Thyroid Surgery

This clinical information has been written by Dr Wilkinson to provide an overview of various conditions that may be relevant to certain patients. When you see Dr Wilkinson, he will provide you with more specific information about your case as well as information developed by the Royal Australasian College of Surgeons.

You may be referred to Dr Wilkinson with one of the following concerns.

Thyroid nodule
Goitre (also known as Goiter)
Graves’ Disease (also known as Primary Thyrotoxicosis)
Hashimoto’s Thyroiditis
Thyroid cancer or possible cancer

 

1. Thyroid nodule

  • This is a lump in the thyroid gland which may or may not be able to be felt.
  • It may be anywhere from a few millimeters to several centimeters in size.
  • An ultrasound of the thyroid will usually have been organised by your referring doctor.
  • Fine Needle Aspiration (FNA) biopsy, often referred to as ‘needle biopsy’, may have been organised by your referring doctor but sometimes a decision about this will be left for Dr Wilkinson to make.
  • Surgery will be considered for a nodule which is causing symptoms of pressure, is overactive in production of thyroid hormone, or is suspicious for thyroid cancer. The FNA is the main method for determining if cancer is a concern.
  • When indicated, surgery will usually be a hemithyroidectomy (removal of one half of the thyroid).
  • Thyroid hormone levels will need to be measured six weeks after surgery to assess whether the remaining half of the gland is producing adequate levels. In a minority of patients, a thyroid hormone supplement will be required.

 

2. Goitre (also known as Goiter)

  • This term simply means enlargement of the thyroid and is usually an obvious mass at the front of the neck.
  • It may be a single large nodule, but is more commonly due to several nodules, which would make it a “multinodular goitre”, usually affecting both halves of the thyroid gland.
  • Surgery will be offered if you have symptoms such as pressure on your neck or throat which may cause difficulty swallowing or breathing. You may have a sense of choking when you lie down flat, or just a general tightness in the neck area.
  • An ultrasound of the thyroid will usually have been organised by your referring doctor.
  • Needle biopsy will often be organised by your referring doctor or Dr Wilkinson to assess the largest nodule or any nodules which look suspicious on the ultrasound. Multinodular goitres are usually benign but may contain malignant (cancerous) nodules. An abnormal FNA would be another reason to have surgery.
  • Surgery is also considered for goitres which are overactive, or which extend down into the chest which are referred to as retrosternal.

 

3. Graves’ Disease (also known as Primary Thyrotoxicosis)

  • This autoimmune condition refers to a thyroid which is overactive due to an immune system error which makes antibodies against the thyroid. These antibodies stimulate the thyroid to produce excessive amounts of thyroid hormone resulting in a tremor, a racing heart (sometimes sensed as palpitations), weight loss or gain, anxiety, sweating and other symptoms.
  • Initially treatment is with medication but sometimes an operation is recommended.
  • Surgical treatment is removal of the entire gland (total thyroidectomy) because the antibodies affect all of it.

 

4. Hashimoto’s Thyroiditis

  • Like Graves’ Disease, this is an autoimmune condition. However, the immune system produces a slightly different set of antibodies with a different clinical picture.
  • It results in a spectrum of possibilities ranging from an almost normal gland, through to a massive goitre. A “Hashi goiter” usually requires thyroidectomy and is frequently a challenge to the surgeon due to the stiffness, inflammation and vascularity of the gland.
  • The commonest situation is that the antibodies cause general irregularity of the gland which does not need specific treatment at first, but has a tendency to lead to an underactive thyroid in the long term, referred to as hypothyroidism.
  • A thyroid affected by Hashimoto’s thyroiditis may contain nodules which need to be assessed by needle biopsy to exclude cancer.

 

5. Thyroid cancer or possible cancer

  • The possibility of cancer is usually raised by the finding of abnormal cells via needle biopsy.
  • If the biopsy provides a firm diagnosis of a cancer type called “papillary”, a cancer operation will be planned. This will usually be a total thyroidectomy along with removal of the lymph nodes around the thyroid and those around the upper part of the trachea, or windpipe.
  • If the biopsy is only able to produce a diagnosis of “suspicious”, then a hemithyroidectomy (removal of that half of the gland) will be performed to obtain a definitive diagnosis. Only those patients with a firm diagnosis of cancer will proceed to a total thyroidectomy, with the second half of the gland being removed at a second operation a few days later, once the pathologist has made a full assessment.
  • The exact treatment strategy will vary from patient to patient depending on a number of factors.

 

To help understand what your experience may be like as a patient, please peruse Patient Information written by Dr Wilkinson for this website.