Endocrine glands are the structures in the body which secrete hormones and the thyroid gland, anatomically placed in the front of the neck, is responsible for the production of thyroxine. Thyroxine is produced and passes into the blood and its function is to control the metabolism with some control over the functioning of all the cells in the body. More thyroxine can be stored and produced by the thyroid gland than can be used by the body so if a partial thyroid removal is the necessary operation then the patient may not need to take thyroid replacement tablets.
If the whole thyroid gland is excised then the patient will need to take tablets for thyroxine replacement throughout their life. The size of four small rice grains, the minute parathyroid glands adhere to the thyroid gland and secrete a hormone called parathyroid hormone. Parathyroid hormone is closely involved in the blood regulation of calcium concentrations, which promotes good health and the maintenance of a healthy skeletal structure. During the thyroid removal operation the surgeons take care not to affect the parathyroid glands but the secretions of the glands can be altered.
The excision of the thyroid gland is called thyroidectomy and the surgeons either remove the whole gland (total), partial (sub-total) or a hemithyroidectomy or removal of a lobe of the gland (lobectomy). Thyroidectomy is performed for several reasons with hyperthyroidism being the commonest, which means overactivity of the thyroid. An enlargement of the thyroid gland, known as goitre, can cause compression of the gullet or windpipe, may look unpleasant or interfere with swallowing or breathing. Removal of goitre is a typical thyroid operation.
A general anaesthetic is used to carry out the thyroidectomy operation so the patient is unconscious during the entire procedure. The incision is made in the neck, mostly in the natural crease of the skin just above the sternum and is made on both sides at the same time. The incision heals well in these cases, gradually becoming inconspicuous and eventually almost disappears completely. A small tube may be placed in the neck to act as a drain to collect any fluid from the wound. This helps the process of healing and the drain is removed in the first day or so after operations. Two to four days in hospital is the typical stay.
Patients should refrain from eating for six hours before the operation and take clear fluids only up to two hours before the event. A venflon will be placed in the arm and through this the anaesthetic is given to last for the hour or two the operation will take. Some surgeons put stitches under the skin so removal is not necessary, others may use clips or stitches in the skin which are taken out after a few days. Two to four days is the typical hospital stay but this is dependent on how well people are, and on discharge they should be collected by a relative. The level of pain after thyroidectomy varies and typically patients have some around the neck.
There are various post-operative risks and many of them are rare. Infection can occur in the wound and if it develops redness and soreness then antibiotic treatment is prescribed. Wound reopening and exploration to remove any accumulated pus is also rarely required. Bleeding in the wound can occur, leading to a haematoma which necessitates wound exploration and washing out, with a one in fifty chance of this occurring. Patients will have some bruising and also swelling around the wound area caused by the bleeding under the wound.
A check of the vocal chords will be performed on all patients before surgery and operating very close to the larynx and the nerves which supply it is discussed with the patient. The nerves can lose partial function if they are bruised during surgery and weakness and hoarseness of the voice can be affected as the nerves control vocal chord movements. It may take months for the voice to recover and in rare, severe cases the nerve can be permanently altered. It is very rare for both nerves to be affected and a serious complication as the ability to speak is lost and a tracheotomy in the trachea is necessary to maintain breathing. - 14130
If the whole thyroid gland is excised then the patient will need to take tablets for thyroxine replacement throughout their life. The size of four small rice grains, the minute parathyroid glands adhere to the thyroid gland and secrete a hormone called parathyroid hormone. Parathyroid hormone is closely involved in the blood regulation of calcium concentrations, which promotes good health and the maintenance of a healthy skeletal structure. During the thyroid removal operation the surgeons take care not to affect the parathyroid glands but the secretions of the glands can be altered.
The excision of the thyroid gland is called thyroidectomy and the surgeons either remove the whole gland (total), partial (sub-total) or a hemithyroidectomy or removal of a lobe of the gland (lobectomy). Thyroidectomy is performed for several reasons with hyperthyroidism being the commonest, which means overactivity of the thyroid. An enlargement of the thyroid gland, known as goitre, can cause compression of the gullet or windpipe, may look unpleasant or interfere with swallowing or breathing. Removal of goitre is a typical thyroid operation.
A general anaesthetic is used to carry out the thyroidectomy operation so the patient is unconscious during the entire procedure. The incision is made in the neck, mostly in the natural crease of the skin just above the sternum and is made on both sides at the same time. The incision heals well in these cases, gradually becoming inconspicuous and eventually almost disappears completely. A small tube may be placed in the neck to act as a drain to collect any fluid from the wound. This helps the process of healing and the drain is removed in the first day or so after operations. Two to four days in hospital is the typical stay.
Patients should refrain from eating for six hours before the operation and take clear fluids only up to two hours before the event. A venflon will be placed in the arm and through this the anaesthetic is given to last for the hour or two the operation will take. Some surgeons put stitches under the skin so removal is not necessary, others may use clips or stitches in the skin which are taken out after a few days. Two to four days is the typical hospital stay but this is dependent on how well people are, and on discharge they should be collected by a relative. The level of pain after thyroidectomy varies and typically patients have some around the neck.
There are various post-operative risks and many of them are rare. Infection can occur in the wound and if it develops redness and soreness then antibiotic treatment is prescribed. Wound reopening and exploration to remove any accumulated pus is also rarely required. Bleeding in the wound can occur, leading to a haematoma which necessitates wound exploration and washing out, with a one in fifty chance of this occurring. Patients will have some bruising and also swelling around the wound area caused by the bleeding under the wound.
A check of the vocal chords will be performed on all patients before surgery and operating very close to the larynx and the nerves which supply it is discussed with the patient. The nerves can lose partial function if they are bruised during surgery and weakness and hoarseness of the voice can be affected as the nerves control vocal chord movements. It may take months for the voice to recover and in rare, severe cases the nerve can be permanently altered. It is very rare for both nerves to be affected and a serious complication as the ability to speak is lost and a tracheotomy in the trachea is necessary to maintain breathing. - 14130
About the Author:
Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapy, back pain, orthopaedic conditions, neck pain, injury management and physiotherapists in Edinburgh. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.
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