Thyroid Surgery Singapore

Why is the Thyroid Gland important?

The thyroid gland in front of the neck over the voice box is crucial in regulating various body metabolic functions.

The thyroid gland produces two key hormones: thyroxine (T4) and triiodothyronine (T3). These hormones are vital for regulating metabolism, controlling body temperature, and influencing the function of organs such as the heart, brain, and liver. The release of these hormones is tightly controlled by the pituitary gland, which produces thyroid-stimulating hormone (TSH).

So when thyroid disorders, such as thyroid nodules, hyperthyroidism, hypothyroidism, or thyroid cancer arise, these important organs may be affected. Surgery (known as thyroidectomy) may then be recommended to manage these conditions effectively.

What are the common Thyroid Disorders?

Dysfunction of the thyroid gland can result in the following conditions:

Hypothyroidism

• Hypothyroidism occurs when the thyroid gland fails to produce enough thyroid hormones. This can result in symptoms such as fatigue, weight gain, and sensitivity to cold.
• Autoimmune diseases like Hashimoto's thyroiditis, iodine deficiency, and certain medications have been identified as common causes of hypothyroidism.
• Treatment of hypothyroidism typically involves thyroid hormone replacement therapy.

Hyperthyroidism

• Hyperthyroidism is characterised by an overactive thyroid gland, leading to an excess of thyroid hormones. Symptoms may include weight loss, rapid heartbeat, and anxiety.
• Autoimmune diseases, like Graves' disease, have been identified as a common cause of hyperthyroidism.
• Treatment of hyperthyroidism includes medications, radioactive iodine therapy, or, in severe cases, surgery.

Thyroid nodules

• Thyroid nodules are lumps that form within the thyroid gland. While many are benign, some may be cancerous.
• Regular monitoring and, if necessary, biopsy are essential to assess the nature of the nodules.
• Treatment depends on the type and size of the nodules.

When is Thyroid Surgery necessary?

Thyroid surgery or thyroidectomy is a surgical procedure involving removing all or part of the thyroid gland. Thyroid surgery is a delicate procedure, and the goal is to achieve the best possible outcome while avoiding complications and preserving voice function.

While many thyroid conditions can be managed with medications and lifestyle changes, there are situations where thyroid surgery becomes a necessary intervention.

Thyroid surgery is usually recommended for the following conditions:

• Thyroid nodules and tumours: when thyroid nodules are detected and present a risk of being cancerous, surgery may be recommended. A fine needle biopsy can help determine the nature of the nodules, and if they are found to be malignant or pose a threat, surgical removal is often advised.
• Hyperthyroidism unresponsive to medication: in cases where hyperthyroidism persists despite medical treatment, surgery might be considered. This is often the case with conditions like Graves' disease, where an overactive thyroid produces excessive hormones, leading to symptoms such as rapid heartbeat, weight loss, and anxiety.
• Large goitres: goitres or enlarged thyroid glands can sometimes grow to a size that causes discomfort, difficulty breathing, or swallowing. Surgical intervention may be recommended to reduce the size of the goitre and alleviate these symptoms.
• Thyroid cancer: a diagnosis of thyroid cancer often necessitates surgery to remove part or all of the thyroid gland. Depending on the extent of the cancer, additional treatments, such as radioactive iodine therapy, may be recommended after surgery.
• Recurrent thyroid cysts: for individuals experiencing recurrent thyroid cysts that cause persistent discomfort or difficulty swallowing, surgery may be considered to remove the cysts and prevent their recurrence.
• Cosmetic concerns: in some cases, individuals may opt for thyroid surgery for cosmetic reasons, especially if they have a prominent thyroid or concerns about the appearance of their neck. Cosmetic thyroid surgery, also known as thyroidectomy for cosmetic reasons, is a personal choice and should be thoroughly discussed with your doctor.

Thyroid surgery is not the first line of treatment for most thyroid conditions. However, when specific indicators arise, such as the presence of cancer, unresponsive hyperthyroidism, or significant discomfort due to an enlarged thyroid, surgery becomes a viable and sometimes crucial option. 

If you're experiencing symptoms or have concerns about your thyroid health, consulting with an endocrine specialist is essential to determine the most appropriate course of action, whether it involves surgery or other forms of treatment. Your health and well-being are paramount; timely intervention can lead to effective management and recovery.

How much of my Thyroid Gland needs to be removed?

The extent of your thyroid gland that needs to be removed depends on the specific medical condition for which the surgery is performed. Thyroid surgery, also known as thyroidectomy, can involve various extents of resection ranging from a partial removal to a total removal with occasionally neck lymph node dissections in cancer cases.  

What are the different types of Thyroidectomy techniques?

1. Total endoscopic trans-axillary thyroidectomy

A minimally invasive surgical procedure to remove the thyroid gland through small incisions in the axilla (armpit), this approach is also known as "endoscopic axillary thyroidectomy" or "transaxillary thyroidectomy." 

It is considered a scarless or nearly scarless thyroidectomy because the incisions are made in areas that are not typically visible, with no scars in the neck at all. This requires careful selection based on patient factors and disease type. It has the advantages of excellent cosmetic outcomes, minimal pain, and early recovery that comes at a fraction of the cost compared to more expensive robotic procedures. 

2. Minimally invasive video-assisted thyroidectomy (MIVAT) 

It is a surgical technique used for performing thyroidectomy (removal of the thyroid gland) through a small 2.5 cm incision in the neck. The MIVAT procedure combines video-assisted technology and minimally invasive surgical techniques to access and remove the thyroid gland.

The video-assisted surgical technique markedly shortens incision length (typically around one inch vs three inches with traditional surgery). It also reduces post-operative pain and speeds up recovery time. This technique has been performed in thousands of patients worldwide with consistent, safe results comparable to the conventional technique. It does not increase operative time and incurs no increased risk compared to conventional open thyroidectomy.

3. Conventional open hemithyroidectomy 

A conventional open hemithyroidectomy is a surgical procedure in which one lobe (half) of the thyroid gland is removed through an open surgical approach. Taking a wide 4 to 6-cm skin crease neck incision to remove the abnormal thyroid gland, depending on its size. It is recommended in patients with proven thyroid cancers and large nodular goitres causing symptoms.

4. Near total thyroidectomy

A near-total thyroidectomy is a surgical procedure in which almost all of the thyroid gland is removed, leaving a very tiny amount of thyroid tissue behind to protect the voice nerves. It is mainly done for benign conditions.

5. Total thyroidectomy +/- neck lymph node dissection

Total thyroidectomy with neck lymph node dissection is a surgical procedure performed to address various thyroid disorders, most commonly thyroid cancer. This comprehensive guide provides essential information about the procedure, its indications, preparation, surgery, recovery, and potential risks.

6. Total Thyroidectomy

Total thyroidectomy is the complete removal of the thyroid gland. This procedure is recommended in cases of thyroid cancer or hyperthyroidism (Graves disease ) that is not responding to other treatments.

7. Neck lymph node dissection

Neck lymph node dissection may be performed in conjunction with a total thyroidectomy. Lymph nodes are removed to check for the presence of cancer or to prevent its spread to other parts of the body. This is particularly relevant in cases of thyroid cancer.

Total thyroidectomy with neck lymph node dissection is a crucial surgical procedure for managing thyroid disorders, especially thyroid cancer. Understanding the procedure, preparation, and recovery process is essential to make informed decisions and ensure the best possible outcomes. 

How does Thyroid Surgery work?

Thyroid surgery involves the following steps:

1. Preoperative evaluation: a comprehensive evaluation is conducted to assess the thyroid gland's condition before surgery. This may involve blood tests, imaging studies, and consultations with endocrinologists and surgeons.

2. Anaesthesia and incision: thyroid surgery is typically performed under general anaesthesia. The surgeon makes an incision in the neck to access the thyroid gland. The size and location of the incision depend on the reason for surgery.

3. Partial or total thyroidectomy: the surgeon may perform a partial thyroidectomy, removing only a portion of the thyroid, or a total thyroidectomy, removing the entire gland. The choice depends on the nature of the thyroid disorder.

4. Postoperative monitoring: after surgery, patients are monitored closely for any complications, such as bleeding or changes in voice, which can occur due to the proximity of the vocal cords to the thyroid gland.

What should I expect after Thyroid Surgery? 

Thyroid surgery is usually conducted as an inpatient procedure, and depending on the extent of the surgery, patients may spend a night or more in the hospital. Close monitoring ensures a smooth recovery.

Some pain and discomfort is to be expected after the surgery. Pain medication will be prescribed to help manage postoperative pain and reduce inflammation. While it is essential to resume light activities gradually, rest is crucial during the initial recovery period. Avoiding strenuous activities helps prevent strain on the surgical site.

Regular follow-up appointments with your surgeon will be scheduled to monitor healing, address concerns, and adjust medication if necessary.

Proper care of the incision site is vital to minimise scarring. Follow your surgeon's recommendations for wound care, and avoid sun exposure to the incision area.

Thyroid surgery is a significant step toward managing thyroid disorders, and a successful recovery depends on a combination of medical expertise and patient commitment.

At ACE Specialist Surgery and Endoscopy, our team is here to explain which procedure suits you best so that you fully understand the process and can easily follow the postoperative care guidelines. Together, we'll help ensure a smoother recovery and improved thyroid health.