Thyroid gland surgery (strumectomy)

Introduction
You will soon be admitted to Bronovo for thyroid gland surgery. The aim of this leaflet is to inform you about the surgery procedures.

What reasons are there to operate?

• an overactive thyroid gland (hyperthyroidism)
• a tumour (nodule) in the thyroid gland. This can be a sign of malignancy in 10% of the cases
• several lumps in the thyroid gland (multinodular goitre). These can become so big as to cause problems with breathing and swallowing
• a tumour that has been diagnosed as malign (a carcinoma).

Types of surgery
Your specialist has discussed with you which surgery is required and why. Generally speaking, there are three types of surgery.

1. One half of the thyroid gland is removed (hemithyroidectomy)
2. Both halves of the thyroid gland are removed to a large extent (subtotal thyroidectomy)
3. Complete removal of the thyroid gland (total thyroidectomy)

How is the surgery carried out?
You will be given a general anaesthetic. The operation lasts about one and a half hours. You will be lying on your back with your head tilted backwards.
A horizontal incision is made in the lower neck. The thyroid is easiest to reach in this way. Depending on the type of operation, one or two drains are placed in the wound. Drains are tubes that drain off fluid and blood around the wound in order to avoid any accumulation. The drains are removed after approximately 24 hours. In general, there is little blood loss so a blood transfusion is not necessary.

After surgery
The pain after the operation is in general not too bad; it can be compared to a sore throat. The pain disappears within a few days. The wound heals quickly. After some time, the scar is hardly noticeable. The internal subcutaneous suture (stitching) is removed after five days. You can then go home again. On leaving the hospital, an appointment will be made with you for a checkup in the Outpatients' Clinic by the surgeon and the internist.
You will soon be able to resume your daily activities.

Strumectomy is generally a safe operation with little risk of complications, and with a quick recovery.
However, the risk of complications cannot be ruled out for any kind of surgery.

General complications
Like all operations, this operation has the risk of e.g. subsequent bleeding, pneumonia, bladder infection, or thrombosis.

Specific complications

• Damage to the recurrent laryngeal nerve (nervus recurrens)
  This complication is rare (0.5 %) and usually of a transient nature. Should your recurrent laryngeal nerve malfunction, then speech therapy can help you to improve your speech. However, speaking in a loud voice or shouting will no longer be possible. Even if the recurrent laryngeal nerve is not damaged, temporary changes to your voice may occur.
• Insufficient level of parathyroid hormone
  Thyroid gland surgery may cause a temporary decreased function of the parathyroid glands. During the stay in the hospital, symptoms like the following may develop (in fewer than 5% of the cases): tingling in the finger tips and sometimes also muscle cramps. These respond well to treatment with calcium tablets and vitamin D preparations.
• Insufficient level of thyroid hormone (hypothyroidism)
  An insufficient level may, after a few months, result in fatigue, cold intolerance, constipation, dry skin, loss of hair, swelling of the eyelids, and a swollen tongue. These symptoms can be prevented with thyroid hormone tablets. That is why your internist will be monitoring you for some time after the operation.

Finally
Should you have any questions after reading this leaflet, please do not hesitate to contact the surgeon treating you. Secretariat of the Surgery Outpatients’ Clinic: 070 - 312 43 59 (on weekdays from 09.00 - 11.30 hours and from 14.00 - 15.30 hours).

Edition: April 2010/56