Otolaryngology - Head & Neck Surgery


Along with the pancreas, pituitary gland, and the ovaries, the thyroid gland is one of the endocrine glands. It produces the thyroid hormone which helps regulate growth and metabolism. The thyroid gland is located in the lower-middle section of the neck just below the voice box. It is butterfly-shaped, having right and left sections (lobes) connected by a thinner middle piece (isthmus).

Problems with the thyroid

Diseases of the thyroid gland are very common and affect millions worldwide. Abnormalities are normally due to the underuse or overuse of the gland. As a result, lumps or masses (nodules) may develop on the thyroid gland or the thyroid itself will become enlarged. An enlarged thyroid gland is often referred to as a goiter.

Thyroid Cancer

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A thyroidectomy is the removal of the entire thyroid gland (total thyroidectomy) or parts of the thyroid gland (partial thyroidectomy). The procedure is done with the patient under general anaesthetic. Prior to surgery, the patient will meet with an anaesthesiologist who will determine the exact amount of anaesthetic to give. A normal total thyroidectomy takes around 1.5 hours to complete.

Involved risks of a thyroidectomy

As with any surgery, thyroid surgeries (thyroidectomy) are associated with bleeding, risk of infection, and scarring. Hematomas — pooling of blood outside the blood vessels — bruising, swelling, soreness, tension, redness, and discharge at the incision are possible complications.

Some additional post-operative complications can also occur, including injury to the laryngeal nerve, the neck's strap muscles, and to the parathyroid glands. Damage to the parathyroid glands can disrupt the balance of calcium in the body. Damage to the voice box (larynx) could result in temporary or permanent dysfunction of the vocal chords.

Laryngeal nerve

The laryngeal nerve supplies the larynx (organ involved in speech production, breathing and swallowing) with motor function and sensation. It is composed of two branches: the recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN). Thyroidectomies can damage the RLN and SLN and therefore causing speaking, breathing, and swallowing impairments.

Parathyroid glands

The parathyroid glands are located on the back of the thyroid. They are responsible for regulating calcium levels in the blood. Damage to the parathyroid glands can disrupt these calcium levels and low levels of calcium are referred to as hypocalcaemia.

Hypocalcaemia can be life-threatening, as calcium is vital to muscle function and the maintenance of a healthy heart and brain.

Symptoms of hypocalcaemia

The signs and symptoms of hypocalcaemia include paresthesia and tetany.

Paresthesia is the sensation of tingling, burning, pricking, or numbness in the skin. Hypocalcemic patients typically experience paresthesia around the mouth, hands and feet.

Tetany is involuntary muscle contractions including cramping, twitching and/or stiffening. Tetany in hypocalcemic patients is often experienced in the hands and large muscles of the body. However, tetany can also occur in the throat and heart muscles resulting in laryngospasms (throat muscle contractions) and cardiac arrhythmias (irregular heartbeats).

Hypocalcemia has also been reported to cause seizures, mood disturbances and cognitive impairments (memory loss, fatigue, restlessness and/or depression).

Aiding parathyroid health

To aid in proper parathyroid health, be consistent with your thyroid medication and follow your physician's instructions exactly. Thyroid medication is best taken in the morning on an empty stomach. It is also advised to supplement your diet with calcium and vitamin D3. Antacids (calcium carbonate) are an acceptable form of supplementation but must be taken at meal times or right after eating. Calcium citrate, calcium lactate and calcium gluconate are well absorbed at any time with a glass of water.

Location and contact

Department of Otolaryngology

Sunnybrook Health Sciences Centre
2075 Bayview Avenue,
M-wing, 1st floor, room M1 102
Toronto, ON M4N 3M5

Hours: Mon-Fri, 8:00 a.m. - 4:30 p.m.

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