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Q I am a 44-year-old single woman and I have lumps in my thyroid area. One on the left side is 2.4cm and another on the right is pea-sized.
The ultrasound and blood tests showed normal results and, at the doctor’s suggestion, a biopsy was done. The results were not so good so the doctor advised surgery and total removal of the thyroid gland after which thyroid hormone pills have to be taken for life.
What complications can arise after surgery and what aftercare is necessary? Does the thyroid hormone pill have any side effects and can the body function normally without the thyroid gland? Do I have any option other than surgery? Is the surgery done under local or general anaesthesia?
Answer by Dr Stanley Liew, Raffles Hospital
You mentioned that the results of the thyroid biopsy were “not so good”. It is unclear whether you have benign (non-cancerous) thyroid nodules or thyroid cancer. Sometimes, it is not possible to have diagnostic results from a fine-needle aspiration biopsy of the thyroid.
 As you have been advised to have your thyroid gland totally removed, it suggests that you have thyroid cancer. In that case, you should have the surgery to remove your thyroid gland.
After surgery, you will need radioiodine treatment to totally excise any remnants of your thyroid gland. You will need to take thyroid hormone pills for life after these treatments.
Thyroid hormone or thyroxine is a natural hormone used as a thyroid replacement therapy for a person with hypothyroidism (under-active thyroid), that is, his thyroid gland does not secrete an adequate amount of thyroid hormones.
In your case, it is compulsory to take thyroxine as there is no thyroid gland left after the surgery and radioiodine treatments.
The possible side effects of thyroxine are anxiety, restlessness, palpitation and insomnia and these can occur when the dosage is excessive.
These side effects will disappear once the dosage is properly adjusted. Your body can function normally on thyroxine replacement, without the thyroid gland.
If the thyroid nodules are benign, a partial surgical removal of the affectedthyroid gland would suffice. In this instance, you can choose not to have surgery and opt for monitoring and follow-up by your doctor.
Answer by Prof Walter Tan, Raffles Hospital
As mentioned in Dr Liew’s response, the biopsy findings are not stated and it is unclear if you have benign (non-cancerous) thyroid nodules or thyroid cancer.
However, as your surgeon has recommended a total thyroidectomy procedure, it appears that you have thyroid cancer.
Once the thyroid gland is totally removed, you will need to take thyroid hormone pills for life as thyroid hormones are vital for normal body function and metabolism.
The surgery is always done under general anaesthesia. Complications after total thyroidectomy may include bleeding from the wound, loss of voice from injury to the nerves of the larynx and severe cramping due to low calcium levels. With an experienced thyroid surgeon, the chances of any of these complications will be low.
Depending on the type of thyroid cancer, you may also develop recurrence of the cancer in the lymph nodes in other distant organs like the liver or lungs or the bone.
It is important that you continue to see your surgeon on a regular basis after surgery for proper follow-up care and surveillance for recurrent cancer.
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