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
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)
- 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:
- Bleeding or hematoma formation (collection of blood in the neck tissue)
- Hoarseness or change in voice (due to injury of the recurrent or superior laryngeal nerve)
- Damage to parathyroid glands, causing hypocalcemia
- Wound infection
- Dysphagia (difficulty swallowing)
- Horner syndrome (characterized by a constricted pupil, upper eyelid drooping, absence of facial sweating, and sinking of the eyeball in the eye socket)
- Esophageal injury
- Tracheal injury
- Chyle leak (due to injury to the major lymph vessel called thoracic duct)
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
Top What Are the Types of Thyroidectomy Related Articles
Fine-Needle Aspiration Biopsy of the ThyroidFine-needle aspiration biopsy of the thyroid is used to obtain tissue for analysis. Fine-needle aspiration is also performed to treat thyroid cysts. The fine-needle aspiration biopsy procedure may be recommended to make the diagnosis and/or select therapy of a thyroid nodule. Fine needle aspiration biopsy may also be recommended to drain or shrink a thyroid cyst.
Hyperthyroidism is an excess of thyroid hormone due to an overactive thyroid gland. Symptoms can include increased heart rate, weight loss, heart palpitations, frequent bowel movements, depression, fatigue, fine or brittle hair, sleep problems, thinning skin, and irregular vaginal bleeding.
Graves' disease is the most common cause of hyperthyroidism. Many other health problems or taking excess thyroid hormone medication can cause an overactive thyroid gland. Treatment for the condition is with medication, radioactive iodine, thyroid surgery (rarely), or reducing the dose of thyroid hormone. No diet has been shown to treat hyperthyroidism or its symptoms and signs.
Hyperthyroidism: Symptoms, Treatment, MedicationWhat are the symptoms of hyperthyroidism? What causes hyperthyroidism? What happens when you take thyroid medication? Hyperthyroidism occurs when an overactive thyroid gland produces an excessive amount of thyroid hormone. Learn hyperthyroidism causes, symptoms, and treatment.
Parathyroidectomy SurgeryParathyroidectomy is the removal of one or more of the parathyroid glands to treat hyperparathyroidism. Risks of parathyroidectomy include:
- paralysis of the vocal cords,
- difficulty swallowing thin liquids,
- difficulty breathing,
- and drug reactions.
- damage to the recurrent laryngeal nerve,
- bleeding or hematoma,
- problems maintaining calcium levels in the blood,
- need for further and more aggressive surgery,
- need for a limited or total thyroidectomy,
- prolonged pain,
- impaired healing,
- and recurrence of the tumor.
Thyroid Blood Tests
Thyroid blood tests determine the adequacy of the levels of thyroid hormones in in a patient. The blood tests can determine if the thyroid gland's hormone production is normal, overactive, or underactive. The level of thyroid hormones may help to diagnose hypothyroidism or hyperthyroidism. The test may also point to other diseases of conditions of the thyroid gland.
Thyroid CancerThere are four major types of thyroid cancer: papillary, follicular, medullary, and anaplastic thyroid cancer. Tumors on the thyroid are referred to as thyroid nodules. Symptoms of thyroid cancer include swollen lymph nodes, pain in the throat, difficulty swallowing, hoarseness, and a lump near the Adam's apple. Treatment usually involves chemotherapy, surgery, radioactive iodine, hormone treatment or external radiation and depends upon the type of thyroid cancer, the patient's age, the tumor size, and whether the cancer has metastasized.
Thyroid DisordersThere are several types of thyroid disorders including hypothyroidism, hyperthyroidism, goiters, thyroid nodules, and thyroid cancer. Symptoms vary by condition. Diagnosis is made with blood tests, scans, ultrasound, or biopsy. Treatments depend on the disorder and can include medication or surgery.
Thyroid NodulesThyroid nodules are the most common endocrine problem in the United States. The term thyroid nodule refers to any abnormal growth that forms a lump in the thyroid gland. The vast majority of thyroid nodules are benign.
Thyroid Peroxidase TestThe thyroid peroxidase test measures the level of an antibody that is directed against thyroid peroxidase (TPO). The presence of TPOAb in the blood reflects a prior attack by the body's immune system on thyroid tissue. A positive thyroid peroxidase test may signal chronic thyroiditis. Other autoimmune disorders, however, may have a positive TPOAb test.
Illustrations of ThyroidThe thyroid is a butterfly-shaped gland located in the front of the neck just below the Adams apple. See a picture of the Thyroid and learn more about the health topic.
Thyroid QuizYour unexplained change in weight could indicate a thyroid condition. Take the Thyroid Quiz to learn about common symptoms and treatments of overactive and underactive thyroid disorders.
Thyroid ScanThyroid scanning is used to determine how active the thyroid is in manufacturing thyroid hormone. This can determine whether inflammation of the thyroid gland (thyroiditis) is present. It can also detect the presence and degree of overactivity of the gland (hyperthyroidism) or, conversely, it can determine the presence and degree of underactivity of the gland (hypothyroidism).
Cancer: Visual Guide to Thyroid CancerFind out the symptoms of thyroid cancer, and learn how to treat it after you get a diagnosis.
What Foods are Good and Bad for Hyperthyroidism?What is hyperthyroidism? Learn which foods are good and bad for hyperthyroidism.