Surgical therapy
Surgery of the thyroid gland is always necessary if the other therapeutic options do not show success or cannot be applied. The “cold” nodules are suspected of being cancerous until proven otherwise, unless they have shown up as cysts in the ultrasound examination. Such nodes are therefore almost always operated on.
Most of the nodules then show up in the fine tissue examination as benign tumors (adenomas). In about 3% of cases, however, a malignant tumor is found. Depending on the size of the node, part of a thyroid lobe, a whole lobe, parts of both thyroid lobes or the entire thyroid gland can be removed during surgery.
If there is cancer of the thyroid gland, the remaining thyroid gland and lymph nodes are removed, depending on the stage of the tumor. This can be done in a second operation. Depending on the extent of the remaining thyroid tissue, a temporary or lifelong treatment with thyroid hormones may be necessary.
Thyroid gland surgery risks
The risks of thyroid surgery can be divided into general and specific risks, as with all operations. Bleeding, post-operative bleeding, wound healing disorders and infection are risks that exist with operations of any kind. In the case of thyroid gland surgery, the special risks are very important because they can have serious consequences.
First and foremost, the injury of the vocal cord nerve (recurrence – paresis) must be mentioned here. This nerve runs directly along the thyroid gland on the back of the border between the windpipe and thyroid gland. The unilateral injury of the nerve leads to hoarseness, but the bilateral injury can also lead to shortness of breath.
This is caused by the closed, immobile vocal cords in such a case. Often a reduced or immobile mobility of one or both vocal cords recovers within one to three months. However, a tracheotomy may become necessary if there is no improvement within this period.
The unilateral injury of the vocal cord nerve is relatively rare with 2-3% of all thyroid operations.The bilateral injury is much less likely to occur (in the per mille range). Permanent damage can remain in about 1% of the operated patients. The second specific risk in thyroid surgery concerns the parathyroid gland.
These are very small organs that are located in pairs, four in total, on both sides of the thyroid gland. Here a hormone (parathyroid hormone) is produced, which is important for calcium metabolism. The parathyroid glands are difficult to distinguish from the surrounding fatty tissue with the naked eye.
Therefore, they can be removed during surgery of the thyroid gland, and especially the large thyroid gland with many large nodes. As a rule, even just one parathyroid gland can cover the parathyroid hormone requirement. However, if all four parathyroid glands have been removed, a calcium deficiency will occur, which must be compensated by regular intake of calcium. Due to the very delicate nature of thyroid surgery, surgeons work with magnifying glasses and often use electronic devices to follow the course of the vocal cord nerve.
