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Thyroid Lobectomy

The thyroid is a butterfly-shaped hormonal gland residing at the base of the throat. The organ has two sides called lobes situated on both sides of the windpipe and connected by tissue. Thyroid lobectomy removes one of the lobes of the thyroid gland. The lobectomy is conducted in the following circumstances:

  • Thyroiditis: Inflammation of the thyroid gland. 
  • Thyroid Nodules: Lumps formed on the gland may be cancerous or benign.
  • Follicular Adenoma: Benign tumour on the thyroid gland.
  • Goitre: Enlargement of the thyroid gland.

Alternate Name

Hemi-thyroidectomy

Body location

The front base of the neck

How is the procedure performed? 

The thyroid lobectomy procedure begins with general anaesthesia and the insertion of an endotracheal tube through the mouth or nose. You will be laid flat on your back, with sandbags placed under the shoulder blades. This ensures the extension of the neck and makes the surgical area more prominent. 

After the surgical area is disinfected, a horizontal incision is made along the natural crease of the neck. The tissue and muscles surrounding the thyroid gland are drawn back, and the lobe that has to be removed is lifted away from the parathyroid gland and the recurrent laryngeal nerve (RLN). 

Parathyroid glands are rice grain-sized organs located behind the thyroid organ. The nerve is associated with the functioning of some muscles in the larynx, also known as the voice box. The recurrent laryngeal nerve and the parathyroid glands are close to the thyroid glands and, therefore, at risk of injury or damage.

The intended lobe is removed, and the muscles are strapped back into position. A drain tube is inserted to remove fluids from the operation site. The incision is closed with sutures.

Preparation for the procedure 

The pre-operative steps for a thyroid lobectomy are as follows:

  • Physical examination: Your doctor will physically examine you and check for symptoms. 
  • Diagnostic tests: CT scans and ultrasounds will be conducted to identify the problem. 
  • Fine needle biopsy: If nodules are discovered in testing, a fine needle biopsy will be conducted to extract fluid to determine whether the nodules are cancerous or benign.
  • Vocal cord checking: The doctor will check your vocal cord function to determine if they are affected.
  • Medication and therapy: Till the procedure is scheduled, thyroid-regulating medications are given to control the excess thyroid hormones.
  • Medical history: Your previous medical conditions and medications will be recorded. If you smoke or drink, discuss with your doctor about the same. You will have to avoid taking blood-thinning medicines. 
  • Before surgery: You will be required to fast and avoid drinking water, except for taking necessary medicines, eight hours before surgery.

Procedure type

Surgical

Follow up 

Your doctor will provide you with post-operative care instructions. Follow-up instructions involve taking care of the incisions and the dressing. Keep the area clean and dry, and leave the dressing in place unless instructed otherwise. Avoid scratching the area around the stitches. 

Avoid strenuous physical activities for two weeks following the surgery. Use pillows while sleeping to keep your head elevated. You can do light activities a day after the procedure and return to your regular schedule after two weeks. Avoid driving till you are unable to move your neck freely.

You can consume light food and liquids in the initial days, although there are no dietary restrictions. You can also resume your daily medications after consulting your doctor. Certain medications need to be avoided as they may cause bleeding. Ask your doctor to prescribe pain relief medicines.  

Thyroid lobectomy only removes one of the lobes of the thyroid gland. Therefore, additional thyroid supplements may not be necessary. However, check your thyroid levels six to eight weeks after the procedure to ensure the remaining half is functioning correctly and producing adequate hormones. The doctor will give you supplements if the thyroid levels are not balanced.

Risks 

The risks associated with thyroid lobectomy are as follows:

  • Bleeding: Bleeding may occur post-surgery at the incision site, leading to respiratory complications.
  • Scarring: The incision is made in the neck's natural crease to reduce the scar's appearance. However, there might be some scarring after the healing of the stitches.
  • Injury to the recurrent laryngeal nerve (RLN): The nerve is close to the thyroid gland and, therefore, is at a higher risk of injury. Damage to the nerve may lead to a temporary or permanent change in your vocal chord, like your voice becoming hoarse.

Recovery 

The procedure for thyroid lobectomy takes around 1 to 2 hours. After the patient is shifted to the recovery room, vitals and breathing are monitored.

Thyroid lobectomy is an outpatient procedure. Most patients are discharged on the same day after the effects of the anaesthesia wear off, and the doctor has completed the check-up. However, you may be asked to remain for a day to observe any post-surgery complications. You will have a sore throat due to the insertion of the endotracheal tube; this will subside after a few days. 

The incision is secured with self-dissolving sutures and heals quickly. The scar fades over time and is barely visible. You might experience tightness in the neck after the procedure, but the sensation subsides with the help of light stretching and neck exercises.

You can undertake light activity from the next day of the procedure and go back to your regular daily routine after two weeks. The duration of recovery may vary from person to person depending on their health, the reason for the procedure, age, previous medical problems, and their response to the treatment.

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