Surgery

Thyroidectomy, Thyroid Radiofrequency Ablation (RFA), & Minimally Invasive Parathyroidectomy

Why It’s Done (Indications)

Done to treat thyroid cancer, large non-cancerous thyroid nodules causing swallowing/breathing issues, hyperthyroidism (overactive thyroid), or primary hyperparathyroidism (overactive parathyroid glands causing high calcium).

How to Prepare (Preparations)

• Pre-operative blood tests (thyroid hormone levels, calcium levels) and imaging (ultrasound/CT).
• Your clinical may request laryngoscopy to check vocal cord movement before surgery.
• Fasting (no food or drink) for 6 hours before surgery.
• Pause blood-thinning medications as instructed by your doctor.

What Happens (Procedural Details)

Thyroidectomy (Open): 

1. Anaesthesia & Positioning: Done under general anaesthesia. You lie on your back with your neck gently extended back.
2. Incision: A horizontal crease incision (typically 4–8 cm long) is made across the front lower part of the neck.
3. Exposure: The neck muscles are gently separated in the midline to expose the thyroid gland resting over the windpipe (trachea).
4. Dissection & Nerve Preservation: The surgeon carefully identifies and protects critical structures: the recurrent laryngeal nerves (which control your voice box) and the four tiny parathyroid glands (which control calcium).
5. Removal: The blood vessels feeding the thyroid are clamped and tied. Either one lobe (lobectomy) or the entire gland (total thyroidectomy) is detached from the trachea and removed. The neck muscles and skin are meticulously re-approximated with fine dissolvable stitches. 

Thyroid Radiofrequency Ablation (RFA):

1. Local Anaesthesia: Performed as an outpatient procedure under local anaesthesia injected around the thyroid gland.
2. Needle Electrode Placement: Under continuous, high-resolution ultrasound guidance, a thin needle-like electrode is inserted through the skin directly into the thyroid nodule.
3. Moving Shot Technique: The surgeon delivers radiofrequency energy to heat and destroy small units of the nodule tissue systematically, moving the needle back and forth inside the nodule until the target area is completely treated. The needle is removed, and a small bandage is applied (no incision/scarring).
    

Minimally Invasive Parathyroidectomy:

1. Pre-operative Localization: Advanced imaging (ultrasound, Sestamibi scan, or CT) is used prior to surgery to pinpoint the exact location of the single overactive parathyroid gland.
2. Targeted Incision: Under general anaesthesia, a small 2–3 cm incision is made directly over the identified location on the neck.
3. Focused Removal: The surgeon directly navigates to the abnormal gland, isolates its delicate blood supply, clips it, and removes the gland while preserving the surrounding healthy thyroid tissue and nerves.
4. Hormone Testing (In-surgery): Blood samples may be drawn during surgery to verify that Parathyroid Hormone (PTH) levels drop immediately, confirming successful removal of the problem gland before closing.
    

Recovery (Postoperative Care)

• Most patients stay overnight for monitoring (or go home same-day for RFA).
• Blood calcium levels are monitored post-surgery.
• If the entire thyroid gland is removed, lifelong daily thyroid hormone replacement pills (Levothyroxine) are required.
   

Risks (Potential Complications)

• Temporary or permanent hoarseness/voice changes (due to recurrent laryngeal nerve damage).
• Low blood calcium levels causing numbness/tingling in fingers and around the lips (hypoparathyroidism).
• Neck swelling or bleeding that interferes with breathing (a rare surgical emergency).