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THYROIDECTOMY

What is thyroidectomy ?

A thyroidectomy is a surgery which involves removal of all or part of thyroid gland.

What is thyroid gland ?

It is a very important gland located at the base of the neck. It is butterfly shaped which produces thyroid hormone that regulates metabolism, bone growth. Heat production and heart rate and calorie burning Mechanism. Thyroid nodules are also called thyroid tumors.

More than 95% of thyroid nodules are usually considered to be benign (non cancerous) however, tests are needed to determine if a nodule is cancerous or not. Benign nodules are of several types.

When and why thyroidectomy is performed ?

Thyroidectomy is done to treat thyroid disorders, such as cancer (thyroid cancer), noncancerous enlargement of the thyroid (goiter) and overactive thyroid (hyperthyroidism).

In partial thyroidectomy only a portion of thyroid is removed, after which it starts functioning normally. In total thyroidectomy, the thyroid gland itself is removed, after which one has to be on artificial thyroid hormone as a replacement therapy.

Thyroid cancer : Thyroid cancer occurs at any age. Women are more prone to the same compared to men. It may affect the thyroid gland and may spread to other areas; hence thyroidectomy ensures that the cancer is removed completely.

Goitre : A thyroid gland that grows beyond its proportion is termed as goitre. A goitre may cause problems such as difficulty in breathing or swallowing, the best option would be thyroidectomy.

Hyperthyroidism : Excessive secretion of hormone thyroxin is termed as hyperthyroidism. Usually radio-active iodine therapy is used to treat this condition; thyroidectomy may be opted for by the doctors depending on the prognosis of the patient.

Symptoms

Most thyroid nodules cause no symptoms, but sometimes the person or a family member might see or feel a lump in the front of the neck.

The lump may cause pain or difficulty swallowing. If the nodule is secreting excessive amount of thyroid hormone, the person might feel heat intolerance, palpitation, fast heart beat, nervousness, insomnia, increased bowel movements, absent periods, fatigue, weight loss, hair loss or muscle weakness.

Causes and risk factors

The exact reason why nodules grow in the thyroid gland is not known. But these factors increase the risks of cancer

      Heredity: If a parent or sibling had a thyroid nodule, the chance of developing a nodule is increased manifold.
  • Age : the risk of developing anodules in the thyroid gland increases as one ages.
  • Gender : Women develop nodules more often than men.
  • Thyroiditis : Nodules are more likely to form in people who have chronic inflammation of the thyroid gland.
  • Radiation : Exposure to the head or neck increases the risk.

Exposure to any nuclear power plant accidents, or radioactive particles released into the air during atomic weapons testing also increases the risk.

Diagnosis

A combination of symptoms medical history physical exams and tests are used to determine a diagnosis. The TSH blood test measures a pituitary gland hormone that stimulates the thyroid gland. If the TSH level is increased the thyroid gland may not be functioning properly. Additional blood tests are needed to measure other thyroid hormones T3, T4. Both pituitary and thyroid tests are required to confirm the proximity of the cause to the thyroid gland.

Fine needle aspiration biopsy

A needle is placed into the thyroid nodule the cells are aspirated and then examined under a microscope to determine if a nodule is cancerous or not.

Thyroid ultrasound uses painless sound waves to create an image of the thyroid gland and identify nodules present.

Risks of the surgery

It is a safe and recommended procedure with apparent risks present.

Potential complications include :

Bleeding :

  • Bleeding occurs if a wound is formed after the surgery in very rare cases.
  • Infection after the surgery due to poor hygiene.
  • Airway obstruction caused by bleeding.
  • Permanent hoarse or weak voice due to nerve damage
  • Damage to the four small glands located behind the thyroid gland may lead to hypoprathyroidism, resulting in abnormally low calcium levels and an increase amount of phosphorous in blood levels.
How well it works

The Success rate depends upon the prognosis of the patient, adherence to the advice and maintenance of healthy lifestyle thereupon.

Before surgery
  • Medicenes such as Asprin or any other blood thining medications must be avoided one week prior to the date of surgery
  • Any allergies o specific medications must be screened.
  • Iodine and Potassium supplements may be prescribed to regulate the levels of iodine in the body
  • Fasting two three hours before the surgery is recommended.
During surgery

General Anasthesia is administered during the surgery. The vitals such as oxygen and blood pressure levels are constantly monitored during the surgery. The Surgery is usually done by making a small incision in the nape of the neck to extract the the thyroid gland which is partially affected or fully affected. Usually in case of malignancy, the thyroid gland itself is removed to avoid the same from spreading to other body parts.

Types of surgery

Conventional thyroidectomy :

In this surgeons make a small incision about 3-4 inches in the nape of the neck to directly access the thyroid gland. Then all or part of your thyroid gland will be cut off from surrounding tissues and removed. During the entire procedure the surgeons will have to pay attention to the location of the parathyroid glands (two pairs of small glands located near the thyroid).

Endoscopic thyroidectomy :

Surgical instruments and a small video camera are inserted through the incisions. The camera guides the surgeons through-out the procedure. At the end of the procedure the neck incision will be closed with stitches or dissolvable surgical tape.

Robotic Thyroidectomy :

The robotic approach allows a thyroidectomy to be performed while avoiding an incision in the centre of the neck by using robotic navigation techniques by a robotic machine.

After surgery

The recovery phase is 24 hours. Any fluid under the neck is completly drained off. Antibiotics are prescribed for better healing. Normal activities can be started 10 days after the surgery. In cas of procedures such as thyroidectomy, lobectomy with or without istmectomy or subtotal thyroidectomy, the body develops hypothyroidism. In case of malignancy radioactive iodine therapy is used to make sure that the thyroid tissue and cancer cells are irradicated. After surgery for hyperthyroidism some people will have abysmally low calcium levels and may need to take calcium supplements.

Recovery

The results of the surgery are positive and the expected recovery is very fast. The physiotherapist recommends exercises to reduce the stiffness around the neck muscles. Calcium and thyroid supplements may be prescribed to ease the condition of the patient.

Follow up

Our expert team of Endocrinologists ensure that the surgeries undertaken by us are a complete success. Regular follow up visits will be prescribed and the patient’s condition and his or her response to medication is closely and thoroughly monitored to avoid any post surgery complications at any point of time.

When to call us :-
  • Incision or any part of the neck that becomes red, tender or swollen.
  • Symptoms of a low blood calcium level, such as numbness around the mouth, tingling in your extremities, or spasms in feet hands or face.
  • Fever that persists.
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