PEMBEDAHAN TIROID ENDOSKOPI/ PEMBEDAHAN TIROID TANPA PARUT

Fakta-Fakta Asas Mengenai Tiroid

Kelenjar tiroid adalah organ penting badan anda yang menghasilkan hormon (Thyroid Hormone) yang berfungsi untuk mengawal fungsi seperti tekanan darah, denyut jantung, berat badan dan suhu badan.

Kelenjar terletak pada dasar leher kita dan ketika ada penyakit, saiznya akan membesar.

Terdapat 4 jenis penyakit yang boleh berlaku kepada kelenjar tiroid kami:

1. Hipertiroid (pengeluaran terlalu banyak hormon)
2. Hipotiroid (pengeluaran hormon terlalu kecil)
3. Kanser tiroid
4. Nodul tiroid

Apakah tanda-tanda dan gejala penyakit tiroid yang mungkin berlaku?

1. Hipertiroid: penurunan berat badan, denyutan jantung yang cepat, berpeluh, gegaran, keresahan, kesukaran tidur
2. Hipotiroid: peningkatan berat badan, rasa letih, kehilangan rambut atau penipisan, mood depresi, kelemahan otot
3. Kanser tiroid: ketulan pada leher, kesukaran menelan, nodus limfa bengkak, perubahan suara
4. Nodul tiroid: selalunya, nodul tidak mempunyai gejala. Ada yang boleh tumbuh cukup besar untuk dirasakan. Kebanyakannya adalah benigna, tetapi ada yang boleh menjadi kanser.

Apabila kelenjar tiroid membesar, ia dipanggil goitre. Kebiasaannya, adalah pembengkakan leher, sama ada pada satu pihak (unilateral) atau kedua belah pihak (bilateral). Kelenjar dapat membesar selama beberapa bulan hingga tahun. Gangguan tiroid dan goitres sebenarnya agak biasa di kalangan penduduk Malaysia, terutamanya di kalangan wanita.

Terdapat banyak faktor yang menyebabkan gangguan tiroid, contohnya: faktor alam sekitar dan pemakanan. Penyebab imun, genetik dan sejarah keluarga juga memainkan peranan; tetapi biasanya tiada punca sebenar boleh dijumpai.

Siapa yang anda perlu jumpa jika anda mengesyaki anda mempunyai penyakit tiroid?

Kebanyakan masa, penyakit tiroid pertama kali dievaluasi oleh doktor perubatan dalaman yang akan meminta sejarah terperinci, melakukan pemeriksaan leher dan diminta melakukan ujian darah untuk memeriksa fungsi tiroid anda. Selalunya, pengimejan radiologi seperti ultrasound atau imbasan CT diperlukan.

Kadang-kadang, sampel tisu diperlukan. Ini akan dilakukan oleh pakar bedah atau ahli radiologi intervensi.

Bilakah anda memerlukan pembedahan tiroid?

Rawatan pembedahan adalah disyorkan untuk pesakit dengan nodul tiroid yang dianggap kanser.

• Pesakit dengan pembesaran tiroid yang terlalu aktif mungkin memerlukan rawatan pembedahan terutamanya jika tidak bertindak balas terhadap ubat anti-tiroid.
• Pesakit yang mengalami radiasi di bahagian kepala dan leher, boleh mengembangkan nodulariti kelenjar tiroid yang mungkin memerlukan rawatan pembedahan. Terutamanya jika terdapat kemungkinan 30 hingga 60% kanser di dalam kelenjar itu.
• Pesakit kadang-kadang boleh mengembangkan pembesaran kelenjar tiroid sehingga tekanan pada saluran angin. Tekanan ini boleh menyebabkan pesakit mengalami rasa sukar untuk menelan atau mengalami kesukaran bernafas. Ini boleh disahkan pada pemeriksaan sinar-x di dada di mana saluran angin boleh dilihat menyimpang disebabkan kelenjar tiroid yang membesar. Dalam keadaan ini pembedahan paling berkesan dan boleh diutamakan.

Apakah pembedahan tiroid (tiroidektomi)?

Tiroidektomi adalah operasi di mana satu atau kedua lobus kelenjar tiroid dikeluarkan. Ujian yang paling biasa untuk menentukan sama ada tiroidektomi diperlukan termasuk biopsi aspirasi jarum halus, imbasan tiroid, ultrasound, x-ray dan / atau imbasan CT, dan penilaian tahap hormon tiroid. Prosedur ini biasanya dilakukan di bawah anestesia umum. Tahap pembedahan (penyingkiran salah satu atau kedua-dua lobus) kadang-kadang boleh ditentukan semasa pembedahan selepas pemeriksaan mikroskopik tisu dikeluarkan semasa pembedahan.

Secara tradisional, prosedur ini dilakukan sebagai pembedahan terbuka, yang memerlukan sekurang-kurangnya 8 hingga 10cm hirisan pada bawah leher. Parut itu agak tidak disukai secara estetiknya.

 

MINIMALLY INVASIVE (ENDOSCOPIC) THYROID SURGERY

Using new surgical techniques, specialized surgeons can now perform scarless (otherwise known as minimally invasive) surgery.  Special cameras (endoscopes) are inserted into small holes or very small incisions through which the surgeon can see the thyroid gland. Another specialized instrument can then be inserted to remove the thryoid gland.

There is no neck scar. There will only be a small scar in the armpit area (axilla) and small 5mm scar at the chest area. This operation is safe, achieves aesthetically pleasing scars and requires shorter recovery periods.

Usually, patients will require general anesthesia for thyroid surgery.  However, using endoscopic techniques, patients may only need local anesthesia and moderate sedation for comfort,

Minimally invasive surgery is typically an outpatient procedure, with most patients going home within in a few hours of the operation.  Traditional surgery almost always means at least a one-night stay in the hospital.

Any patients undergoing thyroid surgery will experience a few days of hoarseness and soreness in the throat, but patients who undergo the minimally invasive procedure will have less discomfort around the external wound.   This helps to speed recovery and hasten return to normal daily activities.  

Patients can usually go home in one to two hours after minimally invasive thyroid surgery.  They can resume most normal activities the next day, although return to driving or other activities that require turning the head comfortably may take slightly longer.

What happens before surgery?

We will schedule a pre-operative visit during which the doctor will fill-out hospital forms, go over your medical history, current medications, allergies etc. and perform a complete physical examination.  You will also be given the opportunity to ask questions about the procedure, hospitalization, complications, etc. You will sign the pre-operative surgical consent form and receive your post-operative instructions, and prescriptions for antibiotics, pain killers and other medications you may need after surgery.

What is pre-operative assessment?

After you finish with the doctor, you will then go to the hospital for pre-operative registration and assessment.  This is where pre-operative blood tests, ECG, chest x-rays, etc.  are carried out.  You will also have the opportunity to talk to the anaesthesiologist and ask questions or express concerns about anaesthesia.  Here also, you will be informed of the time of the operation and given instructions about when to take your medications and what to wear.  You may also be asked to sign consent forms for surgery, anaesthesia and blood transfusions.

What happens on the day of surgery?

If you have been assigned a room and have been admitted to a hospital bed, then you will be transported to the pre-operative holding area about 30 minutes prior to your operation.  Your family may remain in your room or wait in the Surgery waiting area.  It would be helpful if family members or friends notify the nurses’ desk or the waiting room receptionist of their whereabouts, so that we can find them to let them know that your surgery is over.

In pre-op holding, the nurses will start an IV line and review your history and medications. They will ask you questions to make sure you understand what is going to be done and that you have consented. They may make you sign the consent forms if you have not signed them during assessment.  They will also mark the operative site with ink and if applicable, write on your neck LEFT or RIGHT so that there will be no confusion as to which side is being operated on.  You may request a tranquiliser if you are very anxious.

What happens after surgery?

When you wake up from surgery, you will be transported to the recovery room , where would spend about 30 minutes to an hour, until you are fully awake and stable for transportation to your room.

You will be asked to speak to find out if your voice is hoarse.  Many patients, especially smokers, have a raspy or hoarse voice when they wake up from anaesthesia.  Smokers have a tendency to cough.

You might notice that there will be a small drain or tube coming out from your wound, and the tube is normal kept for at least 48 hours to prevent collection under the skin.

For 2 – 3 days after the surgery, it is not unusual to have pain or difficulty on swallowing.

Complications

• Bleeding or infection are possible short term complications. Although rare in thyroid surgery, some patients may develop a thick scar or keloid.
• Two complications specific to thyroid surgery are hypocalcaemia and vocal cord weakness or paralysis.
  • Hypocalcaemia, or low blood levels of calcium, may occur after complete removal of both thyroid lobes. This condition is caused by interference with four tiny glands called parathyroid glands, which are located within or very close to the thyroid gland.
  • Hypocalcaemia is usually temporary, but sometimes may require calcium supplements if sufficiently pronounced. Permanent hypocalcaemia is fortunately rare.
  • Vocal cord weakness or paralysis may be caused by swelling, stretching, or injury to the recurrent laryngeal nerve which passes very close to the thyroid gland. Temporary hoarseness may result. Again, this is an uncommon, usually temporary complication. Permanent vocal cord paralysis is rare. Finally, in very infrequent situations, airway obstruction may occur and a tracheotomy may become necessary to gain access to the airway. This is an extremely rare life saving measure and every effort would be made to avoid it.

To know more about Endoscopic Thyroidectomy, speak to our Consultant General Surgeons.