Thyroid Surgery

Specialist assessment and surgery for thyroid nodules, goitre, Graves’ disease and thyroid cancer.

N
Thyroid nodules

Most thyroid nodules are benign. Assessment may include ultrasound and fine needle aspiration where appropriate.

G
Graves’ disease

Surgery can provide definitive treatment for selected patients with overactive thyroid disease.

Go
Goitre

Enlargement of the thyroid can cause neck swelling, pressure, difficulty swallowing or breathing.

Ca
Thyroid cancer

Appropriate surgery forms an important part of treatment for many thyroid cancers.

What is a thyroid nodule?

A thyroid nodule is a lump within the thyroid gland. They are common and are often discovered during examination or imaging performed for another reason.

Most thyroid nodules are benign. Evaluation usually aims to identify the relatively small proportion that may require biopsy, surveillance or surgery.

Assessment typically includes thyroid function testing, high-quality ultrasound and, where indicated, fine needle aspiration.

Assessment may include

  • Thyroid function tests, particularly TSH
  • Ultrasound with TI-RADS assessment
  • Fine needle aspiration when indicated
  • Thyroid uptake scan if the nodule is hyperfunctioning
  • TRAb testing when Graves’ disease is suspected
Surgical Assessment

When is thyroid surgery considered?

Suspicious or malignant cytology FNA suggesting malignancy or an indeterminate nodule with sufficient concern to consider surgery.
Symptomatic or enlarging nodules Pressure, swallowing difficulty, voice symptoms, progressive enlargement or other significant concerns.
Goitre Large or substernal goitre causing compression, symptoms or concern for malignancy.
Graves’ disease Particularly where there is large goitre, thyroid eye disease, poor medical control, drug intolerance or preference for surgery.
Patient preference After discussion of the risks, benefits and reasonable alternatives to surgery.
Extent of Surgery

Hemithyroidectomy or total thyroidectomy?

The amount of thyroid removed depends on the condition being treated, the anatomy of the gland, pathology and the individual patient.

Hemithyroidectomy

  • Removal of one thyroid lobe, with or without the isthmus
  • Appropriate for many benign nodules and selected low-risk cancers
  • Lower risk of postoperative hypocalcaemia than total thyroidectomy
  • Some patients still require thyroid hormone replacement afterwards

Total thyroidectomy

  • Removal of the entire thyroid gland
  • May be appropriate for larger cancers, bilateral disease or Graves’ disease
  • Requires lifelong thyroid hormone replacement
  • Carries a higher risk of temporary postoperative hypocalcaemia
The operation should fit the thyroid condition and the patient, rather than every thyroid problem being treated in the same way.
Voice & nerve protection

The recurrent laryngeal nerves, which control vocal-cord movement, are carefully identified and preserved during surgery.

Intraoperative nerve monitoring may be used as an adjunct to careful surgical technique.

Parathyroid preservation

The parathyroid glands regulate calcium and are carefully preserved, together with their blood supply, wherever possible.

Low calcium after total thyroidectomy is usually temporary, although permanent hypoparathyroidism can rarely occur.

Safety & experience

Thyroid surgery requires careful dissection around delicate structures in the neck.

The aim is a safe operation, preservation of function and the best possible long-term result.

After Surgery

Recovery

Hospital stay Often one night in hospital. Same-day discharge may be appropriate in selected cases.
Return to activity Light activity is encouraged early, with return to work depending on comfort and occupation.
Scar A small scar is placed across the lower front of the neck and generally fades with time.
Thyroid hormone Required after total thyroidectomy and sometimes after hemithyroidectomy.
Eating & voice Most patients return quickly to normal eating and speaking.

Discuss your thyroid condition

Careful assessment and an individualised surgical plan based on the thyroid condition, imaging, pathology and your goals.

Book a consultation