Thyroid Removal Surgery - Types, Indications, Risk Factors, and Procedure

What Is Thyroid?

The thyroid is a small butterfly-shaped endocrine gland in the front of the neck with two lobes joined by the isthmus (a band of tissues). Both the lobes of the thyroid gland are present on either side of the windpipe, beneath the voice box. The thyroid gland's principal purpose is to create thyroid hormones. The thyroid hormones have an important role in growth, development, and metabolism. Thyroxine (T4), triiodothyronine (T3), and calcitonin are three thyroid hormones. These hormones are necessary for physiological functioning, and an imbalance in their levels can lead to hypothyroidism, hyperthyroidism, thyroid nodules, Graves' disease, Hashimoto's disease, thyroiditis, and other issues.

What Is Thyroid Removal Surgery?

Thyroid removal surgery or thyroidectomy is the partial or complete surgical removal of the thyroid gland. Based on the extent and location of the tumor, a total or subtotal thyroidectomy may be performed. Thyroid removal is the most common choice of treatment for thyroid cancer. Thyroidectomy done to remove the entire thyroid gland may take up to four hours, whereas partial thyroidectomy takes a lot less time. In addition, newer techniques have been developed to reduce the size of the incision and scarring for better post-surgical aesthetic results. These new techniques involve the use of endoscopes.

When Is Thyroid Removal Done?

Thyroid removal may be done for the following reasons:

• First, the presence of a thyroid nodule might progress into thyroid cancer.

• A confirmed diagnosis of thyroid cancer.

• Presence of a nodule or goiter that might be causing swallowing difficulties.

• Thyrotoxicosis (a condition when the thyroid gland overproduces thyroid hormones).

What Are the Types of Thyroid Removal Surgery?

The different types of thyroid removal surgeries are classified based on the extent and type of the tumor. The different types of thyroid removal surgeries are:

1. Open Thyroid Biopsy: This is a rarely used operation in which the thyroid nodules are excised directly.

2. A Hemi-Thyroidectomy or Lobectomy: In this surgical process, only one lobe or one-half of the thyroid gland is surgically removed.

3. Isthmusectomy: The bridge of the tissues joining the two lobes of the thyroid gland is removed in this procedure. This removal is done in cases of small tumors located on the isthmus.

4. Total Thyroidectomy: In this procedure, complete removal of the thyroid gland and its tissues is done.

What Should Be Evaluated Before Thyroid Removal?

All thyroidectomy patients must be evaluated preoperatively to avoid complications. Preoperative evaluation is also crucial to assess risk factors. This involves a detailed medical history and physical examinations. The following preoperative assessment may be done:

• An electrocardiogram (ECG) and X-ray of the chest may be performed to check the cardiovascular functioning. For patients over 45 years of age or who have symptoms of heart disease, this evaluation is critical.

• Blood samples are taken and evaluated for bleeding and clotting disorders.

• Vocal cord function evaluation should be done in patients with invasive thyroid cancer, hoarseness of the voice, or previous history of thyroid surgery. This is done to determine that the laryngeal nerves controlling the voice box are functioning normally.

• If medullary thyroid cancer is suspected, patients must be examined for other endocrine tumors in rare cases.

What Are the Risk Factors for Thyroid Removal Surgery?

Thyroid removal surgery is generally very safe if done by an experienced surgeon. The overall risk of any complication is less than two percent. Complications are uncommon, but there can be several risk factors:

• Risk of Anesthesia and Surgery in General:

1. Adverse reactions to medicines, allergic reactions, and breathing problems.

2. Bleeding, blood clot formations, and infections.

• Specific Risks of Thyroidectomy:

1. Damage to vocal cord nerves.

2. Injury to the larynx and recurrent laryngeal nerve.

3. Bleeding in the hours right after surgery causes acute respiratory distress.

4. Damage to the parathyroid gland (which regulates the calcium level in the blood) leads to hypothyroidism and hypocalcemia.

5. A sharp rise in the thyroid hormone levels during the surgery.

6. Thyroid storm due to the overactive thyroid gland.

How Is Thyroid Removal Surgery Done?

Before the Procedure:

Weeks before the thyroid removal surgery is done, the following tests and precautions are taken:

• To study the types of abnormal growth, its location, and extent, imaging tests like a computed tomography (CT) scan or ultrasound are done.

• Fine needle aspiration cytology (FNAC) is also done to check the nature of the tumor and if it is cancerous or non-cancerous.

• Iodine treatment and thyroid therapies may be done one to two weeks before the surgery.

A Few Days Before the Surgery:

• Medications like Anticoagulants (blood thinners) may be stopped before the surgery to avoid excessive bleeding.

• The surgeon should be informed of all the patient's prescription and non-prescription drugs. These include supplements as well.

• Patients who smoke regularly are asked to stop.

On the Day of Surgery:

• The patient should follow the doctor's instructions regarding the time of eating and drinking before the surgery.

• Take all the medications prescribed by the doctor before the surgery.

• Be on time for the surgery.

During The Surgery:

During the surgery, the patient is under general anesthesia, and the doctor performs a thyroidectomy:

• The surgeon makes a horizontal incision above the collarbone in front of the neck.

• All or part of the gland is removed.

• A catheter is inserted into the area to drain the blood and other fluids that build up.

• These tubes are removed after a couple of days.

• The incisions are closed with sutures.

After The Surgery:

• After the surgery, the patient is discharged from the hospital in two days.

• Blood calcium levels are checked.

• Painkillers are prescribed to manage post-surgical pain in the neck.

• Usually, it takes three to four weeks to recover completely.

What Are the Side Effects of Thyroid Removal?

Thyroid removal surgery has several common side effects that are temporary, but some side effects may persist for a long time. These side effects include:

• Pain and stiffness of the neck.

• A sore throat.

• Difficulty in swallowing.

• Hoarseness and voice problems.

• Nausea and vomiting.

• Transient hypoparathyroidism.

• Hypothyroidism.

What Is the Life Expectancy After Thyroid Removal?

Life expectancy and prognosis for thyroid removal are excellent. The recovery is quick and uncomplicated after surgery. Most patients will be able to lead a regular life after the thyroid gland removal. The only problem is hypothyroidism, in which the patient will be bound to take thyroid replacement hormone pills for the rest of their life.

Is There a Diet to Be Followed After Thyroid Removal Surgery?

There are no particular diet restrictions post-surgery, and the patient can eat whatever they want to eat. However, special efforts should be made to eat a healthy and nutritious diet that will help recover after the surgery. It may be difficult for the patient to swallow after the surgery for a few days; therefore, drinking more liquid and eating soft food may be helpful. Foods like mashed potatoes, puddings, yogurt, etc., are easy to swallow and digest.

Conclusion:

Thyroid removal is the number one choice of treatment in cases of thyroid nodules and thyroid cancers. However, the patient may be apprehensive about the surgery; therefore, thorough patient counseling is highly recommended before the surgery. Along with educating the patient, the doctors should also prepare themselves with a detailed history and clinical examination of the patient. Thyroidectomy has an excellent prognosis and life expectancy, and there are significantly fewer complications and risk factors associated with the surgery.