What is total thyroidectomy

What to Expect During a Total Thyroidectomy Total thyroidectomy involves the removal of the entire thyroid gland.

What to Expect During a Thyroid Lobectomy A thyroid lobectomy is used to remove one of your two thyroid lobes, leaving the other intact. Who is a candidate for thyroidectomy versus thyroid lobectomy? For example: If you are taking thyroid hormone replacements or have several nodules on your thyroid, it's usually suggested that you have a thyroidectomy. If you have diffuse thyroiditis — inflammation of the thyroid gland that causes hypothyroidism — a toxic nodule or one specific nodule that needs to be removed, a thyroid lobectomy is often the treatment of choice.

If, after a thyroid biopsy, a pathologist cannot reach a conclusion on whether a nodule is cancerous, a lobectomy is often considered. About 20 percent of thyroid biopsies result in indeterminate test results.

The tissue removed in the lobectomy will then be examined by a pathologist. If cancer is found, you might have to undergo a second surgery to ensure all of the cancerous tissue is removed. Share This Page: Post Tweet. UCSF is a major referral center for endocrine surgery in the region. Surgeons at UCSF perform a high volume of thyroid surgeries, including some of the most complex and technically challenging cases, with generally excellent results.

UCSF also offers the scarless thyroidectomy to selected patients. If there is not a clear diagnosis at the time of the operation half of the thyroid may be removed lobectomy for a final diagnosis. If cancer is found after the initial operation, reoperation depends on what the final pathology shows.

In the case of these biopsy results, a thyroid lobectomy is indicated. Confirmation of a benign or malignant thyroid mass can only be done after removal of the affected thyroid lobe. Pathologists have to look at very thin slices of the tissue to make a diagnosis. If a diagnosis of cancer is confirmed usually about days following your operation , a second operation to remove the other lobe of the thyroid completion thyroidectomy may be needed.

Frozen section is a biopsy done during the operation. It is useful if you have had a suspicious biopsy prior to the operation or if a lymph node is found during the operation that does not appear to be normal. The frozen section can then be used to determine a diagnosis of cancer. If cancer is diagnosed, then a total thyroidectomy and possible removal of surrounding lymph nodes would be indicated.

Frozen section is NOT useful for follicular adenoma, indeterminate, or non-diagnostic biopsy results. You will be seen by the anesthesiologist at least one week prior to your surgery for a preoperative check. At this appointment there may be blood or other tests done to prepare you for your surgery.

If you take blood thinning medications, such as aspirin, Plavix, ibuprofen, or Coumadin, you will need to contact the prescribing physician to discuss stopping these medications prior to your surgery. It is highly unlikely that you will require a blood transfusion during your thyroidectomy, and therefore not medically necessary to donate autologous or designated donor blood prior to your surgery. Most patients only spend a maximum of one night in the hospital. There is no guarantee for a private room.

The incision is about inches in length, and is placed in the midline of the neck in a normal skin crease to minimize scarring and visibility. As for other operations, all patients considering thyroid surgery should be evaluated preoperatively with a thorough and detailed medical history and physical exam including cardiopulmonary heart and lungs evaluation.

An electrocardiogram and a chest x-ray prior to surgery are often recommended for patients who are over 45 years of age or who are symptomatic from heart disease. Blood tests may be performed to determine if a bleeding disorder is present. Importantly, any patient who has had a change in voice or who has had a previous neck operation thyroid surgery, parathyroid surgery, spine surgery, carotid artery surgery, etc.

This is necessary to determine whether the recurrent laryngeal nerves that control the vocal cord muscles are functioning normally. Finally, in rare cases, if medullary thyroid cancer is suspected, patients should be evaluated for endocrine tumors that occur as part of familial syndromes including adrenal tumors pheochromocytomas and enlarged parathyroid glands that produce excess parathyroid hormone hyperparathyroidism.

In general, thyroid surgery is best performed by a surgeon who has received special training and who performs thyroid surgery on a regular basis. The complication rate of thyroid operations is lower when the operation is done by a surgeon who does a large number of thyroid operations each year. Patients should ask their referring physician where he or she would go to have a thyroid operation or where he or she would send a family member. In experienced hands, thyroid surgery is generally very safe.

Complications are uncommon, but the most serious possible risks of thyroid surgery include:. These complications occur more frequently in patients with invasive tumors or extensive lymph node involvement, in patients undergoing a second thyroid surgery, and in patients with large goiters that go below the collarbone into the top of the chest substernal goiter. Prior to surgery, patients should understand the reasons for the operation, the alternative methods of treatment, and the potential risks and benefits of the operation informed consent.

Your surgeon should explain the planned thyroid operation, such as lobectomy hemi or total thyroidectomy, and the reasons why such a procedure is recommended. For patients with papillary or follicular thyroid cancer, many, but not all, surgeons recommend total or neartotal thyroidectomy when they believe that subsequent treatment with radioactive iodine might be necessary.

A hemithyroidectomy may be recommended for overactive solitary nodules or for benign onesided nodules that are causing local symptoms such as compression, hoarseness, shortness of breath or difficulty swallowing. The answer to this depends on how much of the thyroid gland is removed.

The permanent RLN palsy was noted in 1. The Temporary hypocalcaemia rates were These results were consistent with the experiences of other centres [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. According ATA guidelines we performed therapeutic central-compartment level VI neck dissection for patients with clinically involved central nodes and prophylactic central-compartment neck dissection in patients with thyroid carcinoma with clinically uninvolved central neck lymph nodes cN0 who have advanced primary tumors T3 or T4 or clinically involved lateral neck nodes [ 9 ].

The low rate of hypoparathyroidism in the CT group could be due to functional recovery of the parathyroid glands after the injury caused at the first operation. Furthermore, because dissecting the scar tissue at the excised lobe site is not necessary, there is an absence of scar tissue in the remnant lobe region; therefore, the complication rate is low in CT thyroidectomies after hemithyroidectomies. Because use of a harmonic scalpel and nerve monitoring may give a slight advantage in overall outcomes [ 35 , 36 , 37 ], we use these devices for all patients.

In a recent meta-analysis that compared neuromonitoring with recurrent laryngeal nerve visualization, no differences were identified in the transient or permanent RLN palsy rates [ 38 ]. However, data from the literature show that nerve monitoring during completion thyroidectomy may decrease the RLN palsy risk [ 39 ]. The retrospective nature of the study and the presence of a non-homogeneous group of patients represent the main limitations.

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