From the Guidelines
Thyroidectomy is a highly effective treatment for thyroid cancer, goiter, hyperthyroidism, or suspicious thyroid nodules, with a high success rate and minimal complications when performed by experienced surgeons, as evident from the most recent study 1.
Overview of Thyroidectomy
Thyroidectomy is a surgical procedure to remove all or part of the thyroid gland, which is located in the front of the neck and produces hormones that regulate metabolism. This surgery is typically performed to treat thyroid cancer, goiter (enlarged thyroid), hyperthyroidism, or suspicious thyroid nodules. There are different types of thyroidectomies: total (complete removal), partial (removing a portion), or subtotal (leaving a small amount of tissue).
Preoperative and Intraoperative Considerations
Preoperative evaluation, including thyroid and neck ultrasound, CT/MRI with contrast for fixed, bulky, or substernal lesions, and assessment of vocal cord mobility, is crucial for determining the extent of disease and planning the surgical approach 1. Intraoperative nerve monitoring and surgical techniques geared to optimize voice outcomes can help prevent injury to the recurrent laryngeal nerve and other surrounding structures.
Postoperative Care and Follow-up
After surgery, patients may need lifelong thyroid hormone replacement therapy, typically levothyroxine (Synthroid, Levoxyl) at doses ranging from 100-200 mcg daily, adjusted based on blood tests 2. Common side effects include temporary hoarseness, difficulty swallowing, and neck pain. Potential complications include damage to the parathyroid glands causing hypocalcemia (requiring calcium supplements), recurrent laryngeal nerve injury affecting voice, bleeding, and infection. Recovery typically takes 1-2 weeks, with most patients returning to normal activities within 10-14 days. Patients should follow up regularly with their doctor to monitor hormone levels and adjust medication as needed.
Recommendations for Thyroidectomy
- Total thyroidectomy is recommended for patients with thyroid cancer, goiter, or hyperthyroidism, as it provides the best chance for cure and minimizes the risk of recurrence 1.
- Patients with suspicious thyroid nodules should undergo fine-needle aspiration cytology (FNAC) and thyroid ultrasound to determine the need for surgery 3.
- Intraoperative nerve monitoring and surgical techniques geared to optimize voice outcomes should be used to prevent injury to the recurrent laryngeal nerve and other surrounding structures 4.
- Patients should receive lifelong thyroid hormone replacement therapy and regular follow-up to monitor hormone levels and adjust medication as needed 2.
From the Research
Thyroidectomy Overview
- Thyroidectomy is a surgical procedure that involves the removal of all or part of the thyroid gland, and it is often performed to treat thyroid cancer, goiter, or hyperthyroidism 5, 6.
- The incidence of thyroidectomy with lifelong hormone substitution is increasing, highlighting the need for optimal replacement therapy after surgery 5.
Levothyroxine Replacement Therapy
- Levothyroxine (L-T4) replacement therapy is commonly used after thyroidectomy to maintain euthyroidism, and the initial dose is often determined based on the extent of resection and preoperative thyroid function 5, 7.
- Studies have shown that a significant proportion of patients require L-T4 dose adjustments after thyroidectomy, emphasizing the need for close monitoring and follow-up 5, 8.
- Factors such as preoperative TSH levels, thyroiditis, and primary tumor size can influence the need for L-T4 supplementation after thyroid lobectomy 7, 9.
Surgical Management and Guidelines
- The American Association of Endocrine Surgeons has developed evidence-based guidelines for the definitive surgical management of thyroid disease in adults, which include recommendations for thyroidectomy and postoperative care 6.
- These guidelines aim to provide a standardized approach to thyroid surgery and to improve patient outcomes by reducing morbidity and mortality.
Postoperative Care and Complications
- After thyroidectomy, patients are at risk of developing hypothyroidism, which can be managed with L-T4 supplementation 7, 9.
- Close monitoring of thyroid function and adjustment of L-T4 doses are crucial to prevent over- and undersubstitution and to maintain euthyroidism 5, 8.
- Decision trees and algorithms can be used to estimate L-T4 dose adjustments and reduce the time to euthyroidism, although expert provider estimation remains an important aspect of postoperative care 8.