BEFORE THE SURGERY
If a person is experiencing hyperthyroidism (overactive thyroid), they may need to take (or continue to take) medications to control their hormone levels in the weeks before surgery. Surgery is appropriate if the thyroid hormone levels are normal at the time of the operation.
Sometime before surgery they will likely have blood tests, a chest x-ray, and an electrocardiogram (ECG) test to ensure they are fit for surgery. At some hospitals a pre-operative may be offered to check the vocal cords to check they are functioning correctly and assess whether there is any increased risk of harm to them during the operation.
If it’s determined that surgery is needed, the patient will visit a surgeon who will explain how the minimally invasive surgery will be performed, including where the incisions will be made. It may be having just one lobe of the thyroid removed (a lobectomy), almost all the thyroid removed (a sub-total/near-total thyroidectomy) or the entire thyroid removed (total thyroidectomy).
In preparation for surgery, the patient will be asked not to eat anything after the evening meal the day before the operation.
If the thyroid surgery is being performed because the doctor thinks there may be thyroid cancer, the surgeon may also remove some of the lymph nodes close to the thyroid. The extent of the operation in this case will not be known. The surgeon will need to examine the thyroid and the lymph nodes during the operation in order to decide how much needs to be removed.
The anaesthesiologist will explain how the anaesthetic will be given. In traditional thyroid surgery, the patient will have a general anaesthetic and will be asleep during the operation. For minimally invasive thyroid surgery, the patient may only need a local anaesthetic, in which only the neck area is numbed. In this case, they will also get mild sedatives so that they will not feel anxious. With this type of anaesthetic, they will be able to communicate with the surgeon during the operation.
DURING THE SURGERY
An uncomplicated total thyroidectomy should take less than 2 hours to perform. If the patient is having a less extensive operation, it will be quicker. During the surgery, the surgeon may use the NIM™ nerve integrity monitoring system which identifies and monitors your nerves.
AFTER THE SURGERY
When the patient wakes up from the anaesthesia, they will likely be in a special recovery area where the nurses can monitor them closely until they are fully awake. Small tubes going into their body will temporarily provide fluids until they can drink again, as well as drain any excess fluid from the incision area. These tubes will be removed the same day or the next day, depending on the extent of the operation and the speed of the recovery.
They will have some stitches where the incision was made. These will dissolve over a few weeks. Their neck and throat will be sore and stiff for a few days. They will be given pain medicine while at the hospital and to take home with them. The pain will ease and stop within a few days.
They might notice some changes to their voice, which can happen if the nerves supplying the voice box (larynx) are damaged in any way during the operation. These changes should only last a few days. They may also have a laryngoscopic examination of the vocal cords to ensure they are functioning correctly.
The healthcare team will request that the patient get up and about soon after surgery — probably the next day. They will be given exercises to help with the stiffness in their neck. They will also be given some leg and breathing exercises to make sure their circulation and lungs are working well and to help prevent any infections or blood clots after the operation.
The patient will probably be ready to go home one or two days after the operation.