Endocrine surgery can help when the thyroid grows and compresses different structures leading to problems with breathing, swallowing, or voice changes. It is also useful if we find a nodule and need to know whether it is malignant and, if so, treat it, or when there is increased thyroid hormone production causing symptoms not definitively controlled by other treatments. Each patient will undergo surgery appropriate to their diagnosis, general condition and preference, but always in line with European clinical practice guidelines.

There are three possible complications following thyroidectomy, these are voice abnormalities, bleeding and a drop in calcium levels. The first breakthrough useful in the prevention of these were magnifying loupes, enabling careful dissection through very small incisions.
 
In addition, operating theatres are specially equipped with a neuromonitor to confirm the function of the recurrent laryngeal nerves at all times. These nerves carry signals to the vocal cords which, when moving correctly, guarantee a normal voice.
 
To prevent bleeding, forceps with a thermoseal system are used as well as a haemostatic dressings, making a drain unnecessary in the majority of cases.
 
Lastly, we monitor calcium and PTH levels in the immediate postoperative period to enable early detection of a drop in calcium if this occurs, this prevents symptoms which could become significant if not picked up at that time.

The length of surgery depends on the complexity of the procedure. When excision of half the thyroid is necessary, surgery lasts approximately 30-60 minutes, and for the entire thyroid from 90-120 minutes. When we operate on thyroid cancer, we frequently have to excise lymph nodes in the neck region which often requires 2-3 hours, although in particular cases, surgery may require up to 7 hours in operating theatre.

If the operation is to remove half the thyroid, normally one night in hospital is sufficient. If the whole thyroid is removed, it will depend on the calcium and PTH (calcium hormone) levels 24 hours after surgery, these will determine whether discharge is safe at that time. 50% of patients will be able to go home early, the remainder will stay for another day until it is confirmed that levels have stabilised correctly with oral supplements.

After excision of the whole thyroid, and in a quarter of cases after removal of half the gland, hormone replacement therapy with the thyroid hormone will be necessary. Each patient will require a different dose, adjusted according to blood results. When adjusted appropriately, there is no reason for weight gain after thyroid surgery.

The 4 parathyroid glands, responsible for calcium metabolism, are situated behind the thyroid, their blood supply comes from the same vessels that supply the thyroid. When the entire thyroid is removed, it is not uncommon for parathyroid function to be altered and calcium supplements required, but this is usually temporary and 98% of patients do not require long-term treatment. When only half the thyroid is removed, there is no reason for problems with calcium levels.

The great majority of thyroid cancers are papillary or follicular and have an excellent prognosis. They have around a 90% cure rate following appropriate surgery in expert hands. In some cases which involve neighbouring structures, metastasis, or even tumours requiring more aggressive excisions, more complex surgery will be required, but always with the aim of a cure.

After surgery a definitive histological analysis of the surgical specimen will be performed. After analysis, the type of tumour, extension and whether there are any signs of poor prognosis will be evaluated. In some specific cases it may be necessary to use radioiodine to reinforce surgery and prevent future recurrence.