Thyroidectomy (thyroid surgery): what happens, risks and recovery

BAETS gives the main reasons as a goitre pressing on the windpipe or gullet, nodules that need surgical assessment or that cause concern, an overactive thyroid and thyroid cancer. The NHS says surgery is the most common treatment for thyroid cancer, with part or all of the gland removed and nearby lymph nodes taken if the cancer has or might have spread.

Many thyroid lumps are harmless and are simply monitored. Overactive thyroids are often treated with tablets first, and surgery is generally one of several options that a specialist weighs against alternatives. If a nodule causes no pressure symptoms and tests are reassuring, an operation may not be needed at all.

In a lobectomy (hemithyroidectomy) one lobe and the narrow bridge joining the two sides are removed. In a total thyroidectomy the entire gland comes out, and a near-total operation leaves a small amount of tissue to protect nearby structures. BAETS adds that keyhole or mouth-based approaches are occasionally offered, but the neck incision is standard.

The choice follows the diagnosis. A lobectomy keeps some working thyroid and, if the remaining lobe copes, may avoid lifelong tablets; BAETS says about 20 per cent of people having a lobectomy may eventually need hormone treatment, checked at around six weeks. A total thyroidectomy always needs replacement tablets, but is chosen when both sides are affected or a cancer calls for it.

BAETS lists blood tests before surgery that include thyroid function, vitamin D, calcium and parathyroid hormone, and recommends a flexible nasendoscopy, in which a thin camera passed through the nose checks that both vocal cords move. This gives a baseline against which any voice change afterwards can be judged.

As with any general anaesthetic you will receive fasting instructions and be asked about medicines, smoking and allergies; follow the written guidance from your hospital.

The operation takes place under general anaesthetic. The surgeon opens a skin crease in the lower neck and carefully separates the gland from the nerves behind it and the small parathyroid glands beside it. When cancer is the reason, a central or lateral neck dissection may be added; BAETS says not everyone with thyroid cancer needs it.

Recovery is on a ward and, per BAETS, discharge the next day is typical. Hospitals vary in whether a drain is used and when calcium is checked, so ask your own team.

BAETS names bleeding, infection, vocal cord palsy, voice change, parathyroid injury, an underactive thyroid after lobectomy, fluid collection and scar problems. A companion leaflet says one-sided nerve injury typically leaves a hoarse, weak voice, that recovery can take up to 12 months, and that injury to both nerves is uncommon but serious and could need a breathing tube.

The parathyroid glands regulate calcium. Damage, particularly after total thyroidectomy, can cause tingling in the fingers and lips and, in some people, long-term calcium and vitamin D tablets. Bleeding is described as uncommon but can cause neck swelling or breathing difficulty and may need a return to theatre. Scars usually fade to thin white lines after a year or more. Ask your surgeon for figures from their own practice.

BAETS describes thyroid surgery as not particularly painful, with painkillers rarely needed beyond about 72 hours, although tiredness can last up to a month. It suggests driving once you can turn your neck without pain and make an emergency stop, office work after one to two weeks and heavier work after about four weeks.

The wound may be raised and pink at first and takes months to settle. Hormone tablet doses are adjusted after blood tests. GOV.UK says to tell the DVLA if you are still unable to drive three months after an operation, and that insurers matter if you ignore medical advice.

Call 999 for noisy or difficult breathing, or rapidly increasing neck swelling. Tingling or cramping in the lips, hands or feet should be reported urgently to the ward or your GP, since it may mean low calcium. A wound that becomes red, hot or leaks, or a fever, warrants a call to the hospital or NHS 111 out of hours.

• Is a lobectomy enough, or do you recommend a total thyroidectomy, and why?

• Will my vocal cords be checked before and after surgery?

• How will calcium be monitored, and what do I do about tingling?

• Will I need hormone tablets, and when are they checked?

• What does the surgeon's own audit show for voice and calcium problems?

The operation is the same in both settings. Differences lie in waiting time, choice of surgeon and how follow-up blood tests and endocrinology review are arranged. Ask in either setting who manages your tablet dose and calcium checks afterwards, and who you should contact if your voice changes.