Total Thyroidectomy - Post Procedure Healing of Thyroidectomy

   

Thyroidectomy should be performed only in patients who have previously been rendered euthyroid. Conventional practice is to stop the antithyroid drug 10-14 days before operation and to give potassium iodide (60 mg three times daily), which reduces the vascularity of the gland.

The operation should be performed only by experienced surgeons to reduce the chance of complications:

  • Early postoperative bleeding causing tracheal compression and asphyxia is a rare emergency requiring immediate removal of all clips/sutures to allow escape of the blood/haematoma.
  • Laryngeal nerve palsy occurs in 1%. Vocal chord movement should be checked preoperatively. Mild hoarseness is more common and thyroidectomy is best avoided in professional singers!
  • Transient hypocalcaemia occurs in up to 10% but with permanent hypoparathyroidism in fewer than 1%.
  • Recurrent hyperthyroidism occurs in 1-3% within 1 year, then 1% per year.
  • Hypothyroidism occurs in about 10% of patients within 1 year, and this percentage increases with time. It is likeliest if TPO antibodies are positive. Automated computer thyroid registers with annual TSH screening are used in some regions, and have demonstrated that a high proportion of patients become hypothyroid in the long term.

WHAT ARE THE INDICATIONS FOR Thyroidectomy?

Thyroid surgery (thyroidectomy) may be required if there is:

  • A lump that could be a malignant tumour (thyroid cancer). This is usually determined by a fine needle biopsy of the lump.
  • Growth of your thyroid down into the chest cavity (a retrosternal goitre)
  • Excessive activity of the thyroid (hyperthyroidism or thyrotoxicosis)
  • A goitre (enlargement of the thyroid) causing pressure on surrounding organs resulting in symptoms such as difficulty swallowing, difficulty breathing or a persistent cough.

Hyperthyroidism

Choice of therapy

Indications for either surgery or radioiodine are:

  • patient choice
  • persistent drug side-effects
  • poor compliance with drug therapy
  • recurrent hyperthyroidism after drugs.

Particular indications for surgery include:

  • a large goitre, which is unlikely to remit after antithyroid medication.

Why would the thyroid be taken out when it is not making enough thyroid hormones--that seems backwards(?) 

In the case of hypothyroidism, the gland may grow bigger as it tries futilely to produce sufficient amounts of hormones; thyroidectomy would be appropriate when hypothyroidism is accompanied by such resultant hypertrophy.


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