Thyroidectomy

Definition

Surgical removal of all or part of the thyroid gland, which is the gland in the neck that produces hormones that regulate metabolism. Removal of only one lobe of the thyroid is called thyroid lobectomy or partial thyroidectomy.

The Thyroid Gland

The Thyroid

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Parts of the Body Involved

Front of the neck and the thyroid gland

Reasons for Procedure

All or part of the thyroid gland may be surgically removed for any of the following reasons:

  • Overactive thyroid ( hyperthyroid )
  • Underactive thyroid ( hypothyroid ) with thyroid enlargement (goiter)
  • Mass, growth, or cyst of the thyroid
  • Thyroid cancer
  • Very large or toxic goiter (enlarged thyroid) due to hyperthyroidism

Risk Factors for Complications During the Procedure

  • Obesity
  • Smoking
  • Alcoholism
  • Poor nutrition
  • Severe chronic illness, such as poorly controlled diabetes
  • Chronic lung disease

What to Expect

Prior to Procedure

  • Physical exam
  • Laboratory and/or imaging tests such as CT scan , isotope scan, and/or ultrasound to assess thyroid function and anatomy
  • Thyroid medication to suppress thyroid activity in patients with hyperthyroidism
  • Iodine treatments for 10 to 15 days before surgery
  • Fine needle aspiration biopsy to determine if a tumor or nodule is cancerous (in some cases)

During Procedure

  • Anesthesia
  • Breathing tube (intubation)
  • Horizontal incision in the front of your neck, usually above the top of the sternum (breastbone)

Anesthesia

General anesthesia is used fo rthis procedure.

Description of the Procedure

A horizontal incision is made in the front of the neck. The skin is pulled away from the incision and held back with retractors or stitches. Bleeding vessels are clamped and tied off. The surgeon separates muscles, blood vessels, and nerves in the neck to access the thyroid gland. All or part of the thyroid gland is cut away from its attachment to other tissues in the neck and removed. Care is taken to avoid injury to the parathyroid glands (tiiny glands behind the thyroid that regulate calcium metabolism in the body) and nerves that control your vocal cords. Bleeding is controlled with instruments that compress, constrict, and cauterize the ends of blood vessels. The incision is closed and the edges of skin are stitched together.

When this gland is removed to treat thyroid cancer, lymph nodes in the area may also be removed in case the cancer has metastasized.

When only a small thyroid nodule or cyst needs to be removed, the procedure may be performed with a tiny scope (endoscopic thyroidectomy). Several tiny keyhole incisions are made (instead of the larger traditional open thyroidectomy incision), and a fiberoptic scope is inserted to allow the surgeon to view the area. Miniature surgical instruments are inserted through the other openings to perform the procedure. Endoscopic thyroidectomy leaves smaller scars, and often requires a shorter period of recuperation. Endoscopic thyroidectomy cannot be performed to treat thyroid cancer, goiter, or larger nodules.

After Procedure

  • You will have stitches or staples in the front of your neck.
  • There will be discomfort in your neck for several days which can be treated with pain medication.
  • In some cases, you may have a slightly hoarse voice for a few days.
  • You may need to take thyroid medication (in many cases, including all cases of total thyroidectomy) to compensate for loss of thyroid function.
  • In some cases of thyroid cancer, you may need radioactive iodine treatments.

How Long Will It Take?

The procedure typically takes about 2 hours.

Will It Hurt?

Anesthesia prevents pain during the procedure, but pain after the procedure is common.

Possible Complications

  • Infection
  • Bleeding
  • Scarring
  • Voice changes due to damage to nerves leading to the voice box (rare)
  • Damage to the parathyroid gland, which controls calcium metabolism
  • Thyrotoxic crisis (sudden excessive production of thyroid hormone at toxic levels) (very rare)

Average Hospital Stay

1 to 3 days

Postoperative Care

  • Keep the incision clean and dry.
  • Do not get the incision wet for 5 to 7 days, if it does get wet, dry it immediately.
  • Do not apply make-up, lotion, or cream to the incision area.
  • Perform neck exercises as instructed by your doctor.
  • Take all medications as prescribed by your doctor.

Outcome

The outcome after surgery depends on the reason for thyroidectomy.

If the thyroid was removed to treat hyperthyroidism, the following symptoms should subside:

  • Excessive fatigue
  • Weight loss
  • Nervousness
  • Rapid heart beat
  • Excessive sweating
  • Feeling of being hot
  • Tremors
  • Menstrual cycle irregularities

If the thyroid was removed to treat a thyroid tumor, nodule, or excessive goiter, the outcomes include:

  • Removal of cancerous tissue from the body
  • Improvement in swallowing or airflow that may have been compromised by an oversized thyroid gland

Call Your Doctor If Any of the Following Occurs

  • Numbness or tingling around the lips or extremities
  • Twitching or spasms
  • Excessive and progressive fatigue
  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting

RESOURCES:

The American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS)
Your Thyroid Gland
http://www.entnet.org

National Cancer Institute
http://www.cancer.gov

CANADIAN RESOURCES:

Canadian Cancer Society
http://www.cancer.ca

Canadian Society of Otolaryngology
http://www.entcanada.org

References:

Alexander's Care of the Patient During Surgery . 11th ed. Mosby; 1999.

American Association of Clinical Endocrinologists website. Available at: http://www.aace.com/ .

Sabiston DC Jr. Textbook of Surgery . 17th ed. Philadelphia, PA: WB Saunders Co.; 2004.

The Thyroid Society for Education and Research website. Available at: http://www.the-thyroid-society.org/ .



Last reviewed October 2007 by Ronald Nath, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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