Thyroidectomy

A thyroidectomy involves the surgical removal of all or part of the thyroid gland. Surgeons often perform a thyroidectomy when a patient has thyroid cancer or some other condition of the thyroid gland (such as hyperthyroidism). Other indications for surgery include cosmetic (very enlarged thyroid), or symptomatic obstruction (causing difficulties in swallowing or breathing).

The thyroid produces several hormones, such as thyroxine (T4), triiodothyronine (T3) and calcitonin.

After the removal of a thyroid patients usually take prescribed oral synthetic thyroid hormones to prevent the most serious manifestations of the resultant hypothyroidism.

Less extreme variants of thyroidectomy include:
 * "hemithyroidectomy" (or "unilateral lobectomy") -- removing only half of the thyroid
 * "isthmectomy" -- removing the band of tissue (or isthmus) connecting the two lobes of the thyroid

A "thyroidectomy" should not be confused with a "thyroidotomy" ("thyrotomy"), which is a cutting into (-otomy) the thyroid, not a removal (-ectomy) of it. A thyroidotomy can be performed to get access for a median laryngotomy, or to perform a biopsy. (Although technically a biopsy involves removing some tissue, it is more frequently categorized as an -otomy than an -ectomy because the volume of tissue removed is minuscule.)

Indications
Malignancy

Cosmetic reasons

Goitre which is untreatable by medical methods

Severe hyperthyroidism refractory to conservative treatment

Orbitopathy in Graves' disease

Removal and evaluation of a nodule whose FNAB results are unclear

Steps
Main steps of Thyroidectomy:
 * 1) Exposure - horizontal neck incision, +/- raising of flaps, +/- division of strap muscles
 * 2) Identification of essential structures - Recurrent and ext. branch of superior laryngeal nerve, parathyroid glands
 * 3) Devascularization
 * 4) Resection
 * 5) Exploration of other pathology - e.g. contralateral lobe, lymph nodes
 * 6) Closure

Complications

 * 1) Hypothyroidism in up to 50% of patients after ten years
 * 2) Laryngeal nerve injury in about 1% of patients, in particular the recurrent laryngeal nerve: Unilateral damage results in a hoarse voice. Bilateral damage presents as laryngeal obstruction on removal of the tracheal tube and is a surgical emergency: an emergency tracheostomy must be performed. Recurrent Laryngeal nerve injury may occur during the ligature of the inferior thyroid artery.
 * 3) Hypoparathyroidism temporary in many patients, but permanent in about 1-4% of patients
 * 4) Haemorrhage/Hematoma
 * 5) Thyrotoxic crisis
 * 6) Surgical scar/keloid
 * 7) Infection
 * 8) Anesthetic complications