Thyroid Diseases
Thyroidectomy
Modern nerve-sparing thyroidectomy — total/subtotal/lobectomy is patient-specific; voice and calcium balance preserved.
What is thyroidectomy, when is it indicated, and what are the risks?
Thyroidectomy is the surgical removal of the entire thyroid gland (total) or part of it (subtotal/lobectomy). Indications: thyroid cancer, suspicious FNA cytology, compressive goitre, uncontrolled hyperthyroidism. Modern thyroidectomy uses intraoperative recurrent-laryngeal-nerve monitoring — temporary hoarseness 1–3%, permanent 0.5–1%. Parathyroid preservation keeps hypocalcaemia risk at 1–2%. After total thyroidectomy, lifelong levothyroxine replacement is required; after lobectomy, 20% of patients need it.
Total or lobectomy: how is the decision made?
For unilateral low-risk papillary microcarcinoma (≤1 cm) or benign nodule, lobectomy is often sufficient. Bilateral disease, multifocal cancer, high-risk histology, or neck lymph-node involvement requires total thyroidectomy. For hyperthyroidism (Graves), total thyroidectomy is standard.
The decision is shaped by tumour size, number, histology; the patient's general health; planned post-operative radioactive iodine; and lifestyle (nerve preservation is especially critical for professional voice users). ATA (American Thyroid Association) 2024 guidelines are the baseline reference.
Process
- 1
Consultation
1–2 weeks priorUltrasound, FNA if needed, hormone panel, vocal-cord exam.
- 2
Pre-op
1 day priorAnaesthesia consult, final hormone check.
- 3
Surgery
2–4 hoursGeneral anaesthesia, nerve monitoring, parathyroid preservation, drain placement.
- 4
Hospital night(s)
1–2 nightsCalcium monitoring, voice check, drain follow-up.
- 5
Post-op follow-up
Weeks 1, 4, 12TSH titration, calcium balance, voice assessment.
Frequently Asked Questions
- After total thyroidectomy, weight stays balanced on appropriate levothyroxine. Weight gain occurs if dosing is inadequate; regular TSH monitoring guides titration.
- A 4–6 cm horizontal incision in a neck crease is standard. Visibility decreases significantly over 6–12 months. Robotic or endoscopic thyroidectomy in selected cases moves the scar away from the neck (axillary, retroauricular).
- 2–3 days for daily activity, 1 week for desk work, 4 weeks for heavy exercise.
- After total thyroidectomy: initiated at discharge. Dose adjusted by TSH 4–6 weeks later. After lobectomy, initiation timing depends on the case.
- Numbness around the mouth, tingling in hands and feet, muscle spasm. With these symptoms: take your calcium tablet and contact the clinic. Temporary hypocalcaemia occurs in 5–10% and usually resolves in a few weeks.
- Imaging shared → tele-consultation → travel timeline → surgery → 1 hospital night → 2–3 days observation in Istanbul → safe return. Hormone follow-up by email/WhatsApp.
References
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