ENDOCRINE CARE

Thyroid

Investigation and management of thyroid nodules

Thyroid nodules are small lumps that develop in the thyroid. The lumps can be either solid or filled with fluid. In most cases, thyroid nodules are harmless, and don't cause any symptoms. It is possible, however, for the nodules to grow large, making it difficult to swallow and breathe, which may make surgery necessary. A small percentage of nodules, however, may be cancerous and will also require surgical and other treatment. When assessing a nodule, Dr Roodt will perform a thorough physical examination, as well as tests to check the function of the thyroid. These tests may include blood tests, ultrasound, biopsy and a thyroid scan.

Thyroid lobectomy

A thyroid lobectomy is a procedure that involves the surgical removal of parts of the thyroid. Dr Roodt may recommend the surgery in cases of thyroid cancer or where the nature of a thyroid nodule is worrisome. During the procedure, Dr Roodt will make an incision at the base of the neck, through which she is able to access the thyroid. The affected side of the thyroid are then carefully removed, while areas of healthy thyroid tissue are left intact.

Total thyroidectomy

A total thyroidectomy is a procedure that involves the surgical removal of the entire thyroid. This may be performed for large multi-nodular goitres with compressive symptoms or in the case of thyroid cancer. In some cases, the lymph nodes in the neck are also removed. After the surgery, Dr Roodt may recommend thyroid hormone therapy, which works to supply your body with missing hormones and to suppress the production of thyroid-stimulating hormone from your pituitary gland. Dr Roodt will work closely with you to find the correct dosage of these medications, depending on your specific needs. In the case of thyroid cancer, Dr Roodt will work closely with an oncologist and nuclear medicine specialist to plan additional treatment you may require.

How long does a thyroid lobectomy take?
Dr Roodt typically performs a thyroid lobectomy in between one and two hours, depending on the type of surgery that is required. This is determined by the size of the thyroid gland, previous neck surgeries and the pathology.
How long does it take to recover from a thyroid lobectomy?
Dr Roodt will discuss not doing any heavy lifting or activities that strain the neck for three weeks post-surgery. It takes approximately two weeks to heal from thyroid lobectomy surgery.
How long does a total thyroidectomy take?
Like a thyroid lobectomy, Dr Roodt takes between two and three hours to complete a total thyroidectomy. Again, this is very much dependent on the complexity of the surgery required.
What are the main complications of a total thyroidectomy
All possible complications will be discussed with you in-depth before your operation. The most common complications of total thyroidectomy are:
  • Hypocalcaemia due to parathyroid injury – Dr Roodt always attempts to avoid this by identifying the 4 parathyroid glands if possible before removal of the thyroid
  • Recurrent laryngeal nerve injury – Dr Roodt uses an intra-operative nerve monitor during surgery to avoid injury to the nerve
  • Bleeding – if concerned about bleeding, Dr Roodt may place a small drain in the wound that is removed after 24 hours.
What does total thyroidectomy recovery entail?
Dr Roodt will give you a list of what you can and cannot do after removing your thyroid. She will recommend consuming icy items such as ice cream and soft foods like scrambled eggs as patients often experience a sore throat post-operatively. Recovery takes approximately two weeks. It will be very important for you to start taking your prescribed thyroid replacement medication and your thyroid levels will be checked after 2-4 weeks to make sure that the dose is adequate.
How do I prepare for thyroid surgery?
Dr Liana Roodt has created a comprehensive document that discusses all you need to know before having thyroid surgery. You can find this document by clicking: https://capebreastsurgeon.co.za/storage/2020/05/pre-operative-information-thyroid-and-parathyroid-surgery.pdf