Thyroid surgery may be indicated for one of three reasons: cancer, compression or cosmesis. There are about 40,000 new thyroid cancer cases diagnosed per year in the United States. This number has been progressively rising over the last few decades probably because of earlier detection and an actual increase in the incidence with immigrants from areas exposed to radiation. Compression refers to choking or swallowing difficulties resulting from a goiter or from extension of the thyroid to the chest. The final indication, cosmesis, refers to a patient’s wish to eliminate an unsightly goiter in the neck.
Aside from anaesthetic risks, the specific risks of thyroid surgery are hemorrhage, wound infection, voice disturbance and hypocalcemia. Hemorrhage refers to bleeding during or after the procedure. It is important that all vessels supplying the thyroid gland are adequately controlled during the procedure. Hemorrhage after the procedure can be life-threatening. Wound infection is uncommon but a few patients may react to the stitch material used for the closure.
The thyroid gland overlies the larynx and trachea. The nerves supplying the vocal cords traverse the upper and deep portions of the thyroid gland. Disturbances of the voice can result from direct trauma to these nerves or cautery. These injuries can be minimized with the use of the intra-operative nerve monitor, which is akin to the monitor used during spinal surgery. By this means, the surgeon can be alerted to even minimal nerve stimulation and thus avoid any significant trauma to the nerves.
The final potential complication is hypocalcemia, which typically may arise after a total thyroidectomy, which is usually indicated for thyroid cancer or a goiter. It is important for the surgeon to identify and preserve the parathyroid glands with their intricate blood supply intact. If there is any concern, the parathyroid gland should be removed and transplanted into the neck muscles. Post-operative blood tests can show if one has parathyroid malfunction and calcium supplementation should be commenced.
Finally, it is important to discuss with your surgeon their experience in thyroid surgery. Like other surgeries requiring meticulous dissection, the greater experience is generally coupled with reduced risk. Similarly, it is important to ensure that the surgeon will be personally performing or attending the surgery at all times.