Removal of the thyroid gland – an operation to excision a node, one or both lobes together with the isthmus. Surgical intervention is indicated in case of ineffectiveness of medication treatment. Surgical treatment is prescribed for people with Graves’ disease , thyrotoxicosis, adenocarcinoma, multinodular goiter, etc. Possible consequences and complications are determined by the scope of the surgical intervention. 

Is it possible to cure the thyroid gland without surgery

Removal of the thyroid gland is a radical method of treating endocrine diseases.

Surgical intervention is used in extreme cases. If thyrotoxicosis, nodular goiter, and hyperplasia of the thyroid gland respond to drug therapy, they refuse to resect the organ.

The operation is assigned when:

• malignant tumors in the thyroid gland; 
• hormone-active nodes; 
• advanced form of Graves’ disease . 

Surgical treatment is carried out when target cells are insensitive to hormonal drugs, and there is a high risk of recurrence of the disease. Sometimes removing part or all of the gland becomes the only possible way to reduce the amount of thyroid hormones in the body.

Types of thyroid surgery

Many patients ask what is the name of the operation to remove the thyroid gland. It all depends on the method and scope of the surgical intervention. Specialists identify several types of surgical treatment:

• Thyroidectomy is an operation on the thyroid gland , during which both lobes are removed along with the isthmus. It is carried out with toxic goiter and malignant tumors in the gland. 
• Lobectomy – excision of only one lobe or isthmus. Surgeons try to preserve most of the gland in order to prevent a person from postoperative hypothyroidism. With Graves’ disease, one thyroid lobe is excised together with the isthmus and part of the second lobe. 

Partial removal is recommended only for non-oncological pathologies and a low risk of recurrence of neoplasms in the gland.

Total (complete) thyroidectomy provides the maximum radical treatment for malignant tumors in the thyroid gland. In some cases, surgeons excise not only the thyroid gland, but also regional lymph nodes. Subtotal resection involves the removal of more than 90% of the organ.    

Excision of part or all of the gland is performed in two ways:

• Video endoscopic – resection of a node or part of the gland through the mouth, back or front of the neck. The operation takes place under the control of an endoscope with a video camera at the end.
• Open – the classic method of excision of the thyroid gland through an incision in the neck up to 4 cm long. The surgeon carefully separates the recurrent nerves, and then removes the organ. The surgical incision is sutured with self- absorbable sutures.

Surgical intervention is fraught with bad consequences and complications, therefore, the indications for resection of the thyroid gland must be justified.

Indications for removal

Adenocarcinomas and large benign tumors in the thyroid gland are surgical conditions that do not respond to drug therapy. Complete removal is indicated for oncological pathologies: 

• anaplastic adenocarcinoma;
• follicular neoplasia;
• papillary carcinoma in the thyroid gland; 
• germination of the tumor into the surrounding tissue;
• relapses of adenocarcinoma;
• metastasis of cancer to regional lymph nodes, etc.

Surgical intervention is prescribed for advanced forms of non-oncological thyroid pathologies:

• diffuse toxic goiter;
• thyrotoxicosis;
• calcification of the gland parenchyma; 
• resistance to hormone replacement therapy; 
• retrosternal goiter;
• cystic formations in the gland; 
• nodular toxic goiter.

The extent of surgical intervention is determined by the degree of thyroid lesion. The procedure to remove one or both lobes at once takes from 40 minutes to 1.5 hours.

Preparing for thyroid surgery

At the preoperative stage, patients undergo diagnostics, which includes donating blood for hormones and instrumental studies:

• Ultrasound or CT of the thyroid gland;  
• biopsy of neoplasms; 
• scintigraphy – a radiological study of the secretory activity of the gland. 

To determine the scope of the operation, a tumor marker test is done . If atypical cells are found, it will be necessary to remove not only the tumor, but also the adjacent tissues. Before the procedure, patients are informed about all possible risks and complications. 

The decision on partial or complete resection of the thyroid gland is made by the surgeon after consulting an endocrinologist, oncologist, otolaryngologist, etc. In oncological situations, reoperation is possible due to recurrence of adenocarcinoma. To prevent neoplasms, more than 76% of patients undergo further radiation therapy. 

How is the operation going

A person goes to the hospital one day before the operation. The last meal is recommended 12-14 hours before surgery. The procedure is carried out in several stages: 

• Marking and anesthesia. To form an even and inconspicuous scar in the projection of the thyroid gland, the lines of future incisions are marked. General anesthesia is done before the operation.
• Formation of access to the thyroid gland. A 6-7 cm long incision is made on the neck with a scalpel. The surgeon pushes the subcutaneous fat layer apart and examines the gland. In cancer, the condition of the regional lymph nodes is assessed. If there are no metastases, the incision is not deepened.
• Muscle dilution and organ removal. To isolate the thyroid gland, the neck muscles are transected or bred with metal holders. To prevent damage to the nerves, they are pushed closer to the trachea. The vessels are cut off one by one and the affected organ is carefully cut out so as not to hurt the parathyroid glands.   
• Stitching. A drainage tube is brought into the area of ​​the removed gland. The dissected muscles are sutured, after which cosmetic sutures are applied to the skin.

With total (complete) removal of the thyroid gland, continuous hormone replacement therapy with thyroxine is prescribed. For malignant pathologies, X-ray therapy or radioiodine therapy is performed .

In recent years , neuromonitoring has been carried out during thyroidectomy . A special apparatus emits electromagnetic pulses that excite the nerves. This makes it possible to determine the location of the nerve bundles and prevent their dissection at the time of removal of the thyroid gland. Thanks to neuromonitoring, the risk of neurological complications decreased by 58%.

Postoperative period after resection of the thyroid gland

If, after surgical treatment, the person’s condition is satisfactory, he is discharged from the hospital for 2-3 days. Elderly people are more difficult to tolerate surgery. After thyroidectomy, they are often worried about: 

• swelling in the neck;
• bleeding seams;
• dizziness.

Doctors warn that discomfort and pain in the neck area will be annoying for 2-3 weeks. To prevent complications, in the postoperative period it is recommended:

• eat liquid porridge, grated boiled vegetables and meat dishes;
• avoid heavy or prolonged physical activity;
• exclude alcoholic and carbonated drinks;
• take daily walks in the fresh air.

Within a month after surgical treatment, you must strictly observe the sleep and wakefulness regimen. Endocrinologists advise against going to public baths, swimming pools or gyms.

If only one thyroid lobe is removed, patients should undergo regular scintigraphy, at least once every 6-12 months.

Long-term rehabilitation and life after thyroid gland removal

Most patients are discharged 3-7 days after surgery. Within 1-3 months they are under the supervision of an endocrinologist. If most of the thyroid is removed, hormone therapy is prescribed . Patients are prescribed drugs with synthetic substitutes for thyroxine and triiodothyronine – levothyroxine and liothyronine : 

• L-thyroxine;
• Cytomel ;
• Eferox ;
• Triiodothyronine;
• Eutirox , etc.

To speed up recovery, vitamin and mineral complexes are included in the treatment regimen – Doppelgerts Active, Alphabet, Complivit , Vitaton . To prevent infectious diseases, immunostimulants are prescribed – Imunofan , Neovir , Petilam .  

Endocrine organ resection deprives a person of hormones that support the performance of all organs. In this regard, many patients have a reasonable question of how to live without a thyroid gland. 

To maintain hormonal balance, you need to take the medication prescribed by your doctor every day. Thyroid stimulating hormone substitutes compensate for the lack of thyroxine and triiodothyronine.

Within a month after the excision of a part of the gland, you need to follow a therapeutic diet, receive moderate physical activity. Proper nutrition and sports have a tonic and stimulating effect on the body.  

Consequences of thyroidectomy

After removal of the thyroid gland, some patients have early or delayed complications. The former include:

• swelling of the neck;
• postoperative bleeding;
• suppuration.

High fever, redness and soreness of the skin indicate infection of the operated area . In such cases, patients are prescribed antibiotic therapy with drugs from the group of aminoglycosides, cephalosporins. Within 1-3 days after surgery, damaged blood vessels may bleed. Such complications are more common in patients after 55-60 years of age.

Due to the purulent inflammation of the operated tissues, a noticeable scar remains. To remove it, they resort to laser resurfacing or plastic.

If nerves and parathyroid glands are touched during the operation, this is indicated by:

• hoarseness of voice;
• violation of the swallowing reflex;
• complete loss of sonority of the voice;
• convulsive syndrome;
• muscle stiffness.

In 0.5% of patients after thyroidectomy against the background of thyrotoxicosis, a thyrotoxic crisis occurs. It manifests itself with excessive sweating, abnormal heart rhythms, anxiety, and fever. Untimely treatment is dangerous and fatal.

If the thyroid lobes are removed completely, patients must strictly adhere to hormone therapy. Neglect of treatment causes hormonal imbalances and hypothyroid coma. Problems are indicated by: 

• hair loss;
• decrease in temperature;
• pathological dry skin;
• dysphonia (lack of voice);
• drowsiness;
• slow breathing.

In 90% of cases, the cause of death in hypothyroid coma is insufficiency of the respiratory and cardiovascular systems.

Contraindications to surgery

Surgery to remove the gland is not prescribed for:

• exacerbation of infectious diseases;
• uncontrolled hypertension;
• acute heart failure;
• impaired blood clotting.

With absolute contraindications to thyroidectomy, they resort to minimally invasive surgery or radioactive iodine therapy . It is undesirable to remove the thyroid gland during pregnancy. The operation is prescribed only in critical situations that threaten the patient’s life. 

The most popular questions and answers to them

Life without a thyroid gland is not much different from the one that the patient led before the operation. Subject to HRT (hormone replacement therapy), the endocrine system and the most important organs function without failures.

Treatment with hormonal drugs cannot be ignored, as this is fraught with coma and death.

What should be the TSH level after thyroid surgery?

The absence of a thyroid gland requires taking medications with levothyroxine . They prevent an increase in thyrotropin (TSH) in the blood. The reference values ​​of the hormone are in the range of 0.3-4.0 mU / ml.

How long do you live after thyroid resection?

If the thyroid gland is removed due to hyperthyroidism or multinodular goiter, this will not affect life expectancy. But if the cause of thyroidectomy is a cancer in the thyroid lobe, the prognosis will depend on the stage of the disease. The probability of a complete cure without health consequences is 85%, provided that adenocarcinoma is treated promptly. 

Is a normal life possible without a thyroid gland?

Patients who have removed one lobe of the thyroid gland are not prescribed HRT. After a total thyroidectomy, you need to take pills with levothyroxine or liothyronine daily . With HRT, patients live a full life without experiencing health problems.

Is it possible to get pregnant after removing the thyroid gland?

Fertility does not decrease after thyroid surgery. The absence of an organ does not affect pregnancy while maintaining hormonal balance with pills. After thyroidectomy, women can give birth to absolutely healthy children without endocrine pathologies.

Thyroid resection is an operation that is sometimes accompanied by early or delayed complications. After removal of the organ, a therapeutic diet and HRT are prescribed. When following medical recommendations, patients live a full life and do not experience serious health problems.