Primary Indications

• It is highly suspected to be a thyroid malignancy or has been diagnosed as thyroid cancer.
• Patients with hyperthyroidism still fail after 1 year of drug therapy, or those with hyperthyroidism and tumors.
• Surgery is also the best choice for compressive or obstructive symptoms from thyroid nodules and the effect of large thyroid nodules on personal appearance.

Manners and Scope

• Tumor resection: only the nodules themselves are removed.
• Partial thyroidectomy: removal of the tumor and part of the thyroid tissue.
• Unilateral total thyroidectomy: removal of the unilateral total thyroid gland and the isthmus of the thyroid gland in the middle.
• Bilateral subtotal thyroidectomy: removal of more than half of the thyroid tissue on both sides, including the isthmic tissue.
• Near-total thyroidectomy: the thyroid gland and isthmus are resected, and only the posterior tissue of the contralateral thyroid is left less than 10% (about 2-3 grams).
• Total thyroidectomy: removal of both thyroid lobes and the isthmus.

Surgical Risk

Complications from thyroid surgery range from mild to flap hematoma, but can lead to death due to respiratory obstruction. Temporary hoarseness and transient hypoparathyroidism are common postoperative symptoms (< 2%).

Complications are broadly classified as follows:

• Postoperative wound infection (<1 % ).
• Unilateral recurrent laryngeal nerve paralysis may result in hoarseness or paralysis of the vocal cords. Bilateral recurrent laryngeal nerve paralysis may require emergency re-insertion into the endotracheal tube (< 1%). In severe cases, tracheotomy should be considered.
• Transient (2-14 %) or permanent hypothyroidism (<2 %), combined with hypocalcemia, limb numbness and convulsion after thyroid surgery.
• Postoperative bleeding may cause respiratory tract obstruction and endanger life in severe cases (<1 % ).
• Postoperative air embolism (<0.5 %), lymphorrhea (<1 %), esophageal injury (<1 %), pleural injury (< 0.1 %), cervical sympathetic nerve injury.
• Thyroid crisis (thyroid storm) may occur in patients with preoperative hyperthyroidism.
• Hypothyroidism: Treatment of postoperative hypothyroidism, oral thyroxine, follow-up examination of thyroid function. Patients undergoing total thyroidectomy should be given thyroxine for life after operation, while patients with benign thyroid diseases should be given medication or not according to thyroid function after operation.

Alternative Solutions

The treatment of hyperthyroidism includes taking antithyroid drugs and atomic iodine (I-¹³¹).

• Antithyroid drugs: can control thyroid toxicity, but will not permanently destroy the thyroid, and the treatment is more convenient and low-priced.

The side effects are blood and liver toxicity and drug allergy. The recurrence rate after discontinuation is also one of the shortcomings. After drug treatment has lasted for more than one year, if recurrence occurs after discontinuation, surgery may be considered.

• Radioiodine therapy for hyperthyroidism mainly aims to interfere with the replication of thyroid follicular cells, causing irreversible gradual decline in thyroid function.

The advantages are efficacy, safety and no need for hospitalization and surgery.

But there are some potential downsides to managing the condition: about a quarter of patients still experience hyperthyroidism two years later, and another consideration is the potential cancer risk. The biggest disadvantage of atomic iodine therapy is that almost all patients end up with hypothyroidism.

In terms of thyroid cancer, there is no effective alternative to surgical treatment except for the rare poorly differentiated thyroid cancer, for which surgical treatment is less helpful.

• Patients with thyroid cancer need to be de-iodinated for 4 weeks after surgery and have a radioactive iodine 131 (also known as atomic iodine) whole body scan.
• Tumor index blood sampling and follow-up examination will be arranged 3 to 6 months later.

If you have any questions about thyroidectomy, be sure to discuss it with your medical team. We are happy to explain again and serve you for your health.