Thyroidectomy

Overview

Thyroidectomy is the medical term for the surgical procedure that involves removing either a portion or the entirety of the thyroid gland. This gland, which is butterfly-shaped and situated at the front of the neck, plays a crucial role in regulating metabolism through its hormone production, affecting everything from heart rate to calorie burning speed.

Healthcare professionals may recommend a thyroidectomy to address various thyroid issues, such as cancer, benign enlargement of the thyroid (known as a goiter), or an overactive thyroid (hyperthyroidism).

The extent of the thyroid gland removed during the procedure varies based on the underlying reason for the surgery. A partial thyroidectomy involves removing only a section of the thyroid, potentially allowing it to continue functioning normally post-operation. However, a total thyroidectomy, which involves removing the entire gland, necessitates lifelong daily thyroid hormone replacement therapy to mimic the gland’s natural functions.

Types

The purpose of the surgery determines how much of the thyroid gland is removed during a thyroidectomy. The following are the two main category of thyroidectomy.

• Total thyroidectomy: The surgical removal of all or most of the thyroid tissue is known as a total or near-total thyroidectomy. In the event that a total thyroidectomy is required, they will require daily thyroid hormone medication to restore the thyroid’s normal function.
• Partial thyroidectomy: A portion of the thyroid will be removed. The thyroid may function correctly following surgery if only a portion of the thyroid needs to be removed (a partial thyroidectomy). The following are some examples of partial thyroidectomies, which involve removing a portion of the thyroid:
• Hemi-thyroidectomy or thyroid lobectomy: One thyroid lobe, or half of one, is removed by the surgeon.
• Isthmusectomy: The thyroid tissue (thyroid isthmus) between the two lobes is removed by the surgeon. This particular procedure is carried out by surgeons to remove tiny tumors from the isthmus.
• Open thyroid biopsy: The thyroid nodule is directly removed by the surgeon during this procedure. This operation is rarely performed by surgeons.

The surgeon will choose the most advantageous surgical plan for the patient in collaboration with the endocrinologist.

Reasons for undergoing the procedure

If a patient is diagnosed with any of the following conditions, their healthcare provider might recommend undergoing a thyroidectomy:

• Thyroid cancer: Thyroidectomy is most frequently performed due to cancer. Surgery to remove part or all of their thyroid will probably be the course of therapy if they have thyroid cancer.
• Goiter: An enlarged thyroid gland, with or without thyroid nodules, is known as a goiter. It can make it harder to breathe and swallow if it gets big enough to put pressure on the trachea or food pipe (esophagus).
• Thyroid nodules: A growth (lump) of thyroid cells within the thyroid gland is called a thyroid nodule. Although they can be malignant (cancerous), thyroid nodules are typically benign (noncancerous). Thyroid nodules can occasionally overproduce thyroid hormone, which results in specific symptoms.
• Hyperthyroidism: An overactive thyroid produces and releases more hormones than necessary when the thyroid is hyperthyroid. Surgery is one option for treating the medical condition, which has multiple causes.

Risk

The process of a thyroidectomy is usually safe. However, there is always a chance for complications with thyroidectomy.

The following are the most risky results of a thyroidectomy:

• Infection.
• Bleeding following surgery that can cause an obstruction that causes acute respiratory distress.
• Acute respiratory distress and temporary or permanent hoarseness can result from injury to one or both recurrent laryngeal nerves.
• Hypoparathyroidism, characterized by low levels of parathyroid hormone, can occur if the surgery inadvertently harms the parathyroid glands situated behind the thyroid. These glands are responsible for controlling the calcium levels in your blood. Should the calcium levels drop too low, symptoms such as numbness, tingling, or cramping may arise.

Before the procedure

As you prepare for your thyroidectomy, it’s important to understand that the specific steps and procedures leading up to your surgery may vary depending on the reason for your surgery. Here’s what you can expect in the weeks prior to your operation:

• Diagnostic imaging tests: Your healthcare provider may request imaging tests such as a thyroid ultrasound or a computed tomography (CT) scan. These tests are crucial for identifying the exact location and size of any abnormal thyroid growths.
• Fine needle aspiration: If you have a thyroid nodule, a fine needle aspiration biopsy may be conducted. This procedure involves using a thin needle to extract a sample of the nodule to determine whether it is benign or malignant.
• Vocal cord examination: The function of your vocal cords may be assessed. This is an important step to ensure that your vocal cords are not affected by the surgery.
• Thyroid medication: You may be prescribed medication to manage the overproduction of thyroid hormones before the surgery. This step is taken to stabilize your thyroid hormone levels.
• Lifestyle adjustments: If you are a smoker, you will be advised to quit smoking. Smoking can affect your recovery and increase the risk of complications during and after surgery.

Each of these steps is designed to ensure that you are fully prepared for your thyroidectomy, both physically and mentally. Your surgeon and endocrinologist will provide you with detailed instructions tailored to your specific needs and condition.

During the procedure

General anesthesia is administered by an anesthesiologist before to surgery in order to induce muscular relaxation, minimize discomfort, and induce sleep in the patient. During the procedure, a breathing tube will be inserted down their throat by the medical team.
There are several methods for performing a thyroidectomy, such as:

• Conventional thyroidectomy: This method includes accessing the thyroid gland directly by creating an incision in the middle of the neck. Most patients will probably be eligible for this surgery.
• Transoral thyroidectomy: This method involves making an internal oral incision to reach the thyroid.
• Endoscopic thyroidectomy: This method makes smaller neck incisions. Through the incisions, a tiny video camera and surgical tools are introduced. Throughout the surgery, the surgeon is guided via the camera.

The surgeon may take a sample of the lymph nodes around the thyroid gland during surgery to treat thyroid cancer. After surgery, a pathologist will examine the lymph node sample to look for signs of thyroid cancer. The surgeon may additionally remove adjacent neck lymph nodes if they discover malignant cells.
When the surgeon is finished, stitches will be used to close the wound. It might take up to four hours for a thyroid removal surgery. If the thyroid is removed in part, the procedure could take less time.

After the procedure

After undergoing surgery, patients are typically transferred to a recovery room, where healthcare professionals carefully monitor their emergence from anesthesia and surgery. In certain cases, particularly after neck surgeries like a thyroidectomy, a drain may be inserted near the incision to remove excess fluids, which is generally removed the next day. Post-surgery, some individuals might experience temporary neck pain or changes in their voice, such as hoarseness or weakness. These symptoms are often short-lived and can be attributed to the irritation caused by the breathing tube during surgery or nerve irritation from the procedure itself. However, there’s a rare possibility of permanent vocal cord damage leading to lasting voice changes.

Following the surgery, patients are usually allowed to eat and drink normally and, depending on the surgery’s extent, may be discharged on the same day or required to stay overnight for observation. Resuming regular activities is often possible shortly after returning home, but engaging in strenuous activities like heavy lifting or high-impact sports should be avoided for the first 10 days to two weeks to ensure proper healing. The surgical scar may take up to a year to become less noticeable, and the use of sunscreen on the scar is often recommended by doctors to aid in its fading, ensuring a better cosmetic outcome over time.

Outcome

• Partial thyroidectomy: After undergoing a partial thyroidectomy, where only a portion of your thyroid gland is removed, the remaining part typically compensates for the loss. This means it continues to produce thyroid hormones, potentially negating the need for thyroid hormone therapy. Patients often find that their body adjusts naturally without requiring additional medication.
• Complete thyroidectomy: In cases where the entire thyroid gland is removed, known as a complete thyroidectomy, the body loses its ability to produce thyroid hormones. This deficiency leads to hypothyroidism, a condition characterized by symptoms such as dry skin, fatigue, and weight gain. To manage this, patients must take a daily dosage of synthetic thyroid hormone levothyroxine (available under brand names like Synthroid and Unithroid, among others). This hormone replacement mirrors the natural thyroid hormone and fulfills the same bodily functions. Regular blood tests are essential to tailor the hormone dosage to your specific needs.

Following your thyroidectomy, certain signs warrant immediate attention from your healthcare provider. If you experience any of the following, do not hesitate to get in touch:

• Swelling, bleeding, or redness at the incision site
• Warmth at the incision area
• Fever reaching 101 degrees Fahrenheit or higher
• Numbness or tingling sensations in your face, hands, or lips

Monitoring these symptoms and maintaining open communication with your healthcare provider are key to a smooth recovery and adjustment post-thyroidectomy.