Definition & Overview

The thyroid is a gland found in the lower part of the neck, just below the voice box. Shaped like a butterfly, it performs the important function of regulating metabolism and physiological processes. When this gland no longer functions normally, one of the treatment options considered is thyroid gland resection or thyroidectomy. This is the surgical removal of the thyroid gland to prevent the progression and treat several disorders like enlargement of the thyroid, hyperthyroidism, and thyroid cancer.

There are several types of thyroidectomy. These include:

  • Lobectomy, which is the removal of one of the lobes of the gland
  • Subtotal thyroidectomy, or partial thyroid removal
  • Total thyroidectomy, or the removal of the entire thyroid gland

Who Should Undergo & Expected Results

Thyroidectomy is commonly advised for patients with:

  • Hyperthyroidism, a condition in which the thyroid gland produces excessive thyroid hormone. However, this procedure is performed only if patients are allergic to medications and have decided against undergoing radioactive iodine therapy. Thyroid gland resection is also recommended if a toxic nodule is determined to be the cause of hyperthyroidism.
  • Grave's disease, in which there is a noticeable protrusion of the eyes and swelling of the neck.
  • Thyroid cancer, in which the procedure is performed to prevent the spread of malignant cells to other parts of the body
  • Enlarged thyroid gland or the presence of nodules in the gland
    Thyroid gland resection has a high success rate, with virtually no mortality rate. Patients are required to stay in the hospital for a few days but are expected to resume normal daily activities after a few weeks. The patient's calcium levels are monitored and hormone replacement therapy is provided, depending on the extent of the procedure (whether partial or complete removal of the gland).

How Does the Procedure Work?

After anaesthetics have been administered, the surgeon will make an incision to start the procedure. The incision can be made in the centre of the neck or the chest and armpit. The thyroid gland is then located while making sure the parathyroid gland and nearby nerves are not damaged. Blood vessels are tied off and a part or the entire thyroid gland is removed.

The procedure can also be performed using minimally invasive technique that involves making 3-4 smaller incisions in the neck where small surgical instruments with a small camera are inserted to remove the gland or a part of it. This option offers minimal post-operative pain, less bleeding, and faster recovery time.

Before closing the incision, a drain pipe is inserted to prevent fluid build up. Sutures or surgical clips are then used to close the incised wound.

Possible Complications and Risks

Patients are advised of possible complications during surgery, like bleeding or infection. There is also a possibility of adverse reaction to anaesthesia.

Immediately after thyroidectomy, patients complain of pain in the neck and hoarseness of voice. These conditions are caused by the insertion of tubes into the windpipe and would normally resolve itself after a few days.

Though surgeons would take utmost care in performing thyroidectomy, there is still a small risk of injury to the adjacent parathyroid gland, blood vessels, and nerves.

The patient’s calcium levels are closely monitored after the procedure to determine if there is damage to the parathyroid gland. An injury to the laryngeal nerve is also possible and this could lead to paralysis of the vocal chords, making the patient unable to produce speech.

If abscess in the neck develops, it needs to be drained and treated with antibiotics.

Another potential complication is the occurrence of hematoma, which is blood collecting in a particular area of the neck. Medical personnel would need to ensure that it does not enlarge or lead to bleeding, since this would be considered a medical emergency.

Though rare, thyrotoxic storm could also occur during or after surgery. This is manifested by hyperthermia, tachycardia, nausea, and altered mental status. This is a major concern, as it could lead to coma and even death.

Reference

  • Smith PW, Salomone LJ, Hanks JB. Thyroid. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, Pa: Elsevier Saunders; 2012:chap 38.
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