THYROIDECTOMY

What is thyroidectomy?

Thyroidectomy is an operation in which one or both lobes of the thyroid gland are removed.

What is a thyroid gland and what are its functions?
The thyroid is a gland located in the neck. It is a part of the endocrine (hormone) system, and plays a major role in regulating the body's metabolism. Thyroid disorders are more common in older children and adolescents (especially in girls) than in infants. Most thyroid conditions can be treated medically, but occasionally surgery is required.

Child Thyroid Anatomy	Thyroid Anatomy in Adult
Normal Anatomy

Indications for the removal of thyroid gland

Thyroidectomy may be recommended for the following:

• - Increased thyroid function (hyperthyroidism or thyrotoxicosis)
  - Decreased thyroid function (hypothyroidism) with enlargement (hypertrophy) of the gland
  - Primary cancer of the thyroid
  - Enlargement of the thyroid (nontoxic goiter)
  - Patients unwilling to be treated with radioactive iodine whose hyperthyroidism cannot be treated with antithyroid drugs.
  - Hashimoto's disease (a type of hypothyroidism)

Commom tests to determine whether thyroidectomy is necessary
The most common tests to determine whether a thyroidectomy is necessary include a fine needle aspiration biopsy, thyroid scan, ultrasound, x-rays and/or CT scan, and assessment of thyroid hormone levels

The various types of thyroidectomy include:

1. 1. Partial thyroid lobectomy (a rare procedure) - Only part of one thyroid lobe is removed.
   2. Thyroid lobectomy - All of one thyroid lobe is removed.
   3. Thyroid lobectomy with isthmusectomy - All of one thyroid lobe is removed, together with the thyroid isthmus.
   4. Subtotal thyroidectomy - One thyroid lobe, the isthmus, and part of the second lobe are removed.
   5. Total thyroidectomy - The entire thyroid gland is removed.

A thyroidectomy may be performed by using a conventional surgical approach or a newer endoscopic method done through very small incisions.

What It's Used For -
Conventional thyroidectomy is done for the following reasons:

• > To remove malignant (cancerous) or benign (noncancerous) thyroid tumors
  > To treat thyrotoxicosis, a condition in which an overactive thyroid gland produces extremely high levels of thyroid hormone
  > To remove all or part of a goiter (an enlarged thyroid gland) that is pressing on neighboring structures in the neck, especially if this pressure interferes with swallowing or breathing
  > To remove and evaluate an undiagnosed thyroid mass

In some people, as an alternative to a conventional thyroidectomy, an endoscopic thyroidectomy can be performed to remove small thyroid cysts or small benign thyroid nodules (less than 4 centimeters, or about 1½ inches). Endoscopic thyroidectomy is not used to treat multiple thyroid nodules, thyroid cancer or thyrotoxicosis.

How It's Done
Both types of thyroidectomy are done under general anesthesia. However, if general anesthesia is too risky for a patient, local or regional anesthesia may be used to permit the patient to remain awake during the procedure. An intravenous (IV) line will be inserted into one of your veins to deliver fluids and medications.

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Conventional thyroidectomy -

In a conventional thyroidectomy, a 3- to 4-inch incision will be made through the skin in the low collar area of your neck (the lower front portion of your neck, above the collarbones and breast bone). Next, a vertical cut will be made through the straplike muscles located just below the skin, and these muscles will be spread aside to reveal the thyroid gland and other deeper structures. Then, all or part of your thyroid gland will be removed, after first being cut free from surrounding tissues. During the entire procedure, the surgeon will be very careful to preserve your parathyroid glands (two pairs of small glands located near the thyroid) and to avoid damaging important nerves and blood vessels in your neck. After your thyroid gland is removed, one or two stitches will be used to bring your neck muscles together again. Then the deeper layer of your incision will be closed with stitches, and your skin will be closed with sterile paper tapes. A small suction catheter (tube) will be inserted near the area of your incision to drain any blood accumulated inside your neck. Following surgery, you will be taken to a recovery room, where you will be monitored for several hours until you are stable enough to return to your hospital room. After about 24 hours, the suction catheter will be removed from your neck. Most patients go home one or two days after the surgery.

Complications of thyroidectomy
Two complications specific to thyroid surgery are hypocalcemia and vocal cord weakness or paralysis. Hypocalcemia, or low blood levels of calcium, may occur after complete removal of both thyroid lobes. This condition is caused by interference with four tiny glands called parathyroid glands, which are located within or very close to the thyroid gland. Hypocalcemia is usually temporary, but sometimes may require calcium supplements if sufficiently pronounced. Permanent hypocalcemia is fortunately rare. Vocal cord weakness or paralysis may be caused by swelling, stretching, or injury to the recurrent laryngeal nerve which passes very close to the thyroid gland. Temporary hoarseness may result. Again, this is an uncommon, ususally temporary complication. Permanent vocal cord paralysis is rare.

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Endoscopic Thyroidectomy

Endoscopic thyroidectomy - A viewing instrument called an endoscope and small surgical instruments will be inserted into your neck through three or four small incisions

Endoscopic thyroidectomy is a minimally invasive approach to thyroid excision in which the surgeon makes three or four small incisions in the neck (2mm to 5mm in length) instead of a single large incision several inches in length. A miniature fiberoptic video camera and special instruments are inserted through the small openings, enabling the surgeon to perform the operation by remotely manipulating the instruments from outside the body, guiding their movements by watching them on a television monitor. Proper patient selection is the key to the success of this procedure.

Patient eligibility for endoscopic thyroidectomy include:

• Solitary thyroid nodule < 3 cm in diameter
  Small toxic thyroid nodule
  Thyroid cysts
  Absence of malignant features (i.e. benign biopsy)

Contraindications for endoscopic thyroidectomy include:

• Thyroid nodule > 4 cm
  Large multinodular gland
  Graves disease
  Carcinoma
  Prior neck surgery

What are the advantages of endoscopic thyroidectomy

• Smaller scar
  Less pain
  Quicker return to normal activity
  Magnification provided by the endoscope

What are the disadvantages of endoscopic thyroidectomy?

• Longer operating time
  Requires special equipment