Thyroid surgery: when is it necessary?
Thyroidectomy, or the removal of the thyroid gland, is a very common surgery in Italy: in fact, there are different clinical conditions for which, where the drug therapy has not been successful, it is necessary to intervene surgically.
Pathologies such as the so-called goiter, but also nodules or tumors, or a simple hyperthyroidism that cannot be effectively treated with other therapies are some of the cases in which it is necessary to resort to a "surgical action.
Understandably, the patient, when faced with the prospect of undergoing surgery, often has many doubts and some worries. For this reason, Tiroide.com asked Prof. Celestino Pio Lombardi, Director of the U.O. of Endocrine Surgery of the Columbus Integrated Complex (CIC) / Policlinico “A. Gemelli "in Rome, answers to the most common questions regarding thyroidectomy:
What are the surgeries that are performed on the thyroid gland? When are they needed?
Today we essentially practice two types of surgery: hemithyroidectomy (or lobe-isthmectomy) when half of the gland (and possibly also the isthmus) is removed, and total thyroidectomy, when it is completely removed. The indication of the type of intervention is given based on the type of pathology. For example, total thyroidectomy is the intervention of choice in cases of pathological involvement of the entire thyroid gland or in the diagnosis of carcinoma. However, the indications for thyroidectomy can be posed not only for neoplasms but also for benign pathologies that cannot be controlled with medical therapy or with radiometabolic treatment, such as hyperthyroidism (e.g. Basedow's disease) or, as in his case, multinodular goiter.
I was diagnosed with thyroid nodules and the need for thyroidectomy. Does the operation present any risks? What if they couldn't just remove the lumps?
The so-called "enucleo-resection", ie the removal of only the nodules, is an absolutely obsolete operation that has not been done in the Western world for many years, but the thyroidectomy surgery is not particularly heavy for the patient, especially if performed with minimally invasive endoscopic techniques, developed in Italy in the late nineties. The most established is video-assisted thyroidectomy, also known by the acronym MIVAT (Minimally Invasive Video Assisted Thyroidectomy), currently performed routinely in some specialized centers.
It is one of the most performed interventions in our country: over 40 thousand are carried out every year. In fact, more than 6 million people in Italy suffer from thyroid problems. Of these alone in Lazio would be 600,000, of which at least half in Rome. In 80% of cases they are women: a quarter are under 40 years old.
I need to have a thyroidectomy: what kind of anesthesia will they give me? And will the operation have permanent consequences?
For these interventions, anesthesia is almost always of a general type. Only in some very selected cases (such as pregnant women or patients with severe cardio-respiratory diseases), local anesthesia can also be used, "blocking" the superficial cervical plexus and infiltrating the dissection planes.
As for the consequences, keep in mind that endocrine surgeons are top-notch specialists, and in such experienced hands the specific complications of thyroidectomy are very low. There may be dysphonia (altered tone of voice) and low blood calcium levels (hypoparathyroidism) both - almost always - temporary, and which can be treated with medical therapy.
What will be the recovery times after the surgery? What therapy will I have to follow next?
Let's say that, if it does not present particular problems, even in the first day you can get up, walk and have breakfast.
In the case of hemithyroidectomy, the patient can also be discharged the day after surgery. In total thyroidectomy, that is, in his case, discharge usually takes place on the second post-operative day.
Furthermore, the surgery scar generally becomes almost invisible after a few months: as you see, the post-operative course is quick and problem-free.
Also with regard to the subsequent treatment you should not worry: once all or part of the thyroid has been removed, the so-called replacement therapy is necessary with the daily intake of levothyroxine in small tablets or in liquid solution, but this therapy allows you to lead a perfectly life normal. When the patient is discharged, the levothyroxine dosage is calculated on the basis of weight and, after a few weeks, it can be optimized on the basis of hormonal controls.
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