Our Summary

The researchers examined different surgical methods used to remove the thyroid gland, a procedure known as thyroidectomy. They focused on methods that avoid scarring on the front of the neck, reviewing data from 2351 cases. These methods included the conventional approach (TCA), the transaxillary approach (TA), bilateral axillo-breast approach (BABA), and transoral robotic thyroidectomy (TORT).

They found that each method has unique characteristics, benefits, and drawbacks. For example, TORT was most effective at removing central lymph nodes. BABA was excellent for removing the entire thyroid gland and large goiters, but it was associated with a higher incidence of temporary vocal cord paralysis. TA was great at preserving a nerve that’s involved in speech, called the external branch of the superior laryngeal nerve.

The researchers concluded that surgeons should consider these factors when choosing the most suitable method for each patient, aiming to improve cosmetic results, maintain function, and prevent recurrence.

FAQs

  1. What are the different surgical methods used to remove the thyroid gland?
  2. What are the unique characteristics, benefits, and drawbacks of each thyroidectomy method?
  3. How do surgeons decide on the most suitable thyroidectomy method for each patient?

Doctor’s Tip

A helpful tip a doctor might give a patient about thyroidectomy is to discuss with their surgeon the different surgical methods available and how each method may affect their recovery, scarring, and potential complications. It is important for the patient to be informed and involved in the decision-making process to ensure the best possible outcome for their individual situation.

Suitable For

Patients who are typically recommended for thyroidectomy include those with:

  1. Thyroid cancer: Patients with thyroid cancer may undergo thyroidectomy to remove cancerous cells and prevent the cancer from spreading.

  2. Large goiters: Patients with large goiters, which are enlarged thyroid glands, may require thyroidectomy to alleviate symptoms such as difficulty swallowing or breathing.

  3. Hyperthyroidism: Patients with hyperthyroidism, a condition in which the thyroid gland produces too much hormone, may undergo thyroidectomy to regulate hormone levels.

  4. Thyroid nodules: Patients with thyroid nodules, which are abnormal growths on the thyroid gland, may undergo thyroidectomy if the nodules are causing symptoms or are suspicious for cancer.

  5. Recurrent thyroid disease: Patients with recurrent thyroid disease, such as recurrent goiters or thyroid nodules, may undergo thyroidectomy to prevent further complications.

  6. Graves’ disease: Patients with Graves’ disease, an autoimmune disorder that causes the thyroid gland to become overactive, may undergo thyroidectomy if other treatments are not effective.

Overall, the decision to recommend thyroidectomy for a patient is individualized and based on factors such as the patient’s specific condition, symptoms, and overall health. It is important for patients to discuss the risks and benefits of thyroidectomy with their healthcare provider to determine the most appropriate treatment plan.

Timeline

Before thyroidectomy:

  1. Patient consults with their healthcare provider and undergoes various tests to determine the need for thyroidectomy.
  2. Patient receives preoperative instructions and information about the procedure.
  3. Patient may need to undergo additional imaging or biopsies prior to surgery.
  4. Patient undergoes anesthesia and the thyroidectomy procedure is performed.

After thyroidectomy:

  1. Patient is monitored in the recovery room post-surgery.
  2. Patient may experience temporary hoarseness or difficulty swallowing.
  3. Patient is given pain medication and instructions for postoperative care.
  4. Patient may need to take thyroid hormone replacement medication for the rest of their life.
  5. Patient follows up with their healthcare provider for monitoring of thyroid hormone levels and any potential complications.
  6. Patient may undergo vocal cord exercises or speech therapy if they experience persistent hoarseness.
  7. Patient may need to make lifestyle changes, such as dietary adjustments or avoiding certain medications, to manage their thyroid levels effectively.

What to Ask Your Doctor

Some questions a patient should ask their doctor about thyroidectomy include:

  1. What surgical method do you recommend for my specific case?
  2. What are the potential risks and complications associated with the recommended method?
  3. How long is the recovery period after the surgery?
  4. Will I need to take thyroid hormone replacement medication after the surgery?
  5. What are the chances of the thyroid cancer returning after the surgery?
  6. How will the surgery affect my voice and swallowing?
  7. What are the chances of experiencing vocal cord paralysis or other nerve damage?
  8. Will there be visible scarring on the neck after the surgery?
  9. How long will I need to stay in the hospital after the surgery?
  10. Are there any alternative treatment options to consider before proceeding with thyroidectomy?

Reference

Authors: Lee J, Kim SH, Hong H. Journal: Surg Laparosc Endosc Percutan Tech. 2023 Dec 1;33(6):632-639. doi: 10.1097/SLE.0000000000001243. PMID: 37934829