Thyroidectomy - Types, Procedure & Risks

Thyroidectomy is the removal of all or part of your thyroid gland. Your thyroid is a butterfly-shaped gland located at the base of your neck. It produces hormones that regulate every aspect of your metabolism, from your heart rate to how quickly you burn calories.

Thyroidectomy is used to treat thyroid disorders, such as cancer, noncancerous enlargement of the thyroid (goiter) and overactive thyroid (hyperthyroidism).

How much of your thyroid gland is removed during thyroidectomy depends on the reason for surgery. If only a portion is removed (partial thyroidectomy), your thyroid may be able to function normally after surgery. If your entire thyroid is removed (total thyroidectomy), you need daily treatment with thyroid hormone to replace your thyroid's natural function.

Why it's done?

A thyroidectomy may be recommended for conditions such as:

• Thyroid cancer. Cancer is the most common reason for thyroidectomy. If you have thyroid cancer, removing most, if not all, of your thyroid will likely be a treatment option.


• Noncancerous enlargement of the thyroid (goiter). Removing all or part of your thyroid gland is an option if you have a large goiter that is uncomfortable or causes difficulty breathing or swallowing or, in some cases, if the goiter is causing hyperthyroidism.


• Overactive thyroid (hyperthyroidism). Hyperthyroidism is a condition in which your thyroid gland produces too much of the hormone thyroxine. If you have problems with anti-thyroid drugs and don't want radioactive iodine therapy, thyroidectomy may be an option.


• Indeterminate or suspicious thyroid nodules. Some thyroid nodules can't be identified as cancerous or noncancerous after testing a sample from a needle biopsy. Doctors may recommend that people with these nodules have thyroidectomy if the nodules have an increased risk of being cancerous.

Types of thyroid surgery:

There are several different types of thyroid surgery. The most common are lobectomy, subtotal thyroidectomy, and total thyroidectomy.

Lobectomy:

Sometimes, a nodule, inflammation, or swelling affects only half of the thyroid gland. When this happens, a doctor will remove only one of the two lobes. The part left behind should retain some or all of its function.

Subtotal thyroidectomy:

A subtotal thyroidectomy removes the thyroid gland but leaves behind a small amount of thyroid tissue. This preserves some thyroid function.

Many individuals who undergo this type of surgery develop hypothyroidism, a condition that occurs when the thyroid doesn’t produce enough hormones. This is treated with daily hormone supplements.

Total thyroidectomy:

A total thyroidectomy removes the entire thyroid and the thyroid tissue. This surgery is appropriate when nodules, swelling, or inflammation affect the entire thyroid gland, or when cancer is present.

 

Procedure:

Once you're unconscious, the surgeon makes an incision low in the center of your neck. It can often be placed in a skin crease where it will be difficult to see after the incision heals. All or part of the thyroid gland is then removed, depending on the reason for the surgery.

If you're having thyroidectomy as a result of thyroid cancer, the surgeon may also examine and remove lymph nodes around your thyroid. Thyroidectomy usually takes one to two hours. It may take more or less time, depending on the extent of the surgery needed.

There are several approaches to thyroidectomy, including:

• Conventional thyroidectomy. This approach involves making an incision in the center of your neck to directly access your thyroid gland. The majority of people will likely be candidates for this procedure.


• Transoral thyroidectomy. This approach avoids a neck incision by using an incision inside the mouth.


• Endoscopic thyroidectomy. This approach uses smaller incisions in the neck. Surgical instruments and a small video camera are inserted through the incisions. The camera guides your surgeon through the procedure.

Risks:

As with every major surgery, thyroid surgery carries the risk of an adverse reaction to general anesthetic. Other risks include heavy bleeding and infection.

Risks specific to thyroid surgery rarely occur. However, the two most common risks are:

• Damage to the recurrent laryngeal nerves (nerves connected to your vocal cords)


• Damage to the parathyroid glands (glands that control the level of calcium in your body)

Supplements can treat low levels of calcium (hypocalcemia). Treatment should start as soon as possible. Notify your doctor if you feel nervous or jittery or if your muscles start twitching. These are signs of low calcium.