Thyroid surgery is very safe with an operative mortality reported by the BAETS in 2007 of 0.16%. Many senior endocrine surgeons have operated on several thousand thyroid patients without a single death.Surgery is usually performed under general anaesthetic, but can be performed in special circumstances under local anaesthesia. The patient is admitted either on the day of surgery or the night before, and no food or drink is allowed 6 hours prior to surgery. All the relevant tests should have been completed preoperatively.
Immediately following the operation the throat will feel a little sore and there may be some temporary difficulty in swallowing although this settles very quickly. Wound infection is rare (less than 1%). Minor swelling of the neck is common and goes in a few days. If a drain has been used it is removed at 24 to 48 hours. Minor voice change is common and is usually self-limiting. Rarely, damage to the laryngeal nerve is permanent, resulting in a hoarse voice of variable severity(0.2% risk in our hands; BAETS rate 2.2%). We feel very strongly that intra-operative nerve monitoring is mandatory in all thyroid operations. This view is widespread in the USA but not in the UK. The reason we support the American view is that using the nerve monitor we have achieved in in the most complex re-operation a nerve damage rate of 0.2%.
The stitches are removed at around two to three days, and hospital stay is one to three days.
Some centres perform thyroid surgery as a day cases. A report in 2008 from The Basildon and Thurrock University Hospitals comments on their experience of 100 cases of Ambulatory Thyroidectomy. The results are admirable with a 2% rate of hoarseness and similar rate of calcium replacement.No patient bled or needed re-admission. Despite this impressive report Mr Lynn does not think that day case thyroidectomy is inherently safe. The reason he will not do day case thyroidectomies is that even in the best hands bleeding into the neck can occur in the first 24 hours following surgery. It is very rare for this to happen more than 24 hours after the operation. Re-bleeding can usually be dealt with in the hospital setting with little risk, but the danger must never be ignored. If bleeding were to occur in the community it could be fatal.In 2007 a death occurred in a young woman under 25 with two children due to re-bleeding into the neck while an inpatient in a major London teaching hospital. The cause of death was very poor post operative management. Our own re-bleed rate is 1 in 750 cases with no deaths compared with 1 in 20 or 30 quoted by some of our peers. Despite our low complication rate we are still not willing to contemplate day case thyroid surgery, as although the risks are small they are significant.
The need for thyroid hormone replacement varies and depends on the extent of surgery and the natural activity of the remaining thyroid.
Frequently Asked Questions
#1. How do I chose my surgeon? Your surgeon should do at least 50 thyroid operations are year.
#2. Why do I need the operation? Your surgeon should explain why and tell you in the case of Grave's disease about the non surgical options.
#3. What are the overall risks? In experienced hands the risk of death is virtually zero,the complications are less than 1%.
#4. Do I need nerve monitoring? We strongly recommend nerve monitoring - it is easy to use and in our view reduces the risk of damage to the recurrent laryngeal nerve and subsequent hoarseness.
#5.How much thyroid will be removed? Most thyroidectomies are total but in special circumstances only part of the thyroid is removed
#6. How long will be off work? Usually 2 weeks
#7. When can I drive? At about 2 weeks
#8. What happens after the thyroidectomy? You will feel some discomfort in your neck. If you are in severe pain tell the nursing staff straight away.This should not occur!
#9. Will I be normal after thyroidectomy? You will be exactly the same after surgery as you were before. Unless the thyroidectomy was for thyrotoxocosis you will not put on weight but may need thyroid hormone replacement (thyroxine).