What is thyroidectomy?
The thyroid is a gland located in the neck. It is a part of the endocrine (hormone) system, and plays a major role in regulating the body’s metabolism. Thyroid disorders are more common in older children and adolescents (especially in girls) than in infants. Most thyroid conditions can be treated medically, but occasionally surgery is required.
Child Thyroid Anatomy
Thyroid Anatomy in Adult
- – Increased thyroid function (hyperthyroidism or thyrotoxicosis)
– Decreased thyroid function (hypothyroidism) with enlargement (hypertrophy) of the gland
– Primary cancer of the thyroid
– Enlargement of the thyroid (nontoxic goiter)
– Patients unwilling to be treated with radioactive iodine whose hyperthyroidism cannot be treated with antithyroid drugs.
– Hashimoto’s disease (a type of hypothyroidism)
The most common tests to determine whether a thyroidectomy is necessary include a fine needle aspiration biopsy, thyroid scan, ultrasound, x-rays and/or CT scan, and assessment of thyroid hormone levels
- 1. Partial thyroid lobectomy (a rare procedure) – Only part of one thyroid lobe is removed.
2. Thyroid lobectomy – All of one thyroid lobe is removed.
3. Thyroid lobectomy with isthmusectomy – All of one thyroid lobe is removed, together with the thyroid isthmus.
4. Subtotal thyroidectomy – One thyroid lobe, the isthmus, and part of the second lobe are removed.
5. Total thyroidectomy – The entire thyroid gland is removed.
Conventional thyroidectomy is done for the following reasons:
- > To remove malignant (cancerous) or benign (noncancerous) thyroid tumors
> To treat thyrotoxicosis, a condition in which an overactive thyroid gland produces extremely high levels of thyroid hormone
> To remove all or part of a goiter (an enlarged thyroid gland) that is pressing on neighboring structures in the neck, especially if this pressure interferes with swallowing or breathing
> To remove and evaluate an undiagnosed thyroid mass
Both types of thyroidectomy are done under general anesthesia. However, if general anesthesia is too risky for a patient, local or regional anesthesia may be used to permit the patient to remain awake during the procedure. An intravenous (IV) line will be inserted into one of your veins to deliver fluids and medications.
Two complications specific to thyroid surgery are hypocalcemia and vocal cord weakness or paralysis. Hypocalcemia, or low blood levels of calcium, may occur after complete removal of both thyroid lobes. This condition is caused by interference with four tiny glands called parathyroid glands, which are located within or very close to the thyroid gland. Hypocalcemia is usually temporary, but sometimes may require calcium supplements if sufficiently pronounced. Permanent hypocalcemia is fortunately rare. Vocal cord weakness or paralysis may be caused by swelling, stretching, or injury to the recurrent laryngeal nerve which passes very close to the thyroid gland. Temporary hoarseness may result. Again, this is an uncommon, ususally temporary complication. Permanent vocal cord paralysis is rare.
- Solitary thyroid nodule < 3 cm in diameter
Small toxic thyroid nodule
Absence of malignant features (i.e. benign biopsy)
- Thyroid nodule > 4 cm
Large multinodular gland
Prior neck surgery
- Smaller scar
Quicker return to normal activity
Magnification provided by the endoscope
- Longer operating time
Requires special equipment