Thyroid Removal Surgery (Thyroidectomy) Overview | Endocrinology

Thyroidectomy

What is thyroidectomy?

A thyroidectomy is a surgical procedure to remove all or part of the thyroid gland and is used to treat diseases of the thyroid gland including:

  • Thyroid cancer
  • Hyperthyroidism (overactive thyroid gland)
  • Large goiters or thyroid nodules causing symptomatic obstruction such as difficulty swallowing or breathing.
  • Multinodular goiter

Thyroidectomy is traditionally a minimally invasive surgery that is performed through a small horizontal incision in the front of the neck. The entire thyroid gland may be removed or just a lobe, part of a lobe, and the isthmus or other structures. Depending on the extent of the operation, patients may need to take levothyroxine, an oral synthetic thyroid hormone.

Thyroidectomy without mutilation

For a select group of patients who are concerned about the possible cosmetic effects of a neck scar, we offer “scarless” thyroidectomy, a technique of removing the thyroid using small oral incisions that removes the scar from the neck. In this procedure, the surgeon accesses the thyroid gland through the patient’s mouth, known as the “transoral” approach. UCSF endocrine surgery is amongst the first programs in the world to pioneer this technique.

A new hybrid procedure using a transoral and submental technique (TOaST) offers patients an additional option, a refinement that combines the transoral approach with a small incision easily hidden just below the chin, offering the following benefits:

  • The decrease in postoperative complications and patient discomfort.
  • The ability to accommodate larger thyroid samples
  • Maintain practically all the cosmetic benefits of traditional surgery without scars.

Types of thyroid surgery

There are several different types of thyroid surgery. The most communal are lobectomy, subtotal thyroidectomy, and total thyroidectomy.

  • Lobectomy: Sometimes a nodule, inflammation, or swelling affects only half of the thyroid gland. When this occurs, a doctor will remove only one of the two lobes. The part left behind must retain part or all of its function.
  • Subtotal thyroidectomy: A subtotal thyroidectomy eliminates the thyroid gland but leaves a small amount of thyroid tissue. This preserves some of the thyroid function. Many people who have this type of surgery develop hypothyroidism, a condition that occurs when the thyroid does not produce enough hormones. This is treated with daily hormonal supplements.
  • Total thyroidectomy: A total thyroidectomy removes all of the thyroid and thyroid tissue. This surgery is suitable when nodules, swelling, or irritation affect the entire thyroid gland or when cancer is present.

Risks of thyroidectomy

Thyroidectomy is generally a safe surgical procedure. However, some people have major or minor complications. Possible complications include:

  • Hemorrhage (bleeding) under the neck wound: If this occurs, the wound protrudes and the neck swells, possibly compressing the internal structures of the neck and interfering with breathing. This is an emergency.
  • Thyroid storm: If thyroidectomy is performed to treat a very overactive gland, there may be an increase in thyroid hormones in the blood. This is a very rare complication because medicines are given before surgery to avoid this problem.
  • Recurrent laryngeal nerve injury: Because this nerve innervates the vocal cords, the injury can cause vocal cord paralysis and produce a hoarse voice, either in the short or long term.
  • Injury to a part of the superior laryngeal nerve: If this occurs, the singing patients may not be able to reach high notes and the voice may lose some projection.
  • Infection in the wound
  • Hypoparathyroidism: If the parathyroid glands cannot be protected or are damaged through surgery, the person may not be able to make enough parathyroid hormone. The parathyroid hormone helps keep blood calcium levels within the normal range. Low production of parathyroid hormone causes low levels of calcium in the blood.

Why is it for

Your doctor may indorse a thyroidectomy if you have conditions such as:

  • Thyroid cancer: Cancer is the most common cause of thyroidectomy. If you have thyroid cancer, removing most, if not all, of your thyroid is likely a treatment option.
  • Non-cancerous enlargement of the thyroid (goiter): Removal of all or part of the thyroid gland is an option if you have a large goiter that is uncomfortable or causes difficulty in breathing or swallowing, or in some belongings if the goiter is causing hyperthyroidism.
  • Overactive thyroid (hyperthyroidism): Hyperthyroidism is a disorder in which the thyroid gland produces too greatly thyroxine hormone. If you have problems with antithyroid medications and do not want radioactive iodine therapy, thyroidectomy may be an option.
  • Suspicious or indeterminate thyroid nodules: Some thyroid nodules cannot be identified as cancerous or non-cancerous after testing a sample from a needle biopsy. Doctors may recommend that people with these nodules have a thyroidectomy if the nodules are at increased risk of being cancerous.

Prevention

Most people with thyroid cancer have no known risk factors, so most cases of this disease cannot be prevented.

Exposure to radiation, especially in childhood, is a known risk factor for thyroid cancer. Because of this, doctors no longer use radiation to treat less serious illnesses. Imaging tests, such as X-rays and CT scans, also expose children to radiation, but in much lower doses, so it is not clear how much they might increase the risk of thyroid cancer (or other cancers). If there is an increased risk, it is probably small, but to be safe, children should not have these tests unless absolutely necessary. When needed, they should be performed using the lowest dose of radiation that still provides a clear image.

Genetic testing can be done to look for gene mutations found in familial medullary thyroid cancer (MTC). Because of this, most familial cases of TCM can be prevented or treated early by removing the thyroid gland. Once the disease is exposed in a family, the rest of the family associates can be tested for the mutated gene.

If you have a family history of TCM, it is important that you see a doctor who is familiar with the latest advances in genetic counselling and genetic testing for this disease. Removing the thyroid gland in children who carry the abnormal gene will likely prevent cancer that could otherwise be fatal.

Thyroidectomy complications

  • Hypocalcemia (3-5%): Most communal cause of airway obstruction after 24 hours
  • Hematoma (1-2%): Most communal cause of airway obstruction within 24 hours
  • Recurrent injury of the laryngeal nerve (0.77%): Usually causes unilateral damage, stridor, hoarseness
  • Wound infection (0.2-0.5%)
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