Thyroidectomy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
A thyroidectomy involves the surgical removal of all or part of the thyroid gland. Surgeons often perform a thyroidectomy when a patient has thyroid cancer or some other condition of the thyroid gland (such as hyperthyroidism).
The thyroid produces several hormones, such as thyroxine (T4), triiodothyronine (T3) and calcitonin.
After the removal of a thyroid patients usually take prescribed oral synthetic thyroid hormones to prevent the most serious manifestations of the resultant hypothyroidism.
Less extreme variants of thyroidectomy include:
- "hemithyroidectomy" (or "unilateral lobectomy") -- removing only half of the thyroid
- "isthmectomy" -- removing the band of tissue (or isthmus) connecting the two lobes of the thyroid
A "thyroidectomy" should not be confused with a "thyroidotomy" ("thyrotomy"), which is a cutting into (-otomy) the thyroid, not a removal (-ectomy) of it. A thyroidotomy can be performed to get access for a median laryngotomy, or to perform a biopsy. (Although technically a biopsy involves removing some tissue, it is more frequently categorized as an -otomy than an -ectomy because the volume of tissue removed is minuscule.)
Indications
Malignancy
Cosmetic reasons
Goitre which is untreatable by medical methods
Thyroidectomies are usually done for people that are Hyperthyroid or Hypothyroid
In patients with Graves Disease, thyroidectomy is indicated in the following conditions:
- Who have coexistent, confirmed cancer or suspicious thyroid nodules.
- Young patients.
- Pregnant or desire to conceive soon after treatment.
- Allergic to anti-thyroid medications.
- With large goiter causing compressive symptoms.
- Reluctant to undergo RAI therapy.
Steps
Main steps of Thyroidectomy:
- Exposure
- Devascularization
- Resection
- Closure
Complications
- Hypothyroidism in up to 50% of patients after ten years
- Laryngeal nerve injury in about 1% of patients, in particular the recurrent laryngeal nerve: Unilateral damage results in a hoarse voice. Bilateral damage presents as laryngeal obstruction on removal of the tracheal tube and is a surgical emergency: an emergency tracheostomy must be performed. Recurrent Laryngeal nerve injury may occur during the ligature of the inferior thyroid artery.
- Hypoparathyroidism in about 1% of patients
- Haemorrhage/Hematoma
- Thyrotoxic crisis
