Thyroid surgery
The following describes the operation using photographs. The operation is carried out under a general anaesthetic. X-rays before the operation will show if the windpipe (trachea) is pushed to one side by the thyroid swelling. The picture below shows the trachea deviated towards the left.
A sandbag is placed behind the shoulders and the neck extended. The skin is cleaned and sterile drapes positioned to maintain a clean operating field:
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The thyroid swelling is visible in the left side of the neck |
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The same swelling seen from the side |
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The incision is placed in the lower neck, 2 finger
breadths above the inlet to the chest
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A special retractor (Joll) is used to keep the skin edges apart |
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Once the thyroid vein has been divided, the upper pole of the gland (containing the superior thyroid artery and vein) is tied and divided |
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This allows the gland to be pulled up out of the wound |
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Careful exploration to the side will reveal the inferior thyroid artery, the recurrent laryngeal nerve to the vocal cord (seen here just below the finger) and the parathyroid glands |
Once the lesion has been removed any bleeding is stopped. The muscle layers are then closed - sometimes a drain is inserted to prevent the accumulation of blood. The skin is then closed with a dissolving stitch.
The extent of the surgery depends on the underlying condition. Essentially there are 3 possible operations:
Thyroid lobectomy - where one lobe, and usually the isthmus, is removed.
Subtotal thyroidectomy - where approx. 7/8 of the gland is removed. Small remnants are left on each side. This was the operation of choice for multinodular goitre but there is a 15% chance of needing further surgery later in life. This operation is rarely used now.
Total thyroidectomy - where all of the thyroid tissue is removed. Special care has to be taken to preserve the recurrent laryngeal nerves and the parathyroid glands.