Surgical procedure for thyroidectomy (removal of the thyroid gland):
The thyroid gland is an internal endocrine gland responsible for producing and regulating two hormones that contain iodine: thyroxine (T4) and triiodothyronine (T3). Located in the front of the neck, just below the Adam's apple and above the chest bone, the gland consists of two lobes on either side of the trachea (windpipe). Connected by a narrow band called the isthmus, the lobes partially encircle the trachea. The thyroid gland is butterfly-shaped and has a reddish-brown color. Adjacent to the posterior side of the thyroid gland, there are smaller yellowish-brown structures known as the parathyroid glands, which produce parathyroid hormone (PTH) that regulates blood calcium levels.
Two common disorders affecting the thyroid gland's activity are hypothyroidism, characterized by insufficient hormone production or a lack of thyroid hormone production leading to low hormone levels in the blood, and hyperthyroidism, characterized by excessive hormone production resulting in high hormone levels in the blood.
Thyroid nodules can be categorized as benign or malignant. Nodules are more common in young women, and most of them are benign. In contrast, older men have a lower overall incidence of nodules, but their malignant nodules tend to behave more aggressively. Thyroid nodules are rare in children.
The most common source of malignant nodules is the thyroid gland itself. Papillary carcinoma is the most prevalent type of thyroid cancer, accounting for around 800 new cases detected in Israel annually. This type of cancer is typically identified as a non-sensitive lump in the mid-lower neck region, where the thyroid gland is located. A thyroid nodule biopsy is performed during the surgery and lasts about 15 minutes to determine if the nodule is malignant or benign.
The primary treatment for papillary carcinoma of the thyroid gland is a surgical procedure called total thyroidectomy, which involves the complete removal of the thyroid gland. Total thyroidectomy allows for subsequent treatment with radioactive iodine. Radioactive iodine is absorbed by any remaining thyroid tissue and destroys it. After the thyroidectomy, sensitive follow-up measures are employed to determine if the disease has recurred. For certain patient groups, such as young women with small and non-aggressive nodules, some centers have shown that a unilateral lobectomy (removal of one lobe) might be sufficient, though this approach is less common.
Thyroidectomy Procedure:
The surgery is performed under general anesthesia in the operating room. The thyroidectomy is carried out through a neck incision appropriate for the size of the nodule. In most cases, a small incision of about 4-5 cm is sufficient and is placed within skin folds to minimize its visibility. The affected lobe containing the suspicious nodule is removed first and sent for rapid pathological examination during the surgery, taking approximately 15 minutes.
If the pathology report confirms malignancy, based on pre-defined parameters, the surgery proceeds to remove the remaining lobe of the thyroid gland. If the pathology report is inconclusive, the surgery can be concluded with the removal of the first lobe only.
Complications of the surgery depend on the size of the thyroidectomy. In a unilateral thyroidectomy, the primary risk is an injury to the recurrent laryngeal nerve on the same side, which can cause hoarseness and occurs in only 1%-2% of patients.
With a total thyroidectomy, there are additional risks. Firstly, there is the possibility of injuring both recurrent laryngeal nerves, leading to bilateral vocal cord paralysis that might necessitate a tracheostomy to maintain an open airway. More commonly, there is a risk of damaging the parathyroid glands, resulting in a decrease in blood calcium levels, which may require calcium supplements temporarily. As with any surgery, there might be minor and temporary complications, such as local infection or bleeding, which are typically managed effectively.
Post-Surgery Radioactive Iodine Treatment:
The radioactive iodine treatment is designed to destroy any remaining thyroid tissue and nodules originating from the thyroid gland. Radioactive iodine is administered orally and eliminated from the body through bodily fluids, mainly urine, over several days. Special precautions and safety measures are taken during the early days following treatment. While in the past, patients were often hospitalized in isolation for a few days, it is now more common for patients to receive treatment on an outpatient basis, with basic radiation safety protocols observed.