Thyroid surgery in Niš

The thyroid is a small gland at the front of the neck, below the voice box (larynx). It is shaped like a butterfly: two lobes joined by a narrow part called the isthmus. The gland produces hormones that affect the body's metabolism, and therefore also heart function, body temperature, body weight and energy levels.

Thyroid surgery (thyroidectomy) is an operation to remove part or all of the gland. It is usually done through a horizontal cut in the lower part of the neck, which is placed in a natural skin crease where possible. Close to the thyroid are the nerves that move the vocal cords and the small parathyroid glands, usually four, which control the level of calcium in the blood. During the operation, the surgeon takes care to preserve these structures.

The tissue that is removed is sent for histopathology (examination under a microscope). The histopathology report shows the exact nature of the abnormality and helps the doctor decide on further treatment and follow-up. Sometimes the report shows that a further operation is needed, for example to remove the remaining part of the gland, or that another type of treatment is needed.

The decision to operate is made by the doctor and the patient together, after an examination and a review of the test results. The most common reasons for surgery are:

• a thyroid nodule where the cytology result from a fine needle aspiration (FNA) is suspicious or, in some cases, indeterminate
• confirmed thyroid cancer or suspected cancer
• an enlarged thyroid gland (goitre) that presses on the windpipe or the gullet (oesophagus), making breathing or swallowing difficult
• an overactive thyroid (hyperthyroidism), for example in Graves' disease or toxic goitre, when other forms of treatment have not given the desired result or are not suitable
• a large nodule or goitre that visibly changes the appearance of the neck

Most thyroid nodules are benign (non-cancerous) and do not need surgery. Regular monitoring with ultrasound scans and hormone tests is often enough. This is why an assessment by an endocrinologist and a consultation with a surgeon are important before deciding on surgery.

The extent of the operation depends on the test results, the size of the abnormality and the patient's general health. The most common types are:

• Lobectomy (hemithyroidectomy): one lobe of the thyroid gland is removed, usually together with the isthmus. The remaining lobe often continues to produce enough hormone.
• Total thyroidectomy: the whole thyroid gland is removed. After this procedure, thyroid hormone is replaced with a tablet, taken every day for life.
• Isthmusectomy: only the narrow central part of the gland is removed, when the abnormality is limited to that area. This is a less common procedure.
• Removal of lymph nodes in the neck: in cases of cancer, the surgeon may decide that lymph nodes also need to be removed along with the gland.

At the consultation, the surgeon explains which type of operation they recommend, what the expected recovery involves and what the possible risks are.

You come to the hospital at the agreed time, on the day of the operation or the day before, as arranged with the hospital. How long you need to fast before the operation depends on the anaesthetist's instructions. The doctor and the nurse check your medical records, test results and the list of medicines you take regularly. The anaesthetist talks to you and explains what will happen during the anaesthetic.

The operation is usually done under general anaesthetic, so you are asleep during the procedure. The procedure usually takes one to three hours, depending on its extent. Sometimes, at the end, a thin tube (drain) is placed to carry fluid away from the wound, and it is usually removed after one to two days.

After the operation, you are monitored by the medical staff until you wake up from the anaesthetic, and you are then moved to the ward. In the first few hours, you may have pain when swallowing, a feeling of tightness in the neck or mild hoarseness. The doctors monitor your breathing, voice and wound and, after more extensive operations, the calcium level in your blood. You can usually have fluids and light food on the same day, as instructed by the doctor.

Every operation carries certain risks. For thyroid surgery, the most commonly mentioned are:

• hoarseness or a voice that tires more quickly, because of the breathing tube used during the anaesthetic or because the operation is carried out close to the nerves that move the vocal cords. This is usually temporary, and a permanent change in the voice is rare.
• a fall in blood calcium, most often after the whole gland has been removed, because the parathyroid glands are working less well. The fall is usually temporary and is treated with calcium supplements. Rarely, it is permanent, and long-term treatment and monitoring are then needed.
• bleeding in the wound, most often in the first 24 hours. Heavier bleeding can press on the windpipe and needs urgent treatment, which is why patients are monitored in hospital after the operation.
• wound infection, which is rare.

At the consultation, the surgeon explains how high the risks are for each individual patient, depending on the type of operation and the test results.