The thyroid is a small gland shaped a like a butterfly. It’s located in the lower front part of the neck, just below the voice box.
The thyroid produces hormones that the blood carries to every tissue in the body. It helps regulate metabolism (the process during which the body turns food into energy). It also plays a role in keeping the organs functioning properly and helping the body conserve heat.
Sometimes the thyroid produces too much hormone. It may also develop structural problems, such as swelling and the growth of cysts or nodules. Thyroid surgery may be necessary when these problems occur.
What is Minimally Invasive Thyroid Surgery?
The most common reason for thyroid surgery is the presence of nodules or tumors on the thyroid gland. Most nodules are benign, but some can be cancerous or pre-cancerous. Even benign nodules can cause problems if they grow large enough to obstruct the throat, or if they stimulate the thyroid to overproduce hormones (a condition called hyperthyroidism).
Surgery can correct hyperthyroidism. Hyperthyroidism is frequently the result of an autoimmune disorder called Grave’s disease. Grave’s disease causes the body to misidentify the thyroid gland as a foreign body and send antibodies to attack it. These antibodies inflame the thyroid, causing hormone overproduction.
Another reason for thyroid surgery is the swelling or enlargement of the thyroid gland. This is referred to as a goiter. Like large nodules, goiters can block the throat and interfere with eating, speaking, and breathing.
There are several different types of thyroid surgery. The most common are lobectomy, subtotal thyroidectomy, and total thyroidectomy.
Lobectomy:
Sometimes a nodule, inflammation, or swelling affects only half of the thyroid gland. When this happens, a doctor will remove only one of the two lobes. The part left behind should retain some or all of its function.
Subtotal Thyroidectomy:
A subtotal thyroidectomy removes the thyroid gland, but leaves behind a small amount of thyroid tissue. This preserves some thyroid function. Many individuals who undergo this type of surgery develop hypothyroidism, a condition that occurs when the thyroid doesn’t produce enough hormones. This is easily treated with daily hormone supplements.
Total Thyroidectomy:
A total thyroidectomy removes the entire thyroid and the thyroid tissue. This surgery is appropriate when nodules, swelling, or inflammation affect the entire thyroid gland, or when cancer is present.
THE PROCEDURE
Surgery for the thyroid gland is now undergoing a significant advance. The latest approach for performing such operations is a procedure that is easier to undergo and recover from than traditional thyroid gland surgery, as effective as conventional surgery, and most importantly leaves only a tiny scar on the patient's neck.
Traditional surgery of the thyroid gland uses a standard, open-surgery approach requiring an incision that is four to five inches in length. The result is a noticeable and sometimes prominent, life-long scar on the lower portion of the patient's neck.
Today, our specialized surgeons can offer a minimally invasive approach performing this surgery through an incision that is a mere inch or less (approximately) in length. Through this small cut, they insert a tiny endoscope that is only a half-centimeter in diameter. This instrument permits them to see the thyroid gland and surrounding tissue without having to physically expose it.
With the scope, they can view the gland on a video monitor. They can then use another miniaturized instrument called the harmonic scalpel to resect portions of thyroid tissue. This scalpel uses ultrasonic energy to gently and precisely cut tissue and to seal off (ligate) blood vessels, significantly reducing operative time in thyroid surgery. As a surgical tool, this type of scalpel offers a level of versatility that makes the newer, smaller incisions possible.
With slender instruments, the surgeon pushes aside other structures, such as musculature, rather than cut through them, to get to the gland area. The surgeon then removes and retrieves sections of the gland in the surgical treatment and for biopsy specimens.
Thyroid surgery normally takes between 30 and 90 minutes, depending on whether the surgeon removes the entire gland.
The Minimally Invasive Thyroid Advantages
Results are different for each procedure and each patient. Some common advantages of minimally invasive colorectal surgery are:
Shorter hospital stay
Shorter recovery time
Less pain from the incisions
Less tissue trauma
Faster return to normal diet
Faster return to work or normal activity
Better cosmetic healing
PREPARATION FOR SURGERY
Before traveling to Cyprus, as part of your surgery preparation you will complete a detailed specific questionnaire, which will allow our doctors to determine your eligibility for Minimally Invasive Thyroid Surgery.
Ten days prior to your arrival in Cyprus, you will receive all the necessary pre operative instructions, to prepare yourself both physically and mentally for your chosen procedure.
Before your departure your records will be reviewed thoroughly by our surgeon. This includes X-rays and a complete medical and surgical history as well as your specific issues. In addition, you may be asked to consult with a physical therapist to discuss recovery, hip rehabilitation and important precautions you must take postoperatively. The physical therapist may even give you exercises you can begin prior to your surgery in order to aid with recovery.
After traveling to Cyprus, a new set of X-rays will be taken as well as an in person physical examination. The surgeon and anesthetist will also go through you medical and surgical issues with you. During this visit, your surgeon will discuss your Abdominoperineal Resection procedure and answer any questions.
Preparation for the hospital
Here are a few things to keep in mind as you pack and prepare for the hospital and recuperation:
Clothing
Getting dressed in the morning helps you feel better, so be sure to bring some comfortable clothing to the hospital:
Loose shorts or pants
Loose tops or T-shirts
Underwear and socks
Short robe or pajamas
Toiletries
Morning of surgery
Bring all your medicines in their original containers with you to the hospital. You will meet with the anesthesiologist. This doctor will talk to you about general anesthesia. This is a controlled sleep while the surgery is being done so you will not feel any pain or remember the surgery. You will have an IV or intravenous line put in to give you fluid and medicine during your surgery. When it is time for you to go to surgery, your family will be asked to wait in the waiting area. Your doctor will talk to your family there after your surgery is done.
RECOVERY AFTER SURGERY
When you wake up after your surgery, you will be in the recovery room. You will stay there until you are awake and your pain is under control. Most patients return to their room after a few hours, but some will need to stay overnight for observation.
You will receive oxygen through a thin tube called a nasal cannula that rests below your nose. A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels.
You will have an analgesia pump device to deliver pain medication into your IV or epidural space (in your spine). You will also have compression boots on your lower legs to help your circulation. They will be taken off when you are able to walk.
You will most likely be tired and a bit sore for a few days. You may have pain not only from your incision, but also from muscle soreness in your upper back and shoulders. This is from the positioning in the operating room during the surgery. You will have liquid pain medicine in the hospital and a prescription for pain pills at home.
You may have a sore throat. This is a result of the placement of anesthesia tubes during surgery. Throat lozenges and spray usually help.
Your neck may be slightly swollen as well. You may feel like you have a lump in your throat when you swallow. This will improve after a few days but may continue for a week or so.
Hospital discharge and home instructions
Before leaving the hospital, our surgeon and staff will help you adjust to recovery in every way possible. You will receive specific instructions and precautions from your surgeon and nursing staff and they will show you safe techniques of simple activities like getting in and out of bed, bathing, going to the bathroom etc.
You will be able to leave the hospital when you are:
Able to eat a regular diet and drink fluids
Passing gas or you have had a bowel movement
Passing urine
Not having a fever or other signs of infection
Walk for short distances
Most people are able to go home 1 day after their surgery.
LIFE AFTER SURGERY
These guidelines give you an overview of what you may expect as part of your care after you leave the hospital. Be sure to follow your surgeon’s discharge instructions if they are different from what is listed here:
Most people take 1 to 2 weeks off to recover.
You may resume most of your normal activities the day after surgery. However, wait for at least 10 days (or until your surgeon gives you permission) to engage in strenuous activities such as high-impact exercise.
You should not drive for at least a week.
There are no other restrictions.
Depending on the amount of thyroid tissue that was removed and the reason for your surgery, you may be placed on thyroid hormone (Synthroid or Cytomel). Your surgeon will discuss your situation with you.
After your surgery, you may develop hypothyroidism. If this occurs, your doctor will prescribe some form of levothyroxine to help bring your hormone levels into balance. It may take several adjustments and blood tests to find the best dosage for you.
If you notice sudden swelling in your neck contact our surgeon immediately. Your calcium level may drop after surgery. This is related to disturbance of the parathyroid gland, which regulate calcium balance. This will be monitored through blood tests. You may notice numbness and tingling of your fingers or around your mouth. You will have instructions about taking calcium replacement if needed.
Medications
For pain
Your surgeon will order a prescription pain medicine for you after surgery. As your pain lessens, over the counter pain medicines such as acetaminophen or ibuprofen can be used. They can also be used instead of your prescription for mild pain.
For constipation
Prescription pain medicines can cause constipation. Your doctor may order a stool softener to prevent this. You should be back to your normal bowel routine in about 2 weeks. If the stool softener does not work, take Milk of Magnesia. If you still are not getting relief, call your surgeon.
FOLLOW-UP
Follow-up after surgery is extremely important and our surgeons at Salus are committed to providing all the post surgical care you need.