Thyroidectomy

A thyroidectomy removes part or all of the thyroid gland. It may be performed for thyroid cancer, suspicious nodules, compressive goiter, or hyperthyroidism that is not adequately managed with medication or radioactive iodine. The thyroid sits immediately anterior to the trachea. Its location explains the complications that matter most after surgery: bleeding can compress the airway, swelling or nerve injury can alter the voice or obstruct ventilation, and injury or impaired blood supply to the parathyroid glands can cause hypocalcemia. The parathyroid glands are small structures usually located on the posterior thyroid surface. They regulate calcium through parathyroid hormone (PTH). During a total thyroidectomy, the parathyroids can be bruised, devascularized, or inadvertently removed. When PTH falls, serum calcium may fall quickly enough to produce neuromuscular irritability, tetany, seizures, laryngospasm, and dysrhythmias. A lobectomy leaves thyroid tissue behind, so lifelong thyroid hormone replacement is not always needed. After a total thyroidectomy, the patient generally requires lifelong levothyroxine because the body can no longer produce thyroid hormone.