thyroidectomy


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Related to thyroidectomy: Total thyroidectomy

Thyroidectomy

 

Definition

Thyroidectomy is a surgical procedure in which all or part of the thyroid gland is removed. The thyroid gland is located in the forward part of the neck (anterior) just under the skin and in front of the Adam's apple.

Purpose

All or part of the thyroid gland may be removed to correct a variety of abnormalities of the gland. If the patient has a goiter (an enlargement of the thyroid gland, causing a swelling in the front of the neck), it may cause difficulties with swallowing or breathing. Hyperthyroidism (over-functioning of the thyroid gland) produces hypermetabolism (abnormally increased use of oxygen, nutrients, and other materials). If medication cannot adequately treat this condition, or if the patient is a child or pregnant, the thyroid gland must be removed. Both cancerous tumors and noncancerous tumors (frequently called nodules) can occur and they must be removed, in addition to some or all of the thyroid gland.

Precautions

There are definite risks associated with the procedure. Therefore, the thyroid gland should be removed only if there is a pressing reason or medical condition that requires it.

Description

Thyroidectomy is an operative procedure done most commonly by a general surgeon, or occasionally by an otolaryngologist, in the operating room of a hospital. The operation begins when an anesthesiologist puts the patient to sleep. The anesthesiologist injects drugs into the patient's veins and then places an airway tube in the windpipe to ventilate (provide air for) the patient. The surgeon makes an incision in the front of the neck where a tight-fitting necklace would rest. He locates and takes care not to injure the parathyroid glands and the recurrent laryngeal nerves, while freeing the thyroid gland from these surrounding structures. The blood supply to the portion of the thyroid gland that is to be removed is clamped off. Then all or part of the gland is removed. If cancer is present, all, or almost all, of the gland is removed. If other diseases or a nodule is present, the surgeon may remove only part of the gland. The total amount of thyroid gland removed depends upon the thyroid disease being treated. A drain (a soft plastic tube that drains fluid out of the area) may be placed before the incision is closed. The incision is closed either with sutures (stitches) or metal clips. A dressing is placed over the incision and the drain, if one is used.
Patients generally stay in the hospital one to four days after completion of the operation.

Preparation

Before a thyroidectomy is performed, a variety of tests and studies are usually required to determine the nature of the thyroid disease. Laboratory analysis of blood determines the levels of active thyroid hormone circulating in the body. Sonograms and computed tomography scans (CT scans) help to determine the size of the thyroid gland and location of abnormalities. A thyroid nuclear medicine scan assesses the function of the gland. A needle biopsy of an abnormality or aspiration (removal by suction) of fluid from the thyroid gland may also be done to help determine the diagnosis.
If the diagnosis is hyperthyroidism, the patient may be asked to take antithyroid medication or iodides before the operation; or continued treatment with antithyroid drugs may be the treatment of choice. Otherwise, no other special procedure must be followed prior to the operation.

Aftercare

The incision requires little to no care after the dressing is removed. The area may be bathed gently with a mild soap. The sutures or the metal clips are removed three to seven days after the operation.

Risks

As with all operations, patients who are obese, smoke, or have poor nutrition are at greater risk for developing complications related to the general anesthetic itself.
Hoarseness or voice loss may develop if the recurrent laryngeal nerve was injured or destroyed during the operation. This is more apt to occur in patients who have large goiters or cancerous tumors.
Hypoparathyroidism (under-functioning of the parathyroid glands) can occur if the parathyroid glands are injured or removed at the time of the thyroidectomy.
Hypothyroidism (under-functioning of the thyroid gland) can occur if all or nearly all of the thyroid gland is removed. This may be intentional when the diagnosis is cancer. If the patient's thyroid levels remain high, he may be required to take thyroid replacement for the rest of his life.
The neck and the area surrounding the thyroid gland have a rich supply of blood vessels. Bleeding in the area of the operation may occur and be difficult to control or stop. Rarely is a blood transfusion required, although a hematoma (collection of blood) may develop. If this occurs, it may be life-threatening. As the hematoma enlarges, it may obstruct the airway and cause the patient to stop breathing. If a hematoma does develop in the neck, it may require drainage to clear the airway.
Wound infections can occur. If they do, the incision is drained, and there are usually no serious consequences.

Normal results

Most patients are discharged from the hospital one to four days after the procedure. Most resume their normal activities two weeks after the operation. Patients who have cancer may require subsequent treatment by an oncologist or a endocrinologist.

Key terms

Endocrinologist — A physician who specializes in treating patients who have diseases of the thyroid, parathyroid, adrenal glands, and/or the pancreas.
Hyperthyroidism — Abnormal over-functioning of the thyroid glands. Patients are hypermetabolic, lose weight, are nervous, have muscular weakness and fatigue, sweat more, and have increased urination and bowel movements. This is also called thyrotoxicosis.
Hypothyroidism — Abnormal under-functioning of the thyroid gland. Patients are hypometabolic, gain weight, and are sluggish.
Recurrent laryngeal nerve — A nerve which lies very near the parathyroid glands and serves the larynx or voice box.

Resources

Other

"Thyroid Gland Removal." ThriveOnline. http://thriveonline.oxygen.com.

thyroidectomy

 [thi″roi-dek´tah-me]
surgical excision of the thyroid gland. Total thyroidectomy may be performed in cases of cancer of the thyroid. Subtotal thyroidectomy, in which more than two-thirds of the gland is removed, is performed for certain patients suffering from hyperthyroidism. The remaining portion of the gland is left intact and continues to function and produce hormones.

Patient Care. Prior to surgery the patient receives intensive therapy to maximize the possibility of a successful operation. This includes the administration of antithyroid drugs, iodine preparations, and supportive measures to promote rest and improve the nutritional status. Tests of thyroid function should indicate that the patient is euthyroid; that is, the test results show no extremes of thyroid function and the patient presents mild or no symptoms of thyrotoxicosis. When the patient is adequately prepared, the dangers of hemorrhage and thyroid crisis, the two major complications of thyroidectomy, are greatly diminished.



Immediately after surgery the patient is placed in a low Fowler's or semi-Fowler's position. Motion of the head, unnecessary talking, and strenuous coughing should be discouraged. Temperature, pulse, and respirations are taken every 15 minutes until they remain within normal limits for several hours. The dressings are checked frequently for signs of hemorrhage or constriction of the throat. Special note should be made of the back of the neck, where blood may drain unnoticed. Hoarseness and slight difficulty in swallowing can be expected until the local edema subsides, but loss of the voice or severe dyspnea should be reported promptly. A tracheostomy set is kept at the bedside in case of respiratory obstruction.

Other complications to be watched for include tetany and thyroid crisis. Muscular twitching, numbness, or tingling of the hands or feet or other signs of irritability may indicate damage to, or accidental removal of, the parathyroid glands, and a resultant decrease in the calcium level of the blood. Thyroid crisis may occur as a result of an increase in the amount of thyroxine released into the blood during manipulation of the gland at the time of its removal. This complication is indicated by a rapid increase in all the vital signs, marked irritability, restlessness, prostration, and sometimes even death from heart failure. Both tetany and thyroid crisis are rare complications.

thy·roi·dec·to·my

(thī'roy-dek'tŏ-mē),
Removal of the thyroid gland.
[thyroid + G. ektomē, excision]

thyroidectomy

/thy·roid·ec·to·my/ (-ek´tah-me) excision of the thyroid gland.

thyroidectomy

(thī′roi-dĕk′tə-mē)
n. pl. thyroidecto·mies
Surgical removal of the thyroid gland.

thyroidectomy

[thī′roidek′təmē]
Etymology: Gk, thyreos + eidos, form, ektomē, excision
the surgical removal of the thyroid gland. It is performed for colloid goiter, tumors, or hyperthyroidism that does not respond to iodine therapy and antithyroid drugs. All but 5% to 10% of the gland is removed. Regrowth usually begins shortly after surgery, and thyroid function may return to normal. For cancer of the thyroid, the entire gland is removed, followed by iodine-131 remnant ablation. Before surgery the basal metabolism rate is lowered to normal by giving iodine and antithyroid drugs. If a tumor is present, a frozen section of the affected tissue is examined by a pathologist. If malignant cells are found, all the gland is removed. After surgery the patient is most comfortable in semi-Fowler's position with continuous mist inhalation administered to liquefy oral secretions. Oral suctioning may be necessary. A tracheotomy set and oxygen are kept in the room. Calcium gluconate is on hand for use if the patient develops tetany. After surgery the patient is observed for signs of hemorrhage, respiratory difficulty caused by edema of the glottis, and the muscular twitching of tetany from inadvertent removal of a parathyroid gland.

thyroidectomy

Surgery The partial or total surgical removal of the thyroid gland Indications Hyperthyroidism or goiter Complications Hypothyroidism, vocal cord paralysis, accidental removal of parathyroid glands, resulting in low calcium levels–parathyroid glands regulate calcium

thy·roid·ec·to·my

(thī'roy-dek'tŏ-mē)
Removal of the thyroid gland.
[thyroid + G. ektomē, excision]

thyroidectomy

Surgical removal of part, or sometimes the whole, of the THYROID GLAND. This is done to reduce the output of thyroid hormones in some cases of THYROTOXICOSIS and GOITRE, and in the treatment of thyroid cancer. After total thyroidectomy replacement thyroid hormone (thyroxine, levothyroxine) must be given.

thyroidectomy (thīˈ·roi·dekˑ·t·mē),

n the removal of the thyroid gland via surgical methods as a treatment for tumors, colloid goiter, or hyperthyroidism unresponsive to antithyroid medication or iodine therapy.

thy·roid·ec·to·my

(thī'roy-dek'tŏ-mē)
Removal of thyroid gland.
[thyroid + G. ektomē, excision]

thyroidectomy

surgical excision of the thyroid gland; indicated in the treatment of neoplasia or hyperfunction of the gland.
References in periodicals archive ?
Bourrel C, Uzzan B, Tison P, et al: Transient hypocalcemia after thyroidectomy.
Additionally, our preference of total or near-total thyroidectomy in patients undergoing surgery due to benign causes may be another influencing factor.
We conducted a study to assess whether the reductions in incisional length and external exposure during minimally invasive thyroidectomy (herein defined as one that is performed through an incision of 3 cm or less) contributed to a higher incidence of postoperative hypocalcemia compared with historical data on conventionally performed thyroidectomies through larger incisions.
Patients who had childbearing potential, thyroid nodules, or ophthalmopathy were advised to have total thyroidectomy as the definitive treatment.
In animal models, exogenous thyroid hormone administration has resulted in an increase of both medullary and cortical components of thymus (3), while thyroidectomy has resulted in reduction of the size of the thymus (4).
Our data support the need for near-total or total thyroidectomy in patients with multifocal micropapillary thyroid carcinoma," Dr.
It has been reported that apoplexy may occur after head trauma (4), gastric bleeding (5), pituitary testing or treatment with hypothalamic hormones or analogues (6) administration of contrast agents (7), thyroidectomy (8), discontinuation of subcutaneous octreotide (9), and cerebral angiography (10) in acromegalic patients.
The patient subsequently underwent total thyroidectomy with no evidence of carcinoma on histologic examination
A recombinant form of human thyroid-stimulating hormone (TSH) approved as an adjunctive treatment for radioiodine ablation of thyroid tissue remnants in patients who have undergone thyroidectomy for well-differentiated thyroid cancer and who do not have evidence of metastatic thyroid cancer.
We conclude that early measurement of SiCa is a reliable predictor of prolonged temporary hypocalcemia following total or partial thyroidectomy.
I am so thankful for the chance that I was able to avail of the free medical- surgical services, said Jesus Suabinga, a resident of Makilala who underwent thyroidectomy after 15 years.