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Operative Treatment - Thyroid Problems

Author: Jonathan Blood-smyth

The thyroid gland produces hormones and is one of the endocrine glands, placed in the anterior neck just below the voice box and is the source of the hormone thyroxine. The thyroid hormones are secreted into the blood and are important in controlling the metabolism and contribute to the normal function of all the body's cells. The thyroid gland can produce and store more thyroid hormone than the body needs at any period and so a patient may not need to take thyroid replacement hormone if only a proportion of the thyroid gland is removed.

Thyroid hormone replacement tablets will be necessary for the rest of a person's life if the whole thyroid gland is removed. The parathyroid glands are four very small glands about as big as grains of rice and attached to the thyroid. Parathyroid hormone is secreted by these glands which are involved in the regulation of calcium concentration in the blood. It is essential to have normal calcium in the blood for a healthy skeleton and general health. Surgeons try not to remove the parathyroid glands during the operation but gland function can be compromised.

When the surgeons take out the thyroid gland the operation is called thyroidectomy and this can be total, involving the whole gland, or a sub-total or partial removal. Hemithyroidectomy involves removing half the gland and lobectomy a removal of one of the thyroid lobes. Hyperthyroidism, overactivity of the thyroid gland secretions, is the most common reason for this operation although if the thyroid gland enlarges, a condition known as goitre, this may need operation. Goitre can appear unsightly or interfere with breathing or swallowing.

A general anaesthetic is used to carry out the thyroidectomy operation so the patient is unconscious during the entire procedure. The incision is made in the neck, mostly in the natural crease of the skin just above the sternum and is made on both sides at the same time. The incision heals well in these cases, gradually becoming inconspicuous and eventually almost disappears completely. A small tube may be placed in the neck to act as a drain to collect any fluid from the wound. This helps the process of healing and the drain is removed in the first day or so after operations. Two to four days in hospital is the typical stay.

Patients should refrain from eating for six hours before the operation and take clear fluids only up to two hours before the event. A venflon will be placed in the arm and through this the anaesthetic is given to last for the hour or two the operation will take. Some surgeons put stitches under the skin so removal is not necessary, others may use clips or stitches in the skin which are taken out after a few days. Two to four days is the typical hospital stay but this is dependent on how well people are, and on discharge they should be collected by a relative. The level of pain after thyroidectomy varies and typically patients have some around the neck.

Infection in the wound is a risk although it is uncommon, so if the wound becomes red and sore antibiotics may be needed and if pus comes from the wound it may need to be opened up to release the infection. Bleeding into the wound is again uncommon in about one in fifty and in rare cases a re-operation is needed to remove the blood clot. Bruising and swelling are common around the wound, caused by the fluid and blood under the wound and later on by scar formation.

A check of the vocal chords will be performed on all patients before surgery and operating very close to the larynx and the nerves which supply it is discussed with the patient. The nerves can lose partial function if they are bruised during surgery and weakness and hoarseness of the voice can be affected as the nerves control vocal chord movements. It may take months for the voice to recover and in rare, severe cases the nerve can be permanently altered. It is very rare for both nerves to be affected and a serious complication as the ability to speak is lost and a tracheotomy in the trachea is necessary to maintain breathing.

Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapists, physical therapy, Physiotherapists in Kensington, back pain, neck pain and injury management. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.

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operative-treatment-thyroid-problems-789514.html

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