60254 Thyroidectomy, total or subtotal for malignancy; with radical neck dissection

Name of the Procedure:

Thyroidectomy, total or subtotal for malignancy with radical neck dissection

• Common Term: Radical Thyroidectomy
• Medical Term: Total or Subtotal Thyroidectomy with Radical Neck Dissection for Malignancy

Summary

In a radical thyroidectomy, surgeons remove some or all of the thyroid gland and surrounding lymph nodes to treat thyroid cancer. This complex surgery aims to eradicate cancerous tissues and prevent the spread of the disease.

Purpose

This procedure addresses thyroid cancer by removing the primary malignancy and nearby lymph nodes to reduce the risk of metastasis. The goals are to eliminate the cancer cells, improve patient prognosis, and enhance the quality of life.

Indications

• Diagnosed thyroid cancer
• Enlarged thyroid obstructing breathing or swallowing
• Presence of cancerous lymph nodes in the neck

• Failure of other treatments for thyroid malignancy

  Patient criteria include confirmed malignancy via biopsy, visible signs of cancer spread, or significant symptoms impacting daily life.

Preparation

• Patients may need to fast for at least 8 hours before surgery.
• Medications, especially blood thinners, may require adjustment.
• Pre-operative blood tests, imaging studies like ultrasound or CT scans, and possibly a biopsy are performed.
• Consultations with anesthesia and endocrinology teams to optimize health status.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. Incision: A horizontal incision is made along the lower neck.
3. Thyroid Removal: The surgeon removes all (total) or part (subtotal) of the thyroid gland based on the extent of cancer.
4. Radical Neck Dissection: Lymph nodes and surrounding tissues potentially harboring cancer cells are excised.
5. Closure: Incisions are closed with sutures or surgical staples, and a drainage tube may be inserted to prevent fluid accumulation.

Tools used include scalpels, retractors, electrocautery devices, and specialized surgical instruments for delicate tissue handling.

Duration

The procedure typically takes 3-5 hours, depending on the cancer's extent and the amount of tissue removed.

Setting

This surgery is performed in a hospital's operating room and generally requires an inpatient stay for post-surgical monitoring.

Personnel

• Surgeons (often specialized in head and neck or endocrine surgery)
• Anesthesiologists
• Surgical nurses
• Operating room technicians
• Pathologists (may be involved intraoperatively for immediate tissue analysis)

Risks and Complications

• Common: Bleeding, infection, changes in voice, temporary or permanent hypocalcemia.
• Rare: Damage to surrounding structures (nerves, esophagus, trachea), severe hypoparathyroidism.

Complications are managed with antibiotics, pain relief, hormone replacement, or further surgical interventions if necessary.

Benefits

• Removal of cancer can lead to a significant reduction in symptoms and lower the risk of cancer spreading.
• Improved survival rates and long-term outcomes.
• Freed breathing or swallowing if previously obstructed by enlarged thyroid.

Recovery

• Hospital Stay: Typically 1-2 days.
• Post-Procedure Care: Monitoring calcium levels, thyroid hormone replacement therapy.
• Restrictions: Avoid strenuous activities for several weeks.
• Follow-Up: Regular visits to monitor healing and thyroid function, and ensure the absence of cancer recurrence.

Alternatives

• Radioactive iodine therapy: Often used for less invasive cancers.
• External beam radiation: For those unfit for surgery.
• Chemotherapy: Less common for thyroid cancer but used in specific scenarios.

Each alternative has different risk profiles and effectiveness based on individual patient conditions.

Patient Experience

Patients are temporarily uncomfortable with sore throat, hoarseness, or neck stiffness post-surgery. Pain is generally managed with medication, and overall discomfort diminishes as healing progresses. Emotionally, patients might feel anxious about living without a thyroid but are often reassured by the potential of a cancer-free future. Regular follow-ups and hormone management contribute to a positive outcome and gradual return to normal activities.