Hemithyroidectomy with Isthmusectomy
Description
The thyroid gland is a butterfly-shaped gland in the lower front of the neck which has two lobes and a connecting body called the isthmus. The thyroid gland produces hormones into the blood that regulate the functions of muscles and organs such as the brain and heart and help the body use energy and remain warm. The thyroid gland may develop single or multiple, benign or cancerous growths or nodules which may produce symptoms depending on their location and size. Surgery is usually recommended to eradicate nodular growths by removing all or part of the gland. Hemithyroidectomy is a procedure to remove one lobe of the gland while an isthmusectomy involves removal of the isthmus. In case of extensive involvement of the gland, both of these procedures may be combined to remove one lobe along with the isthmus thus leaving a single lobe behind.
Symptoms
The nodular growth of the thyroid gland may be benign or cancerous. Often there are no symptoms and the condition is discovered accidentally on imaging studies for unrelated causes. A nodular growth may produce a visible lump on the neck. Pain or discomfort is sometimes present. Large growths may cause difficulty swallowing or may compress on the windpipe. It may rarely affect the laryngeal nerve controlling the vocal cords and produce hoarseness. There may be an excessive production of thyroid hormones (hyperthyroidism) causing various symptoms such as sweating, anxiety, weight loss or muscle weakness
Diagnosis
Your doctor will review your symptoms and medical history and perform a physical examination to evaluate the thyroid gland. The number, size and the location of thyroid growths are identified. A fine needle may be used to obtain a sample of tissue for laboratory evaluation to check whether the growth is benign or cancerous. Vocal cord function may need to be assessed. Your doctor may also evaluate you for familial syndromes involving thyroid gland tumours, though this is usually rare.
Untreated
Benign thyroid nodules may grow larger and more symptomatic if left untreated. Cancerous thyroid growths can metastasize or spread to other regions of the body and eventually cause death.
Treatment
Surgery is the main treatment for cancerous or symptomatic benign growths of the thyroid. Benign growths that are not symptomatic may be evaluated periodically for changes. The kind of surgery will depend on the extent of the disease. Sometimes only the nodule is excised, though this type of procedure is rarely performed. A hemi-thyroidectomy is more common and involves removal of one of the lobes of the thyroid. An isthmusectomy is performed when there is a small growth confined to the isthmus. For large or multi-nodular growths, a hemithyroidectomy with isthmusectomy may be performed. For more extensive involvement of the thyroid gland or conditions such as Graves’ disease, a total or near-total thyroidectomy may be recommended. In cases of cancer, removal of the surrounding lymph nodes may also be necessary.
Procedure
Surgery is usually performed under a combination of local and general anaesthesia. Your doctor may perform an open surgery using a standard incision in the neck or may use a minimally invasive technique involving a much smaller incision through which an illuminated tube containing a tiny camera is inserted to view the thyroid gland. Magnified images are displayed on a screen and help your surgeon guide miniature instruments to carry out the procedure. Thyroid surgery may also be performed with the help of robotic technology. The involved thyroid lobe and isthmus are removed and all or part of the other lobe is left intact. The skin is closed with dissolvable stitches and a bandage. A surgical drain may be left in the neck incision and is removed after surgery. The entire procedure takes about 2 to 2-1/2 hours and you can usually go home the same day.
Preparation
Before surgery, you will receive a complete medical evaluation and your doctor will discuss your surgery in detail. The anaesthetist attending the procedure will also evaluate you. You should notify your doctor of any allergies or any medications you are taking. You may be instructed to stop taking certain medications prior to surgery. From midnight before the procedure you should have nothing to eat or drink.
Post-operative Information
Following surgery, you will be taken to a recovery room where you are monitored for a few hours and will normally be able to return home the same day. Your throat may feel a little sore from the breathing tube that was inserted during the procedure. Eating and drinking may be a little painful initially. Your doctor will prescribe medications for pain. Routine activities may be resumed the day after your procedure. Avoid strenuous activity initially as this may result in broken stitches or a hematoma or blood clot in the neck. Within 2-4 weeks, your doctor will see you again and you can safely return to activities such as sports with no restrictions.
Outcome
The goal of surgery is to eradicate the nodular growths and retain part of the thyroid so that it can function normally. As with any surgical procedure, a hemithyroidectomy with isthmusectomy may be associated with certain risks such as excessive bleeding, damage to the laryngeal nerve resulting in hoarseness, low blood calcium levels if the parathyroid glands are damaged or removed along with the thyroid.
Down-time, lifestyle or off-work duration
Recovery takes about 1-2 weeks following which you can return to work. You can resume strenuous activity such as sports in 2-4 weeks.
Prognosis
Following surgery and recovery you can usually lead a normal life. Some patients may need thyroid replacement hormones if the remaining thyroid is deficient. In case of low calcium, supplements may be needed.
