Thyroidectomy

Thyroidectomy

Thyroidectomy is a surgical procedure that removes all or part of the thyroid gland. It is indicated in various thyroid pathologies: thyroid cancer, cancerous or large nodule, compressive goiter, etc.

What is a thyroidectomy?

Thyroidectomy is the partial or total removal of the thyroid.

Gland made up of two globes (hence its butterfly shape) located at the base of the neck, under the Adam’s apple, the thyroid regulates the rate of metabolism of many organs, via the hormones T3 and T4 that it secretes. It therefore plays a very important role in our body.

How is the thyroidectomy performed?

The operation takes place under general anesthesia. It lasts from 40 minutes to 1h30. The patient is placed on his back with his head slightly extended.

The surgeon makes a horizontal incision of a few centimeters at the base of the neck. He then proceeds to the resection of the thyroid, partial or total according to the indication of the intervention.

In the event of a simple nodule resection, a microscopic examination called an “extemporaneous examination” is performed during the operation in order to verify the exact nature of the removed nodule. Depending on the result, the surgeon may need to perform a more extensive ablation than that initially planned.

At the end of the operation, a small drain is left in place, then the incision is closed most often by means of staples which give the best aesthetic results.

When to have a thyroidectomy?

Thyroidectomy is indicated in various pathologies of the thyroid:

  • in case of doubtful or cancerous thyroid nodule: the thyroid nodule is a swelling that develops in the thyroid tissue. Common, especially in women over 50, it is most often benign. In 5% of cases, however, it is cancerous. On certain warning signs (risk factors, size and ultrasound characteristics of the nodule, TSH level), a fine needle aspiration will be performed to verify the nature of the nodule. If the result is reassuring, a simple monitoring of the nodule by ultrasound is sufficient. If the results show doubt, removal of the thyroid lobe is indicated;
  • in the presence of a benign nodule but whose large volume (more than 25 mm in diameter) makes it difficult to swallow, breathe and / or speak;
  • in the event of compressive goiter (increase in the volume of the thyroid) causing difficulty in swallowing and breathing;
  • in case of thyroid cancer;
  • in case of multinodular goiter: multiple nodules develop in both thyroid lobes, within a thyroid that is itself enlarged (goiter). Thyroidectomy may be necessary if the nodules are large, if they are suspicious on fine needle aspiration or if the goiter causes compression;
  • in certain cases of so-called “hot” or “toxic” thyroid nodules, that is to say secreting a large amount of thyroid hormones and therefore leading to hyperthyroidism;
  • in Graves’ disease, an autoimmune disease causing hyperthyroidism. In the event of a relapse after a first drug treatment, surgery is sometimes proposed.

Depending on the indication, the resection will be more or less extensive. We thus distinguish:

  • simple resection of the nodule: only the nodule is removed, the rest of the thyroid is preserved;
  • a lobectomy or lobo-isthmectomy: only one thyroid lobe is removed. It’s the most frequent case ;
  • a “sub-total” thyroidectomy: only a fragment of the thyroid gland is left in place on each side;
  • a total thyroidectomy: the thyroid is completely removed;
  • a total thyroidectomy with lymph node dissection, more rare, for certain thyroid cancers.

Today, medical teams have the most conservative attitude possible.

After thyroidectomy

Operative suites

The postoperative effects are not very painful and easily calmed by analgesic treatment if necessary. Feeding can be resumed the day after the operation. The first half of the staples is removed the day after the operation, the other half before discharge. The scar is left in the open, without dressing, and it is not recommended to wet it for ten days.

Hospitalization lasts 2 to 3 days

In the event of total thyroidectomy, daily replacement therapy with thyroid hormones is necessary for life. It is started during hospitalization and subsequently balanced by the attending physician or endocrinologist. This replacement therapy may also be necessary after partial ablation if the secretion of thyroid hormones is insufficient.

Depending on the extent of thyroid ablation, the possible replacement therapy and the nature of the professional activity, the sick leave may last up to 3 weeks.

The scar is located in the natural folds of the neck, so it is usually inconspicuous. But it all depends on the quality of the healing, which varies from person to person.

Risks and complications

Thyroidectomy is a simple procedure with very rare complications: hematoma, hemorrhage, respiratory discomfort, infection.

Different disorders can appear, most often transient:

  • discomfort when swallowing;
  • dysphonia (modification of the pathway) due to the lesion of a recurrent nerve during the operation and which may require, in some cases, speech therapy;
  • swelling in the operated area;
  • a disturbance in the regulation of calcium which can cause tingling and cramping, due to the involvement of one or more parathyroid glands (glands involved in the regulation of calcium) during the procedure. Calcium and vitamin D supplementation (necessary to fix calcium) is sometimes necessary.

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