Thyroid and Treatment
Thyroid – General Information
A thyroidectomy is the surgery performed to remove all or part of the thyroid gland.
The reasons that make it necessary to remove this organ, located in the anterior region of the neck, can be different. Thyroidectomy, for example, can be done in thyroid cancer, in the presence of a nodule or several nodules (polynodular goitre) of the thyroid, or in hyperthyroid conditions.
Surgery does not require special preparation, except in the case of hyperthyroidism.
Without the thyroid, we cannot live. Therefore, after a total thyroidectomy, it is necessary to plan an adequate treatment based on synthetic thyroid hormones.
Thyroid and Treatment
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Brief introduction to the anatomy and functions of the thyroid
Thyroid is a butterfly-shaped gland located in front of the larynx and trachea. It consists of two lateral lobes and a central part which called isthmus. Its weight is generally equivalent to about 20 grams, but it can fluctuate during life (for example during puberty, menopause, pregnancy, menstruation, breastfeeding, etc.). In women, it is smaller than in men.
The thyroid gland is one of the most important organs in the human body, as it regulates:
- Our metabolism: Among other functions, it affects oxygen consumption, controls the synthesis and breakdown of cholesterol, stimulates lipolysis and lipogenesis, increases glycogenolysis and gluconeogenesis, and more.
- Skeletal and brain development
- Protein synthesis in the body
- Skin development, hair health, and genital organ health
- Heart rhythms
- Body temperature
- Blood production
To carry out all these regulatory functions, the thyroid uses three hormones that it produces and releases into the bloodstream. These hormones are: triiodothyronine (also known as T3), thyroxine (also called T4), and calcitonin.
The production of hormones and their release into the bloodstream classifies the thyroid gland as an endocrine gland, which produces and secretes hormones, distinguishing it from exocrine glands.
What is Thyroidectomy
Thyroidectomy is the surgical procedure in which all or part of the thyroid gland is removed.
Since the thyroid is a vital organ for human survival, the removal of the entire thyroid parenchyma (both lobes, isthmus, and pyramidal lobe) requires special medication with synthetic thyroid hormones.
A patient may also require nearly total thyroidectomy. In this case, a minimal residue of the thyroid, around 1-2 grams, is kept on the posterior surface of one or both lobes.
There is also a subtotal thyroidectomy, in which about 4-5 grams of thyroid parenchyma is retained on both sides. The goal is to preserve thyroid function to avoid hormone replacement therapy, while also protecting the recurrent laryngeal nerves and parathyroid glands.
When it comes to partial thyroidectomy, the procedure of isthmectomy differs from hemithyroidectomy:
- Isthmectomy is the surgical procedure to remove the isthmus, the central part of the thyroid gland between the two lobes.
Hemithyroidectomy, on the other hand, is the surgery to remove only one of the two lobes and the isthmus.
When is Thyroidectomy Needed
Thyroidectomy is used to treat certain thyroid disorders. The main causes for this surgical intervention are:
- Thyroid Cancer (Malignancy): This is the leading cause for most thyroidectomy procedures. This malignant tumor occurs when a thyroid cell undergoes an abnormal genetic mutation, leading it to divide uncontrollably and form a more or less stable mass of cells.
This mass is not harmless; it tends to spread and metastasize, sending cancerous cells to the rest of the body. The purpose of thyroidectomy for thyroid cancer is to remove the abnormal mass and any part of the thyroid affected by cancer cells.
- Presence of one or more thyroid nodules: A thyroid nodule is a benign tumor of the thyroid gland. It consists of an abnormal mass of cells, which, unlike thyroid cancer, does not have the ability to spread. Even though benign, a nodule may require thyroidectomy (removal of the affected thyroid area) if it causes hyperthyroidism or compresses nearby organs (trachea and esophagus), resulting in difficulty breathing (dyspnea) or swallowing (dysphagia).
- Goiter: A goiter is the term used in medicine to refer to an enlarged thyroid gland. An enlarged thyroid appears as a more or less visible, symmetrical swelling of the neck. The onset of goiter can be due to symptoms such as difficulty swallowing (dysphagia), difficulty breathing (dyspnea), voice problems (dysphonia), hyperthyroidism or hypothyroidism. In more severe cases of goiter, total thyroidectomy may be necessary.
- Hyperthyroidism: Hyperthyroidism is the medical term for the overactivity of the thyroid, which results in increased levels of thyroid hormones in the blood. In addition to the presence of a thyroid nodule or goiter, hyperthyroidism can also arise from an autoimmune disease known as Graves’ disease or Basedow’s disease.
Preparation for Thyroidectomy
Thyroidectomy requires general anesthesia, so the patient must fast on the day of the surgery (usually from the previous evening).
In cases of thyroidectomy due to hyperthyroidism, the patient is treated with a medication based on potassium iodide. This medication not only inhibits the synthesis of thyroid hormones but also makes the thyroid tissue more compact (a more compact glandular tissue is less prone to large blood losses).
The treatment with potassium iodide should begin 10-14 days before the surgery date.
Equipment and Procedure
The surgeon begins the thyroidectomy only after the patient has been anesthetized, sedated, and connected to devices that monitor vital signs (such as blood pressure and heart rate).
The surgery involves making a small incision on the neck. The location of the incision depends on the chosen surgical method, which is at the surgeon’s discretion.
The entire procedure, which should be performed in a properly equipped operating room, may take more than an hour.
Among the most important tools that the surgical team must have are the neuromonitoring machine and the nerve stimulator. These devices, combined with proper training, minimize the risk of injury (temporary or permanent) to the recurrent laryngeal nerves.
Other essential tools during the thyroidectomy are energy sources, such as bipolar diathermy and ultrasonic scissors, which, when used correctly and with proper training, minimize or eliminate blood loss during the surgery.
Potential Complications of Thyroidectomy
Thyroidectomy is a relatively simple and safe procedure. However, as it is still a surgical operation, it is not completely without risks and complications.
Possible risks include:
- Hemorrhage
- Infection at the surgical area
- Airway obstruction due to bleeding or injury to the recurrent laryngeal nerves
- Permanent voice changes due to damage to the laryngeal nerve that controls speech. The voice may become hoarse or weaker.
- Damage to the parathyroid glands, which are located just behind the thyroid. The parathyroid glands regulate calcium levels in the blood by producing parathyroid hormone (PTH).
- Hypothyroidism: This is a problem that could arise after total thyroidectomy if the patient neglects to take synthetic thyroid hormones regularly, or if the prescribed hormone replacement therapy is insufficient.
The choice of the specialist surgeon is the most important factor in eliminating any risk factors and ensuring a proper diagnosis of whether you really need thyroidectomy — and what type of surgery is required for your condition. Both correct diagnosis and treatment require experience, knowledge, and true dedication to the patient and their problem.
If you are experiencing thyroid problems, do not hesitate to contact me for any questions regarding your thyroid, and schedule an in-person consultation for an accurate diagnosis.
