Thyroidectomy
Thyroidectomy, a surgical procedure to remove the thyroid gland, is divided into three types: total, partial, or completion thyroidectomy.

Thyroidectomy is a surgical procedure to remove the entire thyroid gland or a part of it.

Depending on how much thyroid tissue is removed, thyroidectomy could be:

  • Total thyroidectomy: In this surgery, the entire thyroid gland is removed. The thyroid hormones are essential for survival. Because no thyroid tissue is left in this surgery, the person needs life-long thyroid hormone supplementation after total thyroidectomy. If the thyroid gland removal is done along with the removal of adjacent lymph nodes in the neck, the surgery is called total thyroidectomy with neck dissection.
  • Partial thyroidectomy: In a partial thyroidectomy, only a part of the thyroid gland is removed. Depending on the extent of removal, partial thyroidectomy is further classified into:
    • Thyroid lobectomy: It is also called hemithyroidectomy. In this surgery, only one lobe of the thyroid gland is removed.
    • Thyroid lobectomy with isthmusectomy: This surgery involves the removal of a thyroid lobe along with the isthmus.
    • Partial thyroid lobectomy: Only a part of the thyroid lobe is removed.
    • Subtotal thyroidectomy: A small portion of the thyroid gland is left during the surgery. This portion is near the trachea, parathyroid glands (glands that produce the calcium-regulating hormone called parathormone), and the recurrent laryngeal nerve (a nerve that supplies the larynx, helps with speech). This helps prevent injury to these structures.

Another type of thyroidectomy, called completion thyroidectomy is a surgery done to remove the remaining thyroid tissue after a partial thyroidectomy, such as hemithyroidectomy. It is also called re-operative thyroid surgery. It may be done when analysis of the surgically removed thyroid tissue reveals a malignancy (cancer).

What is the thyroid gland?

The thyroid gland is a butterfly-shaped gland present in the front of the neck, just below Adam’s apple (thyroid cartilage). The gland plays several important roles to ensure the normal functioning of the body.

The thyroid gland has two major types of cells: follicular and parafollicular cells (also called C-cells).

  • The parafollicular or C-cells produce the hormone calcitonin that regulates blood calcium levels and calcium utilization by the body.
  • The follicular cells produce hormones called thyroxine (T4) and triiodothyronine (T3) that regulate the metabolism, heart rate, body temperature, and blood pressure. They are essential for fetal growth and development.

Thyroid hormones play a crucial role in sexual and brain development.

The gland has two lobes connected by a narrow bridge-like structure called the isthmus.

How is a thyroidectomy done?

Thyroidectomy surgery may take one to six hours depending on the type of thyroid surgery (complete or partial).

Most thyroid surgeries are done under general anesthesia (the patient sleeps during the procedure) although in some cases, local or regional anesthesia may be used.

During the procedure

  • The patient lies comfortably on the operating table with their neck extended to expose the front of the neck
  • The healthcare provider establishes an intravenous line and administers anesthesia
  • The operation site is cleaned with antiseptics to prevent infection
  • Depending on the approach used for thyroidectomy, it is classified into:
    • Conventional thyroidectomy: An incision is made in front of the neck to reach the thyroid gland.
    • Transoral thyroidectomy: Instead of the neck incision, an incision is made inside the mouth (transoral) to access the thyroid gland.
    • Endoscopic thyroidectomy: It is also called minimally invasive surgery because a small incision is made on the neck. Through this incision, a flexible tube with a camera and light source (endoscope) is inserted to operate the thyroid gland.
  • The surgeon removes a part of or the entire thyroid gland depending on the type of surgery
  • Lymph node removal (also called lymph node dissection) may be done if needed
  • After the surgery is complete, the incision site is closed and sutures are applied
  • A small tube or drain may be applied to remove any fluid collection at the operated site
  • Bandage dressing is done, and the patient is shifted to a post-operative observation room to monitor their vitals and recovery from anesthesia

SLIDESHOW

Hyperthyroidism: Symptoms, Treatment, Medication See Slideshow

What happens after a thyroidectomy?

Depending on the type of thyroid surgery, the person may be allowed to go home the same day or stay in the hospital for a few days.

  • There may be some neck discomfort or hoarseness that goes away in a few days. 
  • Avoid physical exertion for a week or two after the procedure.
  • The doctor may ask the person to resume their regular diet after surgery.

The doctor may prescribe medications, such as calcium supplements, pain medications, and antibiotics, following the surgery. Thyroid hormone supplementation may be needed in case of total thyroidectomy.

What is thyroidectomy done for?

Thyroidectomy may be done in case of certain thyroid diseases, such as:

  • Thyroid nodules (a lump in the thyroid gland)
  • Goiter
  • Thyroid cancer (such as medullary thyroid cancer or anaplastic thyroid cancer)
  • Hyperthyroidism (an overactive thyroid gland)
  • Thyroid lymphoma
  • Secondaries or metastases in the thyroid (spread of cancer from another site to the thyroid gland)
  • Substernal or obstructive (thyroid gland enlargement that extends into the chest, causing symptoms, such as airway obstruction)

10 risks of thyroidectomy

Some of the risks of thyroidectomy are:

  1. Bleeding or hematoma formation (collection of blood in the neck tissue)
  2. Hoarseness or change in voice (due to injury of the recurrent or superior laryngeal nerve)
  3. Damage to parathyroid glands, causing hypocalcemia
  4. Scarring
  5. Wound infection
  6. Dysphagia (difficulty swallowing)
  7. Horner syndrome (characterized by a constricted pupil, upper eyelid drooping, absence of facial sweating, and sinking of the eyeball in the eye socket)
  8. Esophageal injury
  9. Tracheal injury
  10. Chyle leak (due to injury to the major lymph vessel called thoracic duct)

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Medically Reviewed on 4/12/2022
References
Image Source: iStock Image

Wang TS, Lyden ML, Sosa JA. Thyroidectomy. UpToDate. https://www.uptodate.com/contents/thyroidectomy#H2

Medline Plus. Thyroid gland removal – discharge. https://medlineplus.gov/ency/patientinstructions/000293.htm

Goyal N. Thyroidectomy. Medscape. https://emedicine.medscape.com/article/1891109-overview#a3

The Cochrane Collaboration. Total or near-total thyroidectomy versus subtotal thyroidectomy for multinodular non-toxic goitre in adults. https://www.cochrane.org/CD010370/ENDOC_total-or-near-total-thyroidectomy-versus-subtotal-thyroidectomy-multinodular-non-toxic-goitre-adults

Mayo Clinic. Thyroidectomy. https://www.mayoclinic.org/tests-procedures/thyroidectomy/about/pac-20385195