What is a thyroidectomy?

A thyroidectomy is the removal of all or part of the THYROID GLAND. The thyroid gland consists of two lobes, one on each side of the throat, connected by a narrow band of thyroid tissue called the isthmus. The term thyroidectomy can apply to a total removal of the gland (total thyroidectomy), removal of one or part of one of the lobes (lobectomy), or the isthmus (isthmusectomy).

What are the indications for a thyroidectomy?

A thyroidectomy is performed to assist in treatment of various thyroid diseases.
These include thyroid nodules, HYPERTHYROIDISM (overactive thyroid gland), cancer of the thyroid gland, or an enlarged thyroid (goiter) that may cause breathing or swallowing difficulties.

How does the surgeon know how much thyroid tissue to remove during a thyroidectomy?

The amount of thyroid tissue that needs to be removed is determined prior to the surgical procedure. The surgeon works closely with an endocrinologist (a doctor specializing in gland tissue disorders) to determine what areas of the thyroid gland are not functioning normally. Usually thyroid function tests (blood tests) and thyroid scanning are involved to aid in this decision. For cases in which thyroid cancer is suspected, a fine needle aspiration biopsy (a needle is inserted through the skin to get suspected cancer cells to examine under a microscope) may also be performed.

What is involved with a thyroidectomy?

The patient is fully asleep (under general anesthesia) during this procedure.
An incision (a precise surgical cut) is made across the lower part of the central neck and layers of skin and muscle are lifted up to expose the thyroid gland underneath.

The thyroid tissue to be removed is then exposed, separated from its blood supply, and removed.

Drains are sometimes placed under the skin after the surgery to help drain any blood or fluid that might accumulate after the procedure. The muscle and skin layers are replaced and the surgical incision is then closed with sutures (stitches) or clips (like staples).

A hospital stay of about two to three days is required. During this time, thyroid hormone levels will be checked to make sure they are in the normal range.

Depending on the reason for the surgery and the amount of thyroid tissue removed, thyroid hormone medications may also be started at this time. Once the wound starts to heal and the stitches and drainage tubes can be removed, the patient may leave the hospital.

What are the risks and complications of a thyroidectomy?

A usually expected condition is HYPOTHYROIDISM – Depending on the amount of thyroid tissue that needs to be removed, there may not be enough thyroid tissue left to produce the amount of thyroid hormones needed for the body to function. In these cases thyroid hormone medications are given. Taking the medications as prescribed, as well as checking thyroid hormone levels periodically can avoid hypothyroidism. An endocrinologist usually coordinates this.

Because of the location of the thyroid gland in the neck, damage to close lying structures might occur during a thyroidectomy. These complications, though uncommon with an experienced surgeon, include:

HOARSENESS – The nerve that supplies the VOCAL CORDS (recurrent laryngeal nerve) lies in this area. Damage to this nerve can result in temporary or permanent hoarseness of the voice.

HYPOPARATHYROIDISM – The four PARATHYROID GLANDS are located within the thyroid tissue. It is important for the surgeon to identify the blood vessels supplying the parathyroid glands, so these are not cut during the thyroidectomy procedure. If all of the parathyroid glands cannot be saved (may occur with a total thyroidectomy), then hypoparathyroidism would result. However, in most cases, the surgeon can implant the parathyroid gland into another location in the neck to avoid this complication.

HEMATOMA – If blood collects under the skin after the operation, this is called a hematoma. This fluid collection has a significant chance of becoming infected. Therefore, drains may be inserted at the time of surgery to prevent this complication.

WOUND INFECTION – Bacteria can sometimes infect the incision causing a wound infection. Treating the skin with special medicine before surgery and giving antibiotics during surgery helps to prevent this condition.