A thyroidectomy is an operation that involves the surgical removal of all or part of the thyroid gland.

Surgeons often perform a thyroidectomy when a patient has thyroid cancer or some other condition of the thyroid gland (such as hyperthyroidism) . Other indications for surgery include cosmetic (very enlarged thyroid), or symptomatic obstruction (causing difficulties in swallowing or breathing). One of the complications of "thyroidectomy" is voice change and patients are strongly advised to only be operated on by surgeons who protect the voice by using electronic nerve monitoring. Most thyroidectomies are now performed by minimally invasive surgery using a cut in the neck of no more than 2.5 cms(1 inch). . After the removal of a thyroid patients usually take prescribed oral synthetic thyroid hormones to prevent the most serious manifestations of the resultant hypothyroidism. Less extreme variants of thyroidectomy include: "hemithyroidectomy" (or "unilateral lobectomy") -- removing only half of the thyroid "isthmectomy" -- removing the band of tissue (or isthmus) connecting the two lobes of the thyroid A "thyroidectomy" should not be confused with a "thyroidotomy" ("thyrotomy"), which is a cutting into (-otomy) the thyroid, not a removal (-ectomy) of it.

Indications
Malignancy
Cosmetic reasons Goiter which is untreatable by medical methods Severe hyperthyroidism refractory to conservative

treatment Orbitopathy in Graves' disease Removal and evaluation of a thyroid nodule whose FNAC results are unclear

Steps
Main steps of Thyroidectomy: Exposure - horizontal neck incision, +/- raising of flaps, +/- division of

strap muscles Identification of essential structures - Recurrent and ext. branch of superior laryngeal nerve, parathyroid glands Devascularization Superior thyroid artery Inferior thyroid artery while protecting the supply to the parathyroids

Resection Exploration of other pathology - e.g. contralateral lobe, lymph nodes Closure

Complications
Hypothyroidism/Thyroid insufficiency in up to 50% of patients after ten years Thyrotoxic crisis/Thyroid storm Laryngeal nerve injury in about 1% of patients, in particular the recurrent laryngeal nerve: Unilateral damage results in a hoarse voice. Bilateral damage presents as laryngeal obstruction on removal of the tracheal tube and is a surgical emergency: an emergency tracheostomy must be performed. Recurrent Laryngeal nerve injury may occur during the ligature of

the inferior thyroid artery. Hypoparathyroidism temporary (transient) in many patients, but permanent in about 1-4% of patients Anesthetic complications Infection Stitch granuloma Haemorrhage/Hematoma This may compress the airway, becoming life-threatening. A suture removal kit should be kept at the bedside throughout the postoperative hospital stay. Surgical scar/keloid

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