Strumaresection means the partial removal of the thyroid gland by means of a surgical procedure. The reason for this operation is an unnatural enlargement of the thyroid gland due to nodule formation (goiter). In this case, the thyroid gland is not completely removed on both sides. Healthy parts of the organ usually remain in the body.
What is struma resection?
The thyroid gland is located below the larynx, consists of two lobes, and normally weighs 15 to 20 grams. A goiter that is too large causes symptoms such as tightness, difficulty swallowing, and possibly even breathing problems due to crowding of the trachea. As a rule, a so-called diffuse (uniform) goiter is initially treated with various drugs (including iodide). However, if the number and size of nodular irregularities increase, surgery must be performed. This is also the case with hyperthyroidism. If the nodular formations are too massive, the thyroid gland must be completely removed (thyroidectomy). This is done when not only intact tissue could remain. Total resection of the thyroid lobe on one side (hemithyroidectomy) is also possible. Occasionally, a single nodule can be peeled out (enucleation), usually taking a narrow strip of healthy thyroid tissue with it. If the goiter is caused by thyroid cancer, it is essential to remove it surgically. In such cases, only partial resection is hardly possible.
Function, effect, and goals
Goiter represents a disease of the endocrine glands that is very often brought on by nutritional iodine deficiency. Therefore, in addition to the administration of iodine by medication, radioiodine therapy is also used, but negative radiation exposure must be considered. Radioiodine therapy can effectively shrink a thyroid gland by eliminating growths. The epithet goiter is reminiscent of the so-called sacculation of the esophagus in birds. In humans, this glandular swelling in the neck can reach considerable proportions. It is estimated that in Germany the thyroid gland is more or less enlarged or knotted in up to 30 percent of adults. If the thyroid tissue lacks the nutrient iodine, cell proliferation occurs. If this continues for years, it leads to degenerative abnormalities in the area of the thyroid gland and finally to increasing knotting of the tissue. In extreme cases, even autonomous areas form that are outside the hormonal circuits. During struma resection and any other thyroid surgery, typical damage (paralysis) of the vocal cord nerve occurs with low frequency. Similarly, significant hypofunction of the parathyroid glands can occur after these procedures. The risk of such complications increases in case of repeated surgery and in case of malignant tumors. In general, the various thyroid surgeries can do nothing against the actual causes of struma formation. On the contrary, it is even possible that the remaining tissue of the thyroid gland tends to grow even more than before the operation. This is because, as a result of the surgical procedures, the body’s own ability to produce thyroid hormones itself in appropriate quantities has been reduced. Renewed thyroid growth may also be accompanied by increased postoperative nodule formation. The only remedy here may be lifelong drug treatment with iodide and the active hormone L-thyroxine.
Risks, side effects and dangers
Resection of the thyroid gland requires the physician to be highly attentive to the patient’s potential blood loss because the organ receives a great deal of blood flow. In addition, great surgical skill is required, especially for a second and every subsequent procedure. Removal of the parathyroid gland is much more difficult in these cases due to scarring. Nerves and vessels can take an unpredictable course. The location of the parathyroid glands is also unclear in many cases. They are only the size of a grain of rice and therefore may be difficult to locate during surgery. Last but not least, the operating physicians must always keep an eye on the mobility of the vocal cords. There is a permanent risk of unilateral or bilateral paralysis here, which is why all breathing must be carefully monitored by intensive medical care during the operation and especially during anesthesia.If the struma resection is free of complications, the patient can get up and take liquids on the evening of the day of the operation. The very next day, normal eating is on the agenda. As a rule, there are no restrictions on mobility. Painkillers only need to be administered in relatively small amounts. On the second day after the operation, the drains are usually removed. After four or five days, the patient can usually leave the hospital. If a transverse incision of the neck muscles had to be made because of the size of a goiter, there may be limited mobility of the head for ten to 14 days. The surgical scar is still clearly visible eight to twelve weeks after the operation before it then blends in relatively well with the surrounding skin. Ideally, a thin line remains in a fold of skin on the neck. However, this depends on the specific sensitivities of the individual patient. Aftercare is particularly important following struma resection. The secretion of thyroid hormones must be precisely monitored. If nodules form again, appropriate therapy should follow quickly. The parathyroid glands may produce certain hormones, which are important for the body’s calcium level, only to a limited extent after the operation. Thus, the body may need to be supplied with calcium in the form of special preparations for a transitional period. This nutrient is important for the nerves and muscles, and also stabilizes the bones.
