General Surgery Department
Chief Physician

Thyroid Nodules Surgery

Professor MD MD hc Guido Schumacher

Chief Physician

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Statistics 2017
  • 2762 patient admission
  • 22 physicians
  • 75 medical staff
  • 56 surgery on thyroid gland
  • 41 operations on esophagus
  • 18 partial gastric resections
  • 76 resections of the small intestine
  • 305 partial resections of the colon
  • 416 operations on the intestine
  • 311 appendectomy
  • 352 operations on rectum
  • 85 operations on liver

Thyroid Nodules Surgery

Thyroid body produces hormones that regulate metabolism, growth of separate cells, bone tissues and body in general.

Volume of thyroid body is about 18 cubic cm in women, and 25 cubic cm in men, and weighs about 12-25 grams. It’s located in the neck between larynx and trachea, under thyroid cartilage, and its shape reminds of a butterfly.

If a person has diseases of thyroid body, some life-threatening conditions can develop. Therefore, if you suspect you have disorders of thyroid body, you should visit an endocrinologist.

Symptoms of thyroid conditions in case of excess of thyroid hormones

  • hyperexcitability, emotional instability, irritability, anxiety, easy crying, sleep disorders, hyperactivity, constant weakness and easy fatigue;
  • irritability because of excessive thyroid hormones;
  • fast weight loss with high appetite;
  • poor resistance to heat, high perspiration, constant tremor of arms and body;
  • constant tachycardia even during sleep and rest, high arterial pressure with difference between sistolic and diastolic pressure more than 40 millimeters of mercury;
  • frequent stool, diarrhea;
  • disorders of menstrual period;
  • menostasia and infertility in women;
  • potency disorders in men;
  • loss of glucose tolerance or even development of secondary diabetes;
  • eye symptoms: exophtalm (eye protrusion), swelling of eyelids, irritation of eyes, constant tear shedding, disorders of vision;
  • brittleness of the nails, loss of hair.

Symptoms of thyroid conditions in case of deficiency of thyroid hormones

  • depression and apathy, sleepiness, weakness, easy fatigue, easy crying, sleep disorders, poor memory and problems with concentration and attention;
  • poor resistance to cols;
  • muscle weakness, arthralgia, paresthesia;
  • skin dryness and hyper keratosis in the area of knees, feet and elbows, brittleness of nails and hair loss;
  • swelling of face, feet and hands that’s pretty thick, while diuretic agents only affect water-salt metabolism;
  • disorders in fat metabolism which leads to a high cholesterol level and development of atherosclerosis;
  • low appetite, weight gain, but a person cannot get rid of extra kilograms;
  • disorders in blood production – anemia;
  • low heartbeat rate, stenocardia, arrhythmia, breathlessness;
  • excessive gas production and constipations;
  • disorders of menstrual period;
  • menostasia and infertility in women;
  • during climax, women can have vaginal bleeding.

Diagnostics of thyroid conditions and diseases

Since there are many symptoms of thyroid diseases and conditions, it’s hard to reveal the beginning of disease.

For example, usual premenstrual tension can appear to be a serious complication that’s connected with incorrect hormonal production in women, however, hormonal changes are ignored, and diseases continues progressing.

To diagnose diseases of thyroid body, doctors perform analyses for values T3, T4, TTG and autoimmune process. Besides, the organ itself is checked with the help of instruments and apparatus – ultrasound and MRI examinations are performed.

Treatment of thyroid body

In order to cure thyroid body, immune system should be restored. Some time ago, there were two major approaches to treatment of thyroid body:

  1. treatment with medications, as a rule, hormonal drugs. The risk of recurrence after medication treatment is 75%. Besides, when a person goes through treatment with hormonal medications, there can be irreversible disorders in cardio-vascular, nervous, gastrointestinal and reproductive systems.
  2. partial or full removal of thyroid body with a scalpel or laser, or ray treatment of thyroid body with radioactive iodine, which leads to atrophy of thyroid body. It does not eliminate disorders in functioning of immune system, which can lead to endocrine- gynecological disorders of reproductive organs after operation: endometriosis, myoma of womb, cystic ovary, mastopathy.

These approaches to thyroid body treatment only help to relieve patient’s symptoms and painful sensations. For instance, an operation allows removing nodes on thyroid body, while use of hormonal medications helps to normalize hormonal level.

However, the reason of disease – disorders of immune system – is not cured, which can lead to recurrence of conditions and development of some other diseases.

Indications for surgical treatment

Surgery is used to treat the following problems of thyroid body:

  • Cancer of thyroid body or suspected thyroid cancer with nodular goiter.
  • Benign formations that complicate breathing or swallowing.
  • Reoccurrence of cyst formations.
  • Absence of effect after hyperthyroid treatment with medications and radioactive iodine.

Surgery is rarely used to treat hyperthyroid – only in cases when the increased size of nodular goiter complicates swallowing or breathing. Surgery may also be used in case when a patient cannot use antithyroid medications.

Thyroid body can be partially or fully removed depending on the cause of surgery.

  • Full thyroidectomy. During the procedure, a surgeon removes the entire thyroid body and lymph nodes surrounding it. Additional treatment – suppressive therapy and radioactive iodine – are recommended after full thyroidectomy.
  • Lobectomy of thyroid body – removal of one section of thyroid body. Isthmectomy – cutting of isthmus of thyroid gland that connects these two sections.
  • Subtotal thyroidectomy. The surgeon removes one section, isthmus and a part of another section. This method is used for hyperthyroid caused by Graves disease (exophthalmic goiter).
  • Endoscopic thyroidectomy. This type of surgery is used to remove small cysts and single node formations. When performing endoscopic thyroidectomy, a surgeon makes a few small cuts through which he injects a camera and instruments.

The success of thyroidectomy depends on the type of cancer and metastases. Patient may need further treatment in order to prevent cancer reoccurrence.

Preparation for surgery

When a patient was consulted by a surgeon and an endocrinologist and recommended surgical treatment, it’s necessary to choose an optimal date for operation. It doesn’t matter during which season the operation is performed. Some say that patients shouldn’t go through operation during summertime, but, in fact, it can be performed anytime without risks.

There’s no special preparation needed for thyroid body operations, the only requirement is absence of acute and chronic diseases. Upon coming to the clinic, a person goes through analyses (clinical blood analysis, biochemical analysis, urine analysis, blood group, coagulogram, X-ray of chest and, sometimes – additional analyses). After getting the results of analyses, a patient should be examined by his general practitioner and anesthesiologist.

It’s important to get surgeon’s recommendations – he will answer all patient’s questions. Before the operation, ultrasound of thyroid body should be made.

Course of operation

Operations on thyroid body are performed under anesthesia (patient stays asleep and doesn’t feel pain). Some patients ask about local anesthesia for the operation, but, in fact, modern general anesthesia is pretty safe.

Duration of operation depends on the scope of surgical invasion. Average duration of operation is 60-100 minutes, although there can be longer operations, for instance, in case of lymph node damage, operation can last up to 3-4 hours.

Post-surgery period

After the operation, patient is taken to his ward. During the day after operation, it’s not recommended to stand up. If drainage has been installed, it will be removed the next day in bandaging room. While patient stays in clinic, daily bandages are made.

Average time spent in clinic is usually 2-3 days. After that, a patient can go home. Before that, it’s obligatory to consult with the doctor to discuss further treatment options.

Complications after thyroid body surgeries

Specific complications after thyroid surgery are damage of recurrent laryngeal nerves and hypoparathyroid gland disease. There are two recurrent laryngeal nerves – left and right. They lie behind thyroid body and go through throat joints to vocal cords. The main function of these nerves is sustaining of voice and ability to speak. The risk of nerve damage is less than 1%, if a patient is treated in special clinics. When treated in general surgical departments, a person has a higher risk of damage – from 5% to 13%. Right after the surgery, a person can experience changes in voice, but it’s a temporary condition. The risk of hypoparathyroid gland disease development is less than 1%. hypoparathyroid gland disease is characterized by lack of calcium in body – a patient can experience chillbumps in different body parts – face, legs, arms.

Post-surgery period

After thyroid operation, people can live normally, but replacement therapy and long-term rehabilitation are required. There’s one drawback – after the operation, a patient will need to use thyroxin medication till the end of his life. This is an analogue of thyroid hormone. It’s crucial to figure out the right dosage according to patient’s health condition and peculiarities.

The level of hormone is controlled once a month, and dosage is corrected annually. If surgical invasion took place before cancer, patient will also be administered radioactive iodine. It helps to prevent reoccurence and metastases.

After thyroid body removal, patients experience the following:

  • voice disorders;
  • weakness;
  • hypocalcemia;
  • pain in throat;
  • discomfort in the back part of neck;
  • swelling in the area of cut.

In most cases, if operation was successful, these symptoms will subside in 3 weeks. Only a small scar will be left.

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