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Surgery for Hyperthyroidism

Are You a Candidate for a Thyroidectomy?

Surgery is a treatment option for hyperthyroidism, but it's not as commonly used as antithyroid medications or radioactive iodine. Thyroid surgery is known as a thyroidectomy and involves the partial or total removal of the thyroid gland.

For some types of hyperthyroidism, such as from a solitary toxic adenoma, surgery entails partial removal of the half of your thyroid gland (known as a lobectomy) with the adenoma. For nearly all other types of hyperthyroidism, including Graves' disease, the surgery is a nearly total thyroidectomy.

A thyroidectomy takes several hours to perform and is generally a surgery with a very short recovery time and little, if any, discomfort. A small incision is made in the front of your neck, and it is performed under general anesthetic.

You will be able to function properly (eat, talk, and walk) immediately after surgery. You will likely need to stay in the hospital overnight, but some surgeons release patients with partial thyroidectomies a few hours after the operation.

When Surgery Is Appropriate
A total thyroidectomy is the only option that gives an immediate cure of hyperthyroidism. Although a thyroidectomy is not the most commonly used method to treat hyperthyroidism, there are some cases when it is the most appropriate option.

Some people are allergic to antithyroid medications, and a small percentage of people are resistant to radioactive iodine. But even if you can physically tolerate radioactive iodine or medications, you may refuse the treatment if you're not comfortable with it. Your preferences matter in what treatment route you take.

Another case where surgery is a viable option is if the hyperthyroidism was caused by a hot nodule. A hot nodule (also known as a toxic nodule) refers to a nodule that produces excess thyroid hormone because it doesn't obey the pituitary's signals to stop producing thyroid hormone. This can result in hyperthyroidism. Depending on the location of the nodule, the surgeon can remove the lobe that contains the hot nodule. This leaves part of your thyroid intact, which will usually be enough to supply your body with healthy amounts of hormones.

A total thyroidectomy is also advisable when hyperthyroidism occurs in the setting where the thyroid gland is very large, has nodules that may be concerning for a cancer, or when significant eye changes (ophthalmopathy) exist with Graves' disease.

thyroidectomy Some types of hyperthyroidism will lead to half of your thyroid being removed, this is known as a lobectomy. (Photo:123rf)

What to Know Before Surgery
In many cases—especially if you have severe hyperthyroidism—you will need to manage your condition before surgery. If you don't, you may risk certain heart problems and a dangerous release of thyroid hormone into the bloodstream.

To control your hyperthyroidism before surgery, your doctor may prescribe antithyroid medications or beta blockers. Another option is to use elemental (non-radioactive) iodine the week before surgery. Elemental iodine is a very temporary solution to hyperthyroidism. You shouldn't begin taking it until one week before surgery; if you start earlier, your hyperthyroidism could return right before your surgery—and it could actually be worse than before.

Thyroidectomy Risks
As with any surgical operation, a thyroidectomy poses certain risks and complications that you should understand before pursuing this treatment. When performed by experienced surgeons, these risks are very rare (<2%) and make the rate of adverse side effects from surgery similar to adverse side effects from medications and radioactive iodine. You should consult with your physicians about finding an experienced thyroid surgeon.

There is a very small risk of damaging the structures around the thyroid gland. One such structure is the voice box nerve (known as the recurrent laryngeal nerve). If that nerve is damaged, your voice may permanently sound hoarse or scratchy.

The parathyroid glands are also located near the thyroid gland, and so they too are at a small risk of injury. The parathyroid glands regulate the body's calcium levels. If they are damaged by the thyroidectomy, then hypoparathyroidism can occur. This may eventually trigger hypocalcemia (a condition of abnormally low levels of blood calcium). Even when parathyroids are working normally after your surgery, your body may be more prone to a temporary period of hypocalcemia that responds well to oral calcium supplements and fully recovers. This occurs because hyperthyroidism can deplete the body of its calcium stores before surgery, and it takes some time to replenish this after surgery.

Infection and bleeding are exceedingly rare complications of thyroid surgery.

Another issue to recognize about thyroidectomy is that it causes hypothyroidism. This more often occurs when the entire thyroid is removed, but it can still happen when only part of the thyroid is removed.

To compensate for the lack of thyroid hormones, you will take thyroid hormone replacement therapy . There are much safer long-term treatments available for hypothyroidism than for hyperthyroidism. Though thyroid hormone replacement therapy is for life, it is safe, effective, and affordable.

Though surgery is not the most common method for treating hyperthyroidism, you may be a good candidate based on the specific cause of your condition and your preferences. Talk to your doctor about the benefits and risks of having a thyroidectomy, and don't be afraid to ask questions—they will help you and your doctor determine the best treatment option for you.