Thyroidectomy - Malignant tumours of the thyroid

Thyroidectomy

Hyperthyroid patients must be made euthyroid before thyroid surgery using antithyroid drugs and β-blockers to reduce complications such as cardiac arrhythmias, excessive sympathetic activity and bleeding.

The thyroid is exposed via a transverse skincrease incision above the sternal notch. The lobes of the thyroid are supplied by the superior and inferior artery, and drained by the middle and inferior veins. These are dissected out, ligated and divided removing the desired amount of thyroid tissue. Surrounding structures that require identification and protection include the parathyroid glands and the recurrent laryngeal nerves.

·        Complications include haemorrhage, leading to tracheal compression; damage to the superior or recurrent laryngeal nerve; damage or excision of parathyroid glands; and scarring. Neuropraxia (temporary damage) of the recurrent laryngeal nerve occurs in 5% of operations. The ipsilateral vocal cord becomes paralysed and fixed midway between closed and open. Bilateral nerve injury is rare but causes stridor and may subsequently require laryngoplasty or permanent tra-cheostomy.

·        Postoperative calcium levels should be monitored to look for hypocalcaemia, which is usually transient, due to damage to the parathyroid glands. Subsequent hypothyroidism is treated with lifelong thyroxine supplements.