Thyroidectomy
Encyclopedia
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
). 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. Most thyroidectomies are now performed by minimally invasive surgery using a cut in the neck of no more than 2.5 cms(1 inch).
The thyroid produces several hormone
s, 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:
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.)
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
removal of all or part of the thyroid gland. Surgeons often perform a thyroidectomy when a patient has thyroid cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
or some other condition of the thyroid gland
Gland
A gland is an organ in an animal's body that synthesizes a substance for release of substances such as hormones or breast milk, often into the bloodstream or into cavities inside the body or its outer surface .- Types :...
(such as hyperthyroidism
Hyperthyroidism
Hyperthyroidism is the term for overactive tissue within the thyroid gland causing an overproduction of thyroid hormones . Hyperthyroidism is thus a cause of thyrotoxicosis, the clinical condition of increased thyroid hormones in the blood. Hyperthyroidism and thyrotoxicosis are not synonymous...
). 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. Most thyroidectomies are now performed by minimally invasive surgery using a cut in the neck of no more than 2.5 cms(1 inch).
The thyroid produces several hormone
Hormone
A hormone is a chemical released by a cell or a gland in one part of the body that sends out messages that affect cells in other parts of the organism. Only a small amount of hormone is required to alter cell metabolism. In essence, it is a chemical messenger that transports a signal from one...
s, such as thyroxine
Thyroxine
Thyroxine, or 3,5,3',5'-tetraiodothyronine , a form of thyroid hormones, is the major hormone secreted by the follicular cells of the thyroid gland.-Synthesis and regulation:...
(T4), triiodothyronine
Triiodothyronine
Triiodothyronine, C15H12I3NO4, also known as T3, is a thyroid hormone. It affects almost every physiological process in the body, including growth and development, metabolism, body temperature, and heart rate....
(T3) and calcitonin
Calcitonin
Calcitonin is a 32-amino acid linear polypeptide hormone that is producedin humans primarily by the parafollicular cells of the thyroid, and in many other animals in the ultimobranchial body. It acts to reduce blood calcium , opposing the effects of parathyroid hormone . Calcitonin has been found...
.
After the removal of a thyroid patients usually take prescribed oral synthetic thyroid hormones to prevent the most serious manifestations of the resultant hypothyroidism
Hypothyroidism
Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone.Iodine deficiency is the most common cause of hypothyroidism worldwide but it can be caused by other causes such as several conditions of the thyroid gland or, less commonly, the pituitary gland or...
.
Less extreme variants of thyroidectomy include:
- "hemithyroidectomy" (or "unilateral lobectomy") -- removing only half of the thyroid
- "isthmectomy" -- removing the band of tissue (or isthmusIsthmusAn isthmus is a narrow strip of land connecting two larger land areas usually with waterforms on either side.Canals are often built through isthmuses where they may be particularly advantageous to create a shortcut for marine transportation...
) connecting the two lobes of the thyroid
A "thyroidectomy" should not be confused with a "thyroidotomy" ("thyrotomy
Thyrotomy
Thyrotomy is an incision of the larynx through the thyroid cartilage....
"), 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
Biopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
. (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 (see Thyroid neoplasm)
- Cosmetic reasons
- Goiter which is untreatable by medical methods
- Severe hyperthyroidismHyperthyroidismHyperthyroidism is the term for overactive tissue within the thyroid gland causing an overproduction of thyroid hormones . Hyperthyroidism is thus a cause of thyrotoxicosis, the clinical condition of increased thyroid hormones in the blood. Hyperthyroidism and thyrotoxicosis are not synonymous...
refractory to conservative treatment - Orbitopathy in Graves' diseaseGraves' diseaseGraves' disease is an autoimmune disease where the thyroid is overactive, producing an excessive amount of thyroid hormones...
- Removal and evaluation of a thyroid noduleThyroid noduleThyroid nodules are lumps which commonly arise within an otherwise normal thyroid gland. They indicate a thyroid neoplasm, but only a small percentage of these are thyroid cancers.-Presentation:...
whose FNAC results are unclear
Types of 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 MNG
- Partial thyroidectomy - removal of gland in front of trachea after mobilisation. It is done in nontoxic MNG. role is controversial.
- Near total thyroidectomy - Both lobes except the lower pole which is very close to recurrent laryngeal nerve and parathyroid is removed. In papillary carcinoma thyroid.
- Total thyroidectomy- Entire gland is removed. Done in case of follicular carcinoma of thyroid, medullary ca of thyroid.
- Hartley Dunhill operation- removal of 1 entire lateral lobe with isthmus and partial/subtotal removal of opposite lateral lobe. It is done in non toxic MNG.
Steps
Main steps of Thyroidectomy:- Exposure - horizontal neck incision, +/- raising of flaps, +/- division of strap muscles
- Identification of essential structures - Recurrent and ext. branch of superior laryngeal nerve, parathyroid glands
- Devascularization
- Superior thyroid artery
- Inferior thyroid artery while protecting the supply to the parathyroids
- Thyroid ima if present
- ResectionSegmental resectionSegmental resection is a surgical procedure to remove part of an organ or gland. It may also be used to remove a tumor and normal tissue around it. In lung cancer surgery, segmental resection refers to removing a section of a lobe of the lung.- External links :* entry in the public domain NCI...
- Exploration of other pathology - e.g. contralateral lobe, lymph nodes
- ClosureClosureClosure may refer to:* Closure used to seal a bottle, jug, jar, can, or other container** Closure , a stopper* Closure , the process by which an organization ceases operations...
Complications
- HypothyroidismHypothyroidismHypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone.Iodine deficiency is the most common cause of hypothyroidism worldwide but it can be caused by other causes such as several conditions of the thyroid gland or, less commonly, the pituitary gland or...
/Thyroid insufficiency in up to 50% of patients after ten years - Thyrotoxic crisis/Thyroid storm
- Laryngeal nerveLaryngeal nerveThe laryngeal nerve, or Galen's nerve, is a nerve originating from the vagus nerve. It comprises two branches, the cranial superior laryngeal nerve, which leaves the vagus at the distal ganglion and passes ventrally to the larynx supplying the cricothyroid muscle and laryngeal mucosa, and the...
injury in about 1% of patients, in particular the recurrent laryngeal nerveRecurrent laryngeal nerveThe recurrent laryngeal nerve is a branch of the vagus nerve that supplies motor function and sensation to the larynx . It travels within the endoneurium...
: 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. - HypoparathyroidismHypoparathyroidismHypoparathyroidism is decreased function of the parathyroid glands with under production of parathyroid hormone. This can lead to low levels of calcium in the blood, often causing cramping and twitching of muscles or tetany , and several other symptoms...
temporary (transient) in many patients, but permanent in about 1-4% of patients - Anesthetic complications
- InfectionInfectionAn infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
- Stitch granuloma
- Chyle leak
- Haemorrhage/HematomaHematomaA hematoma, or haematoma, is a localized collection of blood outside the blood vessels, usually in liquid form within the tissue. This distinguishes it from an ecchymosis, which is the spread of blood under the skin in a thin layer, commonly called a bruise...
- This may compress the airway, becoming life-threatening. A suture removal kit should be kept at the bedside throughout the postoperative hospital stay.
- Surgical scar/keloid
- Removal of parathyroids by mistake along with thyroids.
External links
- Patient brochure from the American Thyroid Association
- Surgical procedures Comprehensible and elaborate information from the New York Thyroid Center
- Article at Endocrineweb, written by an MD Goes into more detail
- Early postoperative scar images
- New York Center for Advanced Parathyroid Surgery
- Minimally Invasive Endoscopic Video Assisted Thyroid & Parathyroid Removal Surgery
- Robot-Assisted Endoscopic Thyroid Surgery with No Neck Incisions
- Thyroid Surgery Tutorial From the Patient Education Institute
- Minimally invasive and daycase thryroid surgery Comprehensive information from a UK Specialist Surgeon
