Thyroid surgery

Thyroid surgery is a procedure commonly performed to treat benign and malignant thyroid disorders. Total thyroidectomy entails the removal of the entire thyroid gland and is indicated in the management of thyroid cancer or benign thyroid conditions that affect the entire gland (e.g., Graves disease, multinodular goiter). A small cuff of tissue adjacent to the tracheoesophageal groove is spared in near-total and subtotal thyroidectomy in order to protect the parathyroid glands and the adjacent nerves. Lobectomy (removal of a single lobe) or hemithyroidectomy (removal of a single lobe with the isthmus) is performed for unilateral benign thyroid disorders (e.g., toxic adenoma, recurrent thyroid cysts) and for small, low-risk differentiated thyroid cancers. Postoperative complications include hematoma formation, hypoparathyroidism, nerve palsy (recurrent/superior laryngeal nerve), and hypothyroidism. The greater the extent of resection, the greater the risk of complications. However, the most extensive resections (total thyroidectomy) are associated with the lowest rates of recurrent disease.

See thyroid gland and parathyroid glands.

• Nerves in close proximity to the thyroid gland
  • Recurrent laryngeal nerve (close to the inferior thyroid artery)
  • Superior laryngeal nerve (close to the superior thyroid artery)

• Achieve euthyroid status preoperatively.
  • In hyperthyroidism to minimize the risk of thyroid storm
    • Thioamides
    • Iodides (potassium iodide)
    • Beta blockers (e.g., propranolol)
  • In hypothyroidism: thyroid hormone replacement
• Preoperative oral calcium and vitamin D supplementation
• Preoperative direct/indirect laryngoscopy

References:^{[1][2][3][4][5][6]}

References:^{[1][7][8][9][10][11]}

• Transient/permanent postoperative hypoparathyroidism (most common) or hypothyroidism
• Hematoma
• Transient/permanent RLN palsy
• Superior laryngeal nerve palsy → paralysis of cricothyroid muscle → easy voice fatigability; change in the timbre of voice
• Thyroid storm: if the surgery was performed in inadequately treated patients with hyperthyroidism (see "complications" of hyperthyroidism for further details)

References:^[1][7][12]

We list the most important complications. The selection is not exhaustive.