Thyroid Surgery, Preparation, Implementation and Risk of Side Effects

Thyroid surgery is the removal of part or all of the thyroid, which is a butterfly-shaped gland in the neck that produces hormones that regulate metabolism, growth, and temperature. Although it plays an important role as a treatment for thyroid disorders, thyroid surgery still has side effects. Thyroid surgery is generally performed on thyroid diseases that are classified as severe, such as thyroid cancer, or goiter which has caused interference when swallowing or breathing. In addition, thyroid surgery is also used when drugs or other treatment methods do not work. However, thyroid surgery cannot always be applied to all thyroid patients. Patients with severe and uncontrolled hyperthyroidism, or patients who are pregnant are some conditions that are not recommended to undergo this operation. Based on the gland removed, thyroid surgery is divided into 3 types, namely:

Thyroid lobectomy

In this operation, a part or half of the thyroid gland will be removed. Usually this method is used to remove tumors or enlarged thyroid that are small in size.

Total thyroidectomy

This type of thyroid operation is done by removing the entire thyroid gland.

Thyroid biopsy

Surgery to remove a portion of thyroid tissue, for further examination in the laboratory. A thyroid biopsy is performed to determine whether a thyroid tumor is benign or malignant.

Preparation Before Thyroid Surgery

A few days before the operation, the doctor will first evaluate the patient's overall health condition. This evaluation can be in the form of physical and supporting examinations, such as blood tests, X-rays, and ECGs. In addition to ensuring the patient's condition, the results of this preoperative evaluation also determine the type of anesthesia (anesthetic) that will be used in the operation as well as which parts of the thyroid need to be removed. There are several things that need to be considered when undergoing preparation before surgery, namely:

• All types of thyroid surgery use anesthesia. If you have a history of allergies to the anesthetic that will be used, the patient is required to tell the doctor during a preoperative examination.
• Patients also need to tell the doctor if they are using supplements, herbal products, or certain drugs. The drugs that are being used are feared to cause drug interactions with anesthetics, and cause dangerous side effects during surgery or afterwards.
• Avoiding cigarettes and alcoholic drinks, for at least 2 weeks before the operation.
• The doctor will determine when the patient starts fasting. Patients are usually instructed to fast several hours before surgery, in order to reduce the risk of complications due to anesthesia.

Thyroid Surgery Procedure

Shortly before the operation begins, the doctor will check the patient's condition again. This aims to ensure the patient's readiness for surgery. After the condition is declared ready, the patient will then be delivered to the operating room. In the operating room, the doctor will provide anesthesia, either through injection or a breathing mask. During surgery, the patient's vital signs including blood pressure and oxygen levels in the blood will continue to be evaluated through a monitor. When the patient is anesthetized, the anesthesiologist will give a breathing device through a special tube (endotracheal tube) that is placed in the throat, to help the patient breathe during surgery. After that, the surgeon will clean the area to be cut (the area under the neck) using an antiseptic solution. The size of the incision is not always the same for each patient, depending on the part of the thyroid gland removed and the method of thyroid surgery used. The following are 3 methods of thyroid surgery that can be used to remove the thyroid gland:

Conventional operation

This method requires an incision of about 5-12 cm in the middle of the neck, so the doctor can directly access the problematic thyroid gland and remove it.

Endoscopic Surgery

This method of operation uses a special device called an endoscope, a tube with a small camera at the end, to remove the thyroid gland. The advantage, the incision needed for endoscopic surgery is much smaller than conventional surgery, which is about 0.5 to 1 cm.

Robotic surgery

The operation process is fully carried out with the help of robots. The difference is with endoscopic and conventional surgery, the incision required for robotic surgery is only 8 mm. However, this surgery technique is still not widely practiced in Indonesia. Thyroid surgery generally lasts about 1-2 hours, but it does not rule out surgery running longer than that.

Post Thyroid Surgery

After the operation is completed, the incision will be sutured and then covered with a waterproof tape to protect the surgical scar when the patient is bathing. The doctor will then move the patient to the postoperative recovery room to rest and be evaluated for at least 4-6 hours. If the incision is classified as large and it is feared that bleeding will occur, the doctor will usually install a special tube and tube that serves to collect blood that may come out. The hose and tube can be removed the next day. After thyroid surgery, patients generally need to be hospitalized for several days in the hospital. Patients are allowed to go home after their condition is stable and postoperative pain is reduced. However, patients must avoid strenuous activities for at least 10-14 days.

Risk of Side Effects of Thyroid Surgery

Like surgery in general, thyroid surgery can also cause complications. Some risks of complications that can occur after thyroid surgery are:

• Postoperative hemorrhage.
• Pain in the neck or pain in swallowing.
• Hoarseness.
• Injury or injury to the tissue around the thyroid, such as nerves, lymph nodes, or parathyroid glands. Injury to the parathyroid gland can cause hypoparathyroidism.
• Infection.

Although rare, thyroid surgery can also cause complications in the form of thyroid storms or thyrotoxicosis. Symptoms include frequent anxiety, digestive disorders such as abdominal pain and diarrhea, body trembling (thermor), lots of sweating, rapid heartbeat, and fever. Given these risks, a complete examination and careful preparation needs to be done before deciding to undergo thyroid surgery. If your thyroid disease needs to be operated on, consult a doctor to find out what preparations are needed, and what side effects might occur.