The extent of removal—whether a portion or the entire gland—depends on the nature of the thyroid condition being addressed. These conditions include cancerous growths and nodules to persistent hyperthyroidism or enlarged thyroid glands.
Why are Thyroidectomies performed?
Thyroidectomies are orchestrated to alleviate a spectrum of thyroid concerns such as:
- Thyroid Cancer: When malignancies are detected within the thyroid gland, a thyroidectomy may be recommended to excise the cancerous cells and prevent further spread.
- Nodules or Goiter: The presence of large or problematic thyroid nodules, causing discomfort or affecting breathing and swallowing, may necessitate removal.
- Hyperthyroidism: For individuals grappling with an overactive thyroid, a thyroidectomy can be a viable solution when other treatments prove inadequate or are not well-tolerated.
- Possible Cancerous Thyroid Nodule: Addressing problematic nodules within the thyroid for which biopsies come back inconclusive and there is a risk of the nodule being cancerous.
Type of Thyroidectomies
There are several types of thyroidectomies that Dr. Cohen may perform, these include:
What it Entails: Complete removal of the thyroid gland.
When it’s Recommended: Often chosen in cases of thyroid cancer, extensive thyroid nodules, or when addressing hyperthyroidism affecting the entire gland.
Subtotal or Near-Total Thyroidectomy
What it Entails: Removal of a significant portion of the thyroid gland, leaving a small remnant.
When it’s Recommended: Considered for conditions like Graves’ disease or when preserving a portion of thyroid function is desirable.
What it Entails: Removal of one lobe of the thyroid gland.
When it’s Recommended: Typically performed when addressing a single thyroid nodule or if a specific lobe is affected.
What it Entails: Removal of the isthmus, the bridge-like structure connecting the two lobes of the thyroid.
When it’s Recommended: Appropriate when the condition is isolated to the isthmus or for certain types of thyroid nodules.
Bilateral Subtotal Thyroidectomy
What it Entails: Removal of a significant portion of both thyroid lobes, leaving small remnants.
When it’s Recommended: Considered in specific cases of hyperthyroidism or thyroid nodules.
Central Compartment Neck Dissection
What it Entails: Removal of lymph nodes in the central neck compartment, often performed in conjunction with thyroidectomy for thyroid cancer.
When it’s Recommended: When there’s evidence of lymph node involvement in thyroid cancer.
Preparing for a Thyroidectomy
Before the Thyroidectomy
Prior to the thyroidectomy, Dr. Cohen may go through all or some of the following steps:
- Medical Assessment: Thorough medical evaluation to assess overall health and determine the necessity of a thyroidectomy.
- Communication with the Healthcare Team: Open dialogue with healthcare professionals to discuss the procedure, address concerns, and establish expectations.
- Medication Review: Review and adjustment of medications, especially those affecting blood clotting or thyroid function.
- Fasting and Anesthesia Consultation: Guidelines for fasting before the procedure and consultations with the anesthesia team to ensure a smooth experience.
- Thyroid Function Tests: Comprehensive thyroid function tests to gauge baseline hormone levels and guide post-operative care.
- Evaluate vocal chords: Make sure they’re moving properly to ensure that the nerves are not injured during the operation.
- Pre-operative Instructions: Clear instructions regarding pre-operative protocols, including dietary restrictions and hygiene practices.
During the Thyroidectomy
Performed by a skilled and experienced surgeon, the procedure involves making a meticulous incision in the neck to gain access to the thyroid gland. The incision is strategically placed to optimize visibility and minimize any potential scarring. Careful consideration is given to the surrounding anatomical structures, ensuring precision and safety in navigating the delicate neck area. The surgeon executes a precise removal of the thyroid gland, guided by the specific nature of the procedure prescribed. This step may entail the partial or complete extraction of the thyroid gland, depending on the underlying medical condition. The surgeon’s expertise is paramount in ensuring thorough removal while safeguarding adjacent structures and preserving functionality when applicable.
Post-gland removal, the incision is meticulously closed using either sutures or surgical staples. The choice of closure method is influenced by factors such as the size of the incision and the individual’s healing characteristics. Following closure, a sterile dressing is applied to the incision site, fostering an environment conducive to optimal healing and minimizing the risk of infection.
After the Thyroidectomy
Upon completion of the surgical procedure, the patient is transitioned to a recovery room, where close monitoring ensues. Continuous monitoring includes assessments of vital signs, pain management, and initial recovery progress, ensuring a smooth and well-managed transition from the operative to the postoperative phase. Individuals typically spend a day or more in the hospital for close monitoring.
Most individuals can expect to resume light activities within the first week after surgery. However doctors usually recommend that patients wait 10 days before resuming strenuous activities.
In the initial weeks, patients often focus on managing pain and adapting to changes. Neck pain, a common post-surgical discomfort, typically subsides within the first week, alleviated by prescribed pain medications and attentive care.
Voice changes may also be observed, attributed to the proximity of the thyroid gland to the vocal cords. These changes are often transient, with most individuals regaining their normal voice over time. However, it’s essential to communicate any persistent or concerning changes to the healthcare team for evaluation.
Thyroid Hormone Replacement Therapy
Given the absence of the thyroid gland post-surgery, patients will likely have to be on thyroid hormone replacement therapy for the rest of their lives. If you don’t have your thyroid fully removed there is a possibility that you will not have to take thyroid hormone pills however this is dependent on whether your thyroid is producing sufficient hormones.