Thyroidectomy is the surgical removal of the thyroid gland. This is mostly done to treat a goiter or thyroid cancer.
What is thyroidectomy?
Thyroidectomy or thyroidectomy is the surgical removal of the thyroid gland (thyroid gland). If only a unilateral operation takes place, it is called a hemithyroidectomy. If only a partial removal of the thyroid gland takes place, the doctors speak of a strumaresection. In this way, the functioning rest of the organ remains in the body. Thyroidectomy was first performed in 1791 by the French physician Pierre-Joseph Desault (1744-1795). The first thyroidectomy in Germany was performed by the surgeon Ludwig Rehn (1849-1930) in 1880. Thyroidectomy can be used to treat both benign and malignant diseases of the thyroid gland. If metastases (daughter tumors) already exist in the course of a cancer, a so-called neck dissection, in which all neck lymph nodes are removed, can be performed in addition to the removal of the thyroid gland.
Function, effect, and goals
Thyroidectomy can be performed for a variety of reasons. If a benign nodular goiter is present, removal of the thyroid gland will only take place if there is a complete nodular change in the organ. In this case, it is necessary to remove the complete tissue of the thyroid gland because there is an increased risk of recurrence. However, usually only partial thyroidectomy is performed due to the high risk of complications. Another area of application is the autoimmune disease Graves’ disease, which is associated with hyperthyroidism. In this case, both a partial and a complete thyroidectomy can be performed. Frequent indications for thyroidectomy are also cancers of the thyroid gland. These include papillary thyroid carcinoma, follicular thyroid carcinoma, medullary thyroid carcinoma, and anaplastic thyroid carcinoma. Before a surgical thyroidectomy can be performed, various control examinations must be carried out in advance. The physician checks the patient’s physical condition. The focus of the check-up is on the heart and circulation. X-rays of the lungs are also taken. The preliminary examinations also include determining the blood count, blood coagulation, electrolytes and kidney function. To rule out inflammation, the CRP level is also determined. Routine examinations also include the determination of thyroid hormones. Furthermore, an ear, nose and throat specialist checks how mobile the patient’s vocal cords are. At the beginning of the thyroidectomy, the patient receives intubation anesthesia, which is considered standard procedure for this procedure. He is also positioned with his upper body slightly erect while his head tilts backward into a tray, which allows easy access to the thyroid gland. The first step of thyroidectomy is to expose the anterior surface of the thyroid gland. During this procedure, the tissue bridge on the trachea, which is located between the thyroid lobes, is cut and hemostasis is applied. Then the surgeon detaches the thyroid parts that need to be removed and cuts the blood vessels responsible for blood supply and drainage. During the procedure, the surgeon takes care to spare the vocal cord nerves as well as the parathyroid glands. After cutting the layer of connective tissue between the trachea and the thyroid gland, the flap is removed. If the physician finds metastases to the lymph nodes during the procedure, a radical thyroidectomy including neck dissection must be performed. For this purpose, he extends the so-called Kocher’s collar incision into a door-wing incision. At its midline, he makes a straight longitudinal incision. This ends below the chin and is extended transversely to both sides. The next step in thyroidectomy is the placement of Redon drains to drain blood and wound secretions. Closure of the wound is done in three layers. The surgeon closes muscles and subcutaneous tissue with suture material that resorbs. For closure of the skin, the surgeon resorts to an intracutaneous suture technique, which is considered favorable. Tissue adhesives or adaptive plasters are also considered as alternatives.
Risks, side effects, and hazards
Thyroidectomy involves some risks.Thus, bleeding may occur during the surgical procedure or afterwards. In some cases, these even develop into a threat because the thyroid gland is well supplied with blood. As a rule, therefore, blood reserves are usually available for use. The good blood supply has the advantage that purulent wound infections rarely occur. If they do occur, they can be easily detected and treated accordingly. However, the cosmetic result is often negative. Occasionally, postoperative blood clots or embolisms are also within the realm of possibility. Another conceivable risk of thyroidectomy is severing of the vocal cords. This results in permanent paralysis of the vocal muscles and hoarseness. Loss of function can also occur due to overstretching or bruising of the nerves. However, the nerves usually recover, so that no special treatment is required. Of particular concern is bilateral recurrent paresis, which can cause complete obstruction of the trachea. This poses the risk of the patient suffocating. In such cases, a permanent tracheotomy is necessary. Another danger of thyroidectomy is unintentional injury to the parathyroid glands. It is usually difficult to detect and can derail calcium metabolism. However, this complication is usually easily corrected by vitamin D and calcium supplementation. Other possible risks and side effects include difficulty swallowing, neck pain from positioning, injury to adjacent body structures such as the trachea or esophagus, soft tissue damage, scarring, or allergic reactions that can even result in life-threatening anaphylactic shock.
