Thyroid and Parathyroid Surgical Care
Endocrine surgical specialists, Dr. Trimble and Dr. Wu, provide minimally invasive thyroidectomy and parathyroidectomy. Their surgical management brings quality and unmatched care to you and your loved ones. For surgical procedures concerning the thyroid and parathyroid, we employ the most advanced and minimally invasive techniques developed in the field of Otolaryngology, which means procedures are performed through tiny incisions hidden in the natural creases of the skin. This enables a much faster recovery than traditional surgical methods and allows the patient to, in most cases, return home the day of surgery, as well as return to work and normal activities much more rapidly.
Due to the extensive experience of Trimble ENT’s physicians, the usual risks typically associated with thyroid and parathyroid surgery are significantly reduced. Our physicians also work in close relation to your endocrinologist and primary care physician to provide the best comprehensive management and follow-up care.
Who Needs Thyroid Surgery?
Patients who have thyroid cancer, nodules suspicious for cancer, enlarging benign nodules, toxic nodules, symptomatic goiter (trouble swallowing or breathing), or Grave’s disease where radioactive iodine is not an option or was unsuccessful can benefit from thyroid surgery.
Anyone who has a thyroid nodule that is 1 cm or larger should have this nodule evaluated with a fine needle biopsy or fine needle aspiration (FNA) under ultrasonic visualization. Many endocrinologists do this in their offices today. If the nodule is cancerous, suspicious for cancer, or inconclusive, then thyroid lobectomy is indicated. If cancer is present, the entire gland (total thyroidectomy) is removed. Patients who have benign nodules that are growing may need that lobe removed. Patients who have nodules in both lobes that are growing may need the entire gland removed. Your endocrinologist or ENT doctor (thyroid surgeon) will advise you as to what the best next step is. Patients who are diagnosed with nodules that are less than 1 cm will have a follow-up ultrasound (U/S) in 6 months to determine if the nodule is growing. Patients who have a negative FNA will get a repeat U/S in 6 months. If the nodule is growing or suspicious for cancer, a repeat FNA can be performed or the nodule removed (thyroid lobectomy).
Commonly Treated Conditions
Trimble ENT treats a range of thyroid and parathyroid conditions including, but not limited to:
- Thyroid nodules—Thyroid nodules can be either benign or cancerous. For nodules that are suspect of cancer, usually a thyroid ultrasound evaluation, nuclear medicine scans, and needle aspiration biopsies are performed. If the nodule/s must be removed, this procedure can typically be performed with minimally invasive techniques as an outpatient procedure. To determine if cancer exists, ‘frozen section’ evaluation of the nodule/s is done, in order for the most suitable actions to be taken.
- Thyroid cysts—A benign thyroid cyst can, at times, quickly fill inside the thyroid, which leads to observable tumors in the neck. If after medical aspiration, these cysts refill, it is typically advantageous to surgically remove them. With minimally invasive outpatient procedural techniques, the patient will find the cyst removal much less complicated and recovery time much quicker.
- Thyroid cancer—Several types of thyroid cancer exist, but most are extremely curable with the proper treatment. Our surgical specialists can remove the thyroid partially or completely (thyroidectomy) and any surrounding affected lymph nodes/tissue with minimally invasive procedural techniques. This allows most patients to go home the day of surgery or the day after. We can assure you unmatched care though our wide-ranged experience and comprehensive coordination with your endocrinologist and primary care physician.
- Parathyroid tumors—The parathyroid glands are the small pea-sized glands in the neck. The thyroid and parathyroid glands are closely related and share the same blood supply. Tumors of the parathyroid glands lead to increased calcium levels in the blood and urine and lead to medical issues like hypertension, kidney stones, mental disorders, and constipation. Removing these tumors is crucial and can also be performed through minimally invasive parathyroidectomy techniques.
Thyroid Surgery (Thyroidectomy) Explained
A thyroidectomy is removal of one or both lobes of the thyroid gland due to problems like masses in the thyroid gland and related breathing/swallowing problems, goiters, supposed or proven cancer of the thyroid gland, and overproduction of the thyroid hormone (hyperthyroidism). The decision to remove all or part of the thyroid is supported by a patient’s history and the results of physical examinations and determinative testing. A thyroidectomy procedure is typically performed under general anesthesia, and the extent of tissue or lobe removal must sometimes be determined during surgery under further microscopic evaluation of the situation.
Minimally Invasive Thyroidectomy
At Trimble ENT, we specifically practice the most minimally invasive and advanced techniques available for removal of all or part of the thyroid. This new surgical method is called minimally invasive video-assisted thyroidectomy (MVAT) or simply endoscopic thyroidectomy. Very small surgical instruments called fiber optic endoscopic telescopes and harmonic scalpels make it possible to perform a thyroidectomy through an incision as small as one inch in the neck. Parathyroid tumors can be removed with MVAT as well. The surgical incision in the neck is typically 1-2 inches long, much smaller than the incision made in the traditional more invasive method (4 inches) of performing a thyroidectomy. The traditional method of surgery also requires much larger instruments. The minimally invasive form of this operation creates much less invasive incisions, results in a less painful and quicker recovery, and leads to much smaller, less noticeable scars. Another benefit of a minimally invasive thyroidectomy is no suction drainage tubes (drain tubes for short) are needed. Patients are able to go home the same day when only one lobe of the gland is removed. When the entire gland (thyroidectomy) is removed, the patient may stay in the hospital overnight. By not using a “drain tube”, patients forgo the uncomfortable removal of the tube, as well as having to take care of it while it is in the neck. There is also no unsightly scar from where the tube exited the neck. Patients who have very large nodules (>2 inches) or a goiter may need to have their incision slightly larger (2-3 inches). However, they also do not need surgical drainage tubes.
Before Thyroid Surgery
Before surgery, a patient will undergo a complete physical examinations during a pre-operative office appointment, as well as go over his or her medical history, current medications, and known allergies. The patient will be given the chance to ask any questions they may have concerning the operation, hospitalization, etc., will sign pre-operative surgical consent for the procedure, and will be instructed on post-operative limitations and any prescription medications needed after surgery.
The patient will undergo pre-operative assessments including blood tests, an EKG, chest x-rays, and anything else the doctor deems necessary. The patient will also be given the opportunity to meet the anesthesiologist before surgery to ask questions and sign additional consent forms.
What To Expect The Day Of Thyroid Surgery
Typically, the patient will be asked to arrive at the hospital and hour and a half prior to their scheduled surgery. Usually, the patient will be moved to a pre-operative holding room about hour before surgery, where family members or friends may wait with the patient. This is where a nurse will start an IV line and review the patient’s medications and history. The patient will be asked questions to assure they understand the procedure and consent. The surgical area may also be marked prior to surgery.
During Thyroid Surgery
During thyroid surgery, the patient will be under general anesthesia, which means he or she is completely asleep. After all or part of the thyroid is removed, it will be sent for ‘frozen section,’ where a piece of the gland is frozen and cut for a pathologist to examine for problems under a microscope. If cancer exists, the rest of the thyroid tissue is removed, as well as the lymph nodes of the neck sometimes (neck dissection). It is uncommon, but sometimes the pathologist is not able to diagnose the patient based on the ‘frozen section.’ In this case, the diagnosis may be delayed until the tissue has been permanently processed in the laboratory. This could take several days, and therefore it is feasible, under these circumstances, that a patient may be sent home and called back for more surgery if a cancer is discovered afterward.
During surgery, the laryngeal nerve will also be very carefully avoided through recurrent laryngeal nerve monitoring and mapping through electromyography (EMG). This is cutting edge technology in thyroid and parathyroid surgery, and furthermore decreases the risk of possible complications during minimally invasive surgery. The laryngeal nerve is very sensitive and is housed extremely close to the thyroid gland. If accidentally damaged during surgery, a person may experience voice complications post-operatively. To ensure the laryngeal nerve is not damaged, a specialized endotracheal tube with left and right electrodes is inserted near the muscles of the vocal cords (innervated by the recurrent laryngeal nerve). The electrodes are attached to and analyzed by a computer that reads electrical activity during surgery. If during a thyroidectomy, the recurrent laryngeal nerve, which is constantly monitored, is at all disturbed, the electrical impulse with alert the monitoring technician, who will then notify the surgeon.
After Thyroid Surgery
After about an hour or so of post-operative recovery, the patient will either be transported to a room for hospitalization or will be discharged to go home if they are able. Some patients may experience a temporary hoarseness of the voice when they wake up from anesthesia.
With minimally invasive thyroid surgery, the wound is typically closed simply with medical glue rather than sutures and a dressing with drains. If drains and a dressing are necessary, they are usually removed the day following surgery. The patient may also experience pain or difficulty swallowing for 2-3 days after the operation.
Following surgery, the patient will be given (or will take at home) antibiotics, painkillers, and thyroid replacement hormones if necessary. If a patient develops low blood calcium levels (hypocalcemia), he or she will be administered calcium intravenously or by mouth.
Most patients go home the day of or the day after a thyroidectomy. After minimally invasive thyroid surgery, the patient is typically able to return to normal activities within 3 to 5 days, aside from activities that may require turning of the neck (like driving). After surgery, a cold pack to the neck along with rest and relaxation allow for a comfortable recovery. Heavy lifting and exercise should wait for 10 to 14 days. Most are back to work within 5 to 7 days or less after surgery.
At your first postoperative appointment (usually 1 week later), you are examined and given instructions on further care. Since there are no sutures to be removed and no drains to take out, this appointment is easy and “pain-free”. At one week post-op, you may begin to place vaseline onto the incision site twice daily and clean gently in the shower. Once the incision is healed, sunblock or sunscreen will be needed daily for 6 to 12 months to keep the area from becoming darkly pigmented. Massaging the wound daily and/or applying silicone sheeting may help the scar become less noticeable.
Possible Complications of Thyroid Surgery
The risk of experiencing post-operative complications from minimally invasive thyroid surgery is relatively low, but possible problems after surgery include:
- Scar/keloid tissue (where incision was made)
- Hypocalcemia (low blood calcium levels which requires supplemental calcium)
- Vocal cord weakness or paralysis (caused by stretch, swelling, or injury to recurrent laryngeal nerve and is rare)
- Temporary Hoarseness
After Total Thyroidectomy
The impact of the removal of one’s entire thyroid over time is that he/she will need to take a daily thyroid replacement hormone.
If you have any questions or if you would like to learn more about the services we provide, please call Trimble ENT and Sinus at 817-529-6200 or complete our contact form.