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A thyroidectomy is a surgical procedure to remove all (total thyroidectomy) or part (partial thyroidectomy) of the thyroid gland. When you have your thyroid gland totally removed, you’ll become hypothyroid and need synthetic thyroid hormone replacement for life. But what if you’re already hypothyroid or have Hashimoto’s thyroiditis? Would there ever be a situation when you might need a thyroidectomy?  Is removing your thyroid ever an option for you? Read on to understand the pros and cons so you can have an informed discussion with your doctor.

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Thyroidectomy primarily treats thyroid disorders such as thyroid cancer, Graves’ disease and hyperthyroidism, and goiter (an enlarged thyroid). Thyroidectomy may also be performed when there are suspicious nodules or lumps in the thyroid gland that could potentially be cancerous. By removing the thyroid gland, the production of thyroid hormones is controlled, and any potential cancerous or abnormal cells are eliminated. However, after a thyroidectomy, most patients need to take thyroid hormone replacement medication for the rest of their lives to maintain proper thyroid function.

Surgery to remove the thyroid is not typically considered a treatment for hypothyroidism. Traditionally, hypothyroidism is treated with thyroid hormone replacement medication to help return thyroid hormone levels to normal range. Medication usually resolves symptoms in most patients. In some cases, however, patients with active autoimmune Hashimoto’s thyroiditis as the root cause of their hypothyroidism may experience continuing symptoms, and fluctuating thyroid and antibody levels, making it hard to regulate thyroid function and relieve debilitating symptoms. Doctors sometimes recommend thyroid removal for these patients to help reduce antibodies and improve symptoms.

In a study published by the American Thyroid Association, 150 patients aged 18 to 79 were separated into two groups. The first group had received thyroidectomies and was treated with thyroid replacement hormone. The second group was treated with only thyroid replacement hormone. Both groups had elevated thyroid antibody levels and persistent symptoms, despite having normal thyroid levels on blood tests. Results of the study showed that those patients in the group who had thyroid surgery had higher health-related quality of life scores compared to those who only received thyroid hormone replacement.

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The most significant advantage of having a thyroidectomy is that it can help reduce or even eliminate symptoms that persist despite other treatments. Removing the thyroid decreases the possibility of relapse or recurrence in thyroid-related disorders.

Remember that after removing the entire thyroid gland, patients must take thyroid hormone for life.

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As with any list of pros comes its cons. If you’re considering a thyroidectomy, weigh the benefits and risks and work with your doctor to decide whether it’s an appropriate course of treatment for you. Some of the risks of thyroid surgery include:

• Bleeding after surgery 
• Infection after surgery
• Damage to the parathyroid glands, which can cause hypocalcemia (low calcium levels) or low parathyroid hormone levels
• Damage to the recurrent laryngeal nerve, which can cause permanent hoarseness, a weakened voice, voice changes, or difficulty speaking to nerve damage to the vocal cords 

While complications are uncommon, it is always best to be aware of them. You can avoid the risk of complications by asking the right questions and being fully prepared with a post-surgery plan.

In addition to the risks of surgery, it’s important to know that everyone with a total thyroidectomy becomes hypothyroid, as removing the thyroid gland eliminates its ability to produce thyroid hormones. Hypothyroidism can result in symptoms such as fatigue, weight gain, and dry skin, requiring lifelong hormone replacement therapy. A partial thyroidectomy can also result in hypothyroidism, requiring supplemental thyroid hormone medication. It is important for patients considering thyroidectomy to discuss these risks with their surgeon and carefully weigh the potential benefits against the potential risks and outcomes. 

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If you’re ready to discuss the possibility of thyroidectomy with your doctor, come prepared for your appointment with these questions to ask. Because thyroidectomies are performed only for a small percentage of patients, it’s important to ask the right questions to feel secure in your decision, surgeon, and post-surgery care. Questions to ask your doctor include:

• Why do I need a thyroidectomy?
• Is a thyroidectomy my last resort for treatment, or are there other forms of treatment we have not explored?
• How often do you perform thyroidectomies? (You should choose a surgeon who performs a large number of thyroid surgeries annually to reduce any risk of complications)
• What are your patients’ short- and long-term results?
• What are the risks of a thyroidectomy?
• How much of my thyroid gland is being removed?
• What do you do to help minimize risks, such as bleeding, damage to the vocal cords, or hypocalcemia (low calcium levels)?
• What kind of preparations or testing do you recommend before surgery?
• Can you walk me through the surgery steps?
• What can I expect to experience after surgery?
• How soon after surgery can I return to everyday life?
• If I was your daughter/son/child, would you still recommend that I continue with a thyroidectomy?

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Thyroid surgery is not a standard treatment option for Hashimoto’s and hypothyroidism, and most patients can be treated with medication and lifestyle changes. Our healthcare team at Paloma always strives to put you and your well-being first. If you’d like to chat with one of our doctors about optimally treating your hypothyroidism, contact us and consider signing up for our comprehensive thyroid care membership.

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Does removing the thyroid cure Hashimoto's or hypothyroidism?

Thyroidectomy is not typically considered a treatment for hypothyroidism itself. It's usually reserved for conditions like thyroid cancer, Graves' disease, or a goiter, though it's sometimes recommended for patients with persistent Hashimoto's symptoms despite medication.

What are the benefits of having a thyroidectomy?

The main advantage is that it can reduce or eliminate symptoms that persist despite other treatments and lowers the chance of relapse in thyroid-related disorders. One study found higher quality of life scores in patients who had surgery compared with those on medication alone.

What are the risks of thyroid surgery?

Risks include bleeding, infection, damage to the parathyroid glands (which can cause low calcium levels), and damage to the nerve that controls the vocal cords, which can cause hoarseness or voice changes. Anyone who has their whole thyroid removed also becomes hypothyroid and needs lifelong hormone replacement.

Will I need medication after a thyroidectomy?

Yes. Removing the thyroid gland eliminates its ability to produce thyroid hormone, so patients need thyroid hormone replacement medication for life after a total thyroidectomy, and sometimes after a partial one as well.

What questions should I ask my doctor before considering a thyroidectomy?

Useful questions include why the surgery is recommended, whether other treatments have been explored, how often your surgeon performs thyroidectomies, what the risks and expected outcomes are, and what recovery will look like.