The Thyroid is a small butterfly shaped organ located at the front 

of the neck, it is surrounded by the major vessels of the neck.

The thyroid produces few hormones; the most important are the

Thyroid hormones T3 and T4, both of which control the metabolism

in the body.

Another hormone released by the thyroid gland is Calcitonin;

which is involved in the Calcium regulation.

 

Through the control over metabolism the thyroid gland regulates the following:

 

  • Body weight

  • Body temperature

  • Heart rate

  • Blood pressure

  • Mental alertness

  • Growth

  • Bowel activity

  • Menstrual cycles in women

 

An enlarged thyroid gland can be visible in the mid and lower part of the neck. The thyroid can also grow down into the upper part of the chest cavity; such enlargement might not be visible to the outside.

Enlargement of the thyroid gland irrespective of the cause is called "Goitre". Goitre can be completely without symptoms or it can cause pressure effect on the Trachea or the oesophagus, occasionally on the nerves behind the thyroid.

 

Over activity of the thyroid results in increased metabolism with weight loss despite increased appetite, increased heart rate, intolerance to heat, shaky hands, diarrhoea and occasionally eye bulge. The symptoms of overactivity can vary from one person to the other and with the severity of overactivity

 

There is no direct relationship between the size of the gland and its activity. A very small gland can be overactive while a very large one can have a normal or low activity.

 

Anatomical Relationship

Thyroid gland situated in the front of the neck just

under the “Adam Apple”.  

It lies on either side of the Trachea (windpipe) and

the Oesophagus. It has an extensive blood supply.

 

On either sides of the thyroid gland passes the major

blood vessels of the neck, behind it on each side passes

the recurrent laryngeal nerves on their way to the

voice box.

 

Four small glands called the Parathyroid glands are

situated in the vicinity of the thyroid gland

(usually behind it); these produces a special hormone

that control the calcium levels in the blood

 

 

 

 

Surgery on the Thyroid Gland

There are situation when your doctor would recommend surgical removal of half or whole thyroid gland. The most usual indications for surgery on the thyroid gland are:

  • Proven malignancy (Cancer of the thyroid)

  • Suspicion of malignancy

  • Over active or Toxic thyroid

  • Enlarging nodule in the thyroid

  • Pressure symptoms

  • Multiple large nodules (Multi-nodular goitre or MNG)

  • Cosmetic reasons

 

The operation is done under general anaesthesia through an incision in the front of the neck. The length of the incision depends on the size of the thyroid to be removed. Important structures like muscles and major blood vessels are pushed aside,

while blood vessels to the thyroid itself

are carefully ligated.

The thyroid is lifted off and separated

from the trachea then completely removed.

 

 

During the operation every effort is made to protect

the two very important recurrent laryngeal nerves

(important for speech) and the parathyroid glands

(important for the Calcium control).

 

 

 

 

A final check is done before the closure is completed with absorbable suture. A decision to leave a drain inside the wound or not is made during the operation itself, the drain is usually removed within 48 hours after the surgery.

 

Post Operative Course

After the operation the patient is nursed in semi-sitting position, allowed oral intake few hours after the operation. Patient can shower the day after their surgery, and usually sent home 1-3 days after the operation.

 

It is advisable to take 10-14 days off work for convalescence.

 

Medication after surgery: Usually Thyroid hormone replacement and Calcium supplement. These are indicated after Total Thyroidectomy. The calcium supplement is usually temporary, while the thyroid replacement Hormone (Thyroxin) is for life.

 

Blood tests are required after total thyroidectomy to check the required dose of Thyroxin. The frequency of these tests decrease gradually down to once a year.

 

The Thyroxin tablets provide a complete replacement to the function of the Thyroid gland. Patients on the proper dose have a normal function and life expectancy.

 

Possible Complication of Thyroid Surgery

  • General Complications:

These are complication that can happen with any general anaesthesia and operation; like cardiac and respiratory complications e.g. heart attack or chest infection, a deep venous thrombosis is a rare complication

 

  • Specific Complications:

    • Bleeding: Not common and mostly not serious, occasionally it requires a return trip to theatre for a washout especially if it is causing breathing difficulty.

    • Injury to the recurrent laryngeal nerves: If one nerve is injured the patient will notice a thick harsh voice. The incidence of this complication is around 1% and often is temporary. Injury to both recurrent laryngeal nerves is even more rare (1:500), but ends up with loss of the ability to speak and a possibility to require a tracheostomy. The risk of injury to the nerves increases in thyroid cancer or very large thyroid glands.

    • Injury to the external branch of the superior laryngeal nerve, this is a more often occurence due to the variability of the nerve position in relation to the main vessels of the upper thyroid. Injury of these nerve will manifest itself by inability to produce high note sounds like during screeming.

    • Damage to the Parathyroid glands: A temporary dysfunction of these glands is common for which calcium supplement is provided for few weeks. Complete damage of all four glands is again rare (2%), This will require long-term calcium supplement.

 

  • Delayed Complications:

    • Contact Mr Haddawi / your GP or the Emergency Department if you have any of the following problems after being discharged from the hospital:

      • Tingling sensation around the mouth or the fingers (take 2 Calcium tablets meanwhile).

      • High temperature or redness or swelling around the wound

      • Painful and tender calf muscles

      • Shortness of breath or excessive cough.

 

 

Mr Falah El-Haddawi

Endocrine Surgeon

 

The Thyroid Gland