What is the thyroid gland?

The thyroid gland is a butterfly-shaped organ that cradles the front and sides of the windpipe (trachea) and produces the hormone thyroxine (thyroid hormone). Thyroxine is important for controlling the body's metabolic rate, which is the rate that every cell in the body functions. It is like the accelerator of a car. It can dictate how fast or slow organs in the body actually work. Too much of it, the bodily functions accelerate out of control; too little of it, the body grinds to a halt. Therefore, a well-balanced thyroid function is essential for good health.  Following complete removal of your thyroid through total thyroidectomy, you will need to take the hormone thyroxine indefinitely. Approximately 10% of patients also require thyroxine supplementation following removal of half of the thyroid (hemithyroidectomy).

When is thyroid surgery needed?

Removal of half or all of your thyroid may be required for the following reasons:

• Your thyroid has a large nodule or nodules making it difficult to swallow or breathe especially on exertion.

• Your thyroid is overactive, and non-surgical options (medications or radioactive iodine) are ineffective or not appropriate due to medical reasons or side effects.

• Thyroid cancer is diagnosed or cannot be excluded based on findings of a biopsy, ultrasound, or other tests.

• There may be other less common reasons that A/Prof. Lee will be able to discuss with you.

What are the types of thyroid surgery?

The type of thyroid surgery recommended depends on your condition, test results and how much of the thyroid needs to be removed.

Hemithyroidectomy

A hemithyroidectomy removes one half of the thyroid gland. It may be recommended for certain thyroid nodules, an enlarged thyroid lobe or when a diagnosis cannot be confirmed from a needle biopsy alone.

Total thyroidectomy

A total thyroidectomy removes the whole thyroid gland. It may be recommended for thyroid cancer of a certain size or characteristics, Graves’ disease, a large multinodular goitre or disease affecting both sides of the thyroid. Lifelong thyroid hormone replacement is required afterwards.

Lymph node surgery

If thyroid cancer has spread - or is suspected to have spread - to lymph nodes in the neck, removal of the affected lymph nodes may be recommended at the same time as thyroid surgery.

A/Prof James Lee will discuss the most appropriate procedure with you, including its expected benefits, risks and alternatives.

What is involved with the surgery?

For most patients, thyroid surgery is performed as an “elective procedure”. This means that the date of the surgery is scheduled in advance, and you will be admitted to the hospital on the day of the surgery, having fasted for an appropriate amount of time. You will meet your anaesthetist on the day of the surgery, prior to the procedure.

The surgery is performed under general anaesthesia, with you fully asleep. The general anaesthetic is administered in the operating room, with your vital signs being monitored the entire time. The surgery usually takes 1 to 2 hours, occasionally longer, depending on the extent of the surgery and the condition being treated. You will wake up in the recovery room, with a small dressing over the incision on your neck. 

You will be moved to your ward bed approximately 1 hour after the completion of surgery, and you will be able to receive visitors at this time. You will be able to talk after surgery, and have something soft to eat once you are no longer drowsy.

Most patients are discharged the next morning. In some situations, a longer stay in hospital may be required for further observations, blood tests, or other reasons.

What to expect before and after thyroid surgery?

Before surgery, A/Prof James Lee will review your diagnosis, test results and medical history, explain the recommended procedure and answer your questions. You may require blood tests or additional imaging and will receive instructions about fasting and medications.

Thyroid surgery is performed under general anaesthesia. Most patients can eat, drink and walk soon afterwards and are discharged the following day, although this varies according to the procedure and individual circumstances. A follow-up appointment will be arranged to review your recovery and any pathology results.

Risks and recovery after thyroid surgery

Most patients can eat, drink and walk soon after surgery and are discharged the following day, although recovery varies between individuals. Temporary discomfort, neck tightness, swelling, voice changes or difficulty swallowing can occur.

Less common but important risks include bleeding, infection, injury to the nerves controlling the voice and low calcium levels caused by changes in parathyroid function. After a total thyroidectomy, lifelong thyroid hormone replacement is required; some patients may also need temporary calcium supplementation. A/Prof Lee will explain the risks relevant to your procedure.

Most patients gradually return to normal activities over the following days to weeks, guided by their symptoms and post-operative instructions. You will receive instructions about wound care, medications, activity and follow-up before leaving hospital. Read our detailed After Surgery guide for more information about recovery and when to seek medical assistance.

Why choose A/Prof James Lee for thyroid surgery?

A/Prof James Lee is a specialist endocrine surgeon with more than 15 years’ experience in thyroid, parathyroid and adrenal surgery. He treats thyroid nodules, goitre, Graves’ disease and thyroid cancer, including cases requiring total thyroidectomy or lymph-node surgery.

His clinical practice is supported by academic research, peer-reviewed publications, surgical education and multidisciplinary collaboration. A/Prof Lee provides evidence-based recommendations and personalised care before, during and after surgery.

Read more about A/Prof James Lee’s qualifications, academic appointments and clinical experience.