Thyroidectomy is the surgical removal of the thyroid gland, performed for colloid goiter, tumors, or hyperthyroidism that does not respond to iodine therapy and anti-thyroid drugs.

Description of Thyroidectomy

Surgical removal of the thyroid is necessary in some situations where a goiter becomes life-threatening or in the presence of some cancers.
Post-thyroidectomy treatment with thyroid hormone is routinely done to prevent a condition known as myxedema. The lack of circulating thyroid hormone in the body gives rise to a series of signs and symptoms which represent a severe form of hypothyroidism (underactivity of the thyroid gland). There is swelling of the face and limbs because of fluid deposited under the skin. This may particularly affect the area around the eyes, hands, and feet. The skin becomes dry and rough and there may be some hair loss. The person exhibits slowness of action and thought, and this mental dullness is accompanied by slow speech, with a voice that may become hoarse. Lethargy and weakness may be associated with slowed reflexes, a slow pulse, lowered metabolism and subnormal body temperature. Myxedema also may arise through primary disease of the thyroid.

Reasons for Thyroid Surgery

Thyroid surgery is performed in a number of circumstances:

• as a treatment for thyroid cancer
• when an enlarged thyroid (goiter) or multiple nodules cause cosmetic, breathing or swallowing problems in a pregnant woman, when her hyperthyroidism is not controllable by antithyroid drugs, and requires immediate treatment
• when other forms of treatment for hyperthyroidism -- i.e,. antithyroid drugs or radioactive iodine have not been effective. (This is applicable in the U.S. Outside the U.S., surgery is sometimes performed as a hyperthyroidism treatment before or instead of radioactive iodine.) in children, if the practitioner or parent wishes to avoid radioactive iodine.
• when the patient refuses antithyroid medications or radioactive iodine
• when a patient wants to try to get pregnant quickly after treatment.

Types of Thyroid Surgery

There are three main types of thyroid surgery:

• Total Thyroidectomy -- Complete Removal of the Thyroid.  This is the most common type of thyroid surgery, and is often used for thyroid cancer, and in particular, aggressive cancers, such as medullary or anaplastic thyroid cancer. It is also used for goiter and Graves'/hyperthyroidism treatment.
• Subtotal/Partial Thyroidectomy -- Removal of Half of the Thyroid Gland.  For this operation, cancer must be small and non-aggressive -- follicular or papillary -- and contained to one side of the gland. When a subtotal or partial thyroidectomy is performed, typically, surgeons perform a bilateral subtotal thyroidectomy which leaves from 1 to 5 grams on each side/lobe of the thyroid. A Harley Dunhill procedure is also popular, in which there's a total lobectomy on one side, and a subtotal on the other, leaving 4 to 5 grams of thyroid tissue remaining.
• Thyroid Lobectomy -- Removal of Only About a Quarter of the Gland.  This is less commonly used for thyroid cancer, as the cancerous cells must be small and non-aggressive.

The issue of a subtotal/partial, vs. total thyroidectomy is controversial. Some practitioners prefer to perform a partial thyroidectomy whenever possible, believing that they will leave behind enough thyroid tissue to prevent hypothyroidism. (A total thyroidectomy has nearly a 100 percent chance of causing hypothyroidism). The risk of hypothyroidism with subtotal thyroidectomy is, however, quite high, and some experts say that more than 70 percent of patients receiving a subtotal thyroidectomy will become hypothyroid. Since one of the main reasons for subtotal thyroidectomy is to prevent hypothyroidism, and that goal is achieved in only a minority of cases, experts increasingly believe that there is no added benefit to subtotal thyroidectomy, and are more routinely recommending a total thyroidectomy.

What You Are Likely to Experience

In most cases, surgery of the thyroid is not highly complicated, and usually takes no more than two hours. Removal of half of the thyroid takes 45 minutes to an hour, so if the entire gland is being removed, the surgery will last about an hour and a half.

Check with your surgeon about medications you are taking, and what you should/shouldn't take in the days prior to surgery.

You will most likely be asked to check into the hospital the morning of your surgery. Typically, your surgeon will ask that you refrain from eating or drinking after midnight the night before surgery.

Outpatient or Hospital Admission

Depending on the condition of the patient, an overnight or two-night hospital stay may be planned. Outpatient thyroid surgery is becoming increasingly popular, however, and research shows that outpatient thyroid surgery is safe, effective -- and less expensive -- for most patients, and may be preferable to traditional inpatient hospital stays.