Surgical removal of all or part of the thyroid gland, which is the gland in the neck that produces hormones that regulate metabolism. Removal of only one lobe of the thyroid is called thyroid lobectomy or partial thyroidectomy.
PARTS OF THE BODY INVOLVED
Front of the neck and the thyroid gland
REASONS FOR PROCEDURE
All or part of the thyroid gland may be surgically removed for any of the following reasons:
- Thyroid cancer (benign nodule or malignancy)
- Very large or toxic goiter (enlarged thyroid) due to hyperthyroidism
- Some cases of Grave's disease (a form of hyperthyroidism)
RISK FACTORS FOR COMPLICATIONS DURING THE PROCEDURE
- Obesity
- Smoking
- Alcoholism
- Poor nutrition
- Severe chronic illness, such as poorly controlled diabetes
WHAT TO EXPECT
Prior to Procedure
- Physical exam
- Laboratory and/or imaging tests to assess thyroid function
- Thyroid medication (to suppress thyroid activity in patients with hyperthyroidism)
- Iodine treatments for 10-15 days before surgery
- Fine needle aspiration biopsy to determine if a tumor or nodule is cancerous (in some cases)
During Procedure:
- Anesthesia
- Breathing tube (intubation)
- Horizontal incision in the front of your neck
Anesthesia – General
Description of the Procedure - A horizontal incision is made in the front of the neck. The skin is pulled away from the incision and held back with retractors or stitches. Bleeding vessels are clamped and tied off. The surgeon separates muscles, blood vessels, and nerves in the neck to access the thyroid gland. All or part of the thyroid gland is cut away from its attachment to other tissues in the neck and removed. Bleeding is controlled with instruments that compress, constrict, and cauterize the ends of blood vessels. The incision is closed and the edges of skin are stitched together.
When this gland is removed to treat thyroid cancer, lymph nodes in the area may also be removed in case the cancer has metastasized.
After Procedure:
- Stitches or staples in the front of your neck
- Discomfort in your neck for several days
- Hoarse voice for a few days (in some cases)
- Thyroid medication (in many cases, including all cases of total thyroidectomy) to compensate for loss of thyroid function
- Radioactive iodine treatments (in some cases of thyroid cancer)
How Long Will It Take? About 2 hours
Will It Hurt? Anesthesia prevents pain during the procedure, but pain after the procedure is common.
Possible Complications:
- Infection
- Bleeding
- Scarring
- Voice changes due to damage to nerves leading to the voice box (rare)
- Damage to the parathyroid gland, which controls calcium metabolism
- Thyrotoxic crisis (sudden excessive production of thyroid hormone to toxic levels)
Average Hospital Stay: 1-3 days
Postoperative Care:
- Keep the incision clean and dry
- Do not get the incision wet for 5-7 days, if it does get wet, dry it immediately
- Do not apply make-up, lotion, or cream to the incision area
- Perform neck exercises as instructed by your doctor
- Take all medications as prescribed by your doctor
OUTCOME
The outcomes after surgery depend on the reason for thyroidectomy.
If the thyroid was removed to treat hyperthyroidism, the following symptoms should subside:
- Excessive fatigue
- Weight loss
- Nervousness
- Rapid heart beat
- Excessive sweating
- Feeling of being hot
- Tremors
- Menstrual cycle irregularities
If the thyroid was removed to treat a thyroid tumor, nodule, or excessive goiter, the outcomes include:
- Removal of cancerous tissue from the body
- Improvement in swallowing or airflow that may have been compromised by an oversized thyroid gland
CALL YOUR DOCTOR IF ANY OF THE FOLLOWING OCCURS
- Numbness or tingling around the lips or extremities
- Twitching or spasms
- Excessive and progressive fatigue
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
- Cough, shortness of breath, chest pain, or severe nausea or vomiting
SOURCES:
American Association of Clinical Endocrinologists
The Thyroid Society for Education and Research
Alexander's Care of the Patient During Surgery, 11th ed. Mosby, 1999
