Risks of thyroid and pararthyroid surgery

Suren is a fellowship-trained endocrine surgeon with extensive experience in thyroid, parathyroid, and neck surgery. He performs a range of procedures using minimally invasive and advanced techniques to ensure safe outcomes and optimal recovery. He uses meticulous surgical technique with nerve monitoring to protect the recurrent laryngeal nerves and parathyroid glands, minimising complications such as voice changes or calcium disturbances. Nevertheless, complications can occur that you should be aware of prior to consenting for surgery.

General Risks

Bleeding or bruising – occasionally a collection of blood (haematoma) or tissue fluid (seroma) can form. These usually settle spontaneiously, but very rarely (less than 1%) may affect breathing, which may require a return to the operating theatre to relieve pressure on the windpipe.

Infection – uncommon in neck surgery, but possible. Usually settles with antibiotics.

Voice changes – a temporary huskiness or change in voice can occur from the breathing tube or irritation to nerves.

Anaesthetic risks – such as nausea, vomiting, or reactions, which are generally rare. Your anaesthetist will talk to you in detail about risks associated with general anaesthesia.

Below is a summary of specific risks for operations performed by Suren

Hemithyroidectomy

A hemithyroidectomy involves the removal of one lobe of the thyroid gland. Risks include:

  • Hoarse voice – usually temporary, but can be permanent (around 1%) if the main voice nerve (the recurrent laryngeal nerve) on that side is injured.

  • Swallowing or pitch changes – mild changes may occur, but are uncommon.

  • Calcium levels – rarely affected, since most parathyroid glands remain untouched.

  • Need for further surgery - if the specimen is found to be malignant (ie a thyroid cancer), the case is discussed at a multidisciplinary meeting with a team of specialists after which Suren may recommend removing the other half of the thyroid gland to allow for further treatment or better ongoing surveillance.

  • Need for thyroid hormone supplementation - 20 to 30% of patients undergoing hemithyroidectomy may require a thyroid hormone supplement, determined by how the patient is feeling as well as a blood test taken two months following surgery.

Total Thyroidectomy

Total thyroidectomy involves removing the entire thyroid gland. Risks include:

  • Voice changes – from nerve injury, as for hemithyroidectomy. In rare cases (less than 1%), nerves on both sides can be involved and breathing can be affected. This can result in a prolonged hospital stay or the need for intensive care.

  • Low calcium – due to disturbance of the parathyroid glands, usually temporary. Can be very rarely permanent (less than 1%), where may require long-term calcium or vitamin D supplements.

  • Thyroid hormone replacement – lifelong tablets are required after the thyroid is fully removed.

Neck Dissection for Thyroid Cancer

In cases where thyroid cancer has spread to the lymph nodes, neck dissection may be required alongside thyroidectomy. There are additional risks associated with this more extensive surgery>

  • Voice changes - as above

  • Bleeding or fluid build-up – including a milky fluid called chyle if a lymphatic duct is injured.

  • Nerve effects – possible shoulder weakness, tongue weakness, lip asymmetry, or rarely breathing problems if other nerves are affected.

  • Numbness or stiffness – in the neck or around the ear, which can be temporary or lasting.

  • Scarring – the operation may leave a larger scar, and the neck may feel tight during recovery.

Suren has advanced training in central and lateral neck dissection techniques, including re-operative and revision surgery.

Parathyroidectomy

  • Voice changes – from injury to the main voice nerve (as above)

  • Low calcium – can happen temporarily after surgery (“hungry bone syndrome”) or if remaining glands are affected, sometimes needing supplements.

  • Persistent or returning high calcium – if the overactive gland is not fully removed or another gland later becomes overactive. This may require further surgery or medical management with an endocrinologist.

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