Thyroidectomy
Thyroidectomy is a surgical procedure aimed at removing all or part of the thyroid gland, typically located at the base of the neck. This operation is indicated for various medical reasons, including the removal of thyroid tumors, treatment of thyrotoxicosis (an excessive release of thyroid hormones), evaluation of thyroid masses, or alleviation of an enlarged thyroid that may obstruct breathing, swallowing, or speaking. The surgery is performed under general anesthesia, with a careful incision made to minimize damage to surrounding structures, including important nerves and blood vessels. During the procedure, the surgeon meticulously frees the thyroid from these structures, ligates the blood vessels, and ensures the preservation of the parathyroid glands, which are crucial for calcium regulation. Postoperatively, patients may require synthetic thyroid hormone to compensate for the loss of thyroid tissue. While thyroidectomy is a common procedure, it carries potential complications such as bleeding, thyroid storm, and voice changes due to vocal cord injury. Overall, thyroid surgery has evolved from older methods, with techniques like laser surgery minimizing incision size and scarring.
Thyroidectomy
Anatomy or system affected: Endocrine system, glands, neck
Definition: The surgical removal of all or a portion of the thyroid gland.
Indications and Procedures
A thyroidectomy is performed to remove thyroid tumors, treat thyrotoxicosis (a condition in which the thyroid gland excretes very large amounts of thyroid hormone), evaluate a mass, or excise an enlarged thyroid that is causing problems with breathing, swallowing, or speaking.
The thyroid gland is located at the base of the neck. It is composed of two lobes that straddle the trachea (throat) and a third lobe that is in the middle of the neck. Surgery on the thyroid is usually performed under general anesthesia. The patient’s neck is extended, and an incision along a natural fold or crease is made through the skin, platysma muscle, and fascia that lie over the thyroid. The muscle is cut high up to minimize damage to the nerve that controls it.
The thyroid is then carefully freed from surrounding structures (blood vessels, nerves, and the trachea). One at a time, the upper portion of each lobe is freed to allow identification of the veins that take blood from the thyroid. The veins are ligated (tied) in two places and cut between the ties. The ligaments that suspend the thyroid are cut next. It is important for the surgeon to avoid damaging the superior laryngeal nerve. Once the nerve has been protected, other blood vessels are clamped, tied, and cut. A similar procedure is followed for the lower lobes: ligating and cutting veins, protecting the inferior and recurrent laryngeal nerves, and freeing the remainder of the thyroid lobes.
Four parathyroid glands, each about the size of a pea, are embedded in the thyroid gland. At least one of these must be preserved since they play a vital role in regulating calcium. Once these glands are identified, the tissue of the thyroid is cut away, leaving the parathyroids intact.
The remnants of the thyroid gland are folded in and sutured to the trachea to control bleeding. A final inspection for bleeding is made. The fascia is sutured closed over the thyroid; any muscles that were cut are sewn back together. Finally, the edges of the skin are carefully brought together and sutured with very fine material; occasionally, clips are used. The instruments needed for a tracheostomy are left nearby to cope with any emergency that might occur during the next twenty-four hours.
Uses and Complications
Approximately one week after a thyroidectomy, the patient returns for a postoperative checkup, and sutures or clips are removed. Many, but not all, individuals having this procedure must take a synthetic thyroid hormone to make up for the tissue removed during the thyroidectomy.
Thyroid surgery is not uncommon. In the past, radiation was used to shrink the thyroid, but this procedure led to many cancers and has been discontinued. Laser techniques may reduce the size of the incision, thus reducing the size of the resulting scar in the neck.
Complications that may occur as a result of a thyroidectomy include bleeding into the neck, causing difficulty breathing; a surge of thyroid hormones into the blood, called thyroid storm or thyrotoxic crisis; and injury to the vocal cords, which can result in changes in voice pitch.
Bibliography
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