Thyroid Problems & Indications for Surgery

Surgery for disorders or swellings of the thyroid gland is a specialist procedure, which requires great care to avoid some potentially significant complications. Mark Tomlinson is a very experienced Thyroid surgeon, and has been performing such surgery in Lancaster for over 10years.

Thyroid surgery is usually considered for one or more of the following reasons:

• if the thyroid gland is enlarged and causing symptoms due to pressure on surrounding structures in the neck. Symptoms such as pain or difficulty when swallowing; or noisy breathing or breathlessness due to compression of the airway.
• if the thyroid gland is overactive, producing too much Thyroid hormone, which can be dangerous. This condition is called “thyrotoxicosis” or “hyperthyroidism” and can be associated with inflammation of the thyroid gland (thyroiditis), or an autoimmune condition (Graves’ Disease)
• if there is concern that there may be a tumour or cancer within the thyroid gland.
• if the voice is affected by the thyroid swelling pressing on the nerve(s) which supply the muscles of the voice box; and which thus move the vocal cords. Occasionally the vocal cord function is severely affected i.e. it does not move at all

Nodules & Cysts

It is common to find that when the thyroid gland is scanned, or if the neck is scanned for other reasons, it is noted that the Thyroid contains nodules (solid lumpy areas), or cysts (fluid-filled areas) within the gland. A generally lumpy gland is termed “multinodular”; a visible, enlarged thyroid swelling in the neck is also known as a “Goitre”. If nodules have any potentially suspicious features on ultrasound scanning of the gland, then a small cell sample is usually taken using a fine needle to check this further.  Cysts can have the fluid simply drained with a needle to relieve the pressure or discomfort.

Thyroid Surgery

At surgery usually either the whole of the thyroid gland is removed, or if the swelling affects just one side, half the gland may be removed. If the fine needle cell sample from a nodule is suspicious, then a diagnostic operation may be recommended to remove that side of the gland so that the nodule can be fully assessed to see whether it is benign, or whether it is a cancer. Sometimes if the nodule is confirmed as a cancer, further surgery may be required to remove the remaining thyroid tissue, or to remove lymph glands in the neck also.

Thyroid surgery can be associated with some problems with the voice after surgery. If the nerve(s) to the voice box or vocal cord are affected, this can result in either a hoarse voice, or a weak voice, which may be quiet and fade during long sentences or conversations. This is why thyroid surgery is undertaken only by specialist surgeons, and the risk of a permanent voice problem should be in the order of one percent or less.

Other problems that can arise after surgery are low calcium levels in the blood, which may require additional Calcium & Vitamin D tablet medication, or wound problems such as wound bleeding, infection or fluid collection (seroma). There will of course also be a scar on the neck, though this is kept as small as possible. The scar usually heals well, fades over time, and is placed in a skin crease so that it is even less visible.