Thyroidectomy Health Article

Definition

Thyroidectomy is a surgical procedure in which all or part of the thyroid gland is removed. The thyroid gland is located in the forward (anterior) part of the neck just under the skin and in front of the Adam's apple. The thyroid is one of the body's endocrine glands, which means that it secretes its products inside the body, into the blood or lymph. The thyroid produces several hormones that have two primary functions: they increase the synthesis of proteins in most of the body's tissues, and they raise the level of the body's oxygen consumption.

Purpose

All or part of the thyroid gland may be removed to correct a variety of abnormalities. If a person has a goiter, which is an enlargement of the thyroid gland that causes swelling in the front of the neck, the swollen gland may cause difficulties with swallowing or breathing. Hyperthyroidism (overactivity of the thyroid gland) produces hypermetabolism, a condition in which the body uses abnormal amounts of oxygen, nutrients, and other materials. A thyroidectomy may be performed if the hypermetabolism cannot be adequately controlled by medication, or if the condition occurs in a child or pregnant woman. Both cancerous and noncancerous tumors (frequently called nodules) may develop in the thyroid gland. These growths must be removed, in addition to some or all of the gland itself.

Demographics

Screening tests indicate that about 6% of the United States population has some disturbance of thyroid function, but many people with mildly abnormal levels of thyroid hormone do not have any disease symptoms. It is estimated that between 12 and 15 million people in the United States and Canada are receiving treatment for thyroid disorders as of 2002. In 2001, there were approximately 34,500 thyroidectomies performed in the United States. Females are somewhat more likely than males to require a thyroidectomy.

Description

A thyroidectomy begins with general anesthesia administered by an anesthesiologist. The anesthesiologist injects drugs into the patient's veins and then places an airway tube in the windpipe to ventilate (provide air for) the person during the operation. After the patient has been anesthetized, the surgeon makes an incision in the front of the neck at the level where a tight-fitting necklace would rest. The surgeon 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 next step is clamping off the blood supply to the portion of the thyroid gland that is to be removed. Next, the surgeon removes all or part of the gland. If cancer has been diagnosed, all or most of the gland is removed. If other diseases or nodules are present, the surgeon may remove only part of the gland. The total amount of glandular tissue removed depends on the condition being treated. The surgeon may place a drain, which is a soft plastic tube that allows tissue fluids to flow out of an area, before closing the incision. The incision is closed with either sutures (stitches) or metal clips. A dressing is placed over the incision and the drain, if one has been placed.

People generally stay in the hospital one to four days after a thyroidectomy.

Diagnosis/Preparation

Thyroid disorders do not always develop rapidly; in some cases, the patient's symptoms may be subtle or difficult to distinguish from the symptoms of other disorders. Patients suffering from hypothyroidism are sometimes misdiagnosed as having a psychiatric depression. Before a thyroidectomy is performed, a variety of tests and studies are usually required to determine the nature of the thyroid disease. Laboratory analysis of blood determines the levels of active thyroid hormones circulating in the body. The most common test is a blood test that measures the level of thyroid-stimulating hormone (TSH) in the bloodstream. Sonograms and computed tomography scans (CT scans) help to determine the size of the thyroid gland and location of abnormalities. A nuclear medicine scan may be used to assess thyroid function or to evaluate the condition of a thyroid nodule, but it is not considered a routine test. A needle biopsy of an abnormality or aspiration (removal by suction) of fluid from the thyroid gland may also be performed to help determine the diagnosis.

If the diagnosis is hyperthyroidism, a person may be asked to take antithyroid medication or iodides before the operation. Continued treatment with antithyroid drugs may be the treatment of choice. Otherwise, no other special procedure must be followed prior to the operation.

Aftercare

A thyroidectomy 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.