Thyroidectomy is a surgical procedure in which all or part of the thyroid gland is removed. The thyroid 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.
Precautions
There are definite risks associated with the procedure. Therefore, the thyroid gland should be removed only if there is a pressing reason or medical condition that requires it.
Description
Thyroidectomy is an operative procedure done most commonly by a general surgeon, or occasionally by an otolaryngologist, in the operating room of a hospital. The operation begins when an anesthesiologist puts the patient to sleep. The anesthesiologist injects drugs into the patient's veins and then places an airway tube in the windpipe to ventilate (provide air for) the patient. 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. The blood supply to the portion of the thyroid gland that is to be removed is clamped off. 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.
Patients generally stay in the hospital one to four days after completion of the operation.
If the diagnosis is hyperthyroidism, the patient may be asked to take antithyroid medication or iodides before the operation; or continued treatment with antithyroid drugs may be the treatment of choice. Otherwise, no other special procedure must be followed prior to the operation.
Aftercare
The incision requires little to no care after the dressing is removed. The area may be bathed gently with a mild soap. The sutures or the metal clips are removed three to seven days after the operation.
Risks
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.
Normal results
Most patients are discharged from the hospital one to four days after the procedure. Most resume their normal activities two weeks after the operation. Patients who have cancer may require subsequent treatment by an oncologist or a endocrinologist.
BOOKS
Kaplan, Edwin. "Thyroid and Parathyroid." In Principles of Surgery, ed. Seymour I. Schwartz, et al. New York: McGraw-Hill, 1994.
"Thyroidectomy." In The American Medical Association Encyclopedia of Medicine, ed. Charles B. Claymon. New York: Random House, 1989.
Endocrinologist—A physician who specializes in treating patients who have diseases of the thyroid, parathyroid, adrenal glands, and/or the pancreas.
Hyperthyroidism—Abnormal over-functioning of the thyroid glands. Patients are hypermetabolic, lose weight, are nervous, have muscular weakness and fatigue, sweat more, and have increased urination and bowel movements. This is also called thyrotoxicosis.
Hypothyroidism—Abnormal under-functioning of the thyroid gland. Patients are hypometabolic, gain weight, and are sluggish.
Recurrent laryngeal nerve—A nerve that lies very near the parathyroid glands and serves the larynx or voice box.
