A thyroidectomy is an operation that involves the

surgical Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery ...

removal of all or part of the

thyroid gland The thyroid, or thyroid gland, is an endocrine gland in vertebrates. In humans, it is a butterfly-shaped gland located in the neck below the Adam's apple. It consists of two connected lobes. The lower two thirds of the lobes are connected by ...

. In

general surgery General surgery is a Surgical specialties, surgical specialty that focuses on alimentary canal and Abdomen, abdominal contents including the esophagus, stomach, small intestine, large intestine, liver, pancreas, gallbladder, Appendix (anatomy ...

, endocrine or head and neck surgeons often perform a thyroidectomy when a patient has thyroid

cancer Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...

or some other condition of the thyroid

gland A gland is a Cell (biology), cell or an Organ (biology), organ in an animal's body that produces and secretes different substances that the organism needs, either into the bloodstream or into a body cavity or outer surface. A gland may also funct ...

(such as

hyperthyroidism Hyperthyroidism is a endocrine disease in which the thyroid gland produces excessive amounts of thyroid hormones. Thyrotoxicosis is a condition that occurs due to elevated levels of thyroid hormones of any cause and therefore includes hyperth ...

) or goiter. Other indications for surgery include cosmetic (very enlarged thyroid), or symptomatic obstruction (causing difficulties in swallowing or breathing). Thyroidectomy is a common surgical procedure that has several potential complications or sequelae including: temporary or permanent change in voice, temporary or permanently low calcium, need for lifelong thyroid hormone replacement, bleeding, infection, and the remote possibility of airway obstruction due to bilateral vocal cord paralysis. Complications are uncommon when the procedure i
performed by an experienced surgeon
The thyroid produces several

hormone A hormone (from the Ancient Greek, Greek participle , "setting in motion") is a class of cell signaling, signaling molecules in multicellular organisms that are sent to distant organs or tissues by complex biological processes to regulate physio ...

s, such as

thyroxine Thyroxine, also known as T4, is a hormone produced by the thyroid gland. It is the primary form of thyroid hormone found in the blood and acts as a prohormone of the more active thyroid hormone, triiodothyronine (T3). Thyroxine and its acti ...

(T4),

triiodothyronine Triiodothyronine, also known as T3, is a thyroid hormone. It affects almost every physiological process in the body, including growth and development, metabolism, body temperature, and heart rate. Production of T3 and its prohormone thyroxi ...

(T3), and

calcitonin Calcitonin is a 32 amino acid peptide hormone secreted by parafollicular cells (also known as C cells) of the thyroid (or endostyle) in humans and other chordates in the ultimopharyngeal body. It acts to reduce blood calcium (Ca2+), opposing the ...

. After the removal of a thyroid, patients usually take a prescribed oral synthetic thyroid hormone— levothyroxine (Synthroid)—to prevent

hypothyroidism Hypothyroidism is an endocrine disease in which the thyroid gland does not produce enough thyroid hormones. It can cause a number of symptoms, such as cold intolerance, poor ability to tolerate cold, fatigue, extreme fatigue, muscle aches, co ...

. Less extreme variants of thyroidectomy include: * hemithyroidectomy (or unilateral lobectomy): removing only half of the thyroid * isthmectomy or isthmusectomy: removing the band of tissue (or

isthmus An isthmus (; : isthmuses or isthmi) is a narrow piece of land connecting two larger areas across an expanse of water by which they are otherwise separated. A tombolo is an isthmus that consists of a spit or bar, and a strait is the sea count ...

) connecting the two lobes of the thyroid A thyroidectomy should not be confused with a thyroidotomy ( thyrotomy), which is a cutting into (''‑otomy'') the thyroid, not a removal ('' ‑ectomy'', literally “out-cutting”) of it. A thyroidotomy can be performed to get access for a median laryngotomy, or to perform a

biopsy A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, an interventional radiologist, or an interventional cardiology, interventional cardiologist. The process involves the extraction of sampling (medicine), sample ...

. (Although technically a biopsy involves removing some tissue, it is more frequently categorized as an ''‑otomy'' than an ''‑ectomy'' because the volume of tissue removed is minuscule.) Traditionally, the thyroid has been removed through a neck incision that leaves a permanent scar. More recently, minimally invasive and "scarless" approaches such as
transoral thyroidectomy
] have become popular in some parts of the world. These approaches have been associated wit
reduced pain
an
better quality of life
in some studies. There are a few centers of excellence in the United States that perform this surgery often, while most centers do not routinely offer remote access surgery. Traditional thyroid surgery is a common procedure, performed over 100,000 times per year.

Uses

Thyroidectomy is used in the treatment of: *

Thyroid cancer Thyroid cancer is cancer that develops from the tissues of the thyroid gland. It is a disease in which cells grow abnormally and have the potential to spread to other parts of the body. Symptoms can include swelling or a lump in the neck, ...

* Toxic thyroid nodule (produces too much thyroid hormone) * Multinodular

goiter A goitre (British English), or goiter (American English), is a swelling in the neck resulting from an enlarged thyroid gland. A goitre can be associated with a thyroid that is not functioning properly. Worldwide, over 90% of goitre cases are ca ...

(enlarged thyroid gland with many nodules), especially if there is compression of nearby structures *

Graves' disease Graves' disease, also known as toxic diffuse goiter or Basedow's disease, is an autoimmune disease that affects the thyroid. It frequently results in and is the most common cause of hyperthyroidism. It also often results in an enlarged thyro ...

, especially if there is

exophthalmos Exophthalmos (also called exophthalmus, exophthalmia, proptosis, or exorbitism) is a bulging of the eye anteriorly out of the orbit. Exophthalmos can be either bilateral (as is often seen in Graves' disease) or unilateral (as is often seen in ...

(bulging eyes) * Thyroid nodule, if fine needle aspirate (FNA) results are unclear

Types

Diagram showing a lobectomy of the thyroid gland CRUK 067

Diagram showing before and after a total thyroidectomy CRUK 106

:::::::::::::* ''Hemithyroidectomy'' — Entire isthmus is removed along with 1 lobe. Done in benign diseases of only 1 lobe. :::::::::::::* ''Subtotal thyroidectomy'' — Removal of majority of both lobes leaving behind 4-5 grams (equivalent to the size of a normal thyroid gland) of thyroid tissue on one or both sides—this used to be the most common operation for multinodular goitre. :::::::::::::* ''Partial thyroidectomy'' —Removal of gland in front of trachea after mobilization. Done in nontoxic MNG. Its role is controversial. :::::::::::::* ''Near total thyroidectomy'' — Both lobes are removed except for a small amount of thyroid tissue (on one or both sides) in the vicinity of the recurrent laryngeal nerve entry point and the superior parathyroid gland. :::::::::::::* ''Total thyroidectomy'' — Entire gland is removed. Done in cases of papillary or follicular carcinoma of thyroid, medullary carcinoma of thyroid. This is now also the most common operation for multinodular goitre. :::::::::::::* ''Hartley Dunhill operation'' — Removal of 1 entire lateral lobe with isthmus and partial/subtotal removal of opposite lateral lobe. Done in nontoxic MNG, but rarely performed in the United States.

Complications

Hypothyroidism Hypothyroidism is an endocrine disease in which the thyroid gland does not produce enough thyroid hormones. It can cause a number of symptoms, such as cold intolerance, poor ability to tolerate cold, fatigue, extreme fatigue, muscle aches, co ...

in more tha
20% of patients
*

Laryngeal nerve The recurrent laryngeal nerve (RLN), also known as nervus recurrens, is a branch of the vagus nerve (cranial nerve X) that supplies all the intrinsic muscles of the larynx, with the exception of the cricothyroid muscles. There are two recurr ...

injury in about 1% of patients, in particular the

recurrent laryngeal nerve The recurrent laryngeal nerve (RLN), also known as nervus recurrens, is a branch of the vagus nerve ( cranial nerve X) that supplies all the intrinsic muscles of the larynx, with the exception of the cricothyroid muscles. There are two recur ...

: Unilateral damage results in a hoarse voice. Bilateral damage presents as laryngeal obstruction after surgery and can be a surgical emergency: an emergency

tracheostomy Tracheotomy (, ), or tracheostomy, is a surgical airway management procedure which consists of making an incision on the front of the neck to open a direct airway to the trachea. The resulting stoma (hole) can serve independently as an airway ...

may be needed. Recurrent Laryngeal nerve injury may occur during the ligature of the inferior thyroid artery. *

Hypoparathyroidism Hypoparathyroidism is decreased function of the parathyroid glands with underproduction of parathyroid hormone (PTH). This can lead to low levels of calcium in the blood, often causing cramping and twitching of muscles or tetany (involuntary m ...

temporary (transient) in many patients, but permanent in about 1 to 4% of patients *

Anesthetic An anesthetic (American English) or anaesthetic (British English; see spelling differences) is a drug used to induce anesthesia ⁠— ⁠in other words, to result in a temporary loss of sensation or awareness. They may be divided into t ...

complications *

Infection An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

(at about a 2% rate. Drainage is an important part of treatment.), possibly an increased risk with chronic pre-operative steroid use. * Stitch

granuloma A granuloma is an aggregation of macrophages (along with other cells) that forms in response to chronic inflammation. This occurs when the immune system attempts to isolate foreign substances that it is otherwise unable to eliminate. Such sub ...

Chyle Chyle (; ) is a milky bodily fluid consisting of lymph and emulsified fats, or free fatty acids (FFAs). It is formed in the small intestine during digestion of fatty foods, and taken up by lymph vessels specifically known as lacteals. The lip ...

leak *

Haemorrhage Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vag ...

Hematoma A hematoma, also spelled haematoma, or blood suffusion is a localized bleeding outside of blood vessels, due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillaries. A hematoma is ...

(This may compress the airway, becoming life-threatening.) * Removal or devascularization of the parathyroids

History

Al-Zahrawi Abū al-Qāsim Khalaf ibn al-'Abbās al-Zahrāwī al-Ansari (;‎ c. 936–1013), popularly known as al-Zahrawi (), Latinisation of names, Latinised as Albucasis or Abulcasis (from Arabic ''Abū al-Qāsim''), was an Arabs, Arab physician, su ...

, a tenth century

Arab Arabs (, , ; , , ) are an ethnic group mainly inhabiting the Arab world in West Asia and North Africa. A significant Arab diaspora is present in various parts of the world. Arabs have been in the Fertile Crescent for thousands of years ...

physician, sometimes referred to as the "father of surgery", is credited with the performance of the first thyroidectomy.Ignjatovic M: Overview of the history of thyroid surgery. Acta Chir Iugosl 2003; 50: 9–36.

References

External links