Conventional thyroidectomy can be divided into three types: total thyroidectomy, subtotal thyroidectomy, and hemithyroidectomy. All three procedures are performed under general anesthesia.

Depending on the specific thyroid disease and individual patient circumstances, doctors will recommend different surgical treatment options.

Total Thyroidectomy

Total thyroidectomy is a surgical procedure that involves the complete removal of the entire thyroid gland. The surgery is performed under general anesthesia.

Since the thyroid gland is the only organ in our body that produces thyroid hormones, patients who undergo this surgery will need to take thyroid hormone replacement medication daily to maintain the metabolism of various organs in the body.

Total thyroidectomy is suitable for the following thyroid conditions:

Graves’ Disease with recurrent or refractory symptoms

If a patient with Graves’ disease does not respond well to medical treatment, experiences recurrent symptoms, or has relapses, the doctor may recommend total thyroidectomy to control the condition.

Thyroid Cancer

For most cases of thyroid cancer, total thyroidectomy is the preferred surgical treatment option, especially for patients with papillary thyroid cancer, as this type of cancer often involves multiple tumor nodules within the thyroid gland. Additionally, total thyroidectomy allows for effective monitoring of thyroglobulin levels post-surgery, which serves as an indicator for cancer recurrence. Factors such as the patient’s age, tumor size, and cancer characteristics will be considered by the doctor to determine the need for total thyroidectomy.

Multiple Thyroid Nodules

If a patient has multiple significant thyroid nodules or if the nodules are causing complications such as airway obstruction, the doctor may recommend total thyroidectomy to remove all the nodules.

Subtotal Thyroidectomy

Subtotal thyroidectomy refers to a surgical procedure in which the surgeon removes a portion of the thyroid gland while preserving approximately 4-5g of thyroid tissue on each side. By retaining some of the thyroid tissue, the doctor aims to allow patients with Graves’ disease to potentially avoid the need for thyroid hormone replacement therapy after surgery.

Hemithyroidectomy

Hemithyroidectomy is a surgical procedure in which one lobe of the thyroid gland, along with the isthmus (the middle portion), is removed. The surgery is performed under general anesthesia. Since patients retain one lobe of the thyroid gland after the surgery, they do not require thyroid hormone replacement medication.

Hemithyroidectomy is suitable for the following thyroid conditions:

Thyroid Cancer

For most cases of thyroid cancer, total thyroidectomy is the preferred treatment for a complete cure. However, in cases where the cancer is microscopic in nature (microscopic thyroid cancer), there is a possibility of treating it with a hemithyroidectomy to preserve one lobe of the thyroid gland and avoid the need for thyroid hormone replacement medication. However, there is ongoing debate in the medical community regarding whether these types of cancers should be treated with total thyroidectomy or hemithyroidectomy. Patients should consult with their doctors for advice and make an informed decision. Additionally, patients who undergo hemithyroidectomy for thyroid cancer cannot use thyroglobulin as a cancer marker to monitor for recurrence. The doctor must consider factors such as the patient’s age, tumor size, and cancer characteristics to determine the appropriate surgical approach.

Single Thyroid Nodule

If a patient has a single benign thyroid nodule, the doctor may opt for a hemithyroidectomy, eliminating the need for thyroid hormone replacement medication after surgery.

Multiple Thyroid Nodules

For patients with multiple thyroid nodules that are concentrated in one lobe of the thyroid, hemithyroidectomy may be performed to remove the main nodules while addressing any significant neck swelling issues. This surgical approach also allows patients to avoid the need for thyroid hormone replacement medication post-surgery.

• An enlarged neck goiter can affect a patient’s aesthetic appearance.
• An enlarged neck goiter can compress the trachea, causing difficulty in breathing.
• An enlarged neck goiter can extend posteriorly to the clavicle, encroaching upon the thoracic inlet.

It is recommended in the following conditions:

• Recurrent or uncontrolled Graves’ disease, or cases of Graves’ disease with relapse.
• Thyroid cancer.
• Thyroid nodules with a potential for cancer or cases where cancer cannot be ruled out clinically, such as follicular thyroid tumors or Hurthle cell lesions.
• Toxic nodular goiter, as this type of thyroid tumor can cause hyperthyroidism.

Thyroidectomy is performed under general anesthesia.

After the patient is anesthetized, the surgeon makes an incision of approximately 5 centimeters along the neck crease. Depending on individual case, the surgeon will perform a total thyroidectomy, subtotal thyroidectomy, or hemithyroidectomy. During the surgery, the surgeon carefully ligates the thyroid blood vessels and separates the thyroid from surrounding vital structures, such as the parathyroid glands and recurrent laryngeal nerves, to avoid injury to these important structures.

Finally, the surgeon stops any bleeding and sutures the incision, completing the surgery. A total thyroidectomy generally takes about 2.5 hours, while a hemithyroidectomy typically takes about 1.5 hours.

Patients can resume a normal diet approximately 4 hours after the surgery. It is common for the patient to stay in the hospital overnight for observation, and if there are no complications or discomfort during the morning rounds, the patient can be discharged to go home.

The doctor will schedule a follow-up appointment for the patient to return to the clinic after one week. During the follow-up visit, the doctor will explain the thyroid pathology report and remove the surgical sutures.

After surgery, your wound has been covered with sterile dressings and bandages. Please keep the wound clean and dry. Since the surgical wound has been covered with sterile dressings, you do not need to wash the wound regularly. However, if there is slight bleeding or any signs of seepage, you can clean the wound with disinfectant solution or saline solution, or notify the clinic nurse for assistance.

You should follow the doctor’s advice and schedule a follow-up appointment at the clinic to have the stitches removed.

You can resume your normal eating and daily activities during the recovery period.