A surgical procedure performed through the front of the neck in which part or all of the thyroid gland is removed for nodules, goiter, hyperthyroidism, or cancer.
Indication
- Diagnosis of thyroid cancer or nodules suspicious for cancer
- Rapidly enlarging large goiter causing compression (shortness of breath, swallowing difficulty, voice changes)
- Lack of response to medical and radioactive iodine therapy in toxic nodular goiter or Graves' disease
- Recurrent thyroid cysts or large solitary nodules
- Substernal goiter (extending into the chest)
- Cases where medical therapy cannot be continued due to side effects of hyperthyroidism
Preparation
- No food or drink for 8 hours before the procedure
- Thyroid hormone levels (TSH, fT3, fT4) are kept under control
- Hyperthyroidism is brought to a euthyroid state with medical therapy before surgery
- Neck ultrasonography, fine-needle biopsy, and laryngoscopy when needed for vocal cord assessment
- Blood thinners are adjusted with physician approval; routine blood tests and ECG are performed
How it's performed
- Performed under general anesthesia, with continuous monitoring of vital signs
- A 4-8 cm horizontal incision (parallel to the natural skin crease) is made on the front of the neck
- The subcutaneous muscles are separated and the thyroid gland is exposed
- The thyroid tissue is removed while preserving the recurrent laryngeal nerves (controlling the vocal cords) and the parathyroid glands
- Lymph nodes in the neck may be removed when oncologically indicated (neck dissection)
- Bleeding is controlled; the layers are closed with cosmetic suture technique, and a drain is placed if needed
Post-procedure
- Hospital stay is generally 1-2 days
- Calcium levels are monitored; calcium and vitamin D supplements are started when needed
- Lifelong thyroid hormone (levothyroxine) replacement is required after total thyroidectomy
- Outpatient follow-up within 1-2 weeks for voice assessment and incision review
- Additional treatment (radioactive iodine, surveillance) is planned according to pathology results
Risks
- Temporary or permanent hoarseness (recurrent laryngeal nerve involvement, permanent rate 1-2%)
- Temporary or permanent low calcium (hypoparathyroidism)
- Bleeding, hematoma (carefully monitored, especially during the first 24 hours)
- Wound infection, keloid, or thick scar formation
- Anesthesia reactions, rare respiratory complications
FAQ
Will I need lifelong medication after the entire thyroid is removed?
After total thyroidectomy, the body cannot produce thyroid hormone, so lifelong levothyroxine (thyroid hormone) replacement is required. After half-thyroidectomy, some patients may not need medication.
Will I have a scar on my neck?
Because the incision is generally placed within a natural skin crease, its visibility decreases over time. The healing process, skin type, and care affect the quality of the scar.
Will my voice change permanently?
Temporary hoarseness is common and usually improves within weeks. Permanent voice change is rare and is minimized in experienced teams using nerve monitoring.
When can I return to normal life after surgery?
Most patients return to daily activities within 1-2 weeks. A 3-4 week rest period is recommended for heavy physical work and exercise.
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