Introduction to Thyroidectomy
In the year 2001 around 34,500 thyroidectomies were performed in the USA, and ten years later — 72,344 total thyroidectomies were performed in the United States in 2011. The incidence of thyroidectomy is higher in the female population.
The thyroid is a butterfly-shaped glandular organ. It is placed on the trachea in middle of the neck just below the voice box. Its middle part called isthmus lays in the midline and two expanded parts called lobes lay on the sides. The thyroid gland secretes one of the key hormones called thyroxin which regulates body metabolism. Some sources claim about 6% of the population the USA has some disturbance of thyroid gland and many of them are asymptomatic or undiagnosed. However, other sources are a bit milder, estimating 5 percent of women and 3 percent of men in the U.S. have subclinical thyroid dysfunction.
Indications of thyroidectomy
Thyroidectomy is indicated in diverse conditions were either enlarged gland or an excess of the hormone is problematic. In case of cancer, other therapies may be required along with thyroidectomy. Major indications for thyroidectomy are as follows:
- Cancer of thyroid
- Non-cancerous (benign) tumors of the thyroid
- A nodule or cyst on the thyroid
- An overactive thyroid gland which secretes excess of thyroid hormone (thyrotoxicosis)
- A thyroid gland, which is large enough to cause difficulty in swallowing or breathing
- An enlarged thyroid gland causing disfigurement
Types of thyroidectomy and thyroidectomy surgery
Thyroidectomy is classified into three major types depending on the amount and part of the gland is removed.
It is a major procedure in which the whole of the thyroid gland is removed. The patient after surgery may not have enough thyroid hormone in his blood after the surgery and may need hormone replacement pill to regulate body metabolism. When the procedure is done for the treatment of cancer, lymph nodes are also removed and the patient may need other concurrent treatment.
It is performed less frequently than the other two types. In this type, a part of the thyroid gland is removed from each lobe.
Only one side of the thyroid gland is removed and the procedure is also done under local anesthesia. That means only the area around the thyroid gland is anesthetized so that the patient does not feel pain. The patient remains conscious and aware of what goes on.
Types of thyroidectomy surgery
Surgical removal of the thyroid gland may be done by two ways.
It is an open surgical procedure in which a 3-4 inches long cut (incision) is made through the skin in the lower part of the neck above the collarbones and breastbone. Another vertical incision is made to separate the muscles below the skin to reach the thyroid gland. The amount of thyroid tissue to be removed depends upon the underlying pathology and the type of thyroidectomy. Extreme care is required to protect the nearby structure like the parathyroid gland, nerves and blood vessels. After removing the part or the whole of the gland the skin is stitched. A small suction catheter or tube is placed inside to drain out any fluid or blood which may be collected after the surgery. The catheter is generally removed within 24 hours.
It is done through an instrument called endoscope, which allows the surgeon to visualize and operate the gland without completely opening it. In this procedure 3 or 4 small incisions are given to insert the endoscope and another instrument to remove the gland. Endoscopic surgery is often associated with comparatively less complication and quicker healing.
Risks associated with thyroidectomy
Thyroidectomy is generally a safer procedure with good prognosis. However, there may be many complications at different stages.
Risks associated with anesthesia :
- Reactions to drugs
- Respiratory problems
- Risks associated with surgery:
- Bleeding or Hemorrhage beneath the neck wound may occur sometimes. It may compress the structures lying in the vicinity resulting in difficulty in breathing. It may present as a medical emergency.
- Wound infection
- Risks associated with the removal of the thyroid gland:
- Injury to the nerves in the vocal cord leading to weaker voice or difficulty in swallowing liquids after surgery
- Steep rise in thyroid hormone levels, a condition called Thyroid storm
- Injury to the nerves in the vocal cords and larynx which may cause weakness or even paralysis of voice box and larynx on one side. In that case, there may be mild to severe problem in reaching high notes while singing, speaking, coughing, swallowing, etc
- Rarely there may be difficulty in breathing which almost always rectifies after several weeks or months after surgery
- A sore throat after the surgery
- Injury to the parathyroid glands or its accidental removal along with thyroid leads to a deficiency of parathyroid hormone also known as Hypoparathyroidism. It results in the decreased level of calcium in the body (hypocalcemia).
Patients are discharged from the hospital one to four days after the surgery. Most patients resume their normal activities within two weeks after the operation. If everything goes normal, the patient needs to visit a week after the surgery for a follow-up. After thyroid surgery, regular tests to measure thyroid hormone may be required to evaluate the status of the thyroid gland. Another important test at first follow-up is for blood calcium and phosphorus level. Low blood calcium levels — hypocalcemia is a major postoperative complication of total thyroidectomy, causing severe symptoms and increasing hospitalization time — it occurs in up to 40% of patients following a total thyroidectomy. Hypocalcemia can be treated with vitamin D and calcium supplementation.
Thyroidectomy surgery is well tolerated and gives good results. The long-term consequences depend upon the underlying condition and the amount of the gland removed. When only a part of the gland is removed, there may not be any functional deficit as the remaining thyroid tissue can secrete the desired amount of the thyroid hormone. When the entire gland is removed, the patient needs to take thyroid hormone replacement in the form of thyroid hormone pills for the rest of their lives.