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Euthyroid

Thyroid Surgery

Thyroid Surgery



Surgical Options

1.Partial Thyroid Lobectomy (25% removed)

This operation is not performed very often because there are not many conditions which will allow this limited approach. Additionally, a benign lesion must be ideally located in the upper or lower portion of one lobe for this operation to be a choice.

 

2.Thyroid Lobectomy (50% removed)

This is typically the "smallest" operation performed on the thyroid gland. It is performed for solitary dominant nodules, which may be thyroid cancer or those which are indeterminate following fine needle biopsy. This surgery may also be appropriate for follicular adenomas, solitary hot or cold nodules, or goiters which are isolated to one lobe (not common).

 

3.Thyroid Lobectomy with Isthmusectomy (50% + isthmus removed)

 This simply means removal of a thyroid lobe and the isthmus (the part that connects the 2 lobes). This removes more thyroid tissue than a simple lobectomy, and is used when a larger margin of tissue is needed to assure that the "problem" has been removed. Appropriate for those indications listed under thyroid lobectomy as well as for Hurthle cell tumors, and some very small and non-aggressive thyroid cancers.

 

4.Subtotal Thyroidectomy (>50% removed )

Just as the name implies, this operation removes all the "problem" side of the gland as well as the isthmus and the majority of the opposite lobe. This operation is typical for small, non-aggressive thyroid cancers. Also a common operation for goiters that are causing problems in the neck or even those which extend into the chest (substernal goiters).

 

5.Total Thyroidectomy (100% removed)

This operation is designed to remove all of the thyroid gland. It is the operation of choice for all thyroid cancers which are not small and non-aggressive in young patients. Many surgeons prefer complete removal of thyroid tissue for all the different types of thyroid cancer.

Which operation is performed on a thyroid gland depends upon 2 major factors: The first is the thyroid disease present that is necessitating the operation. The second is the anatomy of the thyroid gland itself as is illustrated below.

 

If a dominant solitary nodule is present in a single lobe, then removal of that lobe is the preferred operation (if an operation is even warranted). If a massive goiter is compressing the trachea and esophagus, the goal of surgery will be to remove the mass, and usually this means a sub-total or total thyroidectomy (occasionally a lobectomy will suffice). If a hot nodule is producing too much hormone resulting in hyperthyroidism, then removal of the lobe that harbors the hot nodule is all that is needed.

 

Most surgeons and endocrinologists recommend total or near total thyroidectomy in virtually all cases of thyroid carcinoma. In some patients with small papillary carcinomas, a less aggressive approach may be taken (lobectomy with removal of the isthmus). A lymph node dissection within the anterior and lateral neck is indicated in patients with well differentiated (papillary or follicular) thyroid cancer if the lymph nodes can be palpated. This is a more extensive operation than is needed in the majority of thyroid cancer patients. All patients with medullary carcinoma of the thyroid require total thyroidectomy and aggressive lymph node dissection.

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