Thyroid surgery

The thyroid gland is located in the lower part of the neck, on either side of the trachea, and features two lobes joined by an isthmus.
It is an endocrine gland that secretes T3 and T4 hormones, crucial to the functions of numerous metabolisms in the body. The thyroid gland is controlled by TSH, a hormone produced by the pituitary gland.

Patients generally consult their doctor or endocrinologist for the discovery of a swelling in the lower part of the neck.

This lesion may be painful when swallowing, or lead to respiratory difficulties, or even a change in voice, but generally all this evolves in a painless context, without major discomfort.

The current reference examination is ultrasound of the lower neck, performed by a specialized physician experienced in this type of investigation.

A blood thyroid hormone assay will round off the check-up. 

A nodule’s cytopunction may be requested to obtain cytological information on the absence or presence of suspicious or cancerous cells; this procedure may prove accurate and reliable, but may also be difficult to interpret.

A thyroid nodule, or a goiter formed by several nodules, may be monitored clinically, biologically and via ultrasound, at six-months or annual intervals, if there are no signs of severity.

A combination of clinical indications (pain, neck lymph nodes, difficulty swallowing, vocal changes, etc.), ultrasound (TIRADS score) and cytology (BETHESDA classification) are required to justify surgery.

In other cases, it may exist some hormonal hyperfunction of the gland, or GRAVES BASEDOW’s disease, which will initially be treated with appropriate medication, followed by surgical resection in case of drug resistance.

Normal biological tests do not rule out an underlying cancerous lesion.

This surgical procedure can also affect the vitality and function of the parathyroid glands, located behind the gland and responsible for the body's phosphocalcic metabolism. Biological constants must therefore be monitored on a daily basis post-operatively.

A drop in blood calcium levels, or hypocalcemia, occurs transiently in around 30% of series, and may persist permanently in around 1% of cases. In this type of situation, with tingling sensations in the extremities or even muscle cramps, a calcium supplement with vitamin D may be necessary, followed by very regular monitoring of biological constants for three months by the family physician. In partial procedures, hospitalization can last from 24 to 48 hours.

It rarely exceeds two or three days in the case of total removal of the thyroid gland.

The patient returns home with wound monitoring, nursing care every two days, and a phosphocalcic assay.

An initial consultation is scheduled for the 45th postoperative day, for an initial TSH assessment, with adaptation of hormone replacement therapy, which is absolutely essential for total gland resection, and optional for partial surgery.


According to current recommendations in thyroid surgery, a single lobe (lobectomy), the isthmus (isthmectomy), a large part of the gland (sub- total thyroidectomy), or the entire gland (total thyroidectomy) may be removed.

If cancerous disease is suspected, lymph node dissection may be associated, involving various lymphatic chains not only lateral to the gland, but also above and below it.

There are other therapeutic approaches, such as radiofrequency treatment. These procedures are not recommended by medical associations, are not covered by health insurance as they are currently at the experimental stage.

After an anesthesiology examination, the patient arrives on the morning of the operation, on an empty stomach, with the usual hygiene protocols (preparation according to the protocols in force in the establishment the day before and in the morning).

Prior to the operation, the anesthetist performs an analgesic block under ultrasound, aiming at reducing post-operative pain.

The incision is horizontal, located in a physiological fold of the neck, preferably in the lower part. The lower laryngeal nerves are systematically located by means of intraoperative monitoring, with duplicate responses kept in the file or given to the patient.

After gland removal, and if necessary removal of the cervical lymph nodes, closure remains conventional, with drains in place for one or two days, and possibly the use of absorbable haemostatic products within the cavity. 

Complications are exceptional and can involve hematoma, which may require reoperation for drainage in the days following the operation.
 Wall abscesses may also occur, requiring a second surgery with appropriate antibiotic therapy.

The most serious complications are neurological, affecting the voice linked to dissection of the lower laryngeal nerves or recurrent nerves, which are precisely and meticulously located during the operation.
 Therefore a subsequent voice change may occur, usually transient in 10-15% of cases, or more permanent in 1% of cases.

Recovery of a normal voice usually occurs within two to six months of surgery.

In the event of persistent dysphonia, speech therapy may be necessary.

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