Thyroid nodules are very common. These small tumors form within the thyroid gland. Benign most of the time, they can grow, form a goiter or degenerate into cancer (about 10% of the nodules). As the thyroid increases in size, it can compress the recurrent nerves that control the vocal cords, resulting in impaired voice. Other signs give the alert (discomfort when swallowing or breathing, persistent cough …).
In which cases is a thyroidectomy performed?
Surgical intervention is considered when the symptoms are too severe and, above all, thehen the nodules turn out to be suspicious, cancerous or toxic. Ultrasound and the analysis of punctured cells can classify these tumors according to their size and degree of danger. Depending on the result, the medical team chooses:
- remove the entire thyroid (total thyroidectomy);
- remove part of it (partial thyroidectomy);
- or, simply, place the patient under surveillance.
“In the majority of cases, we can give ourselves time to see how the disease evolves”, specifies Dr Camila Nascimento, endocrinologist.
A sensitive area at the base of the neck
As a reminder, the thyroid has two lobes which give it its butterfly shape. The hormones that it secretes play, from the fetal stage, an essential role in the development of the brain and, throughout life, in the control of the metabolism.
When the gland has been completely removed, the body no longer receives thyroid hormones, which are essential for the proper functioning of the metabolism (regulation of body temperature, cholesterol, weight, etc.).
The patient must then take, for life, hormone replacement therapy with levothyroxine. A situation which is not always easy to accept, as the “Levothyrox affair” has left its mark. In 2017, thousands of people reported side effects after changing the formula of this drug, which was, at the time, the only solution available in France.
“Many patients who have to undergo thyroid surgery are worried about taking levothyroxine. However, today we have several options, with different formulations, assures Dr. Nascimento. If the patient does not tolerate it. not one of them, he can try another. We live perfectly well with this treatment. “
“We must reassure patients: they will not necessarily gain weight, insists on Dr Nascimento. Women often worry about it. In the event of weight gain or, on the contrary, loss of weight, it is quite possible. to adjust the dosage. “
The drug should be taken in the morning on an empty stomach, 20 to 30 minutes before breakfast, because food decreases the absorption of the active ingredient. For the follow-up of the patient, “there is no established rule”, according to the endocrinologist. A blood test for TSH (a hormone whose level indicates the functioning of the thyroid) is usually sufficient once or twice a year and in case of symptoms.
The dosage of treatment is adjusted according to the situation. For example, it may be increased if you are pregnant or are taking another medicine that may affect the absorption of levothyroxine.
What are the risks of having a thyroidectomy?
Surgery involves certain risks, fortunately very rares. The scalpel can affect recurrent nerves near the thyroid. “The risk of injury, with damage to the vocal cords, is very low, says Dr. Nascimento. Today, neuromonitoring is available in virtually all specialist services. It allows monitoring of the nerve during the operation. If the response to stimulation is less good, the surgeon withdraws from the risk area. “
Another difficulty: the proximity of the parathyroids. Located behind the thyroid, these four small glands regulate the level of calcium in the blood. In some situations, the surgeon must remove them in whole or in part. In most cases, the consequences for the patient remain limited. “Calcium and vitamin D supplementation is frequently given after the procedure. The calcium level is then reassessed. In general, if there is a calcium deficit, it is transient and the treatment can be stopped”, assures the endocrinologist.
In the very rare cases where the deficit is permanent, the treatment is given for life and the calcium level monitored regularly.
Three things to know before the operation
1. The thyroid is removed under General anaesthesia.
2. Hospitalization lasts two or three days for a total thyroidectomy. In some hospitals, treatment can be outpatient, during the day, for partial ablation.
3. The incision is made at the base of the neck, but some medical teams first offer other routes (under the armpit or behind the ear), for aesthetic reasons.