Thyroid Disease and Resection

What is the thyroid?

The thyroid is a small gland in the front of the neck. It is shaped like a butterfly. On half (lobe) of the thyroid lies along one side of the windpipe (trachea), and one half lies along the other side, a small “bridge” or “isthmus” of thyroid lies directly on top of the trachea and connects the two lobes. Thy thyroid is located in the middle of the neck, between the Adam’s apple (thyroid cartilage) and breastbone (sternum). The chief function of the thyroid gland is to secrete thyroid hormone, which exerts its effects on nearly all cells of the body. These effects include stimulation of metabolism, growth, and fetal and infant brain development as well effects on heart rate and heart contractility, fertility, and concentration. Thyroid gland disorders therefore have a profound effect upon the human body. When the thyroid gland produces too much thyroid hormone (overactive), the condition is called hyperthyroidism. When the thyroid gland produces too little thyroid hormone (underactive), the condition is called hypothyroidism. Thyroid problems can occur at any age; infants can even be born with a thyroid problem.
  • Too much thyroid hormone (overactive thyroid, or hyperthyroidism) 
  • Too little thyroid hormone (underactive thyroid, or hypothyroidism) 
  • Thyroid nodules 
  • Thyroid cancer
Most children with overactive thyroid have Graves’ disease. In Grave’s disease, the child’s own immune system makes antibodies that are not normal and that increase thyroid activity. Some children with underactive thyroid have Hashimoto’s disease. In Hashimoto’s disease, the child’s own immune system makes antibodies that are not normal and that decrease thyroid activity.

Thyroid nodules are small lumps that form in the thyroid. They can be fluid-filled sacs (cysts) or solid masses. Most thyroid nodules are benign (they are not cancerous). However, benign nodules can become hyperactive and secrete more thyroid hormone that the body needs. In this event, they need to be removed. Less commonly, thyroid nodules contain malignant (cancerous) cells. The most common type of thyroid cancer in children is called papillary carcinoma. Other types of cancer are very rare in children but follicular carcinoma of the thyroid and medullary carcinoma of the thyroid can run in families. Some children with medullary thyroid cancer have another condition that runs in families, called multiple endocrine neoplasia (MEN 2). Children in families with MEN2 need to have a thyroidectomy during early childhood and require surveillance for other tumors over their entire lives.

How is it treated?

Doctors called endocrinologists treat conditions linked to hormones, including problems with the thyroid. Thyroid hormones (and other hormones) are closely linked to a child’s growth and development. Children with thyroid problems need to see pediatric endocrinologists. They specialize in hormone problems in children, and they will tailor treatment to your child’s age and the needs of your child’s growing body.

The team may be able to treat your child’s thyroid problem without a need for surgery. For a child with too much thyroid hormone (overactive thyroid, or hyperthyroidism), doctors may prescribe a medicine to take by mouth every day to block thyroid activity. For a child with too little thyroid hormone (underactive thyroid, or hypothyroidism), doctors may prescribe pills of thyroid replacement hormone. This can keep the hormone level in the right range. Children taking these pills need to see the doctor regularly. The doctor will check their hormone level and adjust their medicine as they age and grow.

Surgery

Some children with thyroid problems do need surgery. A child with overactive thyroid may need surgery to remove the thyroid if one of these things happens:
  • The medicine doesn’t correct their hormone level. 
  • The medicine causes unwanted side effects or an allergic reaction. 
  • The child cannot have radioactive iodine because of their age or size. 
  • The thyroid has gotten too large.
A child with thyroid nodules that clearly are benign (not cancer) might have surgery to remove the nodules if they are causing problems, such as because of their size. A child with nodules that might be cancer or are clearly cancer will have surgery. If the area of concern is in one half, or lobe, of the thyroid, surgeons may remove only that half. This surgery is called lobectomy. If there are concerns about both lobes, they will remove the whole thyroid. This is called total thyroidectomy. If there is cancer in the thyroid, doctors will also check whether the cancer has spread to nearby lymph nodes or other structures. These may need to be removed, too. For children with thyroid cancer, surgery may be all or only part of their treatment. Our surgeons work together with our pediatric endocrinologists and nuclear medicine doctors to create a treatment plan for each child based on his or her needs.

What will happen in the hospital?

You will come to the hospital with your child on the day of your procedure. Your child will not be able to eat or drink before the operation depending on what time you are schedule to go into the operating room. The procedure itself will typically take anywhere from 2-3 hours. When your child wakes up from the procedure he or she will be admitted to a pediatric surgical floor or the pediatric intensive care unit (PICU) for close observation. This observation includes monitoring their incision and neck for any signs of swelling, monitoring their breathing, and checking calcium levels in the blood. The thyroid is adjacent to four small parathyroid glands which secrete a special hormone important in regulating the levels of calcium in the blood. The parathyroids are small (about the size of a pencil eraser) and their (even smaller) blood supply can go into spasm during the thyroidectomy causing a temporary derangement in the regulation of blood calcium levels. For this reason, almost every patient who undergoes a total thyroidectomy receives calcium (and vitamin D) post-operatively. Your child will have a dressing in place on their neck covering the incision that will be removed the next morning after surgery. The incision will be about two to three inches and will be covered with small white tapes call steri strips. Your child’s voice may be hoarse for a few days after surgery, but should become better with recovery.

When will my child be discharged?

Your child will most likely be discharged once they are tolerating a diet without any nausea or vomiting, and their pain is well controlled on pain medications by mouth. Your child’s calcium must also be closely monitored and at a safe level before you go home, occasional blood draws may need to be done to assess this. A prescription will be given for all of the medications your child may need at home.

What should I look out for after the hospitalization/operation?

After surgery to remove the thyroid the white strips on the incision will remain in place for about 10 days. Swimming and bathing are permitted after that, showering is ok immediately after surgery. The edges may slowly start to peel up and you may take them off at home if you are comfortable, or in clinic follow up. Your child’s throat may feel sore from the tube in your throat during surgery, that should resolve on its own, lozenges and throat spray may help as well. Your child’s neck may be slightly swollen as well, and your child may feel a lump in their throat when swallowing, this should also start to improve after the next few days, if not contact your child’s surgeon about this.

What will be my child's recovery?

Everyone’s recovery is different. Most children/teens will need about one week before they start to feel up to any activities including school. Gym and sports can most often resume after about two weeks or when advised by your surgeon.

After surgery to remove the whole thyroid, children may need to take thyroid hormone replacement pill so their bodies get this important hormone. If only half the thyroid is removed, the other half will make enough thyroid hormone to meet their needs. You will continue to be followed by a pediatric endocrinologist who will adjust your medications as needed.