Thyroidectomy

(Thyroid Lobectomy)

Definition

Thyroidectomy is the surgical removal of all or part of the thyroid gland. This gland is in the neck. It produces hormones that regulate metabolism. The surgery may be done as:

  • Total thyroidectomy—all of the thyroid is removed
  • Thyroid lobectomy or partial thyroidectomy—removal of only one lobe of the thyroid

The Thyroid Gland

Thyroidectomy

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Parts of the Body Involved

  • Front of the neck
  • Thyroid gland

Reasons for Procedure

All or part of the thyroid gland may be surgically removed for any of the following reasons:

  • Overactive thyroid ( hyperthyroid)
  • Underactive thyroid ( hypothyroid) with thyroid enlargement (goiter)
  • Mass, growth, or cyst of the thyroid
  • Thyroid cancer
  • Very large or toxic goiter (enlarged thyroid) due to hyperthyroidism

Risk Factors for Complications During the Procedure

  • Obesity
  • Smoking
  • Alcoholism
  • Poor nutrition
  • Severe chronic illness, such as poorly controlled diabetes
  • Chronic lung disease
  • Coronary artery disease

What to Expect Prior to Procedure

Your doctor may recommend:

  • Physical exam
  • Laboratory and/or imaging tests to assess thyroid function and anatomy such as:
    CT scan
    Isotope scan
    Ultrasound
  • Thyroid medication to suppress thyroid activity in patients with hyperthyroidism
  • Iodine treatments for 10 to 15 days before surgery
  • Fine needle aspiration biopsy to determine if a tumor or nodule is cancerous (in some cases)

In the days leading up to your procedure:

  • Talk to your doctor about your current medications. Certain medications may need to be stopped before the procedure such as:
    Aspirin or other anti-inflammatory drugs for up to one week before surgery
    Blood-thinning medications such as clopidogrel (Plavix), warfarin (Coumadin), or ticlopidine (Ticlid)
  • Do not eat or drink anything after midnight the evening prior to the procedure.
  • Arrange for transportation to and from the hospital.

Anesthesia

General anesthesia is used for this procedure.

Description of the Procedure

A horizontal incision is made in the front of the neck. It is about 2 inches above the top of the breastbone. The skin is pulled away from the incision and held back with retractors or stitches. Bleeding vessels are clamped and tied off. The surgeon separates muscles, blood vessels, and nerves in the neck to access the thyroid gland. All or part of the thyroid gland is cut away from its attachment to other tissues in the neck and removed. Care is taken to avoid injury to the parathyroid glands and nerves. These are tiny glands behind the thyroid. They regulate calcium metabolism in the body. The nerves that control your vocal cords are also nearby. Bleeding is controlled with instruments that compress, constrict, and cauterize the ends of blood vessels. The incision is closed. The edges of skin are stitched together. Frequently a drain is left in overnight attached to a small rubber suction bulb. The thyroid may be removed to treat thyroid cancer. In this case, lymph nodes in the area may also be removed. This will test if the cancer has metastasized (spread.

In some cases, only a small thyroid nodule or cyst needs to be removed. This procedure may be done with a tiny scope. This is called an endoscopic thyroidectomy. Several tiny keyhole incisions are made. A fiberoptic scope is inserted. This will allow the surgeon to view the area. Small surgical instruments are inserted through the openings. Endoscopic thyroidectomy leaves smaller scars. It often requires a shorter period of recovery. This type of procedure cannot be performed to treat thyroid cancer, goiter, or larger nodules.

After Procedure

  • You will have stitches or staples in the front of your neck.
  • There will be discomfort in your neck for several days. The pain can be treated with medication.
  • In some cases, you may have a slightly hoarse voice for a few days.
  • You may need to take thyroid medication to replace your thyroid hormones.
  • In some cases of thyroid cancer, you may need radioactive iodine treatments.

After the procedure, be sure to follow your doctor’s instructions.

How Long Will It Take?

The procedure typically takes about 2-4 hours.

Will It Hurt?

Anesthesia prevents pain during the procedure. Pain after the procedure is common. You will be given medication to help manage this.

Possible Complications

  • Infection
  • Bleeding
  • Scarring
  • Voice changes due to damage to nerves leading to the voice box (rare)
  • Damage to the parathyroid gland, which controls calcium metabolism
  • Thyrotoxic crisis (sudden excessive production of thyroid hormone at toxic levels) (very rare)

Average Hospital Stay

1 to 3 days

Postoperative Care

  • Keep the incision clean and dry.
  • Do not get the incision wet for 5 to 7 days. If it does get wet, dry it immediately.
  • Do not apply make-up, lotion, or cream to the incision area.
  • Perform neck exercises as instructed by your doctor.
  • Take all medications as prescribed by your doctor.

Outcome

The outcome after surgery depends on the reason for thyroidectomy.

If the thyroid was removed to treat hyperthyroidism, the following symptoms should subside:

  • Excessive fatigue
  • Weight loss
  • Nervousness
  • Rapid heart beat
  • Excessive sweating
  • Feeling of being hot
  • Tremors
  • Menstrual cycle irregularities

If the thyroid was removed to treat a thyroid tumor, nodule, or excessive goiter, the outcomes include:

  • Removal of cancerous tissue from the body
  • Improvement in swallowing or airflow that may have been compromised by an oversized thyroid gland

Call Your Doctor If Any of the Following Occurs

  • Numbness or tingling around the lips or extremities
  • Twitching or spasms
  • Excessive and progressive fatigue
  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting

Resources

The American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS): entnet.org
National Cancer Institute: cancer.gov

Canadian Resources:

Canadian Cancer Society: cancer.ca
Canadian Society of Otolaryngology: entcanada.org

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