Thyroid Surgery: Thyroidectomy
What is the thyroid?
The thyroid is a butterfly-shaped structure that sits around the windpipe in the middle of the neck. It is a hormonal gland that secretes thyroid hormones, which play a key role in regulating metabolism.
What issues can the thyroid gland develop?
There are thyroid problems related to over- and under-active thyroids, which usually are seen by an endocrinologist. The most common reason to see a surgeon about your thyroid is because you have a mass in the thyroid that is causing compression and altering how you swallow or breathe, or if the thyroid has developed nodules that have cancerous features.
Which conditions does Dr McKenzie treat?
Dr Jo-Lyn McKenzie treats surgical conditions of the thyroid, usually thyroid nodules, which may or may not be malignant, and surgical compressive disorders of the thyroid, where the gland is too big and is causing symptoms that lead to a need to remove that gland.
What is a thyroidectomy?
A thyroidectomy is surgery to remove the thyroid gland. Thyroid surgery can be discussed as a hemi-, or half, thyroidectomy or a total thyroidectomy. This is an operation to remove part or all of the thyroid because it is causing problems.
What conditions does thyroid surgery treat?
Thyroid surgery is primarily used to treat multinodular goitre, Graves' disease, or a thyroid that has become too big and active and does not respond to medications. It's also used to treat thyroid nodules that have malignant potential or are known to be a thyroid cancer.
About thyroid cancer
Thyroid cancer is a range of different cancers that can occur in this gland. They span from the fairly innocent type of thyroid cancer, which will grow very slowly and not cause many problems, to more locally invasive types of thyroid cancers that might invade the windpipe or the structures around the thyroid, to aggressive types of thyroid cancer that can spread and be rapidly fatal.
What problems does thyroid cancer cause?
Thyroid cancer is usually an easy-to-define and cure surgical disease. It can spread to the lymph nodes and it can spread to the other parts of the body, but once identified and treated surgically, most patients have an excellent outcome with normal expected survival.
What are the symptoms of a thyroid tumour?
The most common reason a patient finds a thyroid tumour is because they have felt a lump in their neck; a mass that's growing in the middle of the neck or a mass in a lymph node, which shows that it's spread to a lymph node. The other common way that patients come to an ENT’s attention is because they're having an ultrasound or a scan to investigate some other problem, and then an incidental thyroid nodule is found. In this situation, an ENT like Dr McKenzie needs to very carefully work up the problem and determine what the actual risk of that nodule is, as benign thyroid nodules are very common.
How is thyroid cancer diagnosed?
Usually, thyroid cancer is diagnosed on the basis of a fine needle test, but Dr McKenzie uses a combination of the factors of: a patient's history, their examination findings – how fixed or large the lump is and its location – as well as the ultrasound findings and the results of a needle test that show what the cells inside of the thyroid nodule look like. Sometimes, this can only help stratify the risk of the nodule, and the ultimate diagnosis of the type of thyroid cancer and the significance of that thyroid cancer is found at diagnostic hemithyroidectomy.
How is thyroid cancer treated?
Thyroid cancer is largely a surgical disease and is well treated by simply removing the part of the thyroid or nodes that are affected. If it has spread beyond that or if it has aggressive features, sometimes medical specialists will use radioactive iodine as an adjuvant treatment. Very rarely, your doctor will need to use other treatments such as immunotherapy, injected medications or radiation treatment.
Dr McKenzie is part of a specialist team at the Royal Brisbane and Women’s Hospital and the Queensland Children’s Hospital that reviews most of Queensland’s thyroid cancer cases, and makes recommendations for all complex cases. Every case is risk stratified and has treatment recommended based on the specialist panel’s consensus of the extent of surgery, surveillance and follow-up required.
This mode of patient care is the gold standard for delivering cancer treatment. Dr McKenzie’s experience as part of this panel, where she has oversight of thyroid cases in the state, means she understands which cases can benefit from minimalistic treatment, so patients can be confident they won’t receive surgery unless it is the best-practice treatment for their individual case.
What are the benefits of a thyroidectomy?
A thyroidectomy is a surgery that should only be done if there's a strong medical indication. Firstly, it can help relieve the symptoms of a compressive thyroid, which can markedly improve a patient's life in terms of how they eat and breathe. Another benefit of a thyroidectomy is that it allows doctors to accurately diagnose and treat thyroid lumps, whether or not they are malignant.
Are there alternatives to surgery to treat thyroid cancer?
Australia is one of the places in the world where patients with a small thyroid cancer, known and diagnosed on a needle test, can be observed, because we know that some types of thyroid cancer only progress very slowly. So, active surveillance or observation is one modality that ENTs such as Dr McKenzie apply in very selected cases only.
There are other alternative treatments of thyroid cancer such as radiofrequency ablation of nodules, which currently sits in the evolving scientific space – there are not many providers [BA1] who can deliver this in Australia.
There are no effective treatments for thyroid cancer once it is large or locally progressive or involving lymph nodes that are non-surgical.
About thyroid nodules
Thyroid nodules are small cyst-like areas in the thyroid where one area is prominent or rounded and doesn't look like the surrounding thyroid tissue.
What problems do thyroid nodules lead to?
When thyroid nodules grow too large, they can cause compression of the structures around the thyroid, such as the windpipe and the oesophagus, and cause difficulties with eating or breathing or a sensation of a mass in the throat.
How are thyroid nodules diagnosed?
Thyroid nodules are characterised using ultrasound and sometimes CT scans, and if they have sinister features, then ENTs like Dr McKenzie will perform a needle test to define whether the thyroid nodules are benign or malignant.
How does Dr McKenzie treat thyroid nodules?
Thyroid nodules are assessed on their individual basis, and a tailored treatment plan will be created for you that could involve recommendations for observation, ongoing imaging, or surgery.
Are there alternatives to surgery to treat thyroid nodules?
The short answer is no. The only possible alternative to surgery for thyroid nodules is active observation. Sometimes observation is not required if it's very clear the nodules are benign, not progressive and they're not causing any symptoms.
About goitres
Goitre is a word used to describe a big thyroid. It occurs when the thyroid has enlarged to the point where it is visibly swollen.
What causes a goitre?
The thyroid can get big for multiple reasons. It can get big because it's underactive, or it can get big because it's overactive, such as in Graves’ disease. Usually, the cause can be determined by hormone changes on people's blood work. In those situations, the goitre is often managed with medical treatment by an endocrinologist.
What are the symptoms of goitre?
Goitre is usually noticed as a swelling or a growth in the middle of the neck or a general fullness of the neck. It can also cause problems with swallowing and breathing.
What problems does a goitre cause?
If a goitre has gotten very big, it can cause discomfort for the patient in the neck, and issues with swallowing and breathing. It can also be aesthetically displeasing.
How is goitre treated?
Goitre is addressed with medical treatments if there is an overactive or underactive thyroid, but if it has become large and compressive, and hormonal treatment hasn’t improved your symptoms, then surgery is the best and most effective treatment.
Will a goitre shrink without surgery?
It’s very rare for a goitre to decrease in size without surgical intervention.
What are the risks of surgery for thyroid cancer, nodules or goitre versus the risks of not having the surgery?
While all surgeries carry some risks, these are well understood and carefully managed by specialist doctors and nurses. It’s important to remember that leaving a chronic condition untreated can lead to worsening health problems that may become more difficult to treat over time. Dr. McKenzie will only recommend surgery when the expected benefits clearly outweigh the potential risks.
Where does Dr McKenzie operate?
Dr McKenzie operates at Brisbane Private Hospital in Spring Hill, Mater Children's Private Hospital/Mater Private Hospital in South Brisbane, and Greenslopes Private Hospital in Greenslopes for both paediatric and adult patients.
These hospitals all offer excellent paediatric nursing care support, and Dr McKenzie only uses specialist paediatric anaesthetists for your child’s procedure. This means that you can be assured that your child is in the safest possible hands as it takes a dedicated and comprehensive team of specialist nurses and doctors to safely provide paediatric ear, nose and throat surgery. Dr McKenzie has chosen these hospitals based on their ability to provide the highest level of care to your child.
For adult patients, Dr McKenzie selected these hospitals due to their access to intensive care units and the most modern facilities and resources to ensure the best experience for your procedure.