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Thyroid Surgery

Surgery may be the only option for certain patients with thyroid abnormalities.  


In general, an endocrinologist should be involved in the decision for a patient to have a thyroid surgery (thyroidectomy). Let the doctors at Houston Thyroid and Endocrine help you decide if a surgery is needed and manage the hypothyroidism that may occur afterwards. There are many reasons for a patient with thyroid problems to have a need for a thyroid surgery:
  1. Hyperthyroidism
  2. Establish a final diagnosis of a mass in the thyroid gland when FNA biopsy is not definitive
  3. Thyroid cancer - differentiated thyroid cancer and thyroid lymphoma
  4. Improve the compressive symptoms of an enlarged thyroid
  5. Cosmetic removal of unsightly goiter
  6. Large substernal goiter
 

Three major types of thyroidectomy: 

1. Total thyroidectomy- 
This is removal of all thyroid tissue with preservation of the recurrent laryngeal nerve and parathyroids. Patients will almost always require treatment for hypothyroidism after this type of operation
2. Unilateral thyroidectomy- 
This is when only one thyroid lobe is removed without surgical entry into the contralateral neck. Only some patients may need treatment for hypothyroidism afterwards, especially if there are already known to have Hashimoto's thyroiditis. 
3. Isthmusectomy-
Only the middle portion of the thyroid is removed. 

Note that removal of only the abnormal portion (nodule) of the thyroid like removing a scoop of ice cream is not possible, especially if the reason for surgery is possible thyroid malignancy in a thyroid nodule. 
  

Complications are rare and are lower in patients undergoing surgery by high-volume surgeons: 

1. Metabolic complications
  • Hypocalcemia due to surgical primary hypoparathyroidism- this a rare complication that is caused by either transient (up to 49%) or permanent damage (as high as 13%) to the parathyroid glands which control calcium levels in the body. 
  • Hypothyroidism occurs in patients that undergo total thyroidectomy (100%) and occasionally in patients with partial thyroid surgery. 
  • Anesthesia complications can occur in some patients. 
2. Anatomic complications
  • Temporary (6%) or permanent damage (1% ) to the recurrent laryngeal nerve leads to hoarseness or loss of voice pitch control. Other rare complications include hematoma (<1.2%), seroma, Horner's syndrome (<0.2%), esophageal injury, tracheal injury. 
 

 References
1. Lee YS, Nam KH, Chung WY, Chang HS, Park CS  Postoperative complications of thyroid cancer in a single center experience.  J Korean Med Sci. 2010;25(4):541
2. Bentrem DJ, Rademaker A, Angelos P. Evaluation of serum calcium levels in predicting hypoparathyroidism after total/near-total thyroidectomy or parathyroidectomy. Am Surg. 2001;67(3):249
3. Rosato L, Avenia N, Bernante P, De Palma M, Gulino G, Nasi PG, Pelizzo MR, Pezzullo L Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years.   World J Surg. 2004;28(3):271
 
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