Thyroidectomy

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What is Thyroidectomy? Thyroidectomy surgery is performed to resolve issues such as thyroid disorder, which ranges from cancer of the thyroid gland to an overactive thyroid (hyperthyroidism) to goiter. How much portion of the thyroid gland to be removed is dependent on the cause and severity of the disease. In cases where a part of the thyroid gland is removed, then the patient can return to their normal working condition after a few days. Read More

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Thyroidectomy

What is a thyroidectomy?

Thyroidectomy can be dated back to the 12th and 13th centuries as it involves performing surgery on the thyroid gland by partial removal or removal of the thyroid gland completely. The thyroid gland has the shape of a butterfly, and it is found in the lower part of the neck that secretes hormones responsible for the metabolism from the heart rhythm to the burning of calories.

Thyroidectomy is performed to resolve issues such as thyroid disorder, which ranges from cancer of the thyroid gland to an overactive thyroid (hyperthyroidism) to goiter. How much portion of the thyroid gland to be removed is dependent on the cause and severity of the disease. In cases where a part of the thyroid gland is removed, then the patient can return to their normal working condition after a few days. In contrast, if all of the thyroid glands are removed, then special treatments will be required as an alternative to the thyroid for proper secretion of hormones for metabolism. 

Thyroidectomy
Picture Courtesy: Clevelandclinic

What are the types of thyroidectomies?  

The types of thyroidectomies include the following:

types of thyroidectomies
Picture Courtesy: health-guide
  • Partial (Subtotal) Thyroidectomy

In the case where just a part of the thyroid is extracted, the other parts of the thyroid are present to continue to perform the functions. Hence hormonal therapy might not be required.

  • Total (Complete) Thyroidectomy

The whole thyroid is removed for this type; therefore, a drug known as the “synthetic thyroid hormone levothyroxine” is administered to the patient as the absence of the thyroid can lead to underactive thyroid as nothing is secreting the hormones for metabolism. The drugs perform the same duty as the thyroid.

How is thyroidectomy surgery performed?

Preparation

For patients diagnosed with hyperthyroidism, prior to the surgery, some medications such as iodine and potassium solution will be prescribed by the doctor to reduce the risk of bleeding after the surgery and aid in the control of the thyroid. The doctor recommends not eating or drinking any liquid for a few hours before the surgery to prevent problems related to the anesthesia and surgery. The patient is advised to wear comfortable clothes and not wear any jewelry.

Thyroidectomy Procedure

The process involved with thyroidectomy is categorized into before, during, and after the procedures. These stages are explained below:

Before Thyroidectomy

The patient will be placed under general anesthesia as it is required for the patient to be unconscious when the surgery begins, this anesthesia is given in the form of gas to inhale through the mask, or the anesthesia is administered by injecting the drugs into the body through an intravenous (IV route) route. Then, a flexible tube will be inserted into the patient’s trachea to permit regular breathing while unconscious. Different monitors will be placed on the patient’s body, and a blood pressure cuff will be placed on the arm to monitor the blood oxygen, blood pressure, and heart rhythm to keep it at a stable level throughout the surgery.

During Thyroidectomy

Once the patient is placed under anesthesia, the patient becomes unconscious, then the surgery begins. An incision is made into the lower center of the neck, and then it is kept in the skin crease so it cannot be easily noticed after the operated area heals. Later, a part or all of the thyroid gland is removed depending on the diagnosed thyroid problem. If thyroid cancer is diagnosed, the lymph nodes are removed for examination. Several ways of performing the thyroidectomy are explained below:

  • Conventional Thyroidectomy

The incision is made at the center of the neck for easy access to the thyroid, and this is the most common of all other methods.

  • Transoral Thyroidectomy

This type of thyroidectomy does not require an incision into the throat. During this procedure, the approach accesses the thyroid gland through the mouth.

  • Endoscopic Thyroidectomy

The endoscopic thyroidectomy makes use of a little incision on the neck, whereby a small camera is inserted later to guide the specialist all through the procedure.

  • Robotic thyroidectomy

During this procedure, a small incision is made under the arm and in the chest. The surgeon performs the surgery using robotic hands with surgical instruments attached.

After Thyroidectomy

Once the surgery is performed, the patient is taken to the recovery room, where the patient will be strictly monitored for recovery. When the anesthesia effect wears off, the patient regains consciousness and is shifted to the wardroom for further treatment and care. In a few cases, a drain tube is placed just beneath the incision in order to prevent the collection of the fluid under the skin and is removed after 2-3days. The patient can eat and drink after a few hours post-surgery. Depending on the patient’s overall condition, the patient will be advised to stay in the hospital for 2-3days and later get discharged. The patient will be asked to have regular follow-ups with the doctor so that the doctor can check the recovery of the wound.  

Duration

Thyroidectomy surgery takes about one to two hours to complete depending on the type of surgery that was performed on the patient.

What are the side effects and complications associated with thyroidectomy surgery?

thyroidectomy: side effects and complications
Picture Courtesy: verywellhealth

Complications associated with thyroidectomy surgery are listed below:

  1. Infection.
  2. Bleeding.
  3. Obstruction of the airway as a result of excess bleeding.
  4. Permanent hypoparathyroidism (decrease in parathyroid hormonal levels).
  5. A weak voice from nerve damage.
  6. Laryngeal nerve injury
  7. Infection
  8. Seroma (collection of fluid under the skin)
  9. Thyroid storm

What is the recovery rate of thyroidectomy cases?

The recovery rate for the thyroidectomy is eminent as the patient recovers with just a little mortality rate of 0.065%. 

Specialty

A well-trained surgeon is liable to perform thyroidectomy surgery on the patient. 

What is the cost of thyroidectomy surgery?

The cost of thyroidectomy ranges from $4600 to $6100, depending on the type of surgery and the time spent in the hospital.

Eligibility

All patients can undergo thyroidectomy surgery as long as the thyroid gland is affected. Though thyroidectomy can be performed on a pregnant woman, pregnant women should wait until after delivery to prevent infection and other complications.

What are the most common reasons for thyroidectomy surgery?

Thyroidectomy is performed for some reasons associated with the thyroid gland; these reasons are explained below:

  • Thyroid Cancer

A patient can be diagnosed with cancer in the thyroid, and this cancer can be removed by thyroidectomy. Undergoing surgery and removal of all or some portion of the thyroid gland is considered the treatment of thyroid cancer.

  • Goiter

Goiter is a condition where there is an abnormal enlargement of the thyroid gland. It is caused due to irregular cell growth that results in the formation of one or more nodules (lumps) in the thyroid gland, which can result in difficulty in swallowing or breathing. In such cases, thyroidectomy is considered to be the treatment of choice.

  • Hyperthyroidism

This is also known as the overactive thyroid, this can occur due to goiter, but in most cases, it is caused due to excessive excretion of hormones by the thyroid gland. 

The hormone responsible for this action is thyroxine. Drugs can be used for this, but patients with possible reactions to anti-thyroid drugs and who resist radioactive iodine therapy resort to thyroidectomy.

  • Indeterminate or Suspicious Thyroid Nodules

FAQ

Does thyroidectomy affect life expectancy?

As long as the medications prescribed by the doctor are adhered to, the treatment is safe and does not affect life expectancy.

Has anyone died from thyroid surgery?

Thyroidectomy has a mortality rate of 0.065%. Therefore, death resulting from the surgery is rare, with just approximately 7 deaths recorded in a 10,000 surgery.

What are the food items that have to be avoided? 

Soy foods and vegetables like cabbage, broccoli, kale, cauliflower, or spinach should be avoided if the thyroid has been removed. Also, sweet potatoes, cassava, strawberries, peanuts, and millet should be avoided.

What happens if a person has no thyroid and doesn’t take medicine?

Possible heart disease, low body temperature, weakness in the muscle, depression, and fatigue can occur when medications are not taken.

What are the adverse effects of taking too much thyroid medication?

Rise in blood pressure, anxiety, nervousness, difficulty concentrating, irritation, fatigue, and insomnia can all happen if the medication for the thyroid is abused.

What is the contraindication of thyroidectomy surgery?

The contraindications of thyroidectomy surgery are listed below:
1)       Heart and lung-related illness
2)       Uncontrolled Grave’s disease (the patient should be first stabilized with medications)
3)       Hyperthyroidism in pregnancy, unless the patient cannot tolerate anti-thyroid medications.

How common are thyroidectomy surgeries?

Thyroidectomy surgeries are performed worldwide. Surgeons perform more than 1,50,000 thyroidectomy surgeries annually in the USA [1].

References

  1. https://my.clevelandclinic.org/health/treatments/7016-thyroidectomy