Name of the Procedure:

Thyroidectomy, Total or Subtotal for Malignancy with Limited Neck Dissection

Summary

A thyroidectomy is a surgical procedure to remove all (total) or part (subtotal) of the thyroid gland. This particular procedure also includes a limited neck dissection, which is a smaller-scale removal of lymph nodes around the thyroid to treat or prevent the spread of thyroid cancer.

Purpose

The procedure is aimed at treating thyroid cancer. By removing the thyroid gland and some surrounding lymph nodes, the surgeon aims to eliminate cancerous tissue and prevent the spread of the disease. The expected outcome is to cure or manage thyroid cancer and improve the patient's prognosis.

Indications

• Diagnosis of thyroid cancer
• Suspicious or confirmed malignant thyroid nodules
• Large or growing thyroid nodules that may suggest cancer
• Recurrence of thyroid cancer
• Enlarged lymph nodes in the neck potentially indicating cancer spread
• Patients typically are evaluated based on the stage and type of thyroid cancer, overall health, and response to other treatments.

Preparation

• Patients may need to fast for 8-12 hours before the surgery.
• Certain medications, particularly blood thinners, may need to be adjusted or stopped prior to the procedure.
• Preoperative blood tests, imaging studies (e.g., ultrasound, CT scan), and fine-needle aspiration biopsy may be required for assessment.
• A consultation with the surgical and anesthetic team to discuss the procedure and address any concerns.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made at the base of the neck.
3. The thyroid gland is carefully separated from surrounding tissues and major blood vessels.
4. Depending on the extent needed, the whole thyroid gland (total) or part of it (subtotal) is removed.
5. Limited neck dissection involves removing nearby lymph nodes to examine and prevent cancer spread.
6. The incision is closed with sutures or surgical glue, and a drain may be placed to prevent fluid accumulation.
7. The patient is taken to the recovery room to be monitored as they wake from anesthesia.

Duration

The procedure typically takes 2 to 4 hours.

Setting

The procedure is usually performed in a hospital's operating room.

Personnel

• Surgeon (specialized in head and neck or endocrine surgery)
• Anesthesiologist
• Surgical Nurses
• Operating Room Technicians
• Pathologist (may be consulted during surgery for rapid analysis of tissues)

Risks and Complications

• Common risks: bleeding, infection, hoarseness or change in voice, hypocalcemia (low calcium levels).
• Rare risks: injury to the recurrent laryngeal nerve (affecting voice), thyroid storm (a sudden and severe exacerbation of symptoms), and parathyroid gland damage (affecting calcium levels).

Benefits

• Potentially curative for thyroid cancer.
• Reduces the risk of cancer spreading to other parts of the body.
• Improved prognosis and quality of life.

Recovery

• Patients may stay in the hospital for 1-2 days post-surgery.
• Rest is advised for a few weeks; heavy lifting and strenuous activities should be avoided.
• Follow-up appointments will be scheduled to monitor recovery and hormone levels.
• Patients may be prescribed thyroid hormone replacement therapy since the thyroid gland is removed.

Alternatives

• Radioactive iodine therapy: Effective for some types of thyroid cancer and less invasive.
• Medication: Certain drugs can manage the condition but may not be a long-term solution.
• Close observation: Monitoring without immediate surgery for very small, slow-growing cancers.
• Pros: Less invasive options may have shorter recovery times.
• Cons: Some alternatives may not be as effective in thoroughly treating cancer.

Patient Experience

• Patients are asleep and do not feel pain during the procedure due to general anesthesia.
• Postoperative pain and discomfort are managed with pain medications.
• A sore throat, mild neck pain, and temporary hoarseness are common.
• Most patients can return to normal activities within a few weeks, with long-term follow-up necessary to monitor thyroid hormone levels and general health.