Thyroidectomy: A detailed guide for New Zealanders

What is the thyroid gland?

The thyroid is a butterfly-shaped gland in the front of the neck, just beneath the Adam's apple. It consists of two lobes connected by an isthmus in the middle.

Though small, the thyroid plays an important role in regulating many of the body’s essential functions. It produces two key hormones, triiodothyronine (T3) and thyroxine (T4), which control your body’s metabolism, including heart rate, body temperature, and how fast you burn calories. It also produces calcitonin, the hormone that regulates your calcium levels.

What is a thyroidectomy and what does it treat?

Thyroidectomy is a surgical procedure that involves excising all or a section of the thyroid gland. It is used to treat a range of conditions, including:

Thyroid cancer

One of the most common conditions requiring a thyroidectomy - either partial or total - is thyroid gland cancer. Thyroidectomy is the primary treatment option for this disease, particularly for larger or more aggressive tumours.

Goitre

This refers to an enlarged thyroid gland. While typically not cancerous, a goitre can become quite big and cause discomfort or difficulty swallowing and breathing. Depending on the severity and the presence of other symptoms, a thyroidectomy might be recommended to remove all or part of the gland.

Hyperthyroidism

The excessive hormones produced by a condition called hyperthyroidism (overactive thyroid) may lead to symptoms like weight loss, anxiety, tiredness, heart palpitations, and hand tremors. While medication is often the first-line treatment, a thyroidectomy might be considered if medications are ineffective or cause side effects, or if a patient prefers to avoid radioiodine therapy.

Thyroid nodules

These are growths on the thyroid that become lumps, known as nodules. While most nodules are benign (non-cancerous), some may require further investigation and removal. When a thyroid nodule is determined to be cancerous, thyroidectomy will likely be the first line of treatment. 

Types of thyroidectomy

The scope of the thyroidectomy varies according to the patient’s medical condition and will involve either a total thyroidectomy or partial thyroidectomy.

The decision between a total or partial thyroidectomy depends on several key factors, particularly the type, stage, and extent of the thyroid disease or cancer.

Consultation with your specialist will ensure the best approach for managing your thyroid condition while minimising long-term health impacts.

The thyroidectomy procedure

Pre-surgery preparations

Before your thyroid surgery, your healthcare provider will guide you through several preparations to ensure the procedure goes smoothly.

• Medical evaluation: You will undergo blood and imaging tests to assess the condition of your thyroid. If you have a nodule, a needle biopsy may also be performed, to determine whether the growth is cancerous.
• Fasting: You will likely be advised not to eat or drink several hours before the surgery.
• Medications: Certain medications, especially blood-thinning drugs, may need to be paused to reduce the risk of bleeding during surgery. If you have an overactive thyroid, you might be prescribed medication to regulate hormone levels.
• Consultation with the anaesthetist: You will meet with the anaesthetist to discuss your questions and the type of anaesthesia to be used, typically general anaesthesia, meaning you will be asleep for the entire procedure.

During the surgery

Thyroidectomy surgery generally takes 1 to 2 hours, depending on the type performed. Here’s what happens:

• Incision: A small horizontal incision is made in the front of your neck, a few centimetres above your collarbone, to access the thyroid gland.
• Removal: The surgeon removes a part or the entire thyroid gland, as well as affected lymph nodes if needed.
• Post-surgery closure: The incision is closed with sutures or surgical glue and a small bandage is applied. A drainage tube may be placed temporarily to remove excess fluids.

Post-surgery recovery

While you may be able to resume your usual activities fairly quickly after surgery, it’s best to avoid strenuous tasks for a week or two. Recovery from a thyroidectomy typically takes at least two weeks. Here's what you can expect:

• Hospital stay: Most people stay in hospital for one night, although some may be discharged the same day.
• Managing pain: Mild pain and discomfort at the incision site are common. Your doctor will prescribe pain relievers to manage this. Swelling and bruising in the neck area may also occur but should subside within a few weeks.
• Thyroid hormone replacement: If your entire thyroid is removed, you will take thyroid hormone replacement medication (levothyroxine) to replace the natural hormone. This treatment allows you to avoid symptoms of hypothyroidism (underactive thyroid), such as fatigue and muscle weakness.
• Follow-up appointments: You will have follow-up visits to check your recovery and ensure that your hormone levels are stable.

Possible risks, complications, and side effects of thyroidectomy

While thyroidectomy is generally considered a safe procedure, like any surgery, it carries potential risks and side effects.

Bleeding and haematoma

Though rare, bleeding can occur during or after thyroid surgery, potentially leading to the formation of a haematoma (a collection of blood outside a blood vessel). This complication may require additional surgery to control the bleeding.

Infection

Infections following a thyroidectomy are rare. Contact your healthcare provider immediately if you experience symptoms such as a high temperature and redness or swelling around the incision. Prompt treatment with antibiotics typically resolves any issues.

Thyroid storm

For individuals with hyperthyroidism, a rare emergency complication called a thyroid storm can occur if the thyroid hormone levels spike during surgery. This condition can lead to a racing heart rate, high blood pressure, fever, and confusion. Preventative medications are often prescribed before surgery to minimise the risk.

Anaesthetic complications

As with any surgery involving general anaesthesia, there are risks of anaesthetic-related complications, including allergic reactions or breathing difficulties. These risks are usually very low and are managed by the anaesthesia team during surgery.

Voice changes

Hoarseness or voice changes may occur if the laryngeal nerve (voice box nerve) is irritated or injured during surgery. This is usually a temporary side effect; permanent voice damage is rare.

Calcium deficiency

If the parathyroid glands, which regulate calcium, are affected during surgery, you may experience low calcium levels. This is usually short-term, but in a few cases, lifelong calcium supplementation may be required.

Scar

A scar will form where the incision was made, but typically fades over time and becomes barely noticeable.

Can you live a normal life after a total thyroidectomy?

Yes, you can expect to enjoy a fully functional life after your thyroidectomy and return to normal activities within a few weeks after surgery.

If you’ve had a total thyroidectomy, you will need to take daily thyroid hormone replacement medication. This effectively mimics the function of a natural thyroid, and regular monitoring of your hormone levels will be necessary to ensure that the dose remains appropriate.

How much does a thyroidectomy cost in New Zealand?

You can either have a thyroidectomy performed for free in the public health system; go to a private health facility and pay out of pocket; or have it covered by your private health insurance.

According to nib’s October 2020-February 2021 claims data, a thyroidectomy in a private hospital can cost $11,000-$15,500 if you don’t have health insurance. 

If you do have medical insurance, it’s best to contact your insurer to check which costs are covered and get pre-approval for the surgery to ensure a smoother claims process.

Benefits of private health insurance when undergoing thyroidectomy

Having private health insurance can make a huge difference when undergoing thyroidectomy, both financially and in terms of quick, easy access to care. Here are some key benefits of having private health insurance for thyroidectomy-related expenses in New Zealand:

Financial cover for surgery

Thyroidectomy is a specialised surgical procedure that can be expensive in private healthcare without insurance. However, comprehensive health insurance policies often cover a large portion of surgery costs, including the surgeon’s fees, anaesthesia, and hospital expenses.

Prompt treatment

Instead of facing long waiting times in the public system, private healthcare allows you to undergo surgery promptly and in a hospital of your choice. This means faster access to operating theatres and more comfort during your recovery.

Follow-up care

After your thyroid surgery, ongoing care is essential, especially if you’re being treated for thyroid cancer. Private health insurance can cover many of your private medical expenses.

RECOMMENDED READINGS

Long waiting lists in NZ's public health system: Causes and impacts on patients

Non-Pharmac drugs: What they cost & how health insurance can help

Buying health insurance if you have pre-existing conditions

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^{Disclaimer: This article is for general information only. Nothing in this blog or on this website is intended as medical, dietary, or financial advice. Although we aim to update our content regularly, you are advised to consult a Policywise adviser, health professional, or an appropriate specialist before acting on any information herein. They can factor in your personal circumstances or preferences and help guide your decision-making process.}