The thyroid gland is located low in the neck and is attached to the windpipe, just below the voice box. It has two main lobes – right and left – connected with a band of thyroid tissue called the isthmus.
“Thyroidectomy” refers to the surgical removal of either a portion or all of the thyroid gland. Determination of whether part or all of the gland should be removed is often complex and can depend on several factors, including:
- The presence and location (sidedness) of nodules
- Biopsy results
- Ultrasound findings
- Patient symptoms
- Blood tests
- Patient preference
- Physical exam findings
Generally speaking, cancers greater than 1 cm in size or hyperthyroidism will require total thyroidectomy. Patients who are already taking thyroid hormone supplementation or have very large goiters are also more likely to undergo total thyroidectomy. Ultimately, this decision needs to be made only after consultation with your thyroid surgeon, who will discuss all of the relevant information as well as your personal preferences.
Thyroidectomy procedures are nearly always performed under general anesthesia. For Dr. Wright, a partial thyroidectomy typically takes 75-90 minutes, while a total thyroidectomy usually takes 90-120 minutes.
Recovery. The application of minimally invasive techniques has significantly reduced the recovery period for thyroid surgery. Nearly all of Dr. Wright’s patients who undergo partial thyroid surgery are able to go home the day of surgery.
Dr. Wright uses generous amounts of lidocaine to minimize or eliminate immediate post-operative pain. Most patients take pain pills for less than 3 days and return to most normal activities within a week. Total thyroidectomy still requires a one-night stay in the hospital to monitor calcium levels. In Dr. Wright’s practice, 95% of patients are able to go home the morning after surgery.
Incision and scarring. Approximately 25% of ENT residency training is dedicated to reconstructive and aesthetic surgery; therefore, Dr. Wright is highly trained in plastic surgery techniques and always uses these skills for closure of the thyroid wound.
Dr. Wright always uses a ruler when designing his incisions. As a result, he knows that when he predicts the incision length he expects, it is an accurate prediction. He always uses absorbable sutures and seals the surface with skin glue for the best possible result. In most cases, incisions heal with little or no scarring. Dr. Wright always uses the smallest incision possible to safely perform the procedure. Careful wound care is important once the skin glue is removed. For patients who are prone to scarring, he can perform additional procedures, such as steroid injection, to reduce scarring.
Risks. In experienced hands, thyroid surgery is generally a low-risk procedure. There are two main areas of risk related to thyroid surgery; these are a result of the anatomical structures near the gland.
The first risk is related to the recurrent laryngeal nerve. This nerve passes directly between the thyroid and the trachea as it enters the voice box, where it controls motion of the vocal cords. There is one on each side of the neck. Injury to this nerve can cause hoarseness or weakness of the voice – this can be temporary or permanent. The published national rate of injury is about 2%; Dr. Wright’s complication rate for this issue is substantially lower than the national average.
The second risk is related to parathyroid gland malfunction. Parathyroid glands are small glands located near, against or sometimes within, the thyroid gland. There are typically four parathyroid glands, each between the size of a peppercorn and a pea.
Parathyroid glands regulate calcium levels of the blood. Injury to the parathyroid glands can cause a drop in blood calcium, which if substantial, can cause symptoms of tingling lips and fingers or even cramping of muscles. This is only a risk with total thyroidectomy, as the undisturbed parathyroid glands (two on each side) are sufficient to protect against one-sided malfunction. Mild fluctuations in calcium following total thyroidectomy are not uncommon, occurring in about 20% of cases; problematic fluctuations are uncommon and permanent low calcium levels are very rare.
Risks of bleeding, anesthesia complication, blood clot formation and other problems are no greater for thyroid surgery than for other surgeries in general.
Potential follow-up surgery. If the final pathology diagnosis shows cancer following partial thyroidectomy performed for the removal of a suspicious nodule, there is a chance that a second surgery will be necessary to remove the remaining thyroid gland.
The American Thyroid Association recommends that a total thyroidectomy be performed for cancers greater than 1 cm in size. In most cases, the diagnosis of cancer following the removal of a nodule takes several days to establish, in which case a second surgery will be performed in a timely fashion to remove remaining thyroid tissue.
Selected thyroid-related publications:
- Chang EH, Lobe TE, Wright SK. Our initial experience of the transaxillary totally endoscopic approach for hemithyroidectomy. Otolaryngol Head Neck Surg. 2009 Sep;141(3):335-9.
- Wright SK, Lobe T. Transaxillary totally endoscopic robot-assisted ansa cervicalis to recurrent laryngeal nerve reinnervation for repair of unilateral vocal fold paralysis. J Laparoendosc Adv Surg Tech A. 2009 Apr;19 Suppl 1:S203-6.
- Miyano G, Lobe TE, Wright SK. Bilateral transaxillary endoscopic total thyroidectomy. J Pediatr Surg. 2008 Feb;43(2):299-303.
- Lobe TE, Wright SK, Irish MS. Novel uses of surgical robotics in head and neck surgery. J Laparoendosc Adv Surg Tech A. 2005 Dec;15(6):647-52.
For more information on thyroid cancer: