Thyroid surgery / Top clinic in Germany, Friedrichshafen

Thyroid surgery

What is the thyroid?

The thyroid (Glandula thyreoidea) is a butterfly-shaped organ located in the cervical region in front of the trachea. It has an important body function control function and acts as a hormone storage. A disturbed thyroid function affects a variety of body and organ functions. The thyroid gland is a reddish-brown colored organ in the cervical region. It is often described as a butterfly. This form results from the two side lobes (Lobus dexter and Lobus sinister), which are usually slightly different in size.

The two lateral lobes are connected by a transverse tissue bridge, the isthmus. In addition, there may be a lobe of the lobus pyramidalis originating from the isthmus.

The thyroid gland weighs 18 to 30 grams in adults. It is usually a bit heavier in women than in men.

Outer capsule and organ capsule

Externally, the thyroid is surrounded by a capsule (also called external or surgical capsule). This outer capsule continues inwards as an organ capsule (capsula interna).

Between the two capsules are the larger blood vessels and at the back of the gland the four parathyroid glands. The organ capsule passes into connective tissue streets that divide the glandular tissue (parenchyma) into individual lobules (lobules).

Thyroid lobules (Lobuli)

Each lobule consists of many small, vesicular formations (follicles), the wall of which is composed of a single-layered follicular epithelium. These epithelial cells produce the thyroid hormones T3 and T4 and spill them into the vesicle cavities. There they are stored in droplets, the so-called Kelloid. T3 and T4 are made in stock; the amount stored in the follicles lasts up to two months.

Between the follicles are the C-cells. These are also called parafollicular cells. They produce the hormone calcitonin (English calcitonin) and release it into the blood.

What function does the thyroid have?

Thyroid function is the need-based production, storage and delivery of thyroid hormones. In this way, the organ is involved in the regulation of iodine, calcium and total metabolism.

The thyroid produces the following hormones:

  • Triiodothyronine (T3)
  • Tetraiodothyronine (thyroxine or T4)
  • Calcitonin (calcitonin)

What problems can the thyroid cause?

Common diseases are hyperthyroidism (hyperthyroidism) and hypothyroidism (hypothyroidism).

In case of overfunction, the gland produces too many thyroid hormones. This leads to weight loss due to abnormally increased basal metabolic rate, increased body temperature, increased heart work, insomnia and inner restlessness, mental instability, hands trembling and diarrhea. The cause of hyperthyroidism is usually an autoimmune disease.

Thyroid hypofunction is deficient in thyroid hormones. The result is too low a metabolic rate, which manifests itself in weight gain, constipation and sensitivity to cold. In addition, doughy thickening and swelling of the skin (myxedema), mental retardation and tiredness, shaggy and dry hair and libido and potency disorders. Hypothyroidism can be innate or acquired.

The pathological enlargement of the thyroid gland (goiter, goiter), which is mostly caused by iodine deficiency, is widespread.

More rare are various types of inflammatory diseases of the thyroid gland (thyroiditis). The best known form of thyroiditis is Hashimoto autoimmune thyroiditis.

Thyorid surgery

Under thyroid surgery is usually understood the partial or total removal of the thyroid (thyroidectomy). This is necessary, for example, in the case of cancer or enlargement of the thyroid gland.

Depending on the patient's underlying disease, a distinction is made between thyroid surgery and different procedures:

  • Removal of a node (enucleation)
  • Removal of most of the thyroid (subtotal thyroid surgery)
  • Removal of a thyroid lobe (hemithyroidectomy)
  • Complete removal of the thyroid gland (thyroidectomy)

In addition to these surgical techniques, there are also minimally invasive thyroid surgery in which the removal of the thyroid gland is performed via a probe and only the smallest skin incisions are necessary. Currently, minimally invasive thyroid surgery at specialized centers accounts for about ten percent.

When do you perform a thyroid surgery?

The most common cause of thyroid removal is malignant neoplasm. Even if a node is discovered in the thyroid gland about whose goodness or malignancy no reliable statement can be made, surgery is required. Other reasons for thyroid surgery are:

  • Thyroid enlargement, possibly with constriction of surrounding organs (goiter)
  • Uncontrolled production of thyroid hormones
  • Severe history of Graves' disease (autoimmune thyroid hypofunction)
  • Massive metabolic imbalance in hyperthyroidism (thyrotoxic crisis)

Before the thyroid operation

The patient receives a general anesthetic, so he spends the procedure asleep and painless. The doctor generously disinfects the surgical field and covers the patient with sterile tissue, leaving the anterior region of the neck. Then the surgeon can start with the actual removal of the thyroid gland. If necessary, he monitors the surrounding nerves with the aid of a so-called neuromonitoring system - if he touches a nerve with the surgical instrument a warning signal sounds.

Total thyroidectomy

Total thyroidectomy is used, for example, in the removal of the goiter (struma surgery, strumectomy, struma resection) and large cancerous ulcers. The surgeon sets a four to five centimeters long skin incision. If possible, he seeks a skin fold to achieve a better cosmetic result. Now the doctor cuts the layer of fatty tissue with electric scissors, which immediately stops any bleeding. If the thyroid is exposed, the surgeon separates it from the surrounding tissue.

The doctor can now remove the entire thyroid gland, leaving the parathyroid glands if he finds them. The parathyroid glands are about as big as a grain of rice and can lie in different places in the throat. If the surgeon finds the parathyroid glands only when examining the removed thyroid gland, he replugs them into an artificially created pocket in the cervical musculature. There the parathyroid can resume work.


Hemithyroidectomy removes only one of the two thyroid lobes. It is also used in goiter surgery, but also in unilateral cancerous ulcers. Access is as in total thyroidectomy. If the doctor has a good view of the exposed thyroid lobe, it cuts through the connective tissue bridge that connects the two lobes.


Enucleation is used to remove small, benign nodules. The surgeon makes a small incision through which he carefully accesses the knot. He then removes it with an ultrasonic scissors or an electric knife.

Subtotal thyroid surgery

The subtotal thyroid resection is a rather rare procedure and is usually only used when independently hormone-producing cells are distributed throughout the thyroid gland. The surgeon removes large parts of the thyroid, but protects the healthy thyroid tissue.

After thyroid surgery

After removal of the thyroid gland, the doctor first sutures the muscle and fat layer with self-dissolving threads, then also the skin incision as free of tension as possible, in order to prevent unaesthetic scarring. The wound is connected to sterile plasters. The patient is then taken to the recovery room where he can recover from the anesthetic.

What are the risks of thyroid surgery?

Thyroid surgery is a routine surgical procedure. Nevertheless, as with any surgery, complications can occur. Possible consequences of the operation can be:

  • Secondary bleeding, possibly with surgical removal of the bruise
  • Wound healing
  • Infection of the operating area
  • Cosmetically unsatisfactory result with significant scarring

Injury of nerves

Thyroid removal can damage important nerves that are near the thyroid gland. If the so-called recurrent nerve is injured on one side of the neck, it may cause a slight hoarseness. The rare bilateral transection of the nerve causes respiratory distress; if necessary, the patient must be artificially ventilated.

What should I watch for after a thyroid operation?

As with any surgery, you may experience soreness in the first few days after surgery. If necessary, your doctor prescribes you an analgesic drug. To protect the wound, wash only with the neck area cut out or using a special shower patch.

Hormone replacement therapy after thyroid surgery

By removing the thyroid gland, the body lacks the hormones triiodothyronine and thyroxine it produces. These must be permanently delivered after complete thyroid surgery. Your doctor will prescribe tablets for you to take daily. After four to six weeks, he controls the hormone levels in the blood and adjusts the dose to your individual needs. If only part of the thyroid gland is removed during thyroid surgery, it is usually not necessary to take hormones.

Thyroid surgery

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Medical Staff

MD PV Thorsten Lehmann

MD PV Thorsten Lehmann
Head of the Surgery Department

MD Jürgen Kies

MD Jürgen Kies
Senior physician

MD Frank Aspacher

MD Frank Aspacher
Senior physician

MD Stefan Tange

MD Stefan Tange
Senior physician

B. Schmollinger

B. Schmollinger
Medical secretary


General Surgery



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