Thyroidectomy is a surgical procedure in which all or part of the thyroid gland is removed. The thyroidthyroidectomy gland is located in the forward part of the neck (anterior) just under the skin and in front of the Adam's apple.
Purpose
All or part of the thyroid gland may be removed to correct a variety of abnormalities of the gland. If the patient has a goiter, an enlargement of the thyroid gland, causing a swelling in the front of the neck, it may cause difficulties with swallowing or breathing. Hyperthyroidism (over-functioning of the thyroid gland) produces hypermetabolism (abnormally increased use of oxygen, nutrients and other materials). If medication cannot adequately treat this condition or if the patient is a child or pregnant, the thyroid gland must be removed. Both cancerous tumors and noncancerous tumors (frequently called nodules) can occur and they must be removed, in addition to some or all of the thyroid gland.
Thyroidectomy is an inpatient operative procedure done most commonly by a general surgeon, or occasionally by an otolaryngologist. The operation is performed under general anesthesia. The surgeon makes an incision in the front of the neck where a tight-fitting necklace would rest. He locates and takes care not to injure the parathyroid glands and the recurrent laryngeal nerves, while freeing the thyroid gland from these surrounding structures and clamping the blood supply. Then all or part of the gland is removed. If cancer is present, all, or almost all, of the gland is removed. If other diseases or a nodule is present, the surgeon may remove only part of the gland. The total amount of thyroid gland removed depends upon the thyroid disease being treated. A drain (a soft plastic tube that drains fluid out of the area) may be placed before the incision is closed. The incision is closed either with sutures (stitches) or metal clips. A dressing is placed over the incision and the drain, if one is used.
Preparation
Before thyroidectomy a variety of tests are done to determine the nature of the thyroid disease. Laboratory analysis of blood determines the levels of active thyroid hormone circulating in the body. Sonograms and computed tomography scans (CT scans) help to determine the size of the thyroid gland and location of abnormalities. A thyroid nuclear medicine scan assesses the function of the gland. A needle biopsy of an abnormality or aspiration (removal by suction) of fluid from the thyroid gland may also be done to help determine the diagnosis.
If the diagnosis is hyperthyroidism, the patient may be asked to take anti-thyroid medication or iodides before the operation; or continued treatment with anti-thyroid drugs may be the treatment of choice. Otherwise, no other special procedure must be followed prior to the operation.
As with all operations, patients who are obese, smoke, or have poor nutrition are at greater risk for developing complications related to the general anesthetic itself.
Hoarseness or voice loss may develop if the recurrent laryngeal nerve was injured or destroyed during the operation. This is more apt to occur in patients who have large goiters or cancerous tumors.
Hypoparathyroidism (under-functioning of the parathyroid glands) can occur if the parathyroid glands are injured or removed at the time of the thyroidectomy.
Hypothyroidism (under-functioning of the thyroid gland) can occur if all or nearly all of the thyroid gland is removed. This may be intentional when the diagnosis is cancer. If the patient's thyroid levels remain high, he may be required to take thyroid replacement for the rest of his life.
The neck and the area surrounding the thyroid gland have a rich supply of blood vessels. Bleeding in the area of the operation may occur and be difficult to control or stop. Rarely is a blood transfusion required, although a hematoma (collection of blood) may develop. If this occurs, it may be life-threatening. As the hematoma enlarges, it may obstruct the airway and cause the patient to stop breathing. If a hematoma does develop in the neck, it may require drainage to clear the airway.
Wound infections can occur. If they do, the incision is drained and there are usually no serious consequences.
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