Thyroid Surgery and Minimally Invasive Thyroidectomy
Surgery on the thyroid gland - a thyroidectomy - involves the removal of all or part of the thyroid gland. This is now achieved with small cosmetic scars usually and just one night in hospital.
A thyroid lobectomy or hemithyroidectomy hemithyroidectomy involves the removal of half of the thyroid gland. The affected thyroid lobe and isthmus that connects it to the opposite lobe are removed along with the upward projection of the thyroid – the pyramidal lobe. This operation is performed mainly for the diagnosis of suspicious nodules, to exclude cancer, for unilateral thyroid swellings (goitres) and overactive thyroid nodules. Most patients will not require thyroid hormone (thyroxine) replacement following this procedure but patients are monitored in case it becomes necessary. Operations less than a lobectomy are outmoded and should not be performed.
A thyroid isthmusectomyis sometimes performed when just the isthmus (central part of the thyroid) requires removal
A total thyroidectomy is a procedure where all the thyroid gland is removed. This is the operation of choice in multinodular goitres, patients with Graves’ disease where surgery has been chosen, and it is mandatory in thyroid cancer. In the case of thyroidectomies for thyroid cancer the operation is slightly more involved since tissue surrounding the thyroid and lymph nodes that may have been involved in the cancer are also removed.
Thyroid surgery is safe when performed by experienced and appropriately trained specialist surgeons. Complications in thyroid surgery are infrequent and less likely to occur when surgery is undertaken by specialist thyroid surgeons working in a team that regularly undertake thyroid surgery. The principle permanent problems that may be encountered after thyroid surgery are voice change or hoarseness and a low calcium leading to the need to take calcium and vitamin D supplements for life. Bleeding, bruising and infection are all uncommon and should occur in less than 1% of cases.
Choosing your surgeon. There is a strong link between training and the experience of the surgeon and better outcomes in thyroid and parathyroid surgery. A very large study from Germany has demonstrated that surgeons performing less than 30 thyroidectomies per year are more likely to have complications following thyroid surgery. A study from the USA reinforces these findings suggesting that surgeons performing cumulatively more than 100 thyroidectomies and parathyroidectomies per year are most likely to achieve the benchmarks set by the world’s leading centres. Unfortunately, currently over 80% of thyroidectomies in the UK are performed by surgeons that perform less than 30 thyroidectomies per year. We recommend that patients requiring thyroid surgery find a specialist surgeon that regularly undertakes thyroid surgery in high volume. At the London Endocrine Centre we have well known teaching hospital endocrine surgeons Mr Palazzo and Mr Sadler that each perform over two hundred endocrine procedures per year.