Thyroid Surgery: FAQ’s by Prof.Dr.

Iyad Hassan,
Thyroid Doctor Abu Dhabi

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 What is Thyroid Gland?
The thyroid is a butterfly-shaped gland that sits in your neck, draped across the
windpipe and just under the larynx (voice box, adam’s apple.) It makes thyroid
hormone, which controls your body’s metabolism, including weight, heart rate,
temperature, and mental alertness. An enlarged thyroid is called a “goiter.” Most
thyroids with a goiter or a lump still work properly, but some may be overactive.

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 What are the symptoms of thyroid problems?
Each thyroid problem has its own symptoms. Here are common symptoms to look
for with each condition:
Hyperthyroidism: Weight loss, rapid heartbeat, anxiety, fatigue, trouble sleeping,
tremors and sweating.
Hypothyroidism: Thinning hair, weight gain, fatigue, muscle weakness, joint pain,
depression and impaired memory.
Thyroid cancer: A lump on your neck, difficulty swallowing, swollen lymph nodes
and changes in your voice.
Thyroid nodules: In many cases, nodules don’t produce symptoms. In other cases,
nodules become large enough that you can see and/or feel them. Some nodules
are cancerous, although most are benign.

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 What is thyroidectomy?
Thyroidectomy is the removal of all or part of your thyroid gland.
Thyroidectomy is used to treat thyroid disorders, such as cancer, noncancerous
enlargement of the thyroid (goiter) and overactive thyroid (hyperthyroidism).
How much of your thyroid gland is removed during thyroidectomy depends on
the reason for surgery.

Thyroid Lobectomy
• If only one lobe removed, your thyroid may be able to function normally after
Total Thyroidectomy
• If your entire thyroid is removed, you need daily treatment with thyroid
hormone to replace your Thyroid’s natural

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 What are the risks of Thyroid Surgery?
Thyroidectomy is generally a safe procedure. But as with any surgery,
thyroidectomy carries a risk of complications
• Vocal Cord Paralysis in lifetime 7% and in data for 3 – 18 weeks less than 2%
• Infection of Incision – Less than 1%
• Swelling and black/blue
• Keloid or overgrown scar
• Other organ damage
• Hypocalcemia -16%, on data 2%
• Haematoma or Bleeding – Less than 1%
• Seroma (fluid collection, swelling) – 5%
• Scar tethering/tightness – 5% early, usually settles with time

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What are the standards PreOperative diagnostic needed?

Clinical Examination
Surgeon will inspect your neck to see any visible swelling or thyroid enlargement. He will
palpate your neck from lateral and anterior aspect to assess the consistency and size of
your thyroid and nodule by standing behind you.

He will ask you to swallow during palpation to assess the mobility of your gland and
detect the nodules. He will also palpate the lymph nodes in your neck.

Ultrasound of Neck and Thyroid

Ultrasound will be done to assess the size of the nodules, suspicious malignancy features
and calcification.

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 Blood Tests
Your blood tests particularly the thyroid functions test will be done.

FNAC (Fine Needle Aspiration Cytology)

The interventional radiologist will aspirate in LA(local Anaesthesia) few cells from
the suspicious nodule with ultrasound guidance . Pathologist will give information
if benign, still suspicious of cancer or true cancer.

PreOperative ENT Examination

To check the functionality of your vocal cord.

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 How will you prepare for Thyroid Surgery?

When to stop eating and drinking?

You may need to avoid eating and drinking 8 hours before surgery. If you don’t,
your surgery may be cancelled.For morning surgery, Do Not Eat or Drink anything
after midnight 12:00AM the night before surgery unless otherwise instructed.For
afternoon surgery, avoid eating 8 hours before surgery.

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 What happens on the day of surgery?

Once You’ve Arrived In the Hospital

You will be directed to the Admission Desk at Ground Floor where you will tell
your name and details, show your emirates ID, you will be asked all the details,
they will verify and check your operation date which is scheduled, your admission
will be done and you will be advised to shift in the designated room.
From Room to Pre-Operative Unit
When it’s time to change for surgery, you will get a hospital gown, cap, disposable
underclothes to wear. Hospital staff will shift you from your room to Pre-Operative
Unit for the surgery

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 Meet With Nurse in Pre-Operative Unit
You will meet with your nurse before surgery. You will be asked few questions
regarding the last meal time and medications you took and other checklist. Tell your
nurse the dose of any medications you took after midnight and the time you took
them.

Meet With Anesthesiologist in Pre-Operative Unit

Your anesthesiologist will:

• Review your medical history with

• Ask you if you’ve had any problems with anesthesia in the past, including nausea
• Ask you if you’ve had any drug allergy, smoking, and medications you

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 Preparation before the Surgery
From Preoperative Unit to Operation Room
Once your nurse and anesthesiologist have seen you, You will be taken in on a
stretcher bed to the operation room by a member of operating room. He or She will
help you onto the operating bed. Compression boots will be placed on your lower
legs. These gently inflate and deflate to help blood flow in your legs.

The Surgical Procedure

Once you’re unconscious, the surgeon makes a small 3 to 5 cm incision in the center
of your neck. All or part of the thyroid gland is then removed, depending on the
reason for the surgery.

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 After the Surgery
From Operation Room to PACU (Post Anesthesia care Unit)
After surgery, you’re moved to PACU where the health care team monitors your
recovery from the surgery and anesthesia. Once you’re fully conscious and stabilized,
you’ll be moved to your hospital room.

You may have a drain in your neck under your incision but usually we do not insert a
drain as in routine. In some cases with Hashimoto’s goitre leaving a cavity or patient
under aspirin we may insert a drain to avoid collection of fluid. It’s usually removed
the day after surgery.

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 Thyroid hormone medication
If your whole thyroid was removed, you will be prescribed thyroid hormone tablets
following surgery. You should take these on an empty stomach with water usually in
the morning 30-40 mins before breakfast.. Milk, food, and other pills interfere with
your stomach’s ability to absorb the thyroid hormone. 10 days after the date of
discharge you will be called for the follow up in clinic.

Calcium supplements
If you have parathyroid dysfunction or hypocalcemia after your surgery, you may also
need to take calcium supplements. If you’re taking calcium, your doctor may also
want you to take vitamin D to help your body absorb it.

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 At the day of discharge
Your wound dressing will be changed. You will be provided with discharge summary
and discharge medication prescription which include “calcium and thyroid hormones
as well as painkillers. Usually there is no need for antibiotic treatment as the Thyroid
surgery is a clean surgery.

Appointment for follow up:

Appointment for the first follow up in OPD after 7 – 10 days will be given, you will
come for removal of stitches and to review the histopathology, optimization of
hormone and calcium treatment will also be given.

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 • Stitched will be removed
• ENT postoperative concern for review of vocal cord
• Clinical review of organ system particularly the wound, if needed Ultrasound will
be done to assess retained Anti scar cream will be prescribed.
• Blood test for calcium, PTH and Thyroid functions will be done to optimize the
hormone
• Histopathology report will be discussion and possible referral to oncology
department to plan further adjuvant

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Thyroid Surgery: FAQ’s by Prof.Dr.Iyad Hassan, Thyroid Doctor Abu Dhabi

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