Thyroidectomy: Indications, Types, Risks, and Recovery

Thyroidectomy = surgical removal of part or all of the thyroid gland.

Indications

• Thyroid cancer (papillary, follicular, medullary, anaplastic).
• Symptomatic goiter (compression, cosmetic).
• Hyperthyroidism refractory/unsuitable for RAI/meds (Graves, toxic MNG).
• Indeterminate nodules (Bethesda III–IV) with molecular risk.

Types

• Total thyroidectomy: Entire gland removed. Standard for cancer, Graves.
• Near-total / subtotal: Small remnant left (historical for Graves; less common now).
• Lobectomy (hemithyroidectomy): One lobe ± isthmus. For low-risk unilateral cancer, toxic adenoma.
• Isthmusectomy: Isthmus only (rare).

Key Risks

• Recurrent laryngeal nerve injury → hoarseness (1–2% permanent).
• Hypoparathyroidism → hypocalcemia (transient 10–30%, permanent 1–3%).
• Hematoma, infection, seroma.
• Permanent hypothyroidism (total thyroidectomy) → lifelong levothyroxine.

Recovery

Outpatient or 23-hr stay. Calcium/vitamin D monitoring post-op. Voice check. Return to normal activity 1–2 weeks.