What actually happens when a patient undergoes thyroid surgery?

In preparation for the operation, the patient lies back on the operating table, and a rolled-up sheet or an inflatable pillow is positioned under the shoulders so that the neck and head are tilted backwards. This helps to provide the surgeon with optimal exposure to the thyroid gland and other structures in the neck. The patient is then placed under general anesthesia by the anesthesiologist or anesthetist. When the patient is has gone to sleep, the skin overlying the neck is carefully cleaned with antiseptic solutions, and sterile towels are draped around the neck to maintain a field that limits exposure to infection.

After the neck has been cleaned and draped, a horizontal incision is made through the skin along the front of the neck. The length of this incision may vary depending on the size of the thyroid and the amount of work that needs to be done to explore other structures in the neck. If a neck dissection is planned, the incision is continued in a vertical direction along the side of the neck up to the level of the jaw. After the incision is made, the skin is retracted so that the muscles that run along the front of the neck are made visible. A vertical incision is then made through a layer of tissue called fascia to expose the thyroid gland.

When the thyroid is located, the muscles that run along the front of the neck are retracted outward to provide access to the edges of a lobe of the thyroid. If the lobe of the thyroid is very large, the muscles may be cut in the middle to provide a greater degree of access. If cancer has extended beyond the thyroid and spread into the muscles, the involved portions may be cut away and removed along with the cancer. The lobe of the thyroid is then pulled towards the midline of the neck while the edges are carefully separated from the larynx and the large blood vessels that travel through the neck. Great care is taken to avoid any damage to the recurrent laryngeal nerve and parathyroid glands located beneath each lobe of the thyroid. As the lobe is separated, small blood vessels leading to the thyroid are isolated and tied or cauterized to prevent bleeding. When a lobe has been fully mobilized, it is cut away from a ligament that attaches it to the trachea and is removed and sent for pathologic examination.

Throughout the course of the operation, the surgeon explores exposed areas, looking for any lymph nodes that look or feel suspicious for possible involvement with cancer. If lymph nodes are located, they may be removed and sent for pathologic examination.

When the operation is completed, the incision is closed with stitches. If there is concern about possible bleeding into the operation site, a drain may left in place. This usually consists of a tube that passes through the incision, connecting to a small suction device. Drains are usually removed within a few days.

After the patient wakes up from anesthesia, careful monitoring is instituted to evaluate the strength of the voice and the calcium balance in the body. In uncomplicated cases, the patient is usually able to go home the next day.

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