Our Summary

This research paper discusses the modern-day approach to total thyroidectomy, a surgical procedure to remove all or part of the thyroid gland. Over the past 30 years and 21,000 cases, the method has been refined to enhance patient outcomes. Notable changes include a different approach to a specific nerve (the recurrent laryngeal nerve), which is now dissected before the thyroid lobe is adjusted.

The authors also report that the use of nerve monitoring systems during surgery has increased, allowing for better nerve preservation and a lower risk of nerve damage. Advanced energy devices are being used more frequently, which has led to a decrease in post-operative complications like bleeding.

Additionally, the researchers have a low threshold for transplanting parathyroid glands (a group of small endocrine glands located near the thyroid) unless it’s clear they are not at risk. After surgery, patients are routinely given Caltrate, a calcium supplement, to reduce the risk of low calcium levels in the blood.

Despite these advancements, the basic principles of exposure and dissection developed over the years remain fundamental to the surgical approach.

FAQs

  1. What changes have been made to the approach of total thyroidectomy in the past 30 years?
  2. How has the use of nerve monitoring systems and advanced energy devices improved the outcomes of total thyroidectomy?
  3. What measures are taken post-operatively to reduce the risk of low calcium levels in the blood?

Doctor’s Tip

One helpful tip a doctor might tell a patient about thyroidectomy is to follow post-operative care instructions closely, including taking any prescribed medications, attending follow-up appointments, and monitoring for any signs of complications such as difficulty breathing, excessive bleeding, or changes in voice. It’s important to communicate any concerns or symptoms to your healthcare provider promptly. Additionally, maintaining a healthy lifestyle, including proper nutrition and regular exercise, can help support recovery and overall thyroid health.

Suitable For

Patients who are typically recommended for thyroidectomy include those with:

  1. Thyroid cancer: Patients with thyroid cancer may require total or partial thyroidectomy to remove the cancerous tissue and prevent it from spreading to other parts of the body.

  2. Benign thyroid nodules: Thyroid nodules that are causing symptoms such as difficulty swallowing or breathing, or are suspicious for cancer, may require surgical removal through thyroidectomy.

  3. Hyperthyroidism: Patients with hyperthyroidism, a condition where the thyroid gland produces excess hormones, may require thyroidectomy to control hormone levels.

  4. Enlarged thyroid gland (goiter): A goiter can cause symptoms such as difficulty swallowing or breathing, and may require surgical removal through thyroidectomy.

  5. Recurrent thyroid nodules: Patients with recurrent thyroid nodules that continue to grow or cause symptoms despite previous treatments may be recommended for thyroidectomy.

  6. Graves’ disease: Patients with Graves’ disease, an autoimmune disorder that causes hyperthyroidism, may require thyroidectomy if other treatments are ineffective.

  7. Family history of thyroid cancer: Patients with a family history of thyroid cancer may be recommended for thyroidectomy as a preventive measure to reduce the risk of developing cancer.

Overall, the decision to recommend thyroidectomy is based on the individual patient’s medical history, symptoms, and risk factors, as well as the expertise of the healthcare team managing the patient’s care.

Timeline

Before a thyroidectomy, a patient will typically undergo several tests and evaluations to determine the need for surgery, such as blood tests, imaging scans, and a biopsy. They may also be prescribed medication to manage symptoms or stabilize hormone levels.

During the surgery, the patient will be under general anesthesia, and the surgeon will make an incision in the neck to access the thyroid gland. The thyroid gland is then carefully removed, along with any surrounding tissue if necessary. After the procedure, the incision is closed, and the patient is monitored in the recovery room before being transferred to a hospital room or discharged home.

After a thyroidectomy, patients may experience side effects such as temporary hoarseness, difficulty swallowing, or changes in voice quality. They will need to take thyroid hormone replacement medication for the rest of their lives to regulate hormone levels. Regular follow-up appointments with the surgeon and endocrinologist will be necessary to monitor recovery and ensure appropriate hormone levels.

Overall, the timeline of a patient’s experience before and after a thyroidectomy involves pre-operative testing and evaluation, the surgical procedure itself, and post-operative care and monitoring to ensure a successful recovery and optimal long-term outcomes.

What to Ask Your Doctor

Questions a patient should ask their doctor about thyroidectomy may include:

  1. What are the risks and benefits of total thyroidectomy in my specific case?
  2. How experienced are you in performing thyroidectomies?
  3. Will nerve monitoring systems be used during my surgery to reduce the risk of nerve damage?
  4. What is your approach to transplanting parathyroid glands during the surgery?
  5. How will my calcium levels be monitored post-surgery, and what steps will be taken to prevent low calcium levels?
  6. What post-operative complications should I be aware of, and how will they be managed?
  7. What is the expected recovery time and follow-up care after the surgery?
  8. Are there any specific lifestyle changes or medications I will need to take after the surgery?
  9. How will my thyroid function be monitored and managed after the thyroidectomy?
  10. Are there any alternative treatment options to consider before proceeding with total thyroidectomy?

Reference

Authors: Papachristos AJ, Glover A, Sywak M, Sidhu SB. Journal: ANZ J Surg. 2022 Jul;92(7-8):1626-1630. doi: 10.1111/ans.17783. Epub 2022 Jun 10. PMID: 35689169