Overview
Thyroidectomy is used to treat thyroid disorders, such as cancer, a noncancerous enlargement of the thyroid (goiter), and overactive thyroid (hyper-thyroidism). It's an operation that involves the surgical removal of all or part of the thyroid gland.
About Thyroidectomy
A thyroidectomy may be appropriate for people who have a thyroid tumor, thyroid nodules, or hyperthyroidism, which occurs when the thyroid gland produces too much thyroid hormone. Hyperthyroidism can be the result of an autoimmune problem, too much iodine in the diet, a benign tumor in the pituitary gland, too much thyroid medication, swelling (goiter) in the thyroid gland, or an inflammatory process. It takes about two weeks to fully recover from this surgery. This surgery is performed to treat thyroid disorders, such as cancer, a noncancerous enlargement of the thyroid (goiter), and an overactive thyroid (hyperthyroidism). Depending on the reason for surgery, some or all of your thyroid gland may be removed. If only part of your thyroid is removed (partial thyroidectomy), your thyroid may work normally after surgery. But if the entire thyroid is removed (total thyroidectomy), you’ll need daily treatment with thyroid hormone to replace your thyroid's natural function.
What is Thyroidectomy?
A thyroidectomy is a surgical procedure that involves the removal of all or part of the thyroid gland, a butterfly-shaped organ located at the front of the neck. This gland plays a crucial role in the body's metabolism by producing hormones that regulate heart rate, body temperature, and how quickly the body burns calories. The procedure is typically performed to address various thyroid-related health issues. The most common reasons for a thyroidectomy include:
Thyroid cancer: When cancerous cells are detected in the thyroid gland, a thyroidectomy may be necessary to remove the tumor and prevent the spread of cancer.
Goiter: A noncancerous enlargement of the thyroid can sometimes grow large enough to cause discomfort or difficulty in breathing or swallowing, warranting surgical intervention.
Hyperthyroidism: In cases where the thyroid gland is overactive, producing an excess of hormones, a thyroidectomy may be performed if other treatments, such as anti-thyroid drugs or radioactive iodine therapy, are not suitable or desired by the patient.
Suspicious thyroid nodules: Nodules that cannot be conclusively diagnosed as benign or malignant after a needle biopsy may require removal through a thyroidectomy, especially if they are at an increased risk of being cancerous.
The extent of the thyroidectomy depends on the underlying condition being treated. A total thyroidectomy involves the removal of the entire gland, while a partial thyroidectomy may involve removing only one lobe or part of the gland². The decision between a total or partial thyroidectomy is made based on factors such as the size and location of the thyroid issue, the presence of nodules, and the patient's overall health.
Why is Thyroidectomy needed?
Thyroidectomy, the surgical removal of all or part of the thyroid gland, is a critical procedure for managing various thyroid-related conditions. The thyroid gland, situated at the front of the neck, plays a pivotal role in regulating metabolism through hormone production. When its function goes awry, it can lead to serious health complications.
One of the primary reasons for thyroidectomy is thyroid cancer. Cancerous growths within the thyroid necessitate the removal of the affected tissue to prevent the spread of malignancy. The extent of the surgery, whether partial or total, depends on the cancer's progression. Early intervention with thyroidectomy can be life-saving and is often followed by additional treatments like radioactive iodine therapy or hormone replacement.
Another condition warranting thyroidectomy is a noncancerous enlargement of the thyroid, known as goiter. Goiters can cause discomfort, and difficulty in breathing or swallowing, and may also lead to cosmetic concerns. In some cases, goiters produce excessive thyroid hormones, leading to hyperthyroidism, which can exacerbate heart problems, osteoporosis, and other health issues.
Hyperthyroidism itself is another indication for thyroidectomy. When the thyroid gland produces an excess of hormones, it can result in weight loss, heart palpitations, anxiety, and other symptoms. If anti-thyroid medications or radioactive iodine therapy are ineffective or unsuitable, thyroidectomy offers a permanent solution to restore hormonal balance.
Thyroid nodules, which are lumps in the thyroid gland, may also necessitate surgery, especially if they are suspicious of cancer or cause symptoms due to their size or hormone production. While most thyroid nodules are benign, a thyroidectomy may be recommended if there's a risk of malignancy or if they contribute to hyperthyroidism.
In autoimmune conditions like Hashimoto's thyroiditis and Graves' disease, the immune system mistakenly attacks the thyroid, leading to its dysfunction. Surgery might be considered when other treatments fail to control the symptoms or when there's a significant goiter causing obstruction or cosmetic issues.
Post-surgery, patients may require lifelong hormone replacement therapy to compensate for the loss of thyroid function. This underscores the importance of a thorough evaluation and discussion with healthcare professionals to weigh the benefits and risks before proceeding with thyroidectomy.
What are the risks and side effects of thyroidectomy?
Voice changes, such as hoarseness
Sore throat
Bleeding and blood clots
Adhesions or scar tissue that require another surgery
Injury to the esophagus or trachea (windpipe)
Hypoparathyroidism (too little parathyroid hormone, which can result in abnormally low blood calcium levels)
Thyroidectomy recovery
Most people are ready to return home within one day of surgery, but you'll need 2 weeks off to fully recover. Patients should refrain from heavy lifting for 3 weeks after surgery.
Thyroidectomy Procedure
Diagnosis of thyroid diseases
The diagnosis of thyroid disease is a systematic process that involves a combination of medical history, physical examination, and specialized tests. The thyroid gland, responsible for regulating metabolism, can be affected by conditions such as hypothyroidism, hyperthyroidism, thyroid nodules, and thyroid cancer, each requiring a unique diagnostic approach.
Initially, healthcare providers gather a comprehensive medical history and perform a physical exam. Symptoms of thyroid dysfunction vary widely and can mimic other conditions, making accurate diagnosis challenging. Common symptoms include fatigue, weight changes, temperature sensitivity, and changes in heart rate.
Blood tests play a crucial role in diagnosing thyroid diseases. The primary test measures the level of thyroid-stimulating hormone (TSH) in the blood. Elevated TSH levels can indicate hypothyroidism, while low levels suggest hyperthyroidism. Further tests measure thyroid hormones, such as thyroxine (T4) and triiodothyronine (T3), to confirm the diagnosis.
In cases where thyroid nodules are present, additional tests such as ultrasound imaging help determine the nodules' characteristics. If cancer is suspected, a fine-needle aspiration biopsy may be performed to extract cells from the nodule for examination under a microscope.
For hypothyroidism, the diagnosis is confirmed when blood tests reveal high TSH and low T4 levels. Subclinical hypothyroidism, a milder form, is diagnosed when TSH is elevated, but T4 and T3 levels remain within the normal range. Treatment often involves thyroid hormone replacement therapy.
Hyperthyroidism diagnosis requires evidence of low TSH and high thyroid hormone levels. Conditions like Graves' disease or toxic nodules can cause hyperthyroidism. Treatment options vary from anti-thyroid medications to radioactive iodine therapy or thyroidectomy.
In autoimmune thyroid diseases like Hashimoto's thyroiditis and Graves' disease, antibodies against thyroid tissue may be detected through blood tests, providing further insight into the underlying cause of thyroid dysfunction.
Monitoring thyroid function is essential, especially after initiating treatment. Regular TSH tests ensure that medication dosages are appropriate and effective. Patients may need to adjust their treatment over time based on these test results.
Before Thyroidectomy
Before undergoing a thyroidectomy, a series of preoperative procedures are essential to ensure the safety and readiness of the patient for surgery. The process begins with a comprehensive evaluation by the healthcare team, including a detailed discussion of the patient's medical history and a physical examination. This pre-surgical phase is crucial for identifying any potential risks and preparing the patient for the procedure.
Patients may undergo several diagnostic tests before the surgery. These can include blood tests to assess thyroid function and levels of calcium and other electrolytes, which are vital for planning the surgery and postoperative care. Imaging studies such as an ultrasound of the neck may be performed to provide the surgeon with a clear view of the thyroid gland and surrounding structures.
In cases of hyperthyroidism, patients might be prescribed medications such as iodine and potassium solutions to stabilize thyroid hormone levels before the operation. This helps to minimize the risk of thyroid storm, a sudden and severe increase in thyroid hormones that can occur during or after the surgery.
Patients are also advised on medication management, especially if they are taking blood thinners or other drugs that could affect the surgery. They may need to stop certain medications or adjust dosages under the guidance of their healthcare provider.
On the day before the surgery, patients are typically instructed to fast, refraining from eating or drinking after midnight. This is to reduce the risk of aspiration during the administration of anesthesia. They are also advised to shower using antiseptic soap to decrease the risk of postoperative infection and to avoid applying lotions, perfumes, or deodorants.
The surgical site should not be shaved by the patient, as this can increase the risk of infection. Jewelry, piercings, and contact lenses must be removed to prevent any complications during the procedure.
On the day of the surgery, the patient will arrive at the hospital or surgical center, where the healthcare team will perform a final review of the patient's health status and surgical plan. The patient will then be taken to the preoperative area, where they will change into a hospital gown and have an intravenous (IV) line placed for the administration of fluids and medications.
How is Thyroidectomy performed?
The procedure begins with the administration of general anesthesia to ensure the patient is asleep and pain-free during the surgery. The surgeon then makes a horizontal incision in the neck, just above the collarbone, to access the thyroid gland. The size of the incision depends on the extent of the surgery required.
In a total thyroidectomy, the entire thyroid gland is removed. This is often necessary in cases of thyroid cancer or when the entire gland is overactive. A partial thyroidectomy, also known as a lobectomy, involves removing only one of the two lobes of the thyroid. This may be sufficient if the problem is limited to one side of the gland.
During the surgery, the surgeon must carefully identify and preserve the parathyroid glands, which are small glands located behind the thyroid that regulate calcium levels in the body. The surgeon also takes care to avoid damaging the recurrent laryngeal nerves, which control the vocal cords and are located near the thyroid gland.
The surgical approach can vary. The open method is the traditional approach, where the gland is removed through a single large incision. Endoscopic surgery is a minimally invasive option that uses smaller incisions and a camera to guide the surgery. Robotic surgery is another minimally invasive technique where the surgeon controls robotic arms to perform the procedure through small incisions, often resulting in less pain and a quicker recovery.
After the thyroid gland or the necessary part of it has been removed, the incision is closed with sutures or surgical glue. The procedure typically takes about 1-2 hours, and patients may spend a few hours to overnight in the hospital for observation.
Postoperative care includes monitoring for complications such as bleeding, infection, or voice changes. Patients may also require medication to manage pain and prevent infection. If the entire thyroid gland is removed, patients will need lifelong thyroid hormone replacement therapy to maintain normal metabolic function.
Type of Thyroidectomy
The types of thyroidectomies are primarily categorized based on the extent of the gland removed and the surgical approach used. The main types of thyroidectomies include:
Total Thyroidectomy: This involves the removal of the entire thyroid gland. It's typically indicated for thyroid cancer, large goiters causing symptoms, or an overactive thyroid when other treatments have failed. After a total thyroidectomy, patients require lifelong thyroid hormone replacement therapy.
Partial Thyroidectomy: Only part of the thyroid gland is removed in this procedure. Depending on the extent of the removal, partial thyroidectomy is further classified into:
Thyroid Lobectomy: Also known as hemithyroidectomy, where one lobe of the thyroid gland is removed.
Thyroid Lobectomy with Isthmusectomy: This surgery involves the removal of a thyroid lobe along with the isthmus.
Partial Thyroid Lobectomy: Only a part of the thyroid lobe is removed.
Subtotal Thyroidectomy: A small portion of the thyroid gland is left intact, often to prevent injury to nearby structures such as the parathyroid glands and the recurrent laryngeal nerve.
Completion Thyroidectomy: This procedure is performed to remove the remaining thyroid tissue after a partial thyroidectomy. It's typically done when the initial surgery's pathology report indicates cancer.
Near-Total Thyroidectomy: Most of the thyroid gland is removed, but a small amount of tissue is left on one side. This method is sometimes chosen to reduce the risk of damage to the parathyroid glands and the recurrent laryngeal nerve.
Isthmusectomy: Removal of the central part of the thyroid gland, which is less common and usually done for small nodules or cancers confined to the isthmus of the thyroid.
Each type of thyroidectomy has specific indications and is chosen based on the patient's condition, the nature of the thyroid disease, and the surgeon's expertise. The goal is to effectively treat the thyroid condition while minimizing the risk of complications and preserving the function of nearby structures. The choice of procedure is a critical decision made by the surgeon in consultation with the patient, considering the benefits and potential risks.
Thyroidectomy in Iran
Equipped hospitals and advanced specialized centers with experienced doctors and specialists are available in all medical treatment areas in Iran. Also, good hotels and entertainment centers have made Iran an appropriate choice for patients who suffer from thyroid gland diseases.
Thyroidectomy Cost in Iran
The cost of a thyroidectomy in Iran can vary depending on several factors, including the type of surgery, the hospital or medical center, the surgeon's expertise, and any additional treatments or services required. However, Iran is known for offering medical procedures, including thyroidectomies, at a fraction of the cost compared to many Western countries, without compromising on quality.
Iran has become a hub for medical tourism, attracting patients from all over the world seeking high-quality medical care at affordable prices. The country boasts some highly skilled surgeons and state-of-the-art medical facilities that are well-equipped to perform complex surgeries like thyroidectomies. Iranian surgeons are experienced in both conventional and minimally invasive thyroid surgery techniques, ensuring patients have access to the best possible care.
The affordability of thyroidectomies in Iran is one of the key reasons international patients choose to undergo surgery there. The cost of the procedure typically includes the surgeon's fee, hospital charges, anesthesia, and postoperative care. The cost of a thyroidectomy in Iran is around 2000-2500 USD. It's important to note that these prices are subject to change and may not include all potential costs, such as preoperative testing, medications, or any additional treatments that may be necessary.
