Thyroidectomy


            We’ll discuss our approach to thyroidectomy in general terms then address specific variations that apply to thyroidectomy for cancer, goiter, thyroid nodules, and endoscopic techniques. Click on these pages for other issues related to thyroidectomy: pre-op care, post-op care, post-op issues, risk of surgery, follow-up.

           The patient is taken to the operating room and given general anesthesia. Intravenous medication is given. Once the patient is completely asleep a tube is placed in the trachea to breathe for the patient during the procedure. This tube has a device on it that allows us to monitor the vocal cords during the procedure.

             An incision is made on the lower neck, horizontally, typically in a skin crease. The size of the incision varies according to the size of the thyroid, the patient’s body habitus, and the reason for surgery.

The operation last 1-3 hours again depending on a variety of factors that we’ll discuss later. If the patient’s family waits in the waiting room, we will keep in touch by phone regarding the progress of the operation. The wound is closed with skin glue. There are no stitches or bandages. Drains are not used.    

        When the operation is over Dr. Faust will discuss the operative findings with the patient’s family. If the patient has a total thyroidectomy, calcium supplements are started in the recovery room (usually 3 extra-strength tums every 6 hours or with each meal and at bedtime). Thyroid replacement medication is started the next day. The patient is taken to the recovery room typically spending about an hour there. The patient is then taken to a room. IV fluids are continued until the patient is fully awake and taking fluids by mouth. The patient is encouraged to be out of bed. Most patients are observed 4-6 hours. Discharge is considered after this time if the patient feels well, they are taking food well, there is no significant neck swelling and the patient is comfortable with the idea of going home. Any patient who desires to stay in the hospital over night is welcome.  All patients are discharged within 23 hours.

                                                                Thyroidectomy for cancer

              A total thyroidectomy is performed. If the diagnosis is papillary, medullary or hurthle cell cancer a level 6 lymph node dissection is also done. This usually takes about 2 1/2 hours. The lymph nodes that need to be removed are interspersed with the parathyroid glands on the affected side. To remove these nodes frequently one or, rarely, both of the parathyroids on the side of the cancer may have to be removed. We dissect the parathyroid gland away from the lymph nodes, cut it into small pieces and re-implant it in the muscles of the neck where it will re-grow and start working in about 6-8 weeks. If the thyroid gland is fairly normal in size  we typically make about a 4 cm (< 2 inch) incision. With follicular cancer again a total thyroidectomy is performed, but a lymph node dissection is not done unless grossly metastatic nodes are present. 

                                                              Thyroidectomy for goiter

               A total thyroidectomy is recommended. Partial or subtotal thyroidectomy offers no advantage to the patient. Thyroid replacement therapy is still required. In experienced hands the risks are similar. Leaving thyroid tissue behind could lead to re-growth of the goiter. While this is infrequent, it may result in re-operation, which may be attended with significant risks. The incision size depends on the size of the goiter, but it is uncommon that it is longer than 5-6 cm even with very large goiters. The operation usually takes about 2 hours. The recovery is the same as thyroidectomy for cancer. Patients are observed 4-6 hours. If they feel well and desire discharge the day of surgery, this is consider on a case by case basis as long as the post-op calcium level is normal. Again the last patient of the day  usually spends the night in the hospital.

                                                              Thyroidectomy for thyroid nodules

                Removal of half of the thyroid is appropriate. This called a thyroid lobectomy or hemi-thyroidectomy.  If the thyroid gland is normal in size, we usually make a 2.5-3 cm incision. The operation last  about an hour. Discharge the same day is common, though the patient may stay the night if they desire. There is no concern about low calcium. Usually thyroid replacement medication is not required.

                                                               Endoscopic Thyroidectomy

                Endoscopic assisted thyroidectomy is an option in patients with small nodules (< 2.5 cm or about an inch) with a normal size gland. The operation can be completed with a 2- 2.5 cm incision. The procedure actually takes a little longer than traditional techniques. The recovery, post-op pain and time in the hospital are the same as with traditional techniques. The only advantage with this technique is a slightly smaller incision. When we have asked our patients, the same percentage of patients believe they have a good cosmetic result regardless of whether they had an endoscopic thyroidectomy or a traditional operation through a minimal incision . The endoscopic technique has the disadvantage of longer operative time and increased over-all cost due to the specialized equipment that is used. Given these issues, this approach is not usually recommended, but we do offer the approach if the patient wishes. ( View a video clip of an endoscopic thyroidectomy performed by Dr. Faust)

   

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