60260 Thyroidectomy, removal of all remaining thyroid tissue following previous removal of a portion of thyroid

Name of the Procedure:

Thyroidectomy (Completion Thyroidectomy)

Summary

A thyroidectomy (specifically completion thyroidectomy) is a surgical procedure to remove the remaining thyroid tissue following a previous partial thyroidectomy. This procedure ensures that the entire thyroid gland is removed.

Purpose

The primary purpose of a completion thyroidectomy is to address residual thyroid tissue that may still cause or continue contributing to medical conditions. Expected outcomes include the reduction or elimination of symptoms and prevention of potential complications associated with thyroid tissues left behind, such as cancer recurrence or hyperthyroidism.

Indications

• Residual thyroid cancer or suspicious nodules detected after partial thyroidectomy.
• Persistent hyperthyroidism or thyroid disease not managed by initial surgery.
• Diagnostic evaluation revealing incomplete removal of thyroid tissue.
• Symptoms of thyroid dysfunction post initial surgery.

Preparation

• Fasting for a specified period before surgery (commonly 6-8 hours).
• Adjustment or discontinuation of certain medications as advised, especially anticoagulants.
• Preoperative blood tests, thyroid function tests, and imaging studies (e.g., ultrasound, CT scan).
• Discuss anesthesia options and any potential allergies with the surgical team.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made in the lower neck where previous surgery was performed.
3. Remaining thyroid tissue is carefully identified and dissected.
4. The thyroid tissue is removed, taking care to preserve surrounding structures such as the parathyroid glands and recurrent laryngeal nerves.
5. The incision is closed with sutures or surgical glue.
6. A drain may be placed to prevent fluid accumulation.

Duration

The procedure typically takes 1 to 3 hours.

Setting

Performed in a hospital's operating room or a surgical center equipped for major surgeries.

Personnel

• Surgeon (typically a general surgeon or an ENT specialist)
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Bleeding
• Infection at the surgical site
• Injury to nearby structures (e.g., parathyroid glands, recurrent laryngeal nerves)
• Transient or permanent hypocalcemia (low calcium levels)
• Temporary or permanent voice changes
• Seroma (fluid accumulation)

Benefits

• Complete removal of the thyroid tissue may cure or significantly manage the underlying thyroid condition.
• Reduces the risk of recurrence of thyroid nodules or cancer.
• Symptom relief usually begins shortly after the procedure.

Recovery

• Hospital stay for 1 to 2 days post-operation, depending on recovery and monitoring needs.
• Instructions for incision care and activity restrictions.
• Regular follow-up appointments to monitor recovery and thyroid function.
• Lifelong thyroid hormone replacement therapy may be necessary.
• Usually, normal activities can be resumed in a few weeks.

Alternatives

• Radioactive iodine therapy for certain thyroid conditions or cancer.
• Continued medical management with medications for non-cancerous conditions.
• Observation with regular monitoring if surgery poses high risks.
• Each alternative has specific pros and cons depending on the patient's situation.

Patient Experience

• Patients typically feel discomfort and mild to moderate pain at the surgical site for a few days, managed with prescribed pain medication.
• Drains, if placed, are usually removed within a few days.
• Hoarseness or voice changes may occur but often resolve over time.
• Expect some level of fatigue during healing, with gradual improvement over several weeks.