Thyroidectomy

About Thyroidectomy

Thyroidectomy removes part of the thyroid gland, a hemithyroidectomy or lobectomy, or all of it, a total thyroidectomy. Indications include thyroid cancer, of which papillary carcinoma is by far the most common type, suspicious nodules, large or symptomatic goiters, and Graves disease that is not well controlled by other treatments. The Swiss surgeon Theodor Kocher transformed thyroid surgery in the late nineteenth century, greatly reducing its mortality, and was awarded the Nobel Prize in Physiology or Medicine in 1909. The standard operation uses a horizontal collar incision in a skin crease of the lower neck. The strap muscles are separated, and the surgeon carefully identifies and preserves the recurrent laryngeal nerves, which control the vocal cords, and the parathyroid glands, which regulate calcium, before dividing the thyroid blood vessels and removing the gland. Intraoperative nerve monitoring is widely used to help locate the nerves. The main complications are injury to the recurrent laryngeal nerve, causing hoarseness or, if both sides are affected, airway problems; low calcium levels from parathyroid injury, which are usually temporary; and bleeding in the neck, which can compress the airway and is treated as an emergency. Remote access techniques through the mouth or armpit avoid a neck scar. After total thyroidectomy, lifelong thyroid hormone replacement is needed, and radioactive iodine treatment may follow for some differentiated thyroid cancers.