Related Subjects:
|Thyrotoxicosis and Hyperthyroidism
|Thyroid Storm - Thyrotoxic crisis
|Graves Disease (Thyrotoxicosis)
|Amiodarone and Thyroid disease
|Thyroid Surgery (Thyroidectomy)
|Hypothyroidism
|Hashimoto's thyroiditis
|DeQuervain's thyroiditis
|Subacute Thyroiditis
|Thyroid nodule
|Congenital Hypothyroidism
|Thyroid Function Tests and antibodies
|Post partum thyroiditis
|Sick Euthyroid Syndrome
|Thyroid Exam (OSCE)
|Thyroid Gland anatomy and Physiology
|Thyroid Cancer
📖 About
- Total Thyroidectomy: Complete removal of the thyroid gland.
- Subtotal / Partial Thyroidectomy: Removal of part of the thyroid, sparing some functional tissue.
📋 Indications
- 🔁 Relapsed Grave’s disease unresponsive to medical therapy.
- 👁️ Grave’s ophthalmopathy with goitre.
- 🧬 Thyroid cancers (papillary, follicular, medullary, anaplastic).
- 🔎 Thyroid nodules/goitres (benign or malignant) with diagnostic uncertainty.
- 🫁 Obstructive goitre causing airway or oesophageal compression.
🔪 Types of Operations
- Hemithyroidectomy: One lobe + isthmus, usually for benign unilateral disease.
- Subtotal Thyroidectomy: Most of the gland removed, often in toxic multinodular goitre.
- Partial Thyroidectomy: Removal of anterior gland portion (rarely performed now).
- Near-Total Thyroidectomy: Both lobes removed, leaving small tissue near RLN & parathyroids.
- Total Thyroidectomy: Entire gland removed, usually for thyroid cancer.
- Hartley–Dunhill Operation: One whole lobe + isthmus + subtotal removal of the opposite lobe.
⚕️ Procedure
- 5–7 cm transverse incision above the clavicle line in the neck crease.
- Meticulous dissection to protect parathyroid glands and recurrent laryngeal nerve (RLN).
- Thyroid removed partially or completely, depending on indication.
- 🕒 Duration: typically 1–2 hours.
- 🏥 Hospital stay: ~2–3 days.
🧑⚕️ Preoperative Care
- Continue antithyroid drugs up until surgery day.
- Optimise euthyroid state (to reduce thyroid storm risk).
- Laryngoscopy may be performed pre-op to assess vocal cord function.
⚠️ Complications
- ⬇️ Hypothyroidism: Inevitable after total thyroidectomy → lifelong levothyroxine.
- ⬇️ Hypocalcaemia / Hypoparathyroidism:
Monitor calcium 24 h post-op; supplement with oral calcium (Sandocal, Adcal).
If persistently low >72 h → start alfacalcidol & refer endocrinology.
- 🗣️ Vocal cord palsy: ~1% risk from RLN injury → hoarseness, voice change, stridor.
- 🩸 Bleeding / neck haematoma: Rare but life-threatening (airway compromise). Requires urgent decompression.
- ➖ Scarring: Cosmetic concern, usually fades with time.
- 🌡️ Thyroid storm: Rare, life-threatening complication of untreated thyrotoxicosis.
🛠️ Postoperative Management
- Acute hypocalcaemia → treat with IV calcium, then oral calcium + vitamin D analogue.
- Lifelong levothyroxine for most total thyroidectomy patients.
- Voice assessment if hoarseness or stridor develops post-op.
- Regular follow-up with endocrinology and ENT surgery teams.
📚 References
