Name of the Procedure:

Thyroidectomy, including substernal thyroid; sternal split or transthoracic approach.

Summary

A thyroidectomy is a surgical procedure to remove all or part of the thyroid gland. When the thyroid extends into the chest (substernal thyroid), a more complex approach is required, involving a sternal split or transthoracic approach to access and remove the gland.

Purpose

The procedure is designed to treat thyroid conditions such as large goiters, thyroid cancer, or hyperthyroidism where the thyroid extends into the chest. The goal is to alleviate symptoms, prevent complications, and treat or remove malignancies.

Indications

• Large goiters causing airway or esophagus compression.
• Thyroid cancer with chest involvement.
• Uncontrollable hyperthyroidism.
• Symptoms like difficulty breathing or swallowing due to thyroid size.

Preparation

• Fasting after midnight before the surgery.
• Discontinuation or adjustment of certain medications as advised.
• Preoperative imaging and blood tests.
• A thorough physical examination and consultation with the surgical and anesthesia team.

Procedure Description

1. Anesthesia is administered to ensure the patient is asleep and pain-free.
2. An incision is made at the base of the neck or along the sternum.
3. The sternal bone is split or an alternative transthoracic approach is used to access the thyroid.
4. The thyroid gland is carefully removed through the chest cavity.
5. The surgical site is closed with sutures or staples, and a drainage tube may be placed.
6. The patient is moved to the recovery area for monitoring.

Duration

The procedure typically takes between 2 to 5 hours, depending on the complexity.

Setting

The procedure is performed in a hospital operating room.

Personnel

• A surgeon specializing in thyroid surgery.
• An anesthesiologist.
• Surgical nurses and technicians.
• A respiratory therapist (if needed).

Risks and Complications

• Bleeding and infection.
• Injury to nearby structures such as the vocal cords or parathyroid glands.
• Hypocalcemia (low blood calcium levels).
• Respiratory complications.
• Scarring or keloids.

Benefits

• Relief from compressive symptoms.
• Effective removal of cancerous thyroid tissue.
• Restoration of normal breathing and swallowing functions.
• Improved thyroid hormone levels.

Recovery

• Initial hospital stay of 1-3 days for monitoring.
• Pain management and antibiotics may be prescribed.
• Avoiding heavy lifting and strenuous activities for several weeks.
• Follow-up appointments to monitor calcium levels and surgical site healing.
• Long-term thyroid hormone replacement therapy may be necessary.

Alternatives

• Radioactive iodine treatment for hyperthyroidism.
• Medication to manage thyroid hormone levels or shrink goiters.
• Observation and regular monitoring for small, asymptomatic goiters.

Patient Experience

Patients may experience discomfort and pain after the procedure, managed with medications. Swelling and bruising around the incision site are common. Voice changes and difficulty swallowing may occur but typically improve with time. Most patients can resume regular activities within a few weeks, with specific instructions provided for a smoother recovery.