A thyroidectomy is an operation that involves the surgical removal of all or part of the thyroid gland. General, endocrine or head and neck surgeons often perform a thyroidectomy when a patient has thyroid cancer or some other condition of the thyroid gland or goiter. Other indications for surgery include cosmetic, or symptomatic obstruction. Thyroidectomy is a common surgical procedure that has several potential complications or sequelae including: temporary or permanent change in voice, temporary or permanently low calcium, need for lifelong thyroid hormone replacement, bleeding, infection, and the remote possibility of airway obstruction due to bilateral vocal cord paralysis. Complications are uncommon when the procedure is performed by an experienced surgeon. The thyroid produces several hormones, such as thyroxine, triiodothyronine, and calcitonin. After the removal of a thyroid, patients usually take a prescribed oral synthetic thyroid hormone—levothyroxine —to prevent hypothyroidism. Less extreme variants of thyroidectomy include:
Hemithyroidectomy : removing only half of the thyroid
Isthmectomy: removing the band of tissue connecting the two lobes of the thyroid
A thyroidectomy should not be confused with a thyroidotomy, which is a cutting into the thyroid, not a removal of it. A thyroidotomy can be performed to get access for a median laryngotomy, or to perform a biopsy. Traditionally, the thyroid has been removed through a neck incision that leaves a permanent scar. More recently, minimally invasive and "scarless" approaches such as transoral thyroidectomy have become popular in some parts of the world.
Hemithyroidectomy—Entire isthmus is removed along with 1 lobe. Done in benign diseases of only 1 lobe.
Subtotal thyroidectomy—Removal of majority of both lobes leaving behind 4-5 grams of thyroid tissue on one or both sides—this used to be the most common operation for multinodular goitre.
Partial thyroidectomy—Removal of gland in front of trachea after mobilization. Done in nontoxic MNG. Its role is controversial.
Total thyroidectomy—Entire gland is removed. Done in cases of papillary or follicular carcinoma of thyroid, medullary carcinoma of thyroid. This is now also the most common operation for multinodular goitre.
Hartley Dunhill operation—Removal of 1 entire lateral lobe with isthmus and partial/subtotal removal of opposite lateral lobe. Done in nontoxic MNG.
Complications
Hypothyroidism in up to 50% of patients after ten years.
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 after surgery and can be a surgical emergency: an emergency tracheostomy may be needed. Recurrent Laryngeal nerve injury may occur during the ligature of the inferior thyroid artery.
Hypoparathyroidism temporary in many patients, but permanent in about 1 to 4% of patients
