Total Thyroid Surgery
Total thyroidectomy involves removing both lobes and the isthmus. This operation is taken into account if the volume of the gland or of the nodule, among many other factors, is significantly enlarged and threatens to compress the adjacent anatomical structures, or if the patient has any suspicion of cancer or hyperthyroidism that cannot be cured with simple medication.
Surgery procedure and post-surgery effects
Thyroid ablation is performed in the surgical unit under general anaesthesia and consists of a cervical incision of about 5 cm at the base of the neck.
The neck is held in hyperextension in order to raise the thyroid gland, which is located behind the sternum. This procedure can cause postoperative pain. In the case of cancer, it is necessary to extend the operation to cervical ganglion chains, which lengthens both the skin incision and the duration of the operation.
The patient is hospitalized the day before or the morning of the surgery.
The complete excision of the gland (thyroidectomy) requires a hospitalization of 48 hours. A blood test will be taken every morning to ensure that there is no alteration of blood calcium levels. When leaving the hospital, the patient will receive analgesic treatment and hormone replacement therapy. The head and neck surgeon will visit his patient again after one week, in order to check the local development, mobility of vocal cords and to communicate the histological study of the surgical sample to the patient.
Some complications might occur during thyroidectomy. If one of the two lower laryngeal nerves (also called recurrent nerves, see the tables below), located on each side of the trachea behind each of the thyroid lobes, is injured, a voice problem may occur (dysphonia) because each nerve moves one of the two vocal cords. The injury of both nerves may cause breathing difficulties that require laser vocal cord surgery (a definitive procedure), or a tracheotomy, which is a temporary opening of the trachea at the base of the neck, a complex operation that only an ENT surgeon knows how to perform effectively.
The most common complication concerns the four parathyroid glands, which control the level of calcium in the blood and are contiguous to the thyroid gland (see tables below). In 7% of cases, these four small glands can temporarily stop working, from a few weeks to a few months. This leads to hypocalcaemia, which causes cramps (tetany) requiring daily calcium tablets. In 2% of cases, this hypocalcaemia will be permanent.
Another complication may be a hematoma (accumulation of blood), that can compress the trachea and require emergency intervention in the operating theatre.
Therefore, thyroidectomy is a delicate surgical operation, which must be performed by an experienced surgeon. The parathyroid glands and recurrent nerves should be systematically located and carefully dissected, in order to increase their chances of being preserved.
Two suction drains are left in place from 24 to 48 hours. The cutaneous incision is sutured in two planes with resorbable thread to whipstitch the dermis, which gives an excellent aesthetic result. In most cases, the scar is barely visible after a few months. The scar must be protected from direct exposure to the sun for a year.
Coverage of thyroidectomy by social security
This surgery is covered by social security, but your head and neck ENT surgeon may request an additional fee according to his degree of experience.
Dr. Stéphane Hervé is an ENT specialist and head and neck surgeon, who graduated from some of the best universities in France. In the thyroid surgery, he combines the precision of the surgical technique, which allows a discreet and aesthetic scar, with the technological innovation of the NIM-response 3.0 intraoperative nervous tracking system by Medtronic, which decreases the risk of nerve damage and insures good health at the end of the surgery. This device has led to a new surgical strategy in total thyroidectomy: the second lobe is operated on only if the nerve of the side first operated on is still functional.