Thyroidectomy
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2008-06-05T23:24:02Z
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Date the maintenance tags or general fixes
{{Interventions infobox |
Name = Thyroidectomy |
Image = |
Caption = |
ICD10 = |
ICD9 = 06.3 |
ICD9_mult = {{ICD9proc|06.5}} |
MeshID = D013965 |
OtherCodes = |
}}
A '''thyroidectomy''' involves the [[surgery|surgical]] removal of all or part of the [[thyroid gland]]. Surgeons often perform a thyroidectomy when a patient has thyroid [[cancer]] or some other condition of the thyroid [[gland]] (such as [[hyperthyroidism]]). Other indications for surgery include cosmetic (very enlarged thyroid), or symptomatic obstruction (causing difficulties in swallowing or breathing).
The thyroid produces several [[hormone]]s, such as [[thyroxine]] (T4), [[triiodothyronine]] (T3) and [[calcitonin]].
After the removal of a thyroid patients usually take prescribed oral synthetic thyroid hormones to prevent the most serious manifestations of the resultant [[hypothyroidism]].
Less extreme variants of thyroidectomy include:
* "hemithyroidectomy" (or "unilateral lobectomy") -- removing only half of the thyroid
* "isthmectomy" -- removing the band of tissue (or [[isthmus]]) connecting the two lobes of the thyroid
A "thyroidectomy" should not be confused with a "[[thyroidotomy]]" ("[[thyrotomy]]"), which is a ''cutting into'' (-otomy) the thyroid, not a ''removal'' (-ectomy) of it. A thyroidotomy can be performed to get access for a [[median laryngotomy]], or to perform a [[biopsy]]. (Although technically a biopsy involves removing some tissue, it is more frequently categorized as an -otomy than an -ectomy because the volume of tissue removed is minuscule.)
== Indications ==
Malignancy
<br />Cosmetic reasons
<br />[[Goitre]] which is untreatable by medical methods
<br />Severe [[hyperthyroidism]] refractory to conservative treatment
<br />Orbitopathy in [[Graves' disease]]
<br />Removal and evaluation of a nodule whose [[FNAB]] results are unclear
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== Steps ==
Main steps of Thyroidectomy:
# [[Exposure]] - horizontal neck incision, +/- raising of flaps, +/- division of strap muscles
# [[Identification of essential structures]] - Recurrent and ext. branch of superior laryngeal nerve, parathyroid glands
# [[Devascularization]]
# [[Resection]]
# [[Exploration of other pathology]] - e.g. contralateral lobe, lymph nodes
# [[Closure]]
{{Expand-section|date=June 2008}}
== Complications ==
#[[Hypothyroidism]] in up to 50% of patients after ten years
#[[Laryngeal nerve]] injury in about 1% of patients, in particular the [[recurrent laryngeal nerve]]: Unilateral damage results in a hoarse voice. Bilateral damage presents as laryngeal obstruction on removal of the tracheal tube and is a surgical emergency: an emergency [[tracheostomy]] must be performed. Recurrent Laryngeal nerve injury may occur during the ligature of the inferior thyroid artery.
# [[Hypoparathyroidism]] temporary in many patients, but permanent in about 1-4% of patients
# [[Haemorrhage]]/[[Hematoma]]
# [[Thyrotoxic crisis]]
# [[Surgical scar/keloid]]
# [[Infection]]
# [[Anesthetic complications]]
==External links==
* [http://health.yahoo.com/health/encyclopedia/001159/0.html Yahoo]
* [http://www.thyroidectomy.com Minimally Invasive Endoscopic Video Assisted Thyroid & Parathyroid Removal Surgery]
* [http://gallery.hd.org/_c/medicine/_more2006/_more08/thyroidectomy-total-scar-on-neck-of-adult-male-patient-after-thyroid-gland-surgically-completely-removed-to-eliminate-small-cancerous-nodule-1-ANON.jpg.html Early postoperative scar images]
{{Endocrine system intervention}}
[[Category:Surgical procedures]]
[[Category:Shoulder surgery]]
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