Thyroidectomy

PROCEDURE OF THE DAY

Thyroidectomy

A thyroidectomy 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). Other indications for surgery include cosmetic (very enlarged thyroid), or symptomatic obstruction (causing difficulties in swallowing or breathing). One of the complications of "thyroidectomy" is voice change and patients are strongly advised to only be operated on by surgeons who protect the voice by using electronic nerve monitoring.

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
Severe hyperthyroidism refractory to conservative treatment
Orbitopathy in Graves' disease
Removal and evaluation of a nodule whose FNAB results are unclear
This section requires expansion.

Steps

Main steps of Thyroidectomy:

1. Exposure - horizontal neck incision, +/- raising of flaps, +/- division of strap muscles
2. Identification of essential structures - Recurrent and ext. branch of superior laryngeal nerve, parathyroid glands
3. Devascularization
4. Resection
5. Exploration of other pathology - e.g. contralateral lobe, lymph nodes
6. Closure

This section requires expansion.

[edit] Complications

1. Hypothyroidism/Thyroid insufficiency in up to 50% of patients after ten years
2. Thyrotoxic crisis/Thyroid storm
3. 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.
4. Hypoparathyroidism temporary (transient) in many patients, but permanent in about 1-4% of patients
5. Anesthetic complications
6. Infection
7. Stitch granuloma
8. Haemorrhage/Hematoma
9. Surgical scar/keloid



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