SURGICAL TREATMENT OF THYROTOXICOSIS (OVERACTIVE THYROID GLAND)

Thyrotoxicosis or an overactive thyroid gland is  a condition in which the  thyroid gland is producing excessive Thyroid harmones.

This  can significantly affect the  quality of life.

The usual symptoms often include rapid heartbeat (palpitations), weight loss, sweating, fatigue and anxiety.

Treatment with medication ( Carbimazole / Propylthiouracil) is the first line of treatment and is effective in most patients.

However in patients who are resistant or intolerant to these medications and in patients whose symptoms relapse after medical treatment RadioactiveIodine and Surgical treatment are the other options.

This blog explores the indications for surgical treatment of thyrotoxicosis, the procedures involved, and patient expectations.

Indications for Surgery

Surgical treatment for thyrotoxicosis, primarily is a Total thyroidectomy, removal of the entire Thyroid gland is indicated in

:Patients do not respond well to antithyroid medications or experience adverse effects or have recurrent thyrotoxicosis

:Patients who have a significant enlargement of the thyroid gland - Toxic nodular Goitre.

: Patients in whom the thyrotoxicosis affects the eyes also known as Thyroid associated Opyhalmopathy

:Pregnant patients and patients with young children when radioactive iodine therapy is not an option, and antithyroid medications are not adequately controlling the condition.

:Suspicion of Thyroid cancer (not very common in an overactive thyroid) surgery is the right teatment.

:Patient preference: some patients opt for surgery to avoid the potential side effects of radioactive Iodine when treatment with medication is not effective.

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Types of Thyroidectomy

There are two  types of thyroidectomy procedures that are recommended and  performed, depending on the patient's condition and the surgeon's assessment:

1. Total Thyroidectomy: Removal of the entire thyroid gland. This is often recommended for patients with Graves' disease, a common cause of thyrotoxicosis, or those with a large toxic multinodular goitre.
2. Lobectomy: Removal of one lobe of the thyroid gland. This may be suitable for patients with a single toxic nodule, where investigations have confirmed the nodule  is the cause of the excessive production of thyroid harmones.
3. Subtotal Thyroidectomy: Partial removal of the thyroid gland, leaving a small portion intact is not usually recommended

The Surgical Procedure

A thyroidectomy is usually performed under general anesthesia and involves the following steps:

1. Preoperative Preparation: Patients undergo a thorough evaluation, including blood tests, imaging studies, and sometimes a fine-needle aspiration biopsy to assess the thyroid gland's condition.
2. It is extremely important for the Thyroid function to be well controlled prior to the operation, we work closely with the patient’s Endocinologist both before and after surgery for a smooth safe recovery.
3. Incision: The surgeon makes a small horizontal incision in the front of the neck, typically in a natural skin crease to minimize visible scarring.
4. Gland Removal: The surgeon carefully dissects the thyroid gland, taking care to preserve critical structures such as the recurrent laryngeal nerve and the parathyroid glands, which regulate calcium levels in the body.
5. Closure: The incision is closed with sutures or surgical clips, and a dressing is applied.

Postoperative Care and Recovery ( Should we say, refer to the information on the website?)

Recovery from thyroid surgery generally involves a hospital stay of one to two days, followed by several weeks of home recovery. Key aspects of postoperative care include:

• Monitoring: Vital signs and calcium levels are closely monitored immediately after surgery to detect any complications.
• Medication: Patients may need thyroid hormone replacement therapy if the entire gland is removed. Calcium supplements may be necessary if the parathyroid glands are affected.
• Follow-up: Regular follow-up visits are essential to monitor hormone levels and adjust medication as needed.

Risks and Complications

As with any surgery, thyroidectomy carries risks, including:

• Infection and Bleeding: Though rare, these can occur postoperatively.
• Voice Changes: Injury to the recurrent laryngeal nerve can lead to hoarseness or voice changes.
• Hypocalcemia: Accidental removal or damage to the parathyroid glands can cause low calcium levels, requiring supplementation.

Conclusion

Surgical treatment for thyrotoxicosis is a viable option for many patients, especially those who do not respond to other treatments or have specific indications for surgery. While the procedure carries some risks, advances in surgical techniques have significantly improved outcomes. Patients considering this option should have a detailed discussion with their Endocrinologist and Surgeon to understand the potential benefits and risks, ensuring an informed decision is made. With proper postoperative care, most patients experience a significant improvement in symptoms and quality of life.

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