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.
Thyroid gland anatomy
- Nerves in close proximity to the thyroid gland
- Achieve euthyroid status preoperatively.
- Preoperative oral calcium and vitamin D supplementation
- Preoperative direct/indirect laryngoscopy
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|Subtotal thyroidectomy|| |
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- Transient/permanent postoperative hypoparathyroidism (most common) or hypothyroidism
- Transient/permanent RLN palsy
- Superior laryngeal nerve palsy → paralysis of cricothyroid muscle → easy voice fatigability; change in the timbre of voice
- hyperthyroidism (see "complications" of for further details) : if the surgery was performed in inadequately treated patients with
|Unilateral RLN palsy||Bilateral RLN palsy|
We list the most important complications. The selection is not exhaustive.