A thyroid nodule, goiter, or malignancy is definitively treated with surgical removal. This is a well tolerated surgical procedure, done under general anesthesia. The incision is located in the low anterior neck across the midline. This heals in a cosmetically acceptable fashion and is generally not a source of significant complaint following surgery.
The important surgical risks relevant to the thyroid gland removal include the recurrent laryngeal nerve (RLN), and the parathyroid glands. The RLN is located posterior and medial to the thyroid lobe, and is routinely identified during the procedure to ensure it is protected. It functions to move the vocal cord on the same side, and injury would result in hoarseness or possibly breathing tightness. Great care is taken to ensure it is safe and not traumatized. The parathyroid glands are located in the vicinity of the thyroid lobes. There are typically four glands, and their locations are common but variable. All four can generally be preserved, though sometimes they can be unintentionally disrupted from their tissue connection and blood supply, or accidentally remove if attached or internalized in the thyroid lobe. They can all be preserved, but still have some temporary dysfunction following surgery. Typically, calcium supplementation is used during the post-operative recovery period to avoid extremely low levels of calcium in the blood from developing. Long-term dysfunction requiring supplementation is very uncommon.
Following surgery for a thyroid nodule or cancer, supplementation with thyroid hormone is necessary if the extent of removal of the thyroid gland is enough to cause hypothyroidism. Thyroid hormone is a simple and effective medication to take, typically once daily in the morning on an empty stomach. An endocrinologist or primary care doctor will be involved to manage this in the long-term.
For thyroid malignancy, the pathology report is evaluated following the surgery, as well as the intraoperative findings. No further treatment is needed for well-differentiated thyroid malignancy confined to the thyroid gland without significant adverse features. For some risk factors and patterns of spread, additional treatment with radioactive iodine is considered, in consultation with endocrinologist and nuclear medicine physicians.
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