ENT Surgical Consultants Joliet, New Lenox, Morris

Thyroidectomy and Parathyroidectomy Specialists of Joliet, New Lenox, and Morris

Thyroid Nodules

The thyroid gland is a butterfly-shaped gland located in the low anterior neck. It produces thyroid hormone, which helps to regulate the body’s metabolism. The functional capacity of the thyroid is measured by blood tests. Excessive production of thyroid hormone (hyperthyroidism) can cause palpitations, tremors, weight loss, and heat intolerance. Conversely, an under-active thyroid gland (hypothyroidism) can result in fatigue, weight gain, and cold intolerance.

A thyroid nodule is a growth in the thyroid gland. Thyroid nodules are extremely common, and may be solitary or multiple (multinodular goiter). It is estimated that approximately 5-10% of the population has a palpable thyroid nodule, and between 30-85% have tiny thyroid nodules that are too small to palpate.

In most people with thyroid nodules, the gland produces a normal level of thyroid hormone (euthyroid state). Statistically, approximately 5-10% of nodules are cancerous. Some patients have findings that increase the risk of malignancy. A history of exposure to ionizing radiation to the neck is such a risk factor, as is a family history of thyroid cancer. Hoarseness, lymph node enlargement, and fixation of the nodule can also increase the risk of malignancy. Fortunately, the vast majority of thyroid cancers are treatable and carry an excellent prognosis.

Most thyroid nodules do not require surgery. The primary indications for thyroidectomy are suspicion of cancer, large size, substernal location (nodules that grow inferiorly into the chest), or symptoms (throat pressure, difficulty swallowing, respiratory distress, or cosmetic disfigurement from a visible goiter). Over-functioning nodules are sometimes best treated by surgery, as well.

The most important tests to evaluate a thyroid nodule are a TSH level (a blood test that evaluates the function of the gland) and a fine needle aspiration (FNA) biopsy to evaluate the nodule for malignancy. Although FNA is highly accurate, it is not 100% accurate in making a diagnosis. FNA is usually performed in our office, but for smaller nodules and others that are difficult to palpate, the biopsy is done by the radiologists under ultrasound guidance. There are some types of thyroid nodules (follicular tumors) where FNA cannot distinguish benign from malignant nodules- these nodules are usually best managed by thyroidectomy.


Thyroid Surgery (Thyroidectomy)

Thyroid operations can be divided into several categories, including a unilateral lobectomy (“one-sided” removal of the thyroid gland), total thyroidectomy (removal of both sides of the thyroid gland), or variations in which all of one side of the gland and part of the other side of the gland are removed.

Hospital Course

Patients who have a unilateral (one-sided) thyroidectomy will usually be able to go home the same day with or without a wrap-like pressure dressing in place around the neck. On the day after your discharge, please remove the pressure wrap around your neck if not already done so using a pair of large scissors, or alternatively the wrap may be “unwound” from the neck after any adhesive tape holding the dressing in place has been removed. Your thyroidectomy surgical incision site just above the breastbone will be covered with steri-strips (tape) which will be removed at your follow up appointment. Click here for Head and Neck Wound Care handout for specific instructions.

Patients having a total or subtotal thyroidectomy (operation on both sides of the gland) often go home as well or spend one night in the hospital in order that their calcium levels be monitored, as low calcium levels are seen only with the more comprehensive removal of thyroid tissue. Numbness and tingling in the fingertips or around the lips may be a sign of a low calcium which can be treated by taking calcium (Tums). Please call your doctor if you suspect symptoms of low calcium. Infrequently, a drain is placed during the surgery that is usually removed 1-2 days after surgery. Unless instructed otherwise by your surgeon, the neck wound may be left open to the air. You may shower and get the incision area wet 24 hours after surgery. At least twenty-four hours after receiving general anesthesia, you may drive when you are no longer taking narcotics for pain and able to turn your neck to look for traffic. Be aware that narcotics taken for pain may cause drowsiness, nausea, and constipation. An over-the-counter stool softener such as Colace or Miralax is recommended as prevention. You should avoid strenuous activity for two weeks and call the office to schedule an appointment for about a week after the surgery date.

Medication

Patients will usually be given a prescription for pain medicine, which is to be used as needed. In some cases, you will be also sent home with either a new or continuing prescription for Synthroid, levothyroxine, or Cytomel (thyroid replacement or suppression medication) and this must be used on a regular daily basis at the dose prescribed by your doctor. Calcium and Vitamin D supplements are sometimes prescribed as well.

Complications

Many patients notice a subtle change in their voice quality for the first few weeks postoperatively. Although trauma to the nerves supplying the vocal cords on one or both sides of the voice box may occur during thyroidectomy, frank hoarseness or trouble swallowing is a very rare complication. If you have any questions regarding the fact that your voice may be excessively hoarse or raspy, or if you are experiencing any type of coughing or choking when you attempt to swallow, please call our office immediately.

For patients undergoing a total or subtotal thyroidectomy, normal calcium levels the first several days while hospitalized do not always predict stable blood calcium levels. Occasionally, patients have significant dips in their blood calcium levels after their discharge from the hospital due to manipulating or “bruising” of the parathyroid glands. The symptoms of low calcium would include tingling around the mouth or in the hands or feet, generalized weakness, or feelings of the heart exhibiting an abnormal rate or irregular beat. If any of these symptoms occur, please call our office immediately.

A potentially serious or life-threatening complication of thyroidectomy, which can occur rather abruptly, is formation of a hematoma from a bleeding blood vessel or other area deep in the neck tissues. If you would at any point feel that there has been an abrupt swelling or outward displacement of the wound area in the lower neck, or if the neck wound suddenly starts exhibiting more tenderness, redness, or bogginess than you would expect, you need to contact our office immediately. If any shortness of breath would begin to develop, you are directed to proceed to the emergency room at the hospital where your surgery was performed as quickly as possible. 

ParathyroidParathyroidectomy

Generally, the body has four parathyroid glands that are normally the size of a grain of rice, two on each side of the neck usually hugging the thyroid gland. The parathyroid glands act like thermostats to keep the calcium level in the blood at the normal level (normal calcium is 8.5-10). Occasionally, one or more of the parathyroid glands become overactive and enlarged causing the blood calcium to be high similar to a bad thermostat. So then the overactive parathyroid gland (defective thermostat) needs to be removed to prevent calcium from being pulled out of the bones (osteoporosis) and spilled into the urine (kidney stones). This is called parathyroidectomy. This requires an experienced surgeon because the parathyroid glands are sometimes not where they are supposed to be (ectopic locations). Sometimes more than one parathyroid gland is overactive (15%) and this requires removing 2 or more parathyroid glands. We draw blood tests for PTH levels during surgery to make sure the surgery is successful. If the overactive parathyroid gland has been correctly removed, then the blood PTH level should drop within 30 minutes during surgery. In this particular video, the patient had a rare condition called parathyroid hyperplasia (3%) where all 4 parathyroid glands are enlarged. In this case, three and a half parathyroid glands were removed. Half a gland is left to prevent the calcium from falling too low.

As shown in the video, a Gamma probe can also be used to confirm if a parathyroid gland is overactive.

Schedule Your Appointment!

Please call one of our locations: West Joliet 815-725-1191, New Lenox 815-717-8768, and Morris 815-941-1972 to schedule an appointment.

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