In connection with the rather unfavorable ecological situation of pathology, the thyroid glands are encountered today more often. Often, such a disease requires surgical intervention, involving the removal of the affected glandular tissue. This operation is called thyroidectomy.
The concept of
Thyroidectomy is the surgical removal of part or all of the thyroid gland. Such operations are considered technically difficult, because they require a lot of experience and high qualification from the surgeon.
Types of
There are several technical types of surgery to remove the thyroid:
- Total or complete thyroidectomy - involves the removal of the entire thyroid gland;
- Subtotal - when most of the organ tissues are removed during the procedure, but a very small part of the organ tissues is necessarily retained;
- Hemithyroidectomy - removal of the thyroid gland.
Indications and contraindications
Absolute indications for the operation are:
- Toxic diffuse goiter;
- Tumors of malignant origin;
- The formation of nodules in the thyroid gland that have arisen due to irradiation of the neck and head, or for other reasons;
- Hyper functionality of thyroid gland due to Graves disease;
- Other pathologies of thyroid.
In general, there are no contraindications to the operation, although the patient is necessarily subjected to a thorough preoperative examination, in order to identify problems with blood flow or cardiac activity. Such patients are often abolished or carried out under special control.
If the patient shows an acute infection or any chronic disease has become aggravated, then first he needs to undergo a course of his treatment and only then it will be possible to be operated on.
Preparation of
Operative interventions on the thyroid gland are carried out without any special preparation. The patient gives the necessary tests and passes instrumental and hardware studies.
If contraindications such as heart disease or the presence of acute infection are absent, then an operation is prescribed.
Course of operation
In general, all types of thyroidectomy are practically the same, only the volume of tissue removed and access to the organ differ. With open access on the neck, an incision is made, through which the necessary volume of tissues is removed. Then the wound is sutured, and drainage tubes are installed to avoid accumulation of fluid.
Sometimes, in order to prevent the spread of malignant process, adjacent lymph nodes are additionally removed.
Extraphascial thyroidectomy
This type of surgery involves the removal of the entire thyroid gland in its capsule, while the vessels that feed the gland are bandaged over the capsule. Prior to removal, mandatory visualization is carried out and parathyroid glands and laryngeal nerves are protected.
Video about the first in Russia total thyroidectomy with Da Vinci robot:
Video-assisted
Video-assisted thyroidectomy or MIVAT is a method of removing thyroid using endovideososurgical instruments and minimally invasive mini-access.
Similar operations on the thyroid gland are of low traumatic nature, because as they are carried out all manipulations are controlled by video equipment. That's why they are called video-broadcast.
Subtotal
During this surgical intervention, the isthmus, one lobe and part of the second lobe are removed. Usually, this operation is indicated for toxic diffuse goiter.
Endoscopic
Endoscopic removal of the thyroid gland is indicated in the presence of single nodules or small cysts. All manipulations are carried out through several small holes, in which the instruments and the endoscope chamber are found.
Possible consequences
In general, thyroidectomy is a complex procedure, but not life-threatening. Although the risk of postoperative complications persists.
The most common complications are:
- Possible damage to nerves or ligaments;
- Infection wounds;
- Bleeding;
- Hypothyroidism caused by a deficiency of thyroid hormones.
Usually, most complications arise due to non-compliance with the technology of performing surgery or the inexperience of the doctor. As for hypothyroidism, it occurs when a patient breaks the scheme of taking prescribed hormonal drugs.
Postoperative period
After thyroidectomy, the patient is left under medical supervision for a few more days. In the absence of complications after 3-4 days the patient is discharged home.
To prevent postoperative complications, it is recommended to protect the seam from possible injuries and damage.
Usually correctly performed operation is not complicated by hematomas, swelling and other problems.
Special surgical glue is applied to the seam, and silicone plaster is applied from above, preventing penetration of bacterial or infectious agents, accelerates healing and minimizes the risk of formation of a commissural or scarring process.
A few days after thyroidectomy a patient may feel a slight uncomfortable soreness, which is removed by taking painkillers.
There may also be some hoarseness or hoarseness, but eventually it will also go away if this complication was not caused by damage to the ligament apparatus.
Life after thyroidectomy
If the thyroid gland in the operation has been removed completely, the patient will be assigned lifelong reception of hormonal preparations. Usually they are absorbed without problems and fully replenish the hormonal needs of the body.
With all the recommendations of the endocrinologist and strict admission of prescribed medications, no adverse effects will occur.
Thanks to hormone therapy, patients manage to maintain normal weight and emotional-mental state, as well as other areas of the body. Periodically, it is necessary to take tests to determine the level of thyroid hormones.
What are the disability criteria?
Disability after thyroidectomy is not assigned to all patients.
- Group 1 is assigned if severe form of hypoparathyroidism occurs, undifferentiated cancer, cardiac abnormalities, or hypothyroidism.
- 2nd degree is assigned if the patient has oncology( grade 3) with a doubtful prognosis, hypoparathyroidism or hypothyroidism of grade II;
- 3 group is given to people who need minimum labor restrictions, with voice disorders, motor disorders in the shoulder joint or with mild hypothyroidism.
When appointing a disability, the patient is entitled to medical and social benefits.
Cost of operation
The price for thyroidectomy varies depending on the method of the operation, the clinic that provides such a service and many other factors.
The average cost of such intervention in the capital's clinics is 16,000-84,000 rubles.
The removal of the thyroid gland is not yet a verdict. Yes, the patient's life is changing a little, but it does not become limited and joyless. Therefore, if the endocrinologist insists on thyroidectomy, then there is no need to give up, which means that the operation is really necessary.