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All about Thyroidectomy/Thyroid Surgery

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Procedures of thyroidectomy with steps, types, contraindications, complications and post surgical follow up/care. Thyroidectomy is a procedure that involves the removal of all or part of the thyroid gland. The most common reasons for this operation are to remove goitres and nodules, as well as to treat thyroid cancer.

1. What are the purpose/indications of thyroidectomy :

Abnormal growths-Thyroid gland
  1. Malignancy of thyroid gland
  2. Graves disease
  3. Multinodular goitre
  4. Toxic thyroid nodule
  5. Simple thyroid nodule
  6. Thyrotoxicosis

2. What are the types of thyroidectomy :

Surgeons mainly performs three types of thyroidectomy, and they are – Total lobectomy, Isthmusectomy, and Subtotal lobectomy.

Thyroidectomy - Types
  1. Lobectomy – This is the removal of total lobe with isthmus
  2. Total thyroidectomy – This is the removal of both side lobes with isthmus
  3. Near-total thyroidectomy – This is the removal total lobe with isthmus and sometimes also includes subtotal lobectomy. Subtotal lobectomy is known as Dunhil procedure.
  4. Subtotal lobectomy – Both sides subtotal lobectomy with isthmusectomy also.

3. What are the contraindications of thyroidectomy :

  1. Patients who have had head and neck surgery and/or irradiation of the head and neck or upper mediastinal.
  2. Patients who were declared unfit for surgery or who were unable to endure general anaesthesia were also excluded from the study.
  3. Lymphoma and evidence of extrathyroidal expansion, such as tracheal or esophageal invasion, are other contraindications, according to most high-volume authors.
  4. Patients with preoperative signs of recurrent laryngeal nerve palsy, recurrent goitre, or any evidence of hyperthyroidism were excluded.

4. What are the preoperative preparation of thyroidectomy :

  1. By checking the blood group, the patient’s required blood group should always be available.
  2. By asking the patient to speak “E,” an indirect laryngoscopy is performed to assess for vocal cord abduction.
  3. The calcium level in the blood is measured.
  4. T3, T4, and TSH levels are also measured.
  5. Antibodies to thyroid should be tested.
  6. In the event of toxic goitre, the ECG and cardiac fitness should be evaluated.
  7. To make the gland hard and less vascular, Lugol’s iodine is administered 10 days before surgery.
  8. The vocal cord vibration is visualised by videostroboscopy.

5. What are the steps of thyroidectomy :

We have briefly pointed out the steps of Total thyroidectomy and Hemithyroidectomy.

Thyroidectomy Steps

What are the steps of total thyroidectomy :

  1. Anaesthesia – Endotracheal intubation is used to provide general anaesthesia.
  2. Dressing and drapping
  3. Incision is given
  4. Raising the skin flaps
  5. Incision of the deep cervical fascia
  6. Raising the facial and strap muscles flap
  7. Making division of the middle thyroid vein
  8. Division of the superior thyroid vessels
  9. Division of the inferior thyroid artery
  10. Division of the inferior thyroid vein
  11. Dissection of the thyroid isthmus
  12. Bleeding control procedure and placement of drain
  13. Closure of the wound/incision

What are the steps of hemithyroidectomy :

  1. Anaesthesia is given
  2. Placing the patient in proper position
  3. Dressing and dropping is done
  4. Incision is provided
  5. Skin flaps is should be raised
  6. Incising the investing layer of deep cervical fascia
  7. Thyroid lobes should be exposed
  8. Incision is given at the pre tracheal fascia
  9. Division of middle thyroid vein
  10. Division of superior thyroid vessels
  11. Division of inferior thyroid artery
  12. Division of inferior thyroid vein
  13. Thyroid isthmus is dissected
  14. Bleeding should be carefully checked
  15. Closure of wound/incision

6. What are the complications of thyroidectomy :

  1. Haemorrhage – This is the most prevalent thyroidectomy-related life-threatening consequence. A haematoma occurs in around one out of every 50 patients, and it nearly always occurs during the first 24 hours.
  2. Wound infection – Any kind of wound infection, mostly cellulitis.
  3. RLN Injury – Both unilateral and bilateral RLN injuries are possible. Unilateral injury is not as serious as bilateral injury, but bilateral injury can be fatal. Because of its proximity to the superior thyroid artery, injuries to the external branch of the superior laryngeal nerve are more common. This causes the vocal chord to lose tension, resulting in a loss of power and range in the voice.
  4. Stitch granuloma – This can happen if you employ non-absorbable suture material, such as silk. As a result, absorbable suture and ligature are preferred.
  5. Hypertrophic scar – If the incision is made above the sternum and in dark people, there is a chance of developing a keloid.
  6. Thyroid insufficiency – Clearly, thyroxine replacement will be required after a complete thyroidectomy. Supplementation is required in about one-third of lobectomy patients.
  7. Parathyroid insufficiency – This can happen as a result of parathyroid gland removal or infarction caused by vascular injury to the parathyroid end arteries.
  8. Thyrotoxic storm – Can occur due to inadequately prepared patients.

7. What are the post surgical follow up or care:

  1. After surgery, the patient should be taken to the recovery room and nursed in the hospital the ward overnight.
  2. Keeping an eye out for indicators of a haematoma is an important part of wound care.
  3. Calcium levels should be evaluated post-operatively after a complete thyroidectomy. Not all patients develop hypocalcemia right away, and they should be informed about the symptoms (parasthesia of the fingers and toes or round the mouth). Those at the greatest risk should have their calcium levels monitored on a regular basis.
  4. Patients who have had a total thyroidectomy will need thyroxine replacement, which should begin on the first postoperative day.
  5. In addition to reviewing the histology report, the wound should be examined and the larynx checked for voice cord function at the clinic visit. If necessary, a biochemical examination of thyroid function and calcium should be arranged.

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