WordNet
- surgical removal of the thyroid gland
Wikipedia preview
出典(authority):フリー百科事典『ウィキペディア(Wikipedia)』「2014/04/22 14:31:11」(JST)
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Thyroidectomy |
Intervention |
Thyroid Surgery
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ICD-9-CM |
06.3-06.5 |
MeSH |
D013965 |
A thyroidectomy is an operation that involves the surgical removal of all or part of the thyroid gland. Surgeons often perform a thyroidectomy when a patient has thyroid cancer or some other condition of the thyroid gland (such as hyperthyroidism) or goiter. Other indications for surgery include cosmetic (very enlarged thyroid), or symptomatic obstruction (causing difficulties in swallowing or breathing). Thyroidectomy is a common surgical procedure that has several potential complications or sequela including: temporary or permanent change in voice, temporary or permanently low calcium, need for lifelong thyroid hormone replacement, bleeding, infection, and the remote possibility of airway obstruction due to bilateral vocal cord paralysis. Complications are uncommon when the procedure is performed by an experienced surgeon.
The thyroid produces several hormones, such as thyroxine (T4), triiodothyronine (T3), and calcitonin.
After the removal of a thyroid, patients usually take a prescribed oral synthetic thyroid hormone - levothyroxine (Synthroid) - to prevent hypothyroidism.
Less extreme variants of thyroidectomy include:
- "hemithyroidectomy" (or "unilateral lobectomy") -- removing only half of the thyroid
- "isthmectomy" -- removing the band of tissue (or isthmus) connecting the two lobes of the thyroid
A "thyroidectomy" should not be confused with a "thyroidotomy" ("thyrotomy"), which is a cutting into (-otomy) the thyroid, not a removal (-ectomy) of it. A thyroidotomy can be performed to get access for a median laryngotomy, or to perform a biopsy. (Although technically a biopsy involves removing some tissue, it is more frequently categorized as an -otomy than an -ectomy because the volume of tissue removed is minuscule.)
Contents
- 1 Indications
- 2 Types of Thyroidectomy
- 3 Steps
- 4 Complications
- 5 References
- 6 External links
Indications
- Thyroid cancer
- Toxic thyroid nodule (produces too much thyroid hormone)
- Multinodular goiter (enlarged thyroid gland with many nodules), especially if there is compression of nearby structures
- Graves' disease, especially if there is exophthalmos (bulging eyes)
- Thyroid nodule, if fine needle aspirate (FNA) results are unclear[1]
Types of Thyroidectomy
- Hemithyroidectomy - Entire isthmus is removed along with 1 lobe. Done in benign diseases of only 1 lobe.
- Subtotal thyroidectomy - Done in toxic thyroid, primary or secondary, and also for toxic multinodular goiter (MNG).
- Partial thyroidectomy - Removal of gland in front of trachea after mobilization. Done in nontoxic MNG. Its role is controversial.
- Near total thyroidectomy - Both lobes are removed except for a small amount of thyroid tissue (on one or both sides) in the vicinity of the recurrent laryngeal nerve entry point and the superior parathyroid gland. Done in papillary thyroid carcinoma.
- Total thyroidectomy - Entire gland is removed. Done in case of follicular carcinoma of thyroid, medullary carcinoma of thyroid.
- Hartley Dunhill operation - Removal of 1 entire lateral lobe with isthmus and partial/subtotal removal of opposite lateral lobe. Done in nontoxic MNG.
Steps
Main steps of Thyroidectomy:[1]
- Horizontal anterior neck incision (if possible, within a skin crease)
- Create upper and lower flaps between the platysma and strap muscles
- Divide vertically between the strap muscles and anterior jugular veins
- Separate the strap muscles from the thyroid gland
- Divide the middle thyroid vein
- Mobilize the superior pole of the thyroid lobe. Divide the superior thyroid artery and vein close to the thyroid gland (avoid injury to the external branch of the superior laryngeal nerve and the superior parathyroid gland)
- Identify the recurrent laryngeal nerve whenever possible using the nerve monitoring device
- Identify the inferior parathyroid artery
- Divide the inferior thyroid artery and vein
- Separate the thyroid lobe and isthmus from the trachea
- Repeat this process for the other thyroid lobe. Remove the thyroid gland
- Reapproximate the strap muscles
- Reapproximate the platysma muscle
- Close the skin with a subcuticular stitch
Complications
- Hypothyroidism/Thyroid insufficiency in up to 50% of patients after ten years
- Laryngeal nerve injury in about 1% of patients, in particular the recurrent laryngeal nerve: Unilateral damage results in a hoarse voice. Bilateral damage presents as laryngeal obstruction after surgery and can be a surgical emergency: an emergency tracheostomy may be needed. Recurrent Laryngeal nerve injury may occur during the ligature of the inferior thyroid artery.
- Hypoparathyroidism temporary (transient) in many patients, but permanent in about 1-4% of patients
- Anesthetic complications
- Infection
- Stitch granuloma
- Chyle leak
- Haemorrhage/Hematoma (This may compress the airway, becoming life-threatening.)
- Removal or devascularization of the parathyroids
References
- ^ a b Mathur AK and GM Doherty (2010). "Ch. 1: Thyroidectomy and Neck Dissection". In Minter RM and GM Doherty. Current Procedures: Surgery. New York: McGraw-Hill.
External links
- Patient brochure from the American Thyroid Association
- Surgical procedures Comprehensible and elaborate information from the New York Thyroid Center
- Article at Endocrineweb, written by an MD Goes into more detail
- Early postoperative scar images
- Thyroid Surgery Tutorial From the Patient Education Institute
- Minimally invasive and daycase thyroid surgery Comprehensive information from a UK Specialist Surgeon
Endocrine system intervention / Endocrine surgery (ICD-9-CM V3 06–07, ICD-10-PCS 0G)
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Pancreas |
- Islet cell transplantation
- see also digestive system procedures
- Noninvasive glucose monitor
- Glucose tolerance test
- see also Postprandial glucose test
- diabetes mellitus: Insulin tolerance test
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Hypothalamic/
pituitary axes
+parathyroid |
Pituitary |
- Hypophysectomy/Transsphenoidal surgery
- E/S: Combined rapid anterior pituitary evaluation panel
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Thyroid axis |
- Thyroidectomy
- Parathyroidectomy
- Medical imaging: Radioactive iodine uptake test
- Sestamibi parathyroid scan
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Adrenal axis |
- E/S: Cushing's syndrome
- Dexamethasone suppression test
- adrenal insufficiency
- Captopril suppression test
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Gonadal axis |
- see
- female genital procedures
- male genital procedures
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Pineal gland |
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General hormone therapy |
- Replacement therapy / in oncology
- sex reassignment
- female-to-male
- male-to-female
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noco (d)/cong/tumr, sysi/epon
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proc, drug (A10/H1/H2/H3/H5)
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UpToDate Contents
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English Journal
- An Evaluation of Postoperative Complications and Cost After Short-Stay Thyroid Operations.
- Narayanan S1, Arumugam D2, Mennona S3, Wang M3, Davidov T2,3, Trooskin SZ2,3.
- Annals of surgical oncology.Ann Surg Oncol.2016 May;23(5):1440-5. doi: 10.1245/s10434-015-5004-3. Epub 2015 Dec 1.
- BACKGROUND: Concern for postoperative complications causing airway compromise has limited widespread acceptance of ambulatory thyroid surgery. We evaluated differences in outcomes and hospital costs in those monitored for a short stay of 6 h (SS), inpatient observation of 6-23 h (IO), or inpatient
- PMID 26628433
- Microscopic Positive Tumor Margin Does Not Increase the Risk of Recurrence in Patients with T1-T2 Well-Differentiated Thyroid Cancer.
- Kluijfhout WP1,2, Pasternak JD3, Kwon JS1, Lim J1, Shen WT1, Gosnell JE1, Khanafshar E4, Duh QY1, Suh I5.
- Annals of surgical oncology.Ann Surg Oncol.2016 May;23(5):1446-51. doi: 10.1245/s10434-015-4998-x. Epub 2015 Dec 1.
- BACKGROUND: Incomplete surgical resection with gross positive tumor margin increases the risk of recurrence in patients with well-differentiated thyroid cancer (WDTC); however, it is not clear whether a microscopic positive margin found only on final pathology has similar implications on patient out
- PMID 26628431
- Endoscopic thyroidectomy using the EZ-VANS method.
- Nagata T1, Shimada Y2, Miwa T3, Hashimoto I3, Kojima H3, Okumura T3, Tsukada K3.
- Surgery today.Surg Today.2016 May;46(5):575-82. doi: 10.1007/s00595-015-1209-0. Epub 2015 Jun 22.
- PURPOSE: Several video-assisted and robotic surgery techniques have been reported for resection of the thyroid and parathyroid glands. Our institute has started performing endoscopic thyroidectomy using the Lap-protector and E·Z-access system, referred to as E·Z-access using video-assisted neck su
- PMID 26094967
Japanese Journal
- ステント留置後の肉芽増生管理に難渋した浸潤性甲状腺癌の1例
- 湯浅 玲奈,高木 啓吾,高橋 祥司,佐藤 史朋,田巻 一義,笹本 修一,秦 美暢
- 気管支学 : 日本気管支研究会雑誌 33(6), 458-463, 2011-11-25
- 背景.悪性気道狭窄のステント留置は狭窄解除に有効だが,留置後の肉芽増生は,その対応に苦慮することも多い.症例.71歳,女性.1981年,甲状腺乳頭癌の診断で甲状腺亜全摘術を受けたが,1995年,2001年に局所再発し追加手術を受けた.2007年甲状腺乳頭癌浸潤により左声帯麻痺が出現.2009年8月,甲状腺乳頭癌の気管浸潤によって気管が高度に狭窄し,労作時呼吸苦が出現した.気管切開を勧められるも受容 …
- NAID 110008896963
- 本多 啓吾,安里 亮,辻 純,神田 智子,牛呂 幸司,渡邉 佳紀,森 祐輔
- 耳鼻咽喉科臨床 104(10), 727-732, 2011-10-01
- … The microscopic group tended to undergo total thyroidectomy more often than the macroscopic group (9/13: 42/113, p=0.053, χ2). … Total thyroidectomy is the surgical method of choice in the presence of microscopic <key>multicentric</key> …
- NAID 10029659241
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