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Thyroidectomy Indications and Updates
Lewis Overton, MD, discusses thyroidectomy, including why someone might have to undergo this procedure and what treatment options are available.
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Learn more about Lewis Overton, MD
Lewis Overton, MD
Dr. Lewis Overton is a board-certified ear, nose & throat (ENT) physician with clinical interests in adult and pediatric general ENT, head/neck cancer and endocrine surgery (thyroid, parathyroid, and endoscopic pituitary surgery), as wells as open and endoscopic skull base procedures. He earned his medical degree from the Medical University of South Carolina in Charleston, SC and completed his residency in Otolaryngology at The University of North Carolina at Chapel Hill where he served as the chief resident.Learn more about Lewis Overton, MD
Transcription:
Thyroidectomy Indications and Updates
Prakash Chandran (Host): Many people will experience thyroid issues during their lifetime. For some, their doctor or surgeon may recommend a thyroidectomy, but what exactly is this procedure and what do you need to know ahead of time? We’re gonna talk about it today with Dr. Lewis Overton, a head and neck oncology specialist at WakeMed Health and Hospitals. This is WakeMed Voices, the podcast from WakeMed Health and Hospitals. I'm Prakash Chandran. So Dr. Overton, let’s just start with the basics. What exactly is the thyroid and what does it control in the body?
Lewis Overton MD (Guest): So the thyroid is basically a butterfly shaped organ sitting in the center of your neck, right over your windpipe and just below where your vocal cords are. It releases a hormone. Appropriately it’s called the thyroid hormone that controls all sorts of things in the body. Everything from your heartrate and how your cardiovascular system works all the way up to metabolism and development of other cellular structures. So it has functions throughout the entire body.
Host: Something I've heard often before is oh I have an overactive thyroid. So maybe talk a little bit about when things are going wrong with the thyroid and what that’s called when that’s happening.
Dr. Overton: Exactly. So some people have an overactive thyroid and it generally means that the thyroid hormone is making too much thyroid hormone. Then the downstream effects for that hormone means that they might feel hot flashes, sweatiness, feel like their heart is racing every once in a while. Their skin might get a little clammy, they might get sweaty. Their hair might start getting thin. Essentially the downstream effects of just having too much. They have sometimes restlessness and sleepless nights as well.
Host: Okay, understood. So we’re talking about a thyroidectomy today. Let’s talk about exactly what it is and some of the disorders that it treats.
Dr. Overton: Sure. So a thyroidectomy is just removal of the thyroid. We do it for all sorts of things. Classically is just for a thyroid cancer or some version of a thyroid cancer. We’ll also do it for benign growths to the thyroid or when the thyroid itself just overall gets big. That’s called a goiter. If that’s starting to cause compressive symptoms on your voice box, on your airway, or on your esophagus. Sometimes we’ll remove it in a particular situation for if it is overacting too much and medications to control that are not effective.
Host: So let’s talk about the procedure itself. Maybe talk about what exactly happens and how long the procedure takes and what the recovery time is like.
Dr. Overton: The procedure classically involves a small incision in the middle of the neck just underneath here your Adam’s apple is and essentially right above where your clavicles come together. We’ll just have to go through certain levels of fat and muscle to access where thyroid is. It’s a pretty defined place where it lies. Then it focuses on getting out the thyroid carefully and not disrupting the structures around it. The most important structures around it are small glands called parathyroid glands that control calcium levels in the body. Then there’s a nerve that runs underneath the body beside your windpipe sort of on the backend where your esophagus is. It controls your voice box. That’s the other thing that we’re exceptionally careful to avoid damaging. Ultimately once we can identify those and make sure those are safe, we’re able to get the thyroid appropriately out of the neck and make sure that there's no more bleeding and put a small drain. Typically if we’re moving the entire thyroid, the entire procedure lasts anywhere from an hour and a half to three hours depending on the size, the nature of the thyroid itself. Then recovery is generally maybe a night in the hospital or two depending on the size of the thyroid and the amount of space that needs to recover. Then about a week or so of just light activity after that as the surgical wounds start to heal down and the scar formation takes place.
Host: When do you really feel like you're back to normal after a procedure like this?
Dr. Overton: It sort of varies. Generally within about seven to ten days most people are back to their normal life. The skin has healed appropriately. The general soreness in the neck has settled down to something very small, and they're able to get back on with their life at that amount of time.
Host: Some people listening to this might be wondering. You know I didn’t even realize we could live without a thyroid. So once you get the thyroid removed and you don’t have those hormones being generated, how do you supplement some of the things that your body needs? Maybe talk a little bit about what life is like without a thyroid.
Dr. Overton: That’s a really good point. When we remove the thyroid, we have to have a conversation with the patient about how we replenish those hormones. There is a pill. It’s just the thyroid hormone replacement pill that’s generally dosed for the patient based on their weight, and it just replenishes the hormone via pill. It’s not anything more than that, and we can generally tweak that dosage based on how their body responds to the dosage that they're on that we start them on. That’s generally done in conjunction with an endocrinologist who manages a lot of the hormonal aspects of the body. So there are ways to get you back to the normal scenario with regards to the thyroid hormone levels and how those function in the rest of your body, even without a thyroid in place.
Host: Understood. Just to maybe alleviate some concerns out there, maybe talk a little bit about if there are any significant risks involved with having a thyroidectomy.
Dr. Overton: So the main ones I sort of alluded to earlier with damage to the nerve to the vocal cords and then damage to the smaller glands called the parathyroid glands that can cause low calcium levels. Luckily there are four of those so there’s a little bit of some leeway with regards to that, but ideally we don’t want to damage any of them. With regards to the nerves to the larynx, we don’t plan to injure those in any way and we’re able to monitor those nerves in the operating room in real time. Other surrounding structures are always at risk. There are main vessels in the neck, the carotid, and the jugular vein that are nearby but very big and very, very hard to injure and exceptionally rare to injure. The windpipe and the food pipe themselves sit underneath. Theoretically they can be injured, but again very rare. Then general wound healing issues, scar formation, bleeding, infections, stuff like that, but we use sterile technique and appropriate hemostasis or control of bleeding in the operation to make sure that everything’s done appropriately.
Host: You know just in wrapping up here, I always like to ask this. For the people that are listening that might be potentially struggling with thyroid problems, is there anything that you would like them to know or you wish more patients with thyroid problems knew before coming to see you.
Dr. Overton: I think that it’s important to maybe discuss with your primary care physician if you're concerned. Just a straightforward test of thyroid function levels. It’s pretty straightforward and a small blood draw. That can get us started on figuring out what might be going on. If there needs to be anything more done, that would generally be in conjunction with us and the endocrinologist if it’s just a function of a thyroid issue. I think that they should just know that there are a lot of people out here who are well versed in how to manage thyroid problems, thyroid tumors, thyroid masses of all sorts. They shouldn’t even feel alone. It’s pretty easy to figure out from the beginning with a small blood test and we can always work forward from that.
Host: Alright Dr. Overton. I truly appreciate your time today. That’s Dr. Lewis Overton, a head and neck oncology specialist at WakeMed Health and Hospitals. Thanks for checking out this episode of WakeMed Voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. To learn more about WakeMed’s ENT services, please visit wakemed.org. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll talk next time.
Thyroidectomy Indications and Updates
Prakash Chandran (Host): Many people will experience thyroid issues during their lifetime. For some, their doctor or surgeon may recommend a thyroidectomy, but what exactly is this procedure and what do you need to know ahead of time? We’re gonna talk about it today with Dr. Lewis Overton, a head and neck oncology specialist at WakeMed Health and Hospitals. This is WakeMed Voices, the podcast from WakeMed Health and Hospitals. I'm Prakash Chandran. So Dr. Overton, let’s just start with the basics. What exactly is the thyroid and what does it control in the body?
Lewis Overton MD (Guest): So the thyroid is basically a butterfly shaped organ sitting in the center of your neck, right over your windpipe and just below where your vocal cords are. It releases a hormone. Appropriately it’s called the thyroid hormone that controls all sorts of things in the body. Everything from your heartrate and how your cardiovascular system works all the way up to metabolism and development of other cellular structures. So it has functions throughout the entire body.
Host: Something I've heard often before is oh I have an overactive thyroid. So maybe talk a little bit about when things are going wrong with the thyroid and what that’s called when that’s happening.
Dr. Overton: Exactly. So some people have an overactive thyroid and it generally means that the thyroid hormone is making too much thyroid hormone. Then the downstream effects for that hormone means that they might feel hot flashes, sweatiness, feel like their heart is racing every once in a while. Their skin might get a little clammy, they might get sweaty. Their hair might start getting thin. Essentially the downstream effects of just having too much. They have sometimes restlessness and sleepless nights as well.
Host: Okay, understood. So we’re talking about a thyroidectomy today. Let’s talk about exactly what it is and some of the disorders that it treats.
Dr. Overton: Sure. So a thyroidectomy is just removal of the thyroid. We do it for all sorts of things. Classically is just for a thyroid cancer or some version of a thyroid cancer. We’ll also do it for benign growths to the thyroid or when the thyroid itself just overall gets big. That’s called a goiter. If that’s starting to cause compressive symptoms on your voice box, on your airway, or on your esophagus. Sometimes we’ll remove it in a particular situation for if it is overacting too much and medications to control that are not effective.
Host: So let’s talk about the procedure itself. Maybe talk about what exactly happens and how long the procedure takes and what the recovery time is like.
Dr. Overton: The procedure classically involves a small incision in the middle of the neck just underneath here your Adam’s apple is and essentially right above where your clavicles come together. We’ll just have to go through certain levels of fat and muscle to access where thyroid is. It’s a pretty defined place where it lies. Then it focuses on getting out the thyroid carefully and not disrupting the structures around it. The most important structures around it are small glands called parathyroid glands that control calcium levels in the body. Then there’s a nerve that runs underneath the body beside your windpipe sort of on the backend where your esophagus is. It controls your voice box. That’s the other thing that we’re exceptionally careful to avoid damaging. Ultimately once we can identify those and make sure those are safe, we’re able to get the thyroid appropriately out of the neck and make sure that there's no more bleeding and put a small drain. Typically if we’re moving the entire thyroid, the entire procedure lasts anywhere from an hour and a half to three hours depending on the size, the nature of the thyroid itself. Then recovery is generally maybe a night in the hospital or two depending on the size of the thyroid and the amount of space that needs to recover. Then about a week or so of just light activity after that as the surgical wounds start to heal down and the scar formation takes place.
Host: When do you really feel like you're back to normal after a procedure like this?
Dr. Overton: It sort of varies. Generally within about seven to ten days most people are back to their normal life. The skin has healed appropriately. The general soreness in the neck has settled down to something very small, and they're able to get back on with their life at that amount of time.
Host: Some people listening to this might be wondering. You know I didn’t even realize we could live without a thyroid. So once you get the thyroid removed and you don’t have those hormones being generated, how do you supplement some of the things that your body needs? Maybe talk a little bit about what life is like without a thyroid.
Dr. Overton: That’s a really good point. When we remove the thyroid, we have to have a conversation with the patient about how we replenish those hormones. There is a pill. It’s just the thyroid hormone replacement pill that’s generally dosed for the patient based on their weight, and it just replenishes the hormone via pill. It’s not anything more than that, and we can generally tweak that dosage based on how their body responds to the dosage that they're on that we start them on. That’s generally done in conjunction with an endocrinologist who manages a lot of the hormonal aspects of the body. So there are ways to get you back to the normal scenario with regards to the thyroid hormone levels and how those function in the rest of your body, even without a thyroid in place.
Host: Understood. Just to maybe alleviate some concerns out there, maybe talk a little bit about if there are any significant risks involved with having a thyroidectomy.
Dr. Overton: So the main ones I sort of alluded to earlier with damage to the nerve to the vocal cords and then damage to the smaller glands called the parathyroid glands that can cause low calcium levels. Luckily there are four of those so there’s a little bit of some leeway with regards to that, but ideally we don’t want to damage any of them. With regards to the nerves to the larynx, we don’t plan to injure those in any way and we’re able to monitor those nerves in the operating room in real time. Other surrounding structures are always at risk. There are main vessels in the neck, the carotid, and the jugular vein that are nearby but very big and very, very hard to injure and exceptionally rare to injure. The windpipe and the food pipe themselves sit underneath. Theoretically they can be injured, but again very rare. Then general wound healing issues, scar formation, bleeding, infections, stuff like that, but we use sterile technique and appropriate hemostasis or control of bleeding in the operation to make sure that everything’s done appropriately.
Host: You know just in wrapping up here, I always like to ask this. For the people that are listening that might be potentially struggling with thyroid problems, is there anything that you would like them to know or you wish more patients with thyroid problems knew before coming to see you.
Dr. Overton: I think that it’s important to maybe discuss with your primary care physician if you're concerned. Just a straightforward test of thyroid function levels. It’s pretty straightforward and a small blood draw. That can get us started on figuring out what might be going on. If there needs to be anything more done, that would generally be in conjunction with us and the endocrinologist if it’s just a function of a thyroid issue. I think that they should just know that there are a lot of people out here who are well versed in how to manage thyroid problems, thyroid tumors, thyroid masses of all sorts. They shouldn’t even feel alone. It’s pretty easy to figure out from the beginning with a small blood test and we can always work forward from that.
Host: Alright Dr. Overton. I truly appreciate your time today. That’s Dr. Lewis Overton, a head and neck oncology specialist at WakeMed Health and Hospitals. Thanks for checking out this episode of WakeMed Voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. To learn more about WakeMed’s ENT services, please visit wakemed.org. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll talk next time.