Thyroid Removal Surgery


 

The thyroid gland is a butterfly-shaped gland that is situated above the trachea (wind pipe), which carries air to the lungs and above the larynx (vocal cord). In general, thyroid gland is an endocrine gland that is essential for the regulation of metabolic rate in the body. However, surgical removal of thyroid gland is indicated in case of severe goiter that pressurizes over the underlying vessels, thyroid malignancy, and thyroid condition that doesn’t respond to any other treatment.


Thyroid removal surgery is also referred to as Thyroidectomy; Subtotal thyroidectomy; Partial thyroidectomy; and Total thyroidectomy. Thyroid removal surgery is a procedure that involves partial or complete removal of the thyroid gland. Some of the common types of thyroid removal surgeries include partial or subtotal thyroidectomy, which removes a part of the thyroid gland, thus retaining the underlying structures and blood vessels beneath the gland.In subtotal thyroidectomy, certain parts of the thyroid gland are retained.

The complete removal of the thyroid gland is referred to as a total thyroidectomy, where an entire thyroid gland is removed. The main difference between subtotal and total thyroidectomy is that the former involves removal of only a portion of the gland; whereas the latter involves complete removal of the gland including vital structures like vessels, part of lower jaw, and cervical lymph nodes depending on the extent of tumor involvement.

Here is a detailed highlight about thyroid removal surgery, types, indications and complications associated with it:

About thyroidectomy

  • Thyroidectomy is a procedure that involves surgical excision of a thyroid gland affected with disease.
  • Thyroidectomy is a preferred choice of treatment for various types of diseases, thyroid disorders, and malignancies.
  • It is a commonly preferred, major surgery associated with high risk and potential complications.
  • Various thyroid conditions can be treated with minimally invasive treatments based on the specific circumstances.
  • Surgical removal of thyroid gland is generally preferred when all other treatment fails and in case of thyroid cancers.

Therefore, it is advised to obtain a second opinion and try all other treatment options before opting for thyroidectomy.

Types of thyroidectomy

Different types of thyroidectomy procedures that are performed include:

  • Lobectomy or partial thyroidectomy: It involves surgical removal of either a single lobe or a part of thyroid gland.
  • Lumpectomy: It is the surgical removal of only a small part of thyroid gland and it is commonly indicated for the treatment of small thyroid cysts or benign thyroid nodules of non-cancerous origin.
  • Sub-total or near-total thyroidectomy: Includes surgical removal of almost full portion of the thyroid gland, retaining behind a negligible portion of thyroid tissue.

Total or completion thyroidectomy:

  • Includes complete removal of whole portion of thyroid tissue.
  • A completion thyroidectomy also involves removal of any thyroid tissue remains following a partial thyroidectomy or lobectomy.
  • Lymphadenectomy is another type of procedure that involves sample biopsy or removal of lymph nodes, and it is performed in case of thyroid cancer either alone or in combination with various other surgeries.

Indications of thyroidectomy

Thyroidectomy is advised by an endocrine surgeon to treat various disorders and conditions of the thyroid gland. Surgical excision of thyroid is generally recommended if other treatment choices of minimal risk have not worked. The type of thyroidectomy performed depends on the type of condition, severity and depth of thyroid tissue invasion by a cancerous tumor. Below are some of the common indications of thyroidectomy as follows:

  • Thyroid cysts
  • Benign thyroid nodules
  • Tumors of non-cancerous origin
  • Goiter or thyroid gland enlargement that complicates swallowing and breathing or pressurizes underlying blood vessels.
  • Thyroid cancer
  • Hyperthyroidism (hyperactive thyroid gland) that isn’t responding to medications and radioactive iodine treatment
  • Thyrotoxicosis, also referred to as thyroid storm or thyroid crisis, is a severe worsened state of hyperthyroidism with fatal complications.

Surgical techniques of thyroidectomy

Thyroidectomy can be performed with any one of the following techniques as follows:

Minimally invasive surgery: It is performed by placing a small incision in the neck, followed by the insertion of endoscope and special instruments through it. An endoscope consists of a tiny camera, which transmits images onto the video screen that provides a clear visual field during the surgery.

Open surgery: it involves placement of about 3 to 4 inch incision in the neck to directly view and access the surgical area. It requires a larger incision and more muscle and tissue cutting.

Complications of thyroidectomy

Some of the common complications of thyroidectomy include:

Complications of anesthesia include:

  • Medication side effects
  • Breathing problems
  • Surgical complications include:
  • Bleeding
  • Infection

Complications of thyroid removal include:

  • Injury to the nerves that supple larynx and vocal cords

This can result in various problems such as inability to reach high notes, hoarseness, swallowing problems, coughing, or speaking problems, which may be either mild or severe.

  • Breathing difficulty can occur rarely that can gradually subside after few weeks of surgery.
  • Bleeding
  • Possible airway obstruction
  • Stake in thyroid hormone levels especially, during surgery
  • Injury to the parathyroid glands
  • Injury to the parathyroid vessels which can temporarily reduce calcium levels in the blood (hypocalcemia).
  • Thyroid storm or excessive release of thyroid hormone.