Thyroid surgery

The thyroid and parathyroid glands

The thyroid and parathyroids are endocrine glands that play an essential role in regulating the body by secreting hormones.
The thyroid is located at the base of the neck, in front of the trachea and below the larynx. It consists of two lobes joined by an isthmus, which gives it its characteristic butterfly shape. The four parathyroid glands are positioned in pairs, two at the back of each thyroid lobe.

Conditions that are usually treatable

The vast majority of thyroid conditions are treated effectively. Treatment options are medical or surgical; in some cases, lifelong hormone replacement therapy may be necessary.
Thyroid and parathyroid surgery is now a well-established procedure, considered safe and standardised.

When is thyroid surgery needed?

Surgery may be recommended in the following situations:

Graves’ disease.
A simple goitre.
The presence of one or more thyroid nodules.
Thyroid cancer.

Download the AFCE (Association Francophone de Chirurgie Endocrinienne) information booklet (in French)

What are the benefits?

A cutting-edge technique: transoral thyroidectomy

Some thyroid conditions can now be treated surgically via the transoral route: a minimally invasive endoscopic approach that is still unprecedented in France, performed by Dr Grégoire Deroide.
This technique, known as TOETVA (Transoral Endoscopic Thyroidectomy Vestibular Approach), involves operating from inside the mouth, with no visible incision on the neck. Imported from Thailand, it was developed in Asia, notably to preserve the fertility meridian, a concept from traditional Asian medicine, and thus to protect women against the risk of infertility associated with neck scars.

Its main advantage: no visible scar

Convinced of the clinical and cosmetic benefits of this approach, Dr Deroide trained directly with its inventor, Dr Angkoon Anuwong of the Police General Hospital in Bangkok, a pioneer of the technique worldwide, with thousands of transoral thyroidectomies performed since 2016.
Drawing on this expertise, unique in France, Dr Deroide now offers this procedure at the Franco-British Hospital and at Clinique Ambroise Paré, with nearly 400 cases performed to date.

Dr Deroide and a colleague in the operating room

Patient positioned in the operating room for thyroid surgery

How is the procedure performed?

Transoral thyroidectomy is performed under general anaesthesia. The surgeon makes three small incisions between the lower lip and the gum, through which the trocars are inserted into the chin muscle: one holds the endoscope, the other two the surgical instruments.
This approach gives a remarkable view of the operating field, allowing the surgeon greater precision and better preservation of the adjacent parathyroid glands and recurrent nerves, structures that are particularly important to protect in any thyroid surgery.

Compared with the da Vinci robot-assisted transaxillary approach, the TOETVA technique considerably shortens the access route and is much less expensive, with no compromise on the quality of the surgical procedure, Dr Deroide points out.

Risks and patient eligibility

In terms of risks, this approach is comparable to conventional thyroidectomy. It is specifically intended for patients with isolated nodules or goitres whose diameter does not exceed 6 cm.

However, this technique is contraindicated in certain situations:

Previous neck surgery that may have left adhesions
Uncontrolled Graves’ disease
Acute thyroiditis
Previous radiotherapy to the neck

Frequently asked questions about thyroid surgery

Will I need any treatment after my operation?

It all depends on how much of the thyroid gland remains. If all or almost all of the gland has been removed, you will need to take simple medication: one tablet of replacement hormone a day for the rest of your life. If only one of the thyroid lobes has been removed, you will not need replacement therapy, but in some cases suppressive therapy may be considered.

Will I gain weight after my thyroid is removed?

No. After the operation, the level of thyroid hormone in your blood will need to be monitored regularly with a blood test. If your whole thyroid has been removed, your surgeon, in agreement with your family doctor or your endocrinologist, will prescribe a treatment that will replace your gland and prevent you from gaining weight.

Will I have a scar?

All surgery leaves a mark; this is an anatomical reality. The quality of healing depends largely on the type of skin, which is specific to each individual. That said, the surgeon has many ways of optimising the result: a precise incision, strategic placement and the use of suitable hypoallergenic sutures.
A thyroidectomy performed by an experienced endocrine surgeon is the best assurance of a discreet, well-blended and aesthetically placed scar. The vast majority of patients say they are very satisfied with their result at six months.

What if I don’t want any visible scar?

This is precisely one of the major advantages of the TOETVA technique performed by Dr Deroide: because the operation is carried out from inside the mouth, it leaves no visible scar on the skin. The three micro-incisions made between the lower lip and the gum are completely invisible from the outside.
Robotic transaxillary surgery also offers an alternative, with the scar hidden in the armpit.
These two approaches have specific indications and are not suitable for every patient. During a consultation, Dr Deroide can determine the most appropriate technique for your situation.

Why is the area of my neck around the scar swollen in the days after my operation?

This is a normal part of the healing process and corresponds to inflammation of the tissues beneath the skin. Bear in mind that the scar will reach its final appearance after 6 to 9 months. To speed up the cosmetic result, you can gently massage the scar with a moisturising cream from the 15th day after surgery.

Will there be any restrictions after my operation?

Recovery after surgery is usually straightforward and short.
In the first week, it is common to feel neck pain similar to that of a severe sore throat: a temporary and entirely normal discomfort related to the operation.
It can be managed comfortably at home with suitable painkillers.
Showering is allowed as soon as you get home. However, swimming and sport should be avoided for about three weeks, until healing is complete.
Beyond these precautions, the return to normal life is quick; this is one of the advantages of what is now a well-established operation.

Will I lose my voice after thyroid surgery?

Your voice may indeed sometimes undergo a temporary change, such as voice fatigue or hoarseness. In most cases, everything returns to normal within 6 to 8 weeks. Fewer than 1% of patients have a permanent change in their voice. To reduce this risk as much as possible, it is important to be treated by a surgical team with expertise in this delicate surgery.

What are the signs of a sharp drop in blood calcium levels after surgery?

A few patients have a sharp drop in blood calcium levels after thyroid surgery (this is known as hypocalcaemia). The most common symptoms are tingling in the extremities (particularly in the fingers and around the mouth), which can progress to tetany and temporary paralysis. If you experience such signs, you must tell your surgeon promptly.

When will I get the final result of my thyroid analysis?

After the operation, the removed gland is sent to a pathologist, who carries out a detailed microscopic analysis.
The final result is available in approximately one week to ten days. At the post-operative consultation, Dr Deroide will go through the findings of this examination with you and, if necessary, guide you towards the next stage of your care.

Book an appointment with Dr Deroide today for a personalised diagnosis.

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