What is a thyroidectomy?

Indications and Procedures

A thyroidectomy is performed in order to remove thyroid tumors, to treat thyrotoxicosis (whereby the thyroid gland excretes very large amounts of thyroid hormone), to evaluate a mass, or to excise an enlarged thyroid that is causing problems with breathing, swallowing, or speaking.

The thyroid gland
is located at the base of the neck. It is composed of two lobes that straddle the trachea (throat) and a third lobe that is in the middle of the neck. Surgery on the thyroid is usually performed under general anesthesia. The patient’s neck is extended, and an incision along a natural fold or crease is made through the skin, platysma muscle, and fascia that lie over the thyroid. The muscle is cut high up to minimize damage to the nerve that controls it.

The thyroid is then carefully freed from surrounding structures (blood vessels, nerves, and the trachea). One at a time, the upper portion of each lobe is freed to allow identification of the veins that take blood from the thyroid. The veins are ligated (tied) in two places and cut between the ties. The ligaments that suspend the thyroid are cut next. It is important for the surgeon to avoid damaging the superior laryngeal nerve. Once the nerve has been protected, other blood vessels are clamped, tied, and cut. A similar procedure is followed for the lower lobes: ligating and cutting veins, protecting the inferior and recurrent laryngeal nerves, and freeing the remainder of the thyroid lobes.

Four parathyroid glands
, each about the size of a pea, are embedded in the thyroid gland. At least one of these must be preserved since they play a vital role in regulating calcium. Once these glands are identified, the tissue of the thyroid is cut away, leaving the parathyroids intact.

The remnants of the thyroid gland are folded in and sutured to the trachea to control bleeding. A final inspection for bleeding is made. The fascia is sutured closed over the thyroid; any muscles that were cut are sewn back together. Finally, the edges of skin are carefully brought together and sutured with very fine material; occasionally, clips are used. The instruments needed for a tracheostomy are left nearby to cope with any emergency that might occur during the next twenty-four hours.

Uses and Complications

Approximately one week after a thyroidectomy, the patient returns for a postoperative checkup, and sutures or clips are removed. Many, but not all, individuals having this procedure must take a synthetic thyroid hormone to make up for the tissue removed during the thyroidectomy.

Thyroid surgery is not uncommon. In the past, radiation was used to shrink the thyroid, but this procedure led to many cancers and has been discontinued. Laser techniques may reduce the size of the incision, thus reducing the size of the resulting scar in the neck.

Complications that may occur as a result of a thyroidectomy include bleeding into the neck, causing difficulty breathing; a surge of thyroid hormones into the blood, called thyroid storm or thyrotoxic crisis; and injury to the vocal cords, which can result in changes in voice pitch.

Bibliography

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Bhimji, Shabir. "Thyroid Gland Removal." MedlinePlus, May 6, 2011.

Burman, Kenneth D., and Derek LeRoith, eds. Thyroid Function and Disease. Philadelphia: Saunders/Elsevier, 2007.

Doherty, Gerard M., and Lawrence W. Way, eds. Current Surgical Diagnosis and Treatment. 12th ed. New York: Lange Medical Books/McGraw-Hill, 2006.

Kronenberg, Henry M., et al., eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia: Saunders/Elsevier, 2011.

Miccoli, Paolo, et al., eds. Thyroid Surgery: Preventing and Managing Complications. Hoboken, N.J.: 2013.

Rosenthal, M. Sara. The Thyroid Sourcebook: Everything You Need to Know. 5th ed. New York: McGraw-Hill, 2008.

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