Thyroid Problems
Posted: Wednesday, February 25, 2009
by Jonathan Blood Smyth
The thyroid gland is an endocrine gland which produces hormones. It is situated in the front of the neck just below the Adam's apple and produces the hormone thyroxine. Thyroxine is released into the bloodstream where it controls our metabolism and is responsible for the normal working of every cell of the body. The thyroid gland has the capacity to produce and store more thyroxine that the body requires at any one time so if only part of the thyroid gland is removed it is usually unnecessary to have thyroid replacement after the operation.
The excision of the thyroid gland is called thyroidectomy and the surgeons either remove the whole gland (total), partial (sub-total) or a hemithyroidectomy or removal of a lobe of the gland (lobectomy). Thyroidectomy is performed for several reasons with hyperthyroidism being the commonest, which means overactivity of the thyroid. An enlargement of the thyroid gland, known as goitre, can cause compression of the gullet or windpipe, may look unpleasant or interfere with swallowing or breathing. Removal of goitre is a typical thyroid operation.
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.
It is uncommon to get a wound infection and patients should monitor the wound to check it does not become sore and red, in which case antibiotics will be used. Rarely the wound needs to be re-explored to release pus. There is a one in fifty chance of bleeding occurring into the wound and the haematoma has to be explored and removed in rare cases. It is common to have wound swelling and bruising which is caused by the bleeding under the wound and later by scarring.
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 Physiotherapy, 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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