What is the thyroid?
The thyroid is a gland located in the lower front of the neck. It produces hormones (called thyroid hormones) that are important for:
- energy
- body temperature control
- digestion
- body weight
- mood
- growth
The thyroid can be affected by the immune system. The immune system makes proteins called antibodies that affect the thyroid. This can cause the thyroid to either slow down (hypothyroidism) or, in rare cases, to become overactive (hyperthyroidism).
What is a thyroidectomy?
A thyroidectomy is the surgical removal of all or part of the thyroid gland.
Why does my child need a thyroidectomy?
Your child may need a thyroidectomy to treat the following conditions:
- thyroid cancer
- thyroid nodules
- hyperthyroidism (Graves' disease)
- enlarged thyroid (goitre)
Depending on the condition, your child may need the entire thyroid gland removed (total thyroidectomy) or only half of the gland removed (thyroid lobectomy).
What are the risks of a thyroidectomy?
A thyroidectomy is a safe procedure. However, there are some rare complications, including:
- injury to the parathyroid glands, causing low calcium levels, which may require a child to take medications either temporarily or for the rest of their life
- injury to the recurrent laryngeal nerve, which can affect a child’s breathing, swallowing and the quality of their voice
- injury to the trachea (windpipe)
- bleeding
- infection
Before the surgery
Before surgery, you will meet with the Otolaryngologist (Ear, Nose and Throat (ENT) surgeon) to discuss surgery and associated risks.
The surgeon may prescribe Vitamin D or other medications to be taken once before the surgery. You will be given a prescription for this.
Your child will have a flexible scope before the surgery to check vocal cord function.
What happens during a thyroidectomy?
The surgery is performed under general anaesthesia. The surgeon makes an incision on the lower neck and removes the entire thyroid or one lobe of the thyroid. A special monitor is used to prevent injury to the nerves around the gland.
The surgeon may also put a small tube called a drain in the incision. This allows extra fluid to drain out. This tube will be removed before your child goes home. The incision will be closed with dissolvable sutures and covered with Steri-Strips.
What to expect after a thyroidectomy
Your child will need to spend a few nights in the hospital after surgery. If your child had the entire thyroid removed, the health-care team will monitor blood calcium levels carefully. Once calcium levels are normal, your child can be discharged home.
If your child feels pain, they will receive pain medicine, either through an intravenous (IV) tube in the arm or by a pill or liquid to swallow. If you think your child is in pain, tell a member of the health-care team.
Your child will probably not want to eat or drink right after the operation. They will receive liquids through the IV until they can drink.
After your child can drink, they will slowly be allowed to eat.
Following a total thyroidectomy, your child will need a prescription for levothyroxine (Synthroid or Eltroxin). This is a thyroid hormone pill that replaces the normal function of the thyroid gland and helps prevent symptoms of hypothyroidism (e.g., fatigue, constipation, feeling cold). Your child will need to take this medication once a day for the rest of their life. Do not stop giving your child levothyroxine unless advised by your child’s health-care team.
Your child may also receive a prescription for calcium, calcitriol and/or vitamin D if there were problems with low calcium levels following surgery.
You will receive a lab requisition to check your child’s blood work, which you can take to a lab close to your home. The health-care team will let you know when this blood work should be completed.
Caring for your child at home after thyroidectomy
You will be given prescriptions for pain medications. Give your child the medications as needed.
Your child should not shower or get the incision wet until the surgeon has said it is OK.
Your child should not lift heavy items or engage in vigorous activity until the surgeon has said it is OK.
Protect the incision from the sun. Once the sutures have dissolved and the Steri-Strips are off, your child should use sunscreen over the incision (as well as on the rest of their body) and wear a hat in the sun. The appearance of the incision will change over several months.
Follow-up care after thyroidectomy
You will be contacted by the surgeon’s surgical co-ordinator to book a follow-up appointment. At this appointment, your child will have a flexible scope to look at the vocal cord function again.
Your child will be seen in the Ear, Nose and Throat (ENT) Clinic approximately one month after discharge. Further follow-up is discussed at this clinic visit.
Some children who undergo thyroidectomy for thyroid cancer require additional tests and/or treatment with radioactive iodine.
If your child does not require radioactive iodine therapy, they will be seen in the endocrine clinic several weeks after discharge. Typically, children are monitored every six months with a thyroid ultrasound and blood work.
For children who require radioactive iodine scans and/or therapy
If your child’s health-care provider recommends radioactive iodine following thyroidectomy, this will typically be scheduled eight to twelve weeks following surgery.
Expect to visit the hospital multiple times for the treatment (up to three days in a row the first week and then one day the following week).
Your child will need to follow a low-iodine diet one week before starting radioactive iodine therapy and continue for two days after treatment. Your child’s endocrine nurse will give you specific instructions about this.
Your child will need to be isolated at home for one week following treatment. The Nuclear Medicine Department will contact you two to three weeks before the radioactive iodine treatment start date to review the instructions and to be sure that your child can follow these recommendations. Your child’s nurse will contact you and mail out a package with detailed instructions.
When to seek medical attention
Contact your child's health-care provider immediately or take your child to the nearest Emergency Department if they experience any of the following:
- temperature over 38.5°C beyond the initial 48 hours after surgery
- swelling that causes difficulty breathing or swallowing
- drainage or other signs of infection from the incision