Thyroid and parathyroid surgery

The thyroid is a butterfly-shaped gland at the front of the neck that sets the pace of the body’s metabolism. The four small parathyroid glands behind it regulate the calcium in the blood. Surgery on these glands is delicate work in a crowded space, and it is one of the three main areas of Prof. Hafız’s practice.

What it is

Thyroid surgery (thyroidectomy) removes one lobe of the gland (hemithyroidectomy) or the whole gland (total thyroidectomy). It is done for nodules that are cancerous or suspicious, for thyroid cancer, for a gland that has grown large enough to press on the windpipe or gullet, and sometimes for an overactive gland that does not respond to other treatment. Parathyroid surgery (parathyroidectomy) removes one or more parathyroid glands that have become overactive and are raising the calcium level in the blood (hyperparathyroidism), which can affect the bones, the kidneys and general wellbeing.

Who it is for

Adults whose endocrinologist or physician has recommended an operation after ultrasound, blood tests and, where needed, a needle biopsy of a nodule; people with a confirmed thyroid cancer; and people with an overactive parathyroid gland that has been located on imaging.

Symptoms and diagnosis

Many thyroid nodules cause no symptoms and are found on an ultrasound done for another reason. A visible swelling in the neck, a feeling of pressure, difficulty swallowing, hoarseness or a change in the voice should be examined. Diagnosis involves ultrasound of the neck, blood tests of thyroid function and often a fine-needle aspiration biopsy, in which cells are taken from a nodule with a thin needle and examined under the microscope. For parathyroid disease, blood tests show the raised calcium and parathyroid hormone levels, and ultrasound or a nuclear medicine scan helps to find the overactive gland before surgery.

How the operation is done

The operation is performed under general anaesthesia through an incision low in the front of the neck, placed in a skin crease. The gland is freed from the surrounding tissue with great care for the two structures that matter most: the recurrent laryngeal nerves, which move the vocal cords, and the parathyroid glands, which must be preserved with their blood supply when the thyroid is removed. During the operation the nerves are identified and their function is checked with intraoperative nerve monitoring, a technique in which a small electrode records the response of the vocal cord muscles. When cancer has spread to the lymph nodes of the neck, the nodes in the central or lateral neck are removed in the same operation. The tissue is examined by a pathologist, and the report determines whether further treatment such as radioactive iodine is needed.

Recovery

Most people stay in hospital for one night and go home the next day. The throat is sore for a few days, and the voice can tire easily at first. Calcium levels are checked after a total thyroidectomy, and a short course of calcium tablets is sometimes needed while the parathyroid glands recover. Normal activities resume within one to two weeks. Thyroid hormone tablets are started after a total thyroidectomy and adjusted with blood tests over the following months.

How Prof. Hafız works

Thyroid and parathyroid surgery and recurrent laryngeal nerve monitoring are two of the focus areas Prof. Hafız lists for his practice, alongside head and neck cancer surgery. He has contributed a chapter on laryngeal nerve injury to a Turkish textbook on the thyroid, and he has been a professor of otorhinolaryngology at Istanbul University since 2006. Before the operation he explains what will be removed, what will be preserved and what the pathology report may mean for the next steps.