Thyroidectomy

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Thyroidectomy
Intervention
Thyroid Surgery.jpg
Thyroid Surgery
ICD-9-CM 06.3-06.5
MeSH D013965

A thyroidectomy is an operation that 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) or goiter. Other indications for surgery include cosmetic (very enlarged thyroid), or symptomatic obstruction (causing difficulties in swallowing or breathing). Thyroidectomy is a common surgical procedure that has several potential complications or sequela including: temporary or permanent change in voice, temporary or permanently low calcium, need for lifelong thyroid hormone replacement, bleeding, infection, and the remote possibility of airway obstruction due to bilateral vocal cord paralysis. Complications are uncommon when the procedure is performed by an experienced surgeon.

The thyroid produces several hormones, such as thyroxine (T4), triiodothyronine (T3), and calcitonin.

After the removal of a thyroid, patients usually take a prescribed oral synthetic thyroid hormone - levothyroxine (Synthroid) - to prevent 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[edit]

Types of Thyroidectomy[edit]

  • Hemithyroidectomy - Entire isthmus is removed along with 1 lobe. Done in benign diseases of only 1 lobe.
  • Subtotal thyroidectomy - Done in toxic thyroid, primary or secondary, and also for toxic multinodular goiter (MNG).
  • Partial thyroidectomy - Removal of gland in front of trachea after mobilization. Done in nontoxic MNG. Its role is controversial.
  • Near total thyroidectomy - Both lobes are removed except for a small amount of thyroid tissue (on one or both sides) in the vicinity of the recurrent laryngeal nerve entry point and the superior parathyroid gland. Done in papillary thyroid carcinoma.
  • Total thyroidectomy - Entire gland is removed. Done in case of follicular carcinoma of thyroid, medullary carcinoma of thyroid.
  • Hartley Dunhill operation - Removal of 1 entire lateral lobe with isthmus and partial/subtotal removal of opposite lateral lobe. Done in nontoxic MNG.

Steps[edit]

Main steps of Thyroidectomy:[1]

  1. Horizontal anterior neck incision (if possible, within a skin crease)
  2. Create upper and lower flaps between the platysma and strap muscles
  3. Divide vertically between the strap muscles and anterior jugular veins
  4. Separate the strap muscles from the thyroid gland
  5. Divide the middle thyroid vein
  6. Mobilize the superior pole of the thyroid lobe. Divide the superior thyroid artery and vein close to the thyroid gland (avoid injury to the external branch of the superior laryngeal nerve and the superior parathyroid gland)
  7. Identify the recurrent laryngeal nerve whenever possible using the nerve monitoring device
  8. Identify the inferior parathyroid artery
  9. Divide the inferior thyroid artery and vein
  10. Separate the thyroid lobe and isthmus from the trachea
  11. Repeat this process for the other thyroid lobe. Remove the thyroid gland
  12. Reapproximate the strap muscles
  13. Reapproximate the platysma muscle
  14. Close the skin with a subcuticular stitch

Complications[edit]

References[edit]

  1. ^ a b Mathur AK and GM Doherty (2010). "Ch. 1: Thyroidectomy and Neck Dissection". In Minter RM and GM Doherty. Current Procedures: Surgery. New York: McGraw-Hill. 

External links[edit]