What Is Thyroidectomy:
The surgical procedure of removing the thyroid gland is known as thyroidectomy. This procedure is recommended by an endocrinologist and performed by a general surgeon. Thyroid gland forms an important part of the endocrine system. It is located in the neck region, with a pair of parathyroid glands lying over it. It regulates the calcium metabolism in the body along with performing other functions such as regulating metabolism including the heart rate, how fast the food moves via the gastro intestinal tract, managing iodine levels. The main thyroid hormones are T3 (triiodothyronine) and T4 (thyroxine); calcitonin secreted by the parafollicular cells of the thyroid gland. Thyroid disorders are five times more common in females than in males and affect approximately one third of the world’s female population.
Causes Of Thyroid Disorders:
The basic cause of any thyroid disorder lies in the fact that there is a severe disturbance in the secretion and regulation of the hormones. These are as follows:
- Hormones from the pituitary gland: This gland is located in the cerebrum (brain) area and releases a hormone known as thyroid stimulating hormone TSH. This hormone in turn is responsible for bringing about growth and development of the thyroid gland and triggers the gland for releasing their hormones for the regulation of calcium metabolism, body temperature and heart rate. Any disturbance in the release of TSH adversely affects the functioning of the thyroid gland.
- Radiation exposure: The thyroid cells are highly sensitive to radiation doses. Once this threshold is crossed, damage begins to develop in these cells leading to various degrees of carcinomas of benign and malignant type in the thyroid gland.
- Trauma/stabbing/accidents/injury: Any of these if occur to the thyroid gland either directly or indirectly lead to malfunctioning of the gland and a disturbance in the regulation of the metabolic activities.
- Iodine deficiency: Lack of the trace element iodine in the diet leads to swelling of the thyroid gland known as goitre.
Signs And Symptoms Of Thyroid Disorders:
- Enlarged thyroid gland, swelling in the neck in the midline
- Visible movement of the thyroid gland while swallowing or drinking water
- Pain and discomfort in the throat region
- Huskiness or hoarseness in voice
- Intolerance to heat or cold
- Weight gain even after eating very less; nil food consumption
- Weight loss even after eating sufficiently
- Increased or decreased body temperature
- Fatigue, lethargy
- Disturbed pulse/heart rate
- Hair loss, brittle hair, dry and itchy skin
- Irregular menstrual cycle
Types Of Thyroid Disorders:
- Hypothyroidism: It is the underactive state of the thyroid gland in which the gland produces lesser amount of hormones. Symptoms include intolerance to cold, weight gain, lethargy and swelling in the thyroid gland.
- Hyperthyroidism: This is the over active state of the thyroid gland where large amounts of hormones from the gland are produced. Symptoms include intolerance to heat, weight loss and an increased rate of metabolism such as pulse, heart rate and blood pressure.
- Goitre: This condition arises as a result of deficiency of iodine in the body. As a result of this, the thyroid gland enlarges in size to reach out and compensate for the deficiency of iodine. This element is required in trace amounts to help the thyroid gland to function normally.
- Thyroid nodules: These are lumps that develop within the thyroid gland. These are more common in males than in females above 40 years of age. These are majorly non cancerous nodules, mainly in cystic forms. They do cause discomfort to the affected patient; however pain may remain variable.
- Thyroid cancer: This too begins as a painless lump present in the thyroid gland. This usually causes a change in the voice such as increased hoarseness or huskiness. There are various types of cancers that can occur in the thyroid gland. Most commonly occurring is the papillary or the follicular type of cancer occurring in 85 percent of cases. This is followed by cell carcinoma Hurthle occurring in 10 percent cases. Medullary and anaplastic cancers occur in 3 and 1 percent cases respectively.
Diagnosis Required Prior To Thyroidectomy:
- Physical examination: The thyroid gland is observed for its location in the throat region, whether it moves with deglutition, its shape and size. the same things are confirmed on palpation where the temperature around the thyroid gland is checked, the mass is checked for its consistency. Lymph nodes adjacent to the gland are also palpated to check for their involvement. This will help in further deciding the additional diagnostic aids to be needed and plan the treatment.
- Blood tests: This is the most confirmatory for hyper and hypo thyroidism cases. Any aberrations in the levels of thyroid stimulating hormone TSH will help in the evaluation of thyroid disorders
- Endoscopy: In this method, a small camera fitted at one tube to a long tube is inserted in the throat so as to reach up to the thyroid gland. The entire anatomy of the gland can be studied with the help of images displayed on the television screen in the clinical setup of the endocrinologist.
- Ultrasonography USG: This makes use of non ionizing radiations to scan the thyroid gland and detect the presence of any cysts, tumors and lumps. USG will help in determining the exact location of the pathology, nature of the pathological site whether it is cystic or solid mass.
- Magnetic resonance imaging MRI: This is used to study the histology and cellular activity of the thyroid gland. It gives a complete soft tissue profile and image of the gland, where the tumor is located, to what extent has it invaded the gland and any chance of metastasis that can take place.
- Biopsy: This is an important diagnostic procedure in case of thyroid tumors. To the study the nature of the tumor mass, whether it is malignant or benign, a small portion of the cancer is resected from the thyroid by making incisions in the throat region. the resected part is then sent to the pathology labs for further examinations and deciding on the treatment plan accordingly.
- Fine needle aspiration cytology FNAC: In case any cyst is suspected to involve the thyroid gland, it becomes important to study its contents for understanding the nature of the pathology. Thus a long tubular fine needle is inserted into gland from an extra oral approach and the contents of the cyst are aspirated and sent to the laboratory for examination.
Treatment Procedures For Thyroidectomy:
The procedure is performed under general anesthesia where small incisions are made in the base of the neck in the ventral side and the gland is removed partially or completely depending upon the extent of pathology. However there can be three different approaches to the procedure. These can be as follows:;
- Conventional thyroidectomy: This is the standard method where a large incision is made in the midline of the neck from the front side. The gland is manipulated with hands and forceps and scalpels and removed as per the need.
- Endoscopic thyroidectomy: In this procedure, small incisions are made in the neck. These incisions help in the insertion of small endoscopic cameras and instruments. the cameras guide the surgeon to the gland and the instruments help in the surgical cutting and removal.
- Robotic Thyroidectomy: This is quite a recent advancement in the concept of thyroid removal. The incision is made in the chest, high in the neck or in the armpit region where access ttothe thyroid gland is gained.
Complications And Risk Factors Associated With Thyroidectomy:
The procedure can have both immediate and late complications. Immediate ones can occur at the time of surgery and also a day or two after the procedure has been completed. Complications that occur later happen after a period of one week or ten days. Immediate complications include:
- Hemorrhage, excessive and uncontrolled bleeding
- Airway obstruction
- Incorrect tracheostomy technique
- Parathyroid insufficiency or tetany
- Recurrent laryngeal nerve palsy, this occurs due to damage to the recurrent laryngeal nerve which lies in close proximity to the thyroid gland.
Late complications include:
- Infections at the site of wound
- Incorrect suturing techniques can lead to hematoma formation which can later pose a threat if it begins to bleed
- Overdose of anesthesia can result in variable degrees of numbness in and around the neck and throat
- Heaviness, hoarseness or huskiness in voice can also occur
Am I Good Candidate For Thyroidectomy?
You do not need a thyroidectomy under the following conditions:
- You are suffering from hypothyroidism or hyperthyroidism, since these conditions can be well managed with the help of medications.
- Goitre is on borderline, can be well managed with the help of iodine supplements
However, you do need a thyroidectomy under the following circumstances:
- You have been diagnosed with multiple small nodules in the gland or a single large nodule involving the glands.
- You are suffering from medullary/papillary thyroid carcinoma which is tremendously hampering your thyroid hormonal levels.
- Also the chemotherapy and radiation therapy you are undergoing does not seem to lessen your thyroid cancer symptoms; leave alone subsiding the cancer.
- Whether you need a complete thyroid gland removal or only a partial one, will be decided by your endocrinologist and the surgeon depending upon your symptoms and scans.
Since the procedure is performed under general anesthesia, the patient is required to stay in the hospital for at least a day or two. It also becomes mandatory to monitor the patient’s airway since incisions are done in the throat and a tracheotomy will also be needed. The patient can resume his or her activity after two three days, however heavy lifting of objects is not allowed until after two weeks. In case of any infections, bleeding or difficulty in breathing after ten days, the patient is advised to visit the nearest doctor as soon as possible.
Be it a partial or a complete thyroidectomy, success rate for both papillary and medullary cancers of the thyroid gland have a success rate of 98 percent in patients below 50 years of age. The rate begins to decline if the same is done after 50 years of age, being around 60 percent.
Benefits Of Thyroidectomy:
Following are the major advantages of getting your thyroid removal on time:
- You are spared from the pain (if any)and swelling in the neck
- The discomfort that is caused during eating/drinking water is avoided
- The chance of thyroid cancer getting metastatic and involving the other parts is avoided
- Calcium metabolism can be normalized as soon as possible
- The basic metabolic activities can be resumed and normal body functioning can be started
It would cost you around 80,000 to 90,000 INR if you opt for a thyroid removal operation in India. This is like peanuts as compared to what you will be required to pay in places abroad. This currency maybe what you will be made to pay just for the detection of your thyroid cancer through a single MRI scan!
Why Choose India?
Team MedcureIndia makes quite an apt proclamation is calling itself as one of the prime platforms of medical tourism in the country. And very righteously we direct our clients to the best of endocrinological institutes making sure our people are at safe hands.