Overview
Thyroidectomy is a surgical procedure in which all or part of the thyroid gland is removed. The thyroid gland is located in the forward (anterior) part of the neck just under the skin and in front of the Adam's apple. The thyroid is one of the body's endocrine glands, which means that it secretes its products inside the body, into the blood or lymph. The thyroid produces several hormones that have two primary functions: they increase the synthesis of proteins in most of the body's tissues, and they raise the level of the body's oxygen consumption.
Types of Thyroid Surgery
There are three main types of thyroid surgery:
- Total Thyroidectomy -- Complete Removal of the Thyroid
This is the most common type of thyroid surgery, and is often used for thyroid cancer, and in particular, aggressive cancers, such as medullary or anaplastic thyroid cancer. It is also used for goiter and Graves'/hyperthyroidism treatment. - Subtotal/Partial Thyroidectomy -- Removal of Half of the Thyroid Gland
For this operation, cancer must be small and non-aggressive -- follicular or papillary -- and contained to one side of the gland. When a subtotal or partial thyroidectomy is performed, typically, surgeons perform a bilateral subtotal thyroidectomy which leaves from 1 to 5 grams on each side/lobe of the thyroid. A Harley Dunhill procedure is also popular, in which there's a total lobectomy on one side, and a subtotal on the other, leaving 4 to 5 grams of thyroid tissue remaining. - Thyroid Lobectomy -- Removal of Only About a Quarter of the Gland
This is less commonly used for thyroid cancer, as the cancerous cells must be small and non-aggressive.
The Surgical Procedure
In the surgery, the surgeon will cut a 3- to 5-inch incision across the base of your neck in front. The skin and muscle are pulled back to expose the thyroid gland. The incision is usually made so that it falls in the fold of the skin in your neck, making it less noticeable.
Blood supply to the gland is "tied off," and the parathyroid glands are identified (so that they can be protected). The surgeon then separates the trachea from the thyroid, and removes all or part of the gland.
Treatment of Thyroidectomy
Surgical removal is the treatment of choice for most thyroid carcinomas. The appropriate extent of removal is debatable; some surgeons favoring lobectomy and others near-total thyroidectomy.
The patient is rendered hypothyroid by withdrawing thyroid hormone for four to six weeks until the TSH (thyroid stimulating hormone) is significantly elevated to maximize the iodine uptake by thyroid tissue. At this time, a tracer dose of radioiodine is given, uptake determination and scan are done, and the ablative dose of 131I is calculated and given subsequently. This allows visualization and therapy of the thyroid tissue left in place after surgery and even of metastases that could not be visualized prior to thyroidectomy. Following this procedure, the patient is placed on suppressive doses of T4 (thyroxine, a thyroid hormone) indefinitely.
Aftercare
A thyroidectomy incision requires little to no care after the dressing is removed. The area may be bathed gently with a mild soap. The sutures or the metal clips are removed three to seven days after the operation.
Risks
There are definite risks associated with the procedure. The thyroid gland should be removed only if there is a pressing reason or medical condition that requires it.
As with all operations, people who are obese, smoke, or have poor nutrition are at greater risk for developing complications related to the general anesthetic itself.
Hoarseness or voice loss may develop if the recurrent laryngeal nerve is injured or destroyed during the operation. Nerve damage is more apt to occur in people who have large goiters or cancerous tumors.
Hypoparathyroidism (underfunctioning of the parathyroid glands) can occur if the parathyroid glands are injured or removed at the time of the thyroidectomy. Hypoparathyroidism is characterized by a drop in blood calcium levels resulting in muscle cramps and twitching.
Hypothyroidism (underfunctioning of the thyroid gland) can occur if all or nearly all of the thyroid gland is removed. Complete removal, however, may be intentional when the patient is diagnosed with cancer. If a person's thyroid levels remain low, thyroid replacement medications may be required for the rest of his or her life.
A hematoma is a collection of blood in an organ or tissue, caused by a break in the wall of a blood vessel. The neck and the area surrounding the thyroid gland have a rich supply of blood vessels. Bleeding in the area of the operation may occur and be difficult to control or stop. If a hematoma occurs in this part of the body, it may be life-threatening. As the hematoma enlarges, it may obstruct the airway and cause a person to stop breathing. If a hematoma does develop in the neck, the surgeon may need to perform drainage to clear the airway.
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