Total thyroid lobectomy, unilateral; with contralateral subtotal lobectomy, including isthmusectomy
CPT4 code
Name of the Procedure:
Total Thyroid Lobectomy, Unilateral; with Contralateral Subtotal Lobectomy, including Isthmusectomy
Summary
This procedure involves the surgical removal of one complete thyroid lobe and most of the opposite lobe, along with the removal of the isthmus, which is the thin band of tissue connecting the lobes.
Purpose
The procedure addresses thyroid conditions such as multinodular goiter, hyperthyroidism, or localized thyroid cancer. The goals are to manage thyroid disease, alleviate symptoms, and prevent the spread of cancer, if applicable.
Indications
- Enlarged thyroid (goiter) causing airway obstruction or swallowing difficulties
- Hyperthyroidism unresponsive to other treatments
- Suspicious or malignant thyroid nodules
- Unilateral thyroid cancer with the potential spread to the contralateral lobe
Preparation
- Patients are usually instructed to fast for 8 hours prior to surgery.
- Certain medications, particularly those affecting blood clotting, may need to be adjusted or stopped.
- Preoperative blood tests, thyroid function tests, neck ultrasound, and sometimes a fine needle aspiration biopsy of the thyroid nodule(s) are conducted.
Procedure Description
- Anesthesia: The patient is placed under general anesthesia.
- Incision: A small horizontal incision is made in the neck.
- Exposure: The thyroid gland is carefully exposed.
- Lobectomy: One entire lobe of the thyroid is removed, followed by partial removal of the contralateral lobe.
- Isthmusectomy: The isthmus is excised.
- Closure: The incision is closed with sutures, and a drain might be placed to prevent fluid accumulation.
Duration
The procedure typically takes 2 to 3 hours.
Setting
This surgery is typically performed in a hospital operating room.
Personnel
- Surgeon (usually a specialized endocrine or general surgeon)
- Anesthesiologist
- Surgical nurses
- Operating room technicians
Risks and Complications
- Common risks include infection, bleeding, and temporary voice changes.
- Rare but serious complications may involve damage to the recurrent laryngeal nerve (causing vocal cord paralysis) or hypoparathyroidism due to inadvertent removal of parathyroid glands.
Benefits
- Alleviation of symptoms like breathing difficulty or swallowing problems.
- Management or potential cure of thyroid cancer.
- Resolution of hyperthyroidism leading to improved quality of life.
- Benefits may be noticed immediately to a few weeks post-surgery.
Recovery
- Patients usually stay in the hospital for 1 to 2 days post-surgery.
- Follow-up includes monitoring calcium levels, thyroid function tests, and potentially thyroid hormone replacement therapy.
- Most patients can return to normal activities within 1 to 2 weeks but should avoid strenuous activities for about a month.
Alternatives
- Medication for thyroid hormone control
- Radioactive iodine therapy for hyperthyroidism
- Watchful waiting with regular monitoring for small, non-aggressive tumors
- The choice depends on the specific condition, patient preference, and overall health.
Patient Experience
- During the procedure, the patient will be under general anesthesia and will not feel anything.
- Post-surgery, patients may experience a sore throat, mild neck pain, and temporary voice changes.
- Pain management includes prescribed pain relievers and measures like ice packs to reduce swelling.