甲状腺切除术 - 常见问题解答

Thyroidectomy - Frequently Asked Questions

                               
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Thyroidectomy

Definition

Thyroidectomy is really a surgical treatment in which any part of the thyroid gland is removed. A thyroid problem gland is found in the forward (anterior) part of the neck just below the skin as well as in front of the Adam's apple. The thyroid is one of the body's endocrine glands, which means that it secretes its products inside the body, into the blood or lymph. The thyroid produces several hormones that have two principal functions: they boost the synthesis of proteins in many of the body's tissues, and they raise the degree of the body's oxygen usage. To get rid of the thyroid gland, an incision is made at the front of the neck. Muscles and connecting tissue, or fascia, are divided. The veins and arteries above and below the thyroid are severed, and the gland is removed by 50 percent parts. The tissues and muscles are repaired before the skin incision is closed.

Description

A thyroidectomy starts with general anesthesia administered by an anesthesiologist. The anesthesiologist injects drugs into the patient's veins and then places an airway tube within the windpipe to ventilate the individual throughout the operation. Following the patient continues to be anesthetized, the doctor makes an incision in the front from the neck at the level the place where a tight-fitting necklace would rest. The doctor locates and takes care to not injure the parathyroid glands and the recurrent laryngeal nerves, while freeing a thyroid problem gland from all of these surrounding structures. The next step is clamping from the blood supply to the portion of a thyroid problem gland that's to be removed. Next, the doctor removes all or part of the gland. When cancer continues to be identified and the majority of the gland is removed. If other diseases or nodules can be found, the doctor may remove only part of the gland. The total amount of glandular tissue removed depends on the problem receiving treatment. The doctor may place a drain, the industry soft plastic tube that allows tissue fluids to flow from a place, before closing the incision. The incision is closed with either sutures or metal clips. A dressing is placed over the incision and also the drain, if one has been placed. People generally stay in a healthcare facility one to four days after a thyroidectomy.

Purpose

Any part of the thyroid might be removed to correct a variety of abnormalities. If an individual includes a goiter, that is an improvement of the thyroid that triggers swelling within the front from the neck, the swollen gland may cause problems with swallowing or breathing. Hyperthyroidism (over activity from the thyroid gland) produces hyper metabolism, a condition where the body uses abnormal levels of oxygen, nutrients, and other materials. A thyroidectomy might be performed when the hyper metabolism can't be sufficiently controlled by medicine, or when the condition happens in a pregnant woman or young child. Both cancerous and noncancerous tumors may develop within the thyroid. These growths must be removed, in addition to some or even the whole gland itself.

Demographics

Many people with gently abnormal levels of thyroid hormone do not have any disease symptoms. Females are somewhat much more likely than males to need a thyroidectomy.

Diagnosis/Preparation

Thyroid problems don't invariably develop rapidly; in some cases, the patient's symptoms might be subtle or hard to distinguish in the signs of other disorders. Patients suffering from hypothyroidism are occasionally misdiagnosed as using a psychiatric depression. To determine the character from the thyroid disease before a thyroidectomy is performed, a number of tests and studies are usually necessary. Laboratory analysis of blood determines the amount of active thyroid hormones circulating in the body. The most common test is a blood test that measures the level of thyroid-stimulating hormone (TSH) within the bloodstream. Sonograms and computed tomography scans (CT scans) assistance to determine the size of a thyroid problem gland and location of abnormalities. A nuclear medicine scan enables you to fix thyroid function in order to assess the condition of the thyroid nodule, but it's not considered a routine test. A needle biopsy of the abnormality or aspiration of fluid from the thyroid gland can also be performed to assist determine the diagnosis.

If the diagnosis is hyperthyroidism, an individual might be asked to consider anti-thyroid medicine or iodides before the operation. Ongoing treatment with anti-thyroid drugs could be the treatment of choice. Otherwise, not one other special procedure must be followed before the operation.

Normal results

Most sufferers are released from the hospital 1-4 days after a thyroidectomy. Most return to their normal activities two weeks after the operation. People who have cancer may require subsequent treatment by an oncologist or endocrinologist.

Risks

There are definite risks linked to the procedure. A thyroid problem gland ought to be removed only if there's a pressing reason or medical problem that needs it. As with all operations, people who are obese, smoke, or have poor nutrition are in greater risk for developing complications related to the overall anesthetic itself.

Hoarseness or voice loss may develop if the recurrent laryngeal nerve is injured or destroyed throughout the operation. Nerve damage is more apt to exist in those who have large goiters or cancerous tumors. Hypoparathyroidism may appear if the parathyroid glands are injured or taken out at the time of the thyroidectomy. Hypoparathyroidism is characterized by a drop in blood calcium levels leading to muscle cramps and twitching. Hypothyroidism may appear if all or almost all of the thyroid gland is removed. Total removal, however, might be intentional once the patient is afflicted with cancer. If patient’s thyroid levels remain low, thyroid replacement medicines may be required for the rest of patient life. A hematoma is really an assortment of blood within an organ or tissue, the result of a break in the wall of a circulation system. The neck and the small area around the thyroid gland possess a rich way to obtain blood vessels. Bleeding in the region from the operation may occur and be hard to control or stop. If a hematoma occurs in this the main body, it might be life-threatening. Since the hematoma enlarges, it may block the airway and cause a person to prevent breathing. If a hematoma does develop within the neck, the surgeon may need to perform drainage to clear the airway. Wound infections can occur. When they do, the incision is drained; there are often no serious outcomes.

Aftercare

A thyroidectomy incision demands virtually no care after the dressing is removed. The area might be bathed gently having a gentle soap. The sutures or the metal clips are taken out three to 7 days subsequent the operation.

Morbidity and mortality rates

The mortality of thyroidectomy is basically zero. Hypothyroidism is considered to exist in 12-50% of persons within the first year following a thyroidectomy. Late-onset hypothyroidism evolves among an additional 1-3% of persons every year. Although hypothyroidism may recur several years after a partial thyroidectomy, 43% of recurrences take place within five years. Mortality from thyroid storm, an uncommon complication of thyroidectomy, is incorporated in the selection of 20-30%. Thyroid storm is characterized by fever, weakness and wasting of the muscles, augmentation from the liver, restlessness, moodiness, alternation in mental status, and perhaps, coma. Thyroid storm is a medical emergency requiring immediate treatment. After a partial thyroidectomy, thyroid function results to normalcy in 90-98% of persons.

Alternatives

Injections of radioactive iodine were utilized to destroy thyroid tissue previously.

Who performs the procedure and where?

Thyroidectomies are often performed by doctors with specialized training in otolaryngology, head and neck surgery. Occasionally, an over-all doctor will execute a thyroidectomy. The procedure is performed in a hospital under general anesthesia.

Important Questions to be asked by patient to a doctor

• What will my neck look like after surgery?
• Which areas of the thyroid will be removed?
• Will I want any medicine after surgery?
• What may be the surgeon's complication rate?
• How many radical neck procedures have got the surgeon performed