A thyroidectomy is an operation that involves the

surgical Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

removal of all or part of the

thyroid gland The thyroid, or thyroid gland, is an endocrine gland in vertebrates. In humans it is in the neck and consists of two connected lobe (anatomy), lobes. The lower two thirds of the lobes are connected by a thin band of Connective tissue, tissue cal ...

. In general surgery, endocrine or head and neck surgeons often perform a thyroidectomy when a patient has thyroid

cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...

or some other condition of the thyroid gland (such as

hyperthyroidism Hyperthyroidism is the condition that occurs due to excessive production of thyroid hormones by the thyroid gland. Thyrotoxicosis is the condition that occurs due to excessive thyroid hormone of any cause and therefore includes hyperthyroidism ...

) or goiter. Other indications for surgery include cosmetic (very enlarged thyroid), or symptomatic obstruction (causing difficulties in swallowing or breathing). 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

hormone A hormone (from the Greek participle , "setting in motion") is a class of signaling molecules in multicellular organisms that are sent to distant organs by complex biological processes to regulate physiology and behavior. Hormones are required ...

s, such as

thyroxine File:Thyroid_system.svg, upright=1.5, The thyroid system of the thyroid hormones T3 and T4 rect 376 268 820 433 Thyroid-stimulating hormone rect 411 200 849 266 Thyrotropin-releasing hormone rect 297 168 502 200 Hypothalamus rect 66 216 386 25 ...

(T4),

triiodothyronine Triiodothyronine, also known as T3, is a thyroid hormone. It affects almost every physiological process in the body, including growth and development, metabolism, body temperature, and heart rate. Production of T3 and its prohormone thyroxine ( ...

(T3), and

calcitonin Calcitonin is a 32 amino acid peptide hormone secreted by parafollicular cells (also known as C cells) of the thyroid (or endostyle) in humans and other chordates. in the ultimopharyngeal body. It acts to reduce blood calcium (Ca2+), opposing th ...

. After the removal of a thyroid, patients usually take a prescribed oral synthetic thyroid hormone—

levothyroxine Levothyroxine, also known as -thyroxine, is a manufactured form of the thyroid hormone thyroxine (T4). It is used to treat thyroid hormone deficiency (hypothyroidism), including a severe form known as myxedema coma. It may also be used to tre ...

(Synthroid)—to prevent 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 An isthmus (; ; ) is a narrow piece of land connecting two larger areas across an expanse of water by which they are otherwise separated. A tombolo is an isthmus that consists of a spit or bar, and a strait is the sea counterpart of an isthmu ...

) 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'', literally “out-cutting”) of it. A thyroidotomy can be performed to get access for a median laryngotomy, or to perform a

biopsy A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a diseas ...

. (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.) Traditionally, the thyroid has been removed through a neck incision that leaves a permanent scar. More recently,

minimally invasive Minimally invasive procedures (also known as minimally invasive surgeries) encompass Surgery, surgical techniques that limit the size of incisions needed, thereby reducing wound healing time, associated pain, and risk of infection. Surgery by d ...

and "scarless" approaches such as transoral thyroidectomy have become popular in some parts of the world. In the United States, over 100,000 procedures are performed yearly as it is a common procedure.

Uses

Thyroidectomy is used in the treatment of: *

Thyroid cancer Thyroid cancer is cancer that develops from the tissues of the thyroid gland. It is a disease in which cells grow abnormally and have the potential to spread to other parts of the body. Symptoms can include swelling or a lump in the neck. C ...

* Toxic

thyroid nodule Thyroid nodules are nodules (raised areas of tissue or fluid) which commonly arise within an otherwise normal thyroid gland. They may be hyperplastic or tumorous, but only a small percentage of thyroid tumors are malignant. Small, asymptomatic ...

(produces too much thyroid hormone) * Multinodular

goiter A goitre, or goiter, is a swelling in the neck resulting from an enlarged thyroid gland. A goitre can be associated with a thyroid that is not functioning properly. Worldwide, over 90% of goitre cases are caused by iodine deficiency. The term is ...

(enlarged thyroid gland with many nodules), especially if there is compression of nearby structures *

Graves' disease Graves' disease (german: Morbus Basedow), also known as toxic diffuse goiter, is an autoimmune disease that affects the thyroid. It frequently results in and is the most common cause of hyperthyroidism. It also often results in an enlarged thyr ...

, especially if there is

exophthalmos Exophthalmos (also called exophthalmus, exophthalmia, proptosis, or exorbitism) is a bulging of the eye anteriorly out of the orbit. Exophthalmos can be either bilateral (as is often seen in Graves' disease) or unilateral (as is often seen in ...

(bulging eyes) * Thyroid nodule, if fine needle aspirate (FNA) results are unclear

Types

Diagram showing a lobectomy of the thyroid gland CRUK 067

Diagram showing before and after a total thyroidectomy CRUK 106

:::::::::::::* ''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 (equivalent to the size of a normal thyroid gland) 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. :::::::::::::* ''Near total thyroidectomy'' — Both lobes are removed except for a small amount of thyroid tissue (on one or both sides) in the vicinity of the recurrent laryngeal nerve entry point and the superior parathyroid gland. :::::::::::::* ''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 The recurrent laryngeal nerve (RLN) is a branch of the vagus nerve (cranial nerve X) that supplies all the intrinsic muscles of the larynx, with the exception of the cricothyroid muscles. There are two recurrent laryngeal nerves, right and lef ...

injury in about 1% of patients, in particular the

recurrent laryngeal nerve The recurrent laryngeal nerve (RLN) is a branch of the vagus nerve ( cranial nerve X) that supplies all the intrinsic muscles of the larynx, with the exception of the cricothyroid muscles. There are two recurrent laryngeal nerves, right and ...

: Unilateral damage results in a hoarse voice. Bilateral damage presents as laryngeal obstruction after surgery and can be a surgical emergency: an emergency

tracheostomy Tracheotomy (, ), or tracheostomy, is a surgical airway management procedure which consists of making an incision (cut) on the anterior aspect (front) of the neck and opening a direct airway through an incision in the trachea (windpipe). The r ...

may be needed. Recurrent Laryngeal nerve injury may occur during the ligature of the inferior thyroid artery. *

Hypoparathyroidism Hypoparathyroidism is decreased function of the parathyroid glands with underproduction of parathyroid hormone (PTH). This can lead to low levels of calcium in the blood, often causing cramping and twitching of muscles or tetany (involuntary m ...

temporary (transient) in many patients, but permanent in about 1 to 4% of patients *

Anesthetic An anesthetic (American English) or anaesthetic (British English; see spelling differences) is a drug used to induce anesthesia ⁠— ⁠in other words, to result in a temporary loss of sensation or awareness. They may be divided into two ...

complications *

Infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...

(at about a 2% rate. Drainage is an important part of treatment.), possibly an increased risk with chronic pre-operative steroid use. * Stitch granuloma *

Chyle Chyle (from the Greek word χυλός ''chylos'', "juice") is a milky bodily fluid consisting of lymph and emulsified fats, or free fatty acids (FFAs). It is formed in the small intestine during digestion of fatty foods, and taken up by lymph v ...

leak *

Haemorrhage Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, v ...

/ Hematoma (This may compress the airway, becoming life-threatening.) * Removal or devascularization of the parathyroids

History

Al-Zahrawi Abū al-Qāsim Khalaf ibn al-'Abbās al-Zahrāwī al-Ansari ( ar, أبو القاسم خلف بن العباس الزهراوي;‎ 936–1013), popularly known as al-Zahrawi (), Latinised as Albucasis (from Arabic ''Abū al-Qāsim''), was ...

, a tenth century

Arab The Arabs (singular: Arab; singular ar, عَرَبِيٌّ, DIN 31635: , , plural ar, عَرَب, DIN 31635: , Arabic pronunciation: ), also known as the Arab people, are an ethnic group mainly inhabiting the Arab world in Western Asia, ...

physician, sometimes referred to as the "Father of surgery", is credited with the performance of the first thyroidectomy.Ignjatovic M: Overview of the history of thyroid surgery. Acta Chir Iugosl 2003; 50: 9–36.

References

External links