The thyroid gland sits at the front of the neck beneath the Adam’s apple. It comprises two lobes, which wrap around the windpipe in a butterfly shape. The thyroid absorbs iodine from the diet to produce hormones that regulate metabolism. The main hormones are T3 and T4. These hormones regulate the speed at which food is broken down and converted to energy. They also influence body temperature, weight, blood pressure, heart rate, energy levels and mood.
Indications for thyroidectomy include Graves’ disease, multinodular goitre, Hashimoto’s thyroiditis, thyroid nodules and thyroid cancer.
Graves’ disease develops when thyroid cells are stimulated to grow disproportionately large and too much of the hormone, thyroxine, is produced. The thyroid becomes overactive, producing a ‘fast metabolism’ also known as hyperthyroidism. Symptoms include increased appetite, weight loss, palpitations, restlessness, heat sensitivity, bulging eyes, anxiety and irritability.
Hashimoto’s thyroiditis is an autoimmune disease that eventually destroys the thyroid gland. The reduced inability to produce hormones causes the thyroid to become underactive leading to a ‘slow metabolism’. This state of hypothyroidism causes symptoms such as weight gain, slower heart rate, fatigue and lethargy, sensitivity to cold, and depressed mood. Thyroid nodules and thyroid cancer are commonly seen associated with this disease.
Thyroid nodules may occur singly, affecting just one part of the thyroid, or multiple nodules may occur throughout the thyroid. Excessive thyroid enlargement is commonly known as multinodular goitre. Goitres are often benign but some may be due to cancer. Large benign goitres may require removal if they interfere with breathing or swallowing or become painful.
Thyroid cancer occurs in four main forms: papillary thyroid cancer; follicular thyroid cancer; medullary thyroid cancer and anaplastic thyroid cancer. Most types of thyroid cancer have a very good long-term outcome following removal of the thyroid and subsequent treatment with radioactive iodine.
Minimally-invasive video-assisted thyroidectomy
Small thyroid nodules can be removed with a modern surgical technique called minimally-invasive thyroidectomy. A keyhole incision as small as 2cm leaves a scar that after healing, is often invisible to others. A high-definition camera is passed through the incision to provide the surgeon with a magnified and detailed view of the thyroid, laryngeal nerve and blood vessels. However, sometimes the incision may need to be larger depending on anatomy and findings during surgery. The incision is placed on a skin crease so that the scar blends naturally with the skin to minimise the appearance of scarring. During a thyroidectomy, the thyroid is dissected away from the windpipe with careful preservation of surrounding blood vessels and nerves. Sutures are used to close the wound. The type of stitch usually used is called a continuous subcuticular suture which particularly enhances the cosmetic result because the outer layer of the skin is penetrated only at the beginning and end of the suture line. Drains are very rarely used and usually removed the next day. Sutures are removed 7-10 days after surgery unless they are dissolvable. Patients are admitted to hospital on the day of surgery and usually discharged after one to two nights.