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For many people minimally invasive thyroid surgery is not an option. This may be the case when the amount of tissue to be removed is too large, if the surgery is likely to be complex, or if the surgeon does not perform this type of procedure. When this happens, traditional thyroid surgery will be done.
In the traditional approach, thyroid surgery is performed through an approximately 2 to 8 cm incision (cut) in the skin of the lower part of the neck. The skin and muscle are pulled back to expose the thyroid gland. The incision is usually made so that it falls in the fold of the skin in the neck, making it less visible.
Blood supply to the gland is "tied off" (stopped) and the surgeon then removes all or part of the gland.
During the operation, the surgeon will take great care to identify and avoid damaging the nerves to the voice box or vocal cords that are found just behind the thyroid gland. Injuring these nerves can severely affect the ability to speak, swallow, or breathe. Use of a NIM™ nerve integrity monitoring system from Medtronic may help the surgeon identify these nerves, monitor them, and confirm they have not been damaged during surgery.1,2
The surgeon will also take care to identify and preserve the four small parathyroid glands, which lie next to the thyroid gland. These four very small glands produce a hormone called parathormone, which controls calcium levels in the blood.
The principal benefit of thyroid surgery is that it should relieve some or all of the symptoms that a person may have been experiencing.
The doctor should be asked for a detailed explanation of the benefits and risks of the surgery, as well as their experience performing this kind of procedure. As with all surgery, there are some possible complications that may occur during or following thyroid surgery.
There will be a scar, which usually will fade to a fine line that will look like a crease in the neck. But there is a risk that the scar will not heal as well as hoped and may be broader and/or more raised than expected. There may also be a loss of sensation in the area of skin that was folded back during surgery in order for the surgeon to view the thyroid clearly.
Depending on how much of the thyroid gland is removed, it is likely that a patient will need some form of thyroid hormone-replacement therapy after surgery.
The parathyroid glands, which are located very close to the thyroid gland, control the body's calcium levels. If the parathyroid glands are damaged during surgery, this can cause temporary or (rarely) permanent shutdown. This results in a lowered calcium level, called hypocalcemia. Temporary hypoparathyroidism affects about 7% of people. Symptoms of hypoparathyroidism, which usually appear in the first few days after surgery and last for about a week, may include:
These symptoms are treated with calcium tablets.
The nerves that control the voice (laryngeal nerves) pass very close to the thyroid. There is a risk that they may be damaged during surgery. This is estimated to happen in about 1 out of every 250 thyroid surgeries.3 This damage is likely to be temporary and can cause changes to the voice such as:
Usually, permanent changes are rare, and the voice will return to normal within a few weeks.
As with all surgery, there is a risk of bleeding after the operation, as well as some risk from anaesthesia and possible infection. The doctor should be asked about potential complications from the procedure.
ANZ Thyroid IONM Consensus Statement. ANZ J Surg 84 (2014) 603–605.
Flukes S et al. Intraoperative Nerve Monitoring in Otolaryngology: A Survey of Clinical Practice Patterns International Journal of Otolaryngology and Head & Neck Surgery, 2013, 2, 21-26.
Thomusch O, Sekulla C, Walls G. Intraoperative neuromonitoring of surgery for benign goiter. Am J Surg. 2002 Jun;183(6):673-8.