Thyroidectomy is a surgical procedure that involves the removal of a part, or both lobes of the thyroid gland. The thyroid gland is an endocrine gland that has multiple physiological functions.
Thyroidectomy can be performed in the following cases:
- Thyroid disorders
- Thyroid nodules
- Obstructive goiter
Thyroidectomy can be classified into two types based on the amount of the thyroid gland removed. Partial thyroidectomy is when only a part of the thyroid gland is removed. The removal of the entire thyroid gland is known as a total thyroidectomy.
The thyroid gland is located at the base of the neck and secretes the thyroid hormone.
How is total thyroidectomy performed?
Total thyroidectomy involves total removal of the thyroid gland and tissue due to the entire gland being affected. The procedure occurs under general anesthesia in a hospital. After fluid administration and anesthesia, the surgeon will make an incision over the base of the neck to carefully remove the thyroid gland.
Another method to perform total thyroidectomy is a robotic thyroidectomy. In this case, the surgeon performs an axillary incision through the armpit or opts for a transoral route to remove the thyroid gland.
The procedure takes around 2-3 hours and is performed carefully as the thyroid gland is surrounded by nerves and glands.
Preparation for total thyroidectomy
Before a total thyroidectomy is scheduled, there are diagnostic tests run to confirm the need for the surgery such as:
- Physical examination of the thyroid gland
- Blood tests including thyroid function test
- Ultrasound imaging
- Thyroid FNAC
- Genetic testing
- Direct Laryngeoscopy
Before the procedure
Thyroidectomy is generally a safe procedure. It is recommended to have an attendee post-surgery as it is done under anesthesia. In the case of hyperthyroidism, the doctor may prescribe medication to control thyroid function and lower the risk of bleeding after surgery.
As the procedure is under anesthesia, to limit the risk of complications, the patient is advised to not eat or drink from the previous night of the procedure or a few hours before the procedure.
Type of procedure
The surgical procedure is commenced once the patient is unconscious. The types of total thyroidectomy procedures include:
This procedure involves making an incision at the center of the neck and is preferred for most patients.
The oral route is preferred in this procedure by making an incision through an oral route to access the thyroid gland.
This process involves smaller incisions in the neck to insert a small video camera that guides the surgeon throughout the procedure.
Follow up: recommendations post-surgery
After the surgery, the patient is shifted to a separate room to monitor post-surgery recovery and anesthesia. Once the patient is conscious, conditions such as neck pain, hoarse or weak voice are short-term symptoms of surgery. Regular activities can be resumed post-discharge, with no dietary restrictions unless mentioned. It is recommended to refrain from strenuous activities up to a minimum of 10 days post the procedure.
Risks of the procedure
A total thyroidectomy is a surgical procedure. It accompanies low chances of the following risks:
- Adverse reaction to general anesthesia
- Heavy bleeding/infection
- Damage to nerves in vocal cords
- Damage to parathyroid glands which lie behind the thyroid glands
The management of post-total thyroidectomy is performed through medication. As the thyroid gland is removed, the body requires supplementation of the thyroid hormone. Synthetic thyroid hormone supplementations such as Synthroid and Unithroid are prescribed by the surgeon. The dosage is given based on a blood test to determine the amount of thyroid hormone needed. In case of injury in the parathyroid glands and low calcium, calcium supplements are also prescribed.