Thyroidectomy

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 aremoval (-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.)

INDICATION

Thyroid cancer

Toxic thyroid nodule (produces too much thyroid hormone)

Multinodular goiter (enlarged thyroid gland with many nodules), especially if there is compression of nearby
structures

Graves' disease, especially if there is exophthalmos (bulging eyes)

Thyroid nodule, if fine needle aspirate (FNA) results are unclear

TYPES OF THYROIDECTOMY

A lobectomy of the thyroid gland

A total thyroidectomy

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.

Total thyroidectomy - Entire gland is removed. Done in cases of papillary or 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.

COMPLICATION

Hypothyroidism/Thyroid insufficiency 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 after surgery and can be a surgical
emergency: an emergency tracheostomy may be needed. Recurrent Laryngeal nerve injury may occur during
the ligature of the inferior thyroid artery.

Hypoparathyroidism temporary (transient) in many patients, but permanent in about 1-4% of patients

Anesthetic complications

Infection (at about a 2% rate. Drainage is an important part of treatment.)

Stitch granuloma

Chyle leak

Haemorrhage/Hematoma (This may compress the airway, becoming life-threatening.)

Removal or devascularization of the parathyroids

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