endoscopic surgery are much smaller than conventional surgery, which is around 0.5 to 1 cm.

Robotic operation

The full operation process is carried out with the help of a robot. The difference with endoscopic and conventional surgery, the incision needed for robotic surgery is only 8 mm.

Thyroid surgery generally lasts about 1-2 hours, but does not rule out the possibility that the surgery will last longer than that.

Post Thyroid Surgery

After the surgery is completed, the incision will be sutured and then covered with waterproof tape to protect the operation scar when the patient is taking a shower. The doctor will then move the patient to the postoperative recovery room to rest and be evaluated for at least 4-6 hours.

If the incision is large and it is feared that bleeding occurs, the doctor will usually install a tube and a special tube that serves to accommodate the blood that might come out. The hose and tube can be removed the next day.

After thyroid surgery, patients generally need to be hospitalized for several days in the hospital. Patients are allowed to go home after the condition is stable and postoperative pain decreases. Only, patients must avoid strenuous activities for at least 10-14 days.

Read Also : Thyroid Hormones: Functions, Excess Effects and Deficiency

Risk of Side Effects of Thyroid Surgery

Like surgery in general, thyroid surgery can also cause complications. Some of the risks of complications that can occur after thyroid surgery are:

1. Voice Change

Between the lower part of the thyroid gland and the airway there are nerve nerves recurrent laryngeus. This nerve functions as a regulator of the movement of the vocal cords. If this nerve is cut or bound, it causes a change in sound such as hoarseness or a lost voice.

2. Infection and Bleeding

Infection and bleeding are two things that should be avoided as much as possible during thyroid surgery. Sterility of medical devices is the main key to avoid infection. Infection can cause bleeding in the scars of the surgery and healing will last longer. Wound healing can be supported by food that quickly heals surgical wounds.

3. Blockage of the Airway

Another postoperative disorder is the occurrence of obstruction of the breath. This breath blockage is a further impact of bleeding. If this happens then there must be other actions to facilitate the airway.

4. Hypoparathyroid and hypothyroidism

Hypoparathyroid is a condition of calcium and phosphate imbalance caused by a lack of parathyroid hormone. Hypoparathyroid conditions are caused by a disorder behind the thyroid gland. Furthermore hypothyroidism will occur and have an impact on decreasing calcium levels in the blood.

5. Recurrent Thyroid Disease

This thyroid disease can also reappear despite surgery. The same thyroid disorder is possible to reappear, or in the form of a toxic goiter. This recurrence of thyroid disease can be prevented by several drug, food, and lifestyle patterns.

6. Nerve Disorders

Thyroid surgery allows nerve disorders around the thyroid gland. One of the nerves that usually experience interference is the nerves that are associated with the vocal cords.

Although rare, thyroid surgery can also cause complications in the form of a thyroid storm or thyroxicosis. Symptoms include frequent anxiety, digestive disorders such as abdominal pain and diarrhea, trembling body (thermor), sweating a lot, rapid heart beat, and fever.

Given these risks, a complete examination and careful preparation needs to be done before deciding to undergo thyroid surgery.

If your thyroid disease does need surgery, consult your doctor to find out what preparations are needed, and what side effects might occur.





References

References

1. Johns Hopkins Medicine. Department of Surgery. Thyroid Surgery at Johns Hopkins. 

2. American Thyroid Association. Thyroid Surgery. 

3. Shomon, M. Verywell Health (2019). Thyroid Surgery Recovery, Side Effects, and Complications.


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