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Patient information
Information about the thyroid gland, how thyroid swellings are investigated and what to expect from a thyroidectomy.
The thyroid gland lies in the front of the neck and produces a very important hormone called thyroxine, which regulates the body’s metabolism. Many conditions can affect the size and function of the gland. An enlargement or swelling of the thyroid gland is known as a goitre.
It is quite common for the thyroid to become underactive and produce insufficient thyroxine, leading to tiredness, low mood, weight gain and constipation. This is easily diagnosed with a blood test and simply treated with a daily thyroid hormone supplement.
An overactive thyroid releases excessive thyroxine, causing restlessness, increased appetite, weight loss, difficulty sleeping, feeling hot and sweaty and sometimes palpitations. It is diagnosed with a blood test and initially treated by an endocrinologist with tablets. If the condition persists, a permanent cure is usually recommended – either an operation to remove the thyroid gland or radioiodine treatment. If surgery is advised, your endocrinologist will refer you to a specialist thyroid surgeon.
The thyroid sits in the lower neck in front of the windpipe (trachea). It has two lobes, joined by a narrow part called the isthmus. A normal thyroid cannot usually be seen or felt, but sometimes it enlarges to produce a visible lump. Enlargement of the thyroid is in most instances entirely benign, but it does need to be investigated by an endocrinologist or specialist thyroid surgeon.
If you notice a lump in your neck, you should see your GP, who will usually refer you to a specialist and may arrange an ultrasound scan and a blood test of thyroid function.
At your consultation your neck will be examined and an ultrasound will usually be arranged. Sometimes a needle biopsy (fine needle aspiration cytology) is organised. It is extremely safe and causes minimal discomfort, and helps to diagnose the cause of the swelling. Together, these tests allow an accurate diagnosis to be made.
Most swellings within the thyroid are benign, and no further action is needed unless there is a cosmetic concern or the lump presses on the windpipe or gullet. Sometimes the biopsy diagnoses or suggests the possibility of a tumour, in which case removal of the swelling is recommended to obtain a definite diagnosis. Tumours of the thyroid almost always run a very benign course, and prompt surgery with further non-invasive treatment achieves a permanent cure.
A thyroidectomy is the surgical removal of half or all of the thyroid gland. An operation may be needed:
The operation is carried out through a curved horizontal incision in the lower central neck. Mr Crinnion uses ultrasound immediately before surgery to identify the exact site of a thyroid swelling, allowing the incision to be placed appropriately. At the end of the operation the incision is closed and a small drain may be left for 24 hours.
Some swelling, a sore throat and discomfort on swallowing are usual and transient. Swelling under the scar settles over a few months and most scars become barely visible; occasionally a thickened (keloid) scar takes longer to mature.
The nerves to the vocal cords lie very close to the thyroid and great care is taken to protect them. Temporary hoarseness can occur. There is about a 1% chance of permanent weakness of the voice, but significant difficulty with everyday speech is extremely rare.
The four tiny parathyroid glands next to the thyroid control blood calcium. After total thyroidectomy calcium may fall temporarily, causing tingling around the mouth or in the fingers. This is treated with calcium supplements, which are rarely needed permanently.
If the whole thyroid is removed you will need a daily thyroxine tablet, with blood tests initially to find the correct dose.
Depending on your recovery, you can expect a total hospital stay of 1–2 nights. You will be able to eat and drink normally once you have recovered from the anaesthetic, and any drain is removed before you go home.
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Please contact Mr Crinnion’s secretary, Maxine Levene.
Tel: 0787 028 0264
Email: enquiries@jamescrinnion.co.uk
Mr Crinnion’s office is happy to help before and after your procedure.