Thyroidectomy: Surgery to Remove the Thyroid Gland


Thyroid Surgery

Healthy thyroid gland, artwork Healthy thyroid gland, computer artwork.
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Thyroid surgery, known as thyroidectomy, is a procedure to remove all or part of the thyroid gland. This is done for a variety of reasons, ranging from thyroid cancer to a noncancerous enlargement. The surgical procedure varies based upon the condition that is affecting the thyroid and how much of the thyroid must be removed.

The thyroid gland is shaped like a butterfly and rests at the base of the throat. It can be felt on examination in most cases, but normally is not visible to casual observation. If the thyroid is enlarged, it may be very noticeable, in some cases becoming the size of a golf ball. In most patients, there are four glands adjoining the thyroid gland, called the "parathyroid glands." While the name is similar to that of the thyroid, the functions of the thyroid and parathyroid are very different.


Thyroid Problems

There are four primary types of thyroid problems that make surgery necessary. The most common thyroid problems are hypothyroidism and hyperthyroidism, which are problems with the amount of hormone that the gland secretes. Two additional problems that make thyroid surgery necessary are diseases that enlarge the thyroid and cancer of the thyroid.

The thyroid secretes two hormones, thyroxine (T4) and triiodothyronine (T3). These hormones work together to regulate the body’s metabolism.

Hypothyroidism is a disease where the thyroid produces too little hormones and may result in patients feeling lethargic, depressed, aches and pains and weight gain. Secondary hypothyroidism is a thyroid problem that begins with one of two other glands, the hypothalamus, and the pituitary. In extreme cases, hypothyroidism can result in a life-threatening condition called "myxedema coma."

In most cases, hypothyroidism is easily treated with thyroid replacement (synthetic) hormones. Surgery is not typically required unless the gland is enlarged or diseased.

Causes of Hypothyroidism:

  • Too little thyroid replacement
  • Immune disorders
  • Radiation
  • Surgery to remove the thyroid
  • Tumor of the thyroid -- both benign and cancerous
  • Medications including Lithium, Amiodarone (Cordarone), Interferon and thyroid replacement

Hyperthyroidism is the exact opposite of hypothyroidism, with too much T3 or T4 being produced. The condition is commonly known as overactive thyroid.

Causes of Hyperthyroidism:

  • Graves disease (most common cause)
  • Too much iodine
  • Too much thyroid hormone replacement
  • Tumor of the testes
  • Tumor of the ovaries

Parathyroid Glands: What Are They?

Parathyroid glands are glands that rest in the neck near the thyroid, but despite the similarity in names, they perform different functions. There are four tiny parathyroid glands that rest near the thyroid. They are not typically removed during a thyroidectomy.

The function of the parathyroid glands is to regulate the amount of calcium in the body. The glands manufacture and secrete parathyroid hormone. If the calcium level in the body is low, more hormone is secreted. Too much calcium in the blood and the parathyroid glands decrease the level of hormone.

When parathyroid hormone is released in to the body, the bones of the body release some of their calcium content. Over time, too much parathyroid hormone can result in osteoporosis, or weak and brittle bones.


Tests Before Thyroid Surgery

Prior to surgery, tests will be done including physical examinations, blood tests, and a biopsy may be performed. This will help determine both the nature of the thyroid disorder and the origin of the problem. In some cases, a thyroid gland that is not excreting the proper amount of hormone may be reacting to a problem with the pituitary or hypothalamus. The blood tests can determine which gland is the problem.

Common Tests Before Thyroid Surgery:

  • TSH: Result will be low for hyperthyroidism, high for hypothyroidism
  • T4: High is hyperthyroidism, low for hypothyroidism
  • T3: High levels typically indicate hyperthyroidism
  • Endoscopic visualization: A physician uses an instrument with a light and a camera on it to look at the inside of the throat and the area of the thyroid
  • x-ray
  • Biopsy: A fine needle biopsy may be performed to examine the cells of the thyroid under a microscope
  • Thyroid scan

Reasons for Thyroid Surgery

There are many reasons that thyroid surgery is necessary. Some problems affect the function of the thyroid, while others merely change the size of the thyroid. In some cases, an enlargement of the thyroid gland, even if the thyroid is functioning normally, will necessitate surgery. This is because the thyroid rests on top of the windpipe and as it increases in size, it can cause difficulty breathing.

Reasons for Thyroid Surgery

  • Cancer of the thyroid
  • Hyperthyroidism that does not respond to other treatments
  • Hypothyroidism with enlargement of the gland
  • Goiter: Noncancerous enlargement of the gland that may impair the function of the windpipe and esophagus

Risks of Thyroid Surgery

In addition to the general risks of surgery and the risks of anesthesia, a thyroid surgery has its own risks.

Risks of Thyroid Surgery

  • Hoarseness or vocal cord problems
  • Permanent change in voice
  • Sore Throat
  • Dysphagia, difficulty swallowing
  • Calcium deficiency (if the parathyroid glands are removed or injured)

Types of Thyroid Surgery

There are several types of thyroid surgery. To understand the differences between the procedures, it is important to understand the anatomy of the thyroid gland. The gland is similar in appearance to the shape of a butterfly. Each “wing” is made up of a lobe, and they are connected by the thyroid isthmus or the” body” of the butterfly.

  • Partial lobectomy thyroid surgery: A portion of one lobe of the thyroid is removed
  • Lobectomy thyroid surgery: An entire lobe of the thyroid is removed
  • Lobectomy with isthmusectomy thyroid surgery: One lobe, along with the isthmus, is removed.
  • Subtotal thyroidectomy: Most of the thyroid is removed, but a functioning section remains (typically used for the treatment of Graves disease)
  • Total Thyroidectomy: Both lobes and the isthmus are removed

Thyroid Surgery: The Procedure

Thyroid surgical procedures begin with the insertion of an endotracheal tube, followed by the administration of general anesthesia. Once the anesthesia takes effect, the procedure begins with an incision 2 inches to 4 inches long that stretches horizontally over the thyroid. Based on the tests performed before the procedure and the appearance of the thyroid, the final determination of how much of the thyroid should be removed is made.

At this point, the portion or portions of the thyroid are removed using a scalpel. Special care is taken not to harm or disturb the parathyroid glands and the vocal cords, both of which rest in the neck near the thyroid.

A biopsy may also be done to examine the tissues of the thyroid, the parathyroid and, in rare cases, nearby lymph nodes. This is done to make sure that the portion of the thyroid that is left, if any, is not diseased. In some cases, the tissue is examined by a pathologist immediately, so that a second surgery to remove a diseased portion of the thyroid is not necessary.

Once the thyroid has been removed and any necessary samples have been taken, the area is examined for bleeding. Once the surgeon is confident that there is no bleeding present, the incision is closed. It may be closed with staples or sutures, and in some cases, a surgical drain may be placed to remove fluid from the area in the days after surgery.

Once a sterile bandage is applied to the incision, the surgery is completed. Anesthesia is discontinued and medication is given to wake the patient. The patient is then taken to the recovery room to be closely monitored while the remaining anesthetic wears off.


Recovery After Thyroid Surgery

After your thyroid surgery, you will be taken to the recovery room. It is normal to feel some pain in your neck after a thyroid procedure. Your throat may also be sore, and it may hurt to talk and swallow. This is normal immediately following the procedure. In most cases, you will stay in the hospital for the first night of your recovery to be monitored for any complications, such as bleeding or difficulty breathing.

Initially, you will be limited to taking fluids. If you are able to drink fluids without a problem, you will probably begin eating soft foods the next morning. In most cases, you will be able to return to a normal diet within 72 hours of surgery, barring any unforeseen complications.

Most patients are able to return home within 24 hours after the procedure. Before your discharge, you will be given instructions on how to care for your surgical incision and when to see your surgeon.


Life After Thyroid Surgery

After surgery to remove your thyroid, your body will no longer produce necessary thyroid hormones. These hormones will be replaced with hormone replacement drugs. While synthroid is a particular type of thyroid hormone replacement, you may find that people refer to the entire category of thyroid replacement drugs as “synthroid.”

Your thyroid replacement may begin immediately after your surgery or it may be started several weeks later, depending upon the condition that made the surgery necessary. Once the hormone replacement is started, it will need to be closely monitored to prevent the symptoms of hyper or hypothyroidism.

The level of calcium and vitamin D in your blood may also be monitored. In some cases, a daily supplement will be necessary every day. This is especially true if the parathyroid glands were involved in the procedure.

Once the medication is dosed properly, you should begin to feel a normal level of energy. Symptoms of ongoing lethargy, fatigue and feeling chronically tired should be reported to the physician managing your thyroid-replacement medication.

If you experience ongoing problems with your voice or hoarseness after surgery, let your physician know. While these side effects are normal immediately after surgery, they should resolve during the recovery process.

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