Thyroidectomy in Singapore

What is a Thyroidectomy?

The thyroid gland is a butterfly-shaped gland at the lower front of the neck that produces hormones that regulate metabolism, heart rate, blood pressure, body temperature, and energy expenditure. This gland can develop cancerous tissue, nodules, or other conditions, necessitating a thyroidectomy.

In this surgical procedure, a surgeon will remove part of your thyroid or all of the thyroid gland, depending on the circumstances. The amount of thyroid tissue removed depends on the diagnosis, thyroid anatomy and cancer risk.

When a thyroidectomy is needed, multiple surgical approaches are available, depending on the surgical goal and other patient health considerations. A conventional thyroidectomy uses a low neck incision below the thyroid cartilage. An endoscopic thyroidectomy uses a camera to remove part of the thyroid or the entire thyroid gland through smaller openings. Transoral surgery hides incisions inside the lower lip, while a transaxillary approach places them in the armpit.

Types of Thyroidectomy

The type of thyroidectomy varies depending on how much of the thyroid gland is to be removed.

Total Thyroidectomy

Removes the entire thyroid gland. Lifelong thyroid hormone replacement is needed afterwards.

Partial Thyroidectomy

Removes only part of the gland. The most common form is a thyroid lobectomy, also called a hemithyroidectomy, which removes one thyroid lobe. It may be suitable for a single nodule or selected low-risk cancers confined to one side of the thyroid gland.

Isthmusectomy

Removes only the isthmus, which is the narrow bridge joining the two thyroid lobes. This less common operation may suit selected nodules confined to this area.

Near-Total Thyroidectomy

Removes almost the entire gland but leaves a small amount of thyroid tissue.

Completion Thyroidectomy

Removes the remaining thyroid lobe after an earlier lobectomy. It may be recommended when laboratory examination finds cancer that requires further surgery.

Why Is Thyroid Surgery Done and Who May Need It?

Thyroidectomy surgery may be used to manage thyroid cancer, suspicious nodules, an enlarged thyroid gland or selected cases of an overactive thyroid.

Thyroid Cancer

Thyroidectomies are done frequently to remove or test for thyroid cancer. The amount of tissue removed depends on the cancer type, tumour size and whether it has spread. Papillary and other differentiated thyroid cancers usually grow more slowly than anaplastic thyroid cancer, which is rare and more aggressive.

Surgical planning to treat thyroid cancer may include:

• Lobectomy for selected low-risk cancers contained within one thyroid lobe.
• Total thyroidectomy for tumours larger than 4 cm, cancer that has grown beyond the thyroid, or cancer that has spread to lymph nodes or other parts of the body.
• Individualised surgery for tumours between 2 and 4 cm, based on the tumour’s features, test results and the patient’s circumstances.

It is important to note that a total thyroidectomy is not automatically required for every papillary thyroid cancer larger than 1 cm.

Suspicious Thyroid Nodules

Surgery may be considered when a fine-needle aspiration is conducted and:

• Finds cancer cells
• Suggests that cancer may be present
• Reports a follicular neoplasm that cannot be fully assessed using the cell sample alone
• Does not provide a clear diagnosis

Removing the nodule allows the entire tissue to be examined in a laboratory. This may confirm whether it is cancerous and whether further care is needed.

Not every thyroid nodule needs surgery. Small, low-risk nodules may be monitored with examinations and ultrasound scans. Selected benign nodules may also be managed with aspiration or image-guided ablation. The decision depends on the diagnosis, symptoms, growth and individual risks of surgery compared with continued monitoring.

Enlarged Thyroid Gland or Goitre

A noncancerous nodule or enlarged thyroid may press on the windpipe or oesophagus. This can cause:

• Visible neck swelling
• Pressure or discomfort in the neck
• Coughing
• Difficulty swallowing
• Difficulty breathing

Surgery may be considered when these symptoms are significant, or the thyroid continues to enlarge.

Hyperthyroidism

Hyperthyroidism occurs when the thyroid overproduces hormones. Possible causes of hyperthyroidism include Graves’ disease, a toxic thyroid nodule and a toxic multinodular goitre.

Antithyroid medicines or radioactive iodine may be considered first. Surgery may become appropriate when these options are ineffective or unsuitable, or when the patient also has a large goitre or suspicious nodule. Removing the entire thyroid controls the source of excess hormone, but lifelong thyroid hormone replacement is then required.

When to See an ENT Specialist

See an ENT head and neck specialist for a persistent or enlarged thyroid, pressure symptoms, an unexplained voice change or a suspicious scan or thyroid biopsy.

Arrange an assessment if you’re experiencing any of these symptoms:

• Rapid enlargement of the thyroid
• Swallowing difficulty
• Noisy breathing
• Persistent hoarseness
• Swollen lymph nodes, since thyroid cancer can present this way.

These symptoms may necessitate a thyroidectomy. Palpitations, tremor, heat intolerance and an unexplained weight loss can indicate an excess of thyroid hormone or other thyroid disorders but do not automatically require thyroid surgery. Assessment distinguishes thyroid conditions from other causes of neck swelling or voice change. Importantly, Sudden breathing difficulty or rapidly increasing swelling requires urgent care.

How to Prepare for a Thyroidectomy

Your specialist will walk you through several steps you can do to prepare for your thyroidectomy. They will conduct tests, confirm the diagnosis, discuss the accompanying risks and help you navigate home support.

• Tests may include blood tests to check on thyroid hormone levels, a thyroid ultrasound, fine-needle aspiration, and other imaging.
• Vocal cord function may be checked for voice change, suspected thyroid cancer or previous thyroid surgery.
• People with hyperthyroidism may receive antithyroid medicine, beta blockers to steady heart rate and blood pressure, or iodine. Take these as directed and report any fevers, infections or new symptoms before admission.
• List all medicines and supplements to your medical specialist. Blood thinners may need adjustment, but only on medical advice.
• Follow fasting instructions exactly.
• Stop smoking and vaping because they impair healing and irritate the airway.
• Arrange transport home and help after your discharge.

What Happens During a Thyroidectomy?

A thyroidectomy is usually performed under general anaesthesia and takes about one to two hours. Complex thyroid surgery may take longer.

During conventional thyroid surgery, the main steps for patients in a thyroidectomy procedure are:

1. Starting with the incision
   The surgeon makes a horizontal incision low on the front of the neck, often within a natural skin crease. The neck muscles are then gently separated to reach the thyroid gland.

2. Controlling the blood vessels
   The thyroid’s blood vessels are carefully sealed and divided close to the thyroid capsule. These include:

• The superior thyroid artery, which usually branches from the external carotid artery.
• The inferior thyroid artery.
• The superior and inferior thyroid veins.
  
  The surgeon also works carefully around larger nearby blood vessels, including the internal jugular vein. The exact order in which the vessels are managed depends on the anatomy and operation.

3. Protecting the nerves and parathyroid glands
   The recurrent laryngeal nerves are identified where they run close to the back of the thyroid. These nerves control movement of the vocal cords, so injury may cause temporary or permanent voice changes. The superior and inferior parathyroid glands are also preserved whenever possible. 
   
   Intraoperative nerve monitoring may be used to stimulate, locate and test the recurrent laryngeal nerves. It can be particularly helpful during complex or repeat thyroid surgery. Nerve monitoring supports visual identification, but it cannot prevent every nerve injury, and evidence that it reduces risk in all routine operations is mixed.

4. Removing the planned thyroid tissue
   Depending on the type of thyroidectomy, the surgeon removes part or all of the thyroid gland. The tissue is removed rather than reshaped, while protecting any tissue and parathyroid glands that need to remain.

5. Checking the lymph nodes
   If thyroid cancer has spread or nearby lymph nodes appear suspicious, selected lymph nodes may be sampled or removed. The thyroid tissue and any lymph nodes are sent to a laboratory to help guide further care.

6. Preserving parathyroid function
   If a parathyroid gland loses its blood supply, usually from a small branch of the inferior thyroid artery, the surgeon may reimplant it into a nearby muscle. This gives the gland an opportunity to continue working.

7. Closing the wound
   A drain may be placed to remove blood or fluid from the surgical area. The incision is then closed with stitches or surgical adhesive. Reconstruction is rarely required in standard thyroidectomies.

Alternative Surgical Procedures

Selected patients may be suitable for endoscopic, transoral or robotic thyroid surgery. Some may opt for these if they hope for less scarring. However, these surgeries to remove the thyroid may not be appropriate for:

• A very large goitre
• Invasive thyroid cancer
• Extensive lymph-node disease
• Previous thyroid or neck surgery

The surgical approach depends on the thyroid condition, individual anatomy and level of risk, not thyroidectomy scar preference alone.

What to Expect After Surgery and Recovery

Thyroidectomy recovery usually takes two to three weeks. Hospital stays typically last one to three days, depending on the operation and the patient’s condition.

In Singapore, patients commonly stay:

• One to two days after a thyroid lobectomy
• About three days after a total thyroidectomy

Selected patients may leave sooner, while those undergoing complex surgery or requiring additional monitoring may stay longer.

Immediately After Surgery

In the immediate postoperative period, the hospital team monitors:

• Breathing and neck swelling
• Bleeding around the surgical site
• Voice and swallowing
• Blood pressure
• Pain
• Blood calcium levels, particularly after a total thyroidectomy

These cover most of the potential post-op thyroidectomy complications, and will allow the team to catch any issues before they become serious. Eating and drinking usually resume once the patient is fully awake and can swallow safely. Soft foods may be more comfortable initially.

Common symptoms after a thyroidectomy that do not necessitate urgent action include:

• A sore throat
• Neck tightness
• Mild swallowing discomfort
• A temporarily hoarse or tired voice

Wound and Scar Care

Your specialist will provide instructions for caring for the surgical wound. Avoid scrubbing, scratching or soaking the surgical site while it heals.

A thyroidectomy scar may initially appear raised, red or darker than the surrounding skin. It usually becomes less noticeable over several months. Once the wound has fully healed, sun protection may help reduce discolouration.

Returning to Normal Activities

Walking is encouraged after surgery, but activities should be increased gradually.

• Many patients return to work or school within one to two weeks.
• Avoid heavy lifting and vigorous exercise for 10 to 14 days, or until cleared by your surgeon.
• Drive only when you can move your neck comfortably and are no longer taking medicines that affect your alertness.
• Soft foods may be easier if swallowing remains uncomfortable, though this should normalise over time.

Thyroid Hormone and Calcium Replacement

A total thyroidectomy stops the body from producing thyroid hormones. Patients therefore need lifelong thyroid hormone replacement therapy with levothyroxine. The dose is adjusted using regular blood tests.

After a partial thyroidectomy, the remaining thyroid function and lobe may produce enough hormone. However, some patients still develop an underactive thyroid and need thyroid hormone replacement.

Temporary oral calcium supplements and Vitamin D may be prescribed if blood calcium levels fall after surgery. Calcium supplementation is gradually reduced as the parathyroid glands recover and blood calcium levels return to a safe level.

Follow-up and Longer-Term Care

Follow-up after a thyroidectomy may include checking:

• The surgical wound and thyroidectomy scar
• Voice and vocal-cord function
• Blood calcium levels
• Thyroid hormone levels
• The final laboratory examination of the removed tissue
• Symptoms that require further medical attention

The long-term effects of a thyroidectomy depend on the condition being treated and the extent of thyroid tissue removal. Thyroid cancer may require continued surveillance and, in selected cases, radioactive iodine treatment.

After a partial thyroidectomy, the remaining thyroid tissue can develop new nodules. Thyroid cancer can also recur, so ongoing follow-ups may be needed. 

Risks and Possible Complications

Serious permanent thyroidectomy complications are uncommon, but risk varies with the type and complexity of surgery. Possible complications include:

• Bleeding: Blood may collect beneath the incision, compressing the airway. In rare cases, another operation is needed to stop the bleeding.
• Voice changes: Injury or irritation to the laryngeal nerves may cause hoarseness, vocal cord weakness, swallowing difficulty, reduced voice projection, or difficulty reaching high notes. Changes are often temporary but sometimes can be permanent.
• Low calcium: Temporary hypocalcaemia affects about 15% to 30% of patients after total thyroidectomy. Permanent hypoparathyroidism is much less common, with estimates of about 1% to 3%. Symptoms include tingling around the mouth or fingers, numbness and muscle cramps.
• Infection: Wound infection is uncommon, with most published estimates below 3%.
• Other risks: These include fluid collection, thick scarring, anaesthetic complications and rare injury to the windpipe or oesophagus.

Poorly controlled hyperthyroidism can also cause a rare thyroid storm. Thyroid hormone levels are therefore stabilised before surgery.

Seek urgent medical attention for:

• Sudden neck swelling, tightness or bleeding
• Difficulty breathing or swallowing
• Worsening voice problems
• Severe tingling, numbness or cramps
• Fever of 38°C or higher
• Increasing redness, foul-smelling discharge or wound opening
• Pain that is worsening rather than improving

How Barrie Tan ENT Can Help

Barrie Tan ENT Head & Neck Surgery can assess thyroid nodules, determine whether thyroid surgery is appropriate, and plan the necessary extent and approach. We can also offer you guidance on what thyroidectomy costs in Singapore can be and how different insurance plans or MediShield can help.

When surgical treatment is appropriate, Dr Tan discusses alternatives, the thyroidectomy scar, possible lymph node removal, thyroid hormone replacement, calcium monitoring, risks, and recovery. Operations are performed at Gleneagles Hospital in Singapore.

If you have an enlarged thyroid gland, suspicious thyroid biopsy, compressive goitre, thyroid cancer or hyperthyroidism, contact Barrie Tan ENT Head & Neck Surgery to arrange an assessment to understand the best options available to you.

FAQs about Thyroidectomy

What are the side effects of having no thyroid?

Without thyroid hormone replacement, having no thyroid causes hypothyroidism. Symptoms may include tiredness, weight gain, dry skin, feeling cold, constipation, low mood and a slow heart rate. Taking the correct daily dose of levothyroxine replaces the missing hormone. Some patients also need calcium and vitamin D if parathyroid function is reduced.

Can you live a normal life after a thyroidectomy?

Most patients can return to normal work, exercise, diet and daily activities after recovery. Long-term health depends on taking thyroid hormone correctly when required, attending blood tests and completing any follow-up recommended for the underlying thyroid condition.

Can your thyroid grow back after a thyroidectomy?

An entirely removed thyroid does not usually grow back, although a tiny remnant may occasionally enlarge. After a partial thyroidectomy, the remaining tissue can grow or develop new nodules. Continued follow-up is important when symptoms or the original diagnosis warrant it.

How many years can you live without a thyroid?

The absence of a thyroid does not by itself limit your lifespan when thyroid hormone is replaced appropriately. Life expectancy depends more on general health and the disease that led to surgery, particularly the type and stage of thyroid cancer when cancer is present.