Thyroid surgery is a common operation, but understandably many people worry about their voice afterwards. In this video, ENT surgeon Dr John Charles Hodge explains the types of thyroidectomy, what recovery looks like, and the possible effects on your voice and calcium levels.
What is a thyroidectomy?
A thyroidectomy is an operation to remove part or all of the thyroid, a horseshoe-shaped gland in the lower neck that produces thyroxine, the hormone Dr Hodge describes as your get up and go juice.
Key points from the video
- Three types of operation. The surgeon can remove the middle part of the thyroid (the isthmus), one half (a lobe), or the whole gland.
- It is defined by protecting the voice nerves. Thyroid surgery centres on preserving the nerves to the voice box, which is why surgeons remove a whole lobe rather than part of one.
- Hospital stay and recovery. Dr Hodge usually keeps patients in overnight, sometimes longer for a total thyroidectomy, and uses a drain. The neck is often bruised and tender, settling over about a week.
- Voice outcomes. Around 1% of patients have a poor voice outcome from nerve damage. A vocal cord filler injection can help while the nerve recovers, and implants are an option if the damage is permanent. About 4 to 5% notice subtle changes such as vocal fatigue or loss of range, which usually improve over time.
- Calcium levels. When the whole thyroid is removed, the four small parathyroid glands that control calcium can be affected. If they are damaged or removed, calcium can drop dangerously low and may need temporary or lifelong replacement.
Video transcript
Hi, I’m John Charles. I’m an ear, nose and throat doctor, and I’m going to talk to you today about a thyroidectomy. That’s an operation to remove part of your thyroid, which is a gland that secretes a hormone that gives you your get up and go juice, or thyroxine. It sits like a horseshoe-shaped organ in the lower part of the neck.
I won’t talk about the indications, but there are only really three operations you can do on the thyroid. You can take the middle part out, which is the isthmus. You can take half of the thyroid out, or you can take all of it out. The reason for that is that thyroid surgery is really defined by the preservation of the nerves to the voice box, and the only way you can really protect those is to take the entire lobe out.
With regards to complications and the consequences of surgery, I take care of patients overnight, sometimes longer if they’re having all of the thyroid out. Some people would let you go home as a day case. I tend to use a drain to collect blood that otherwise would collect in the wound. I’ve never regretted doing that, and I think it’s well tolerated. There might be a bit of numbness around the wound. It’s fairly sore. From an operative point of view, most people feel tenderised, quite bruised in that area, and that settles down over a week or so.
The key really is the voice. Probably 1% of patients who undergo a thyroidectomy will have a poor voice outcome. Now, there are things you can do to strengthen the voice. What happens is you need two vocal cords to come together cleanly to generate a nice voice. If you damage the nerve, one of the vocal cords stays out. That means you end up with a very breathy, weak voice and a poor cough, and you don’t swallow quite as well.
So I can inject a filler, a bit like a lip filler, and you can push that vocal cord across as a temporising measure, because the nerve can be damaged either temporarily or permanently. If it’s more permanent, there are other things you can do, implants for example, which are obviously a permanent solution.
So everyone worries about the recurrent laryngeal nerve and the 1% poor voice outcome, but actually less severe voice outcomes are more common. I think about four to 5% of patients will get subtle changes to the voice. Most don’t realise, but professional voice users will notice. It might be some subtle vocal fatigue, or a loss of range or pitch, and mostly that’s because you’re disrupting the muscles in the neck and stitching them together. It generally gets better over time, or may need some speech therapy.
Now, if you take out both lobes of the thyroid, so the whole of the thyroid, another issue comes into play, and that’s your calcium levels. There are four little glands called parathyroids, which are either buried in the thyroid or around it in certain positions. They can vary a bit. You only need one of them, and what it does is maintain your calcium levels. If you do a total thyroidectomy and damage all four of the glands, whether by unintentionally affecting their blood supply or because they’re removed as part of the thyroidectomy, your calcium levels can drop dangerously low, and that may need lifelong or temporary replacement.
Hopefully that demystifies a thyroidectomy for you. Thank you.
Talk to Dr Hodge about thyroid surgery
If you’ve been told you may need a thyroidectomy and would like to discuss your options, book an appointment or get in touch with the rooms.
This information is general in nature and is not a substitute for personalised medical advice. Please speak with your GP or specialist about your individual situation.