The thyroid gland is a butterfly-shaped endocrine gland that produces hormones. It is located in the midline of the neck, at the level of the larynx, in close contact with the trachea and oesophagus. The parathyroid gland secretes parathyroid hormone, which plays a role in the body’s calcium and phosphate balance.
Elevated blood calcium levels are primarily responsible for the symptoms of thyroid disease:
Problems with parathyroid hormone secretion include primary hyperthyroidism and the presence of benign and malignant tumours in the parathyroid gland. In the case of proven malignancies, total or partial removal of the thyroid gland with the affected lymph nodes is necessary.
Depending on the nature of the parathyroid disease, the aim of the surgery is to remove the affected, overactive parathyroid gland or benign or malignant tumour, if necessary by partial or complete removal of the thyroid gland. The parathyroid hormone is secreted by the 3 parathyroid glands left in place after the operation.
The operation is performed under general anaesthesia. A curved skin incision is made in the cervical skin fold above the sternum.
The thyroid gland in the field of view is bluntly circumscribed by passing around the thyroid gland. Any localised overactive parathyroid gland is dissected out during the preoperative imaging scan. If healthy parathyroid glands are also removed, they are reinserted under the skin.
During surgery, a hormone sample is taken from the lesion, and if necessary, and parathyroid hormone levels are not adequate, additional parathyroid glands are removed.
In the case of malignant tumours, the upper and lower veins running to the thyroid gland are explored, cut between ligations.
If the results of the laboratory, ultrasound, bone biopsy, aspiration cytology, CT scan are part of the examination, the patient must also undergo an anaesthetic examination before the operation. Depending on hormone production, it may be necessary to arrange this before surgery.
Most likely you will arrive at our institute on the day of surgery, but rarely you may need to be admitted the night before. One to two weeks before the planned day of surgery, we will carry out the necessary investigations, which may include laboratory tests, ECG, X-rays and, if necessary, anaesthesia.
Only symptoms caused by elevated calcium levels can be treated. Radiotherapy or chemotherapy for proven malignant tumours should only be chosen as a palliative, i.e. life-prolonging but not curative, first-line treatment, usually because of poor general health.
Postoperative pain in the surgical area, skin and tissue damage, inflammation, scarring, wound infection, hernia formation, allergic reactions, deep vein thrombosis.
After waking up, you can expect to feel discomfort, and we will do our best to minimise this, or if it has developed, to alleviate it. After the operation, the incision may be painful, and the wound will be anaesthetised as a final step in the operation. There may also be discomfort around the incisions, which should also improve considerably with the use of painkillers.
We usually remove the drains in the wound cavity 24 hours after surgery, and you can be discharged from our clinic on day 2.
Avoid the development of neck haemorrhage, pressing hard, bending over, lifting heavy objects.
After total thyroidectomy or removal of most of the glandular tissue, thyroid hormone replacement with medication is necessary. This is adjusted in the post-operative period with regular laboratory monitoring. The adjustment sometimes takes longer and the patient may need to have periodic check-ups for years or for the rest of his life.
If there are no complications, the patient can live a full life after a 4-5 week recovery period, with any hormone replacement that may be necessary.
In all cases, the removed glandular tissue will be histologically processed. If this confirms a malignant process, a decision on the course of further treatment is taken with the patient’s involvement, with the help of our institute’s clinical oncologist oncoteam.
Exercise:
Do not climb more than one flight of stairs for 24-36 hours (or longer if you feel up to it)
Strenuous sporting activities and heavy physical work can usually be resumed within 2-3 weeks after the operation, once you are fully recovered
Work:
If you are not doing physical work, you can return to it within a few days of surgery if pain has passed, within a few weeks if hormone level adjustment is needed
If you are doing physical work, wait at least 4 weeks before returning to work
