Chapter 48 - Thyroidectomy

Summary

Surgical resection remains the treatment of choice for most thyroid tumors. Goiters and thyroid nodules are problems of enormous magnitude, present in more than 7% of the world's population. Tracheal compression from goiter may respond only to thyroidectomy, and thyroid nodules may harbor carcinoma, occurring in approximately 15% of solitary thyroid nodules and 5% of multinodular goiters.

Thyroid nodules have an annual incidence of 90 per million (approximately 29,000 new cases of thyroid carcinoma occur each year in the USA). The overall mortality is low, four per million per year (approximately 1,000 deaths per year in the USA). In patients with thyrotoxicosis a thyroidectomy can result in an expedient return to a euthyroid state. Included among these are children and women of childbearing age with Graves' disease, those who have failed medical or radioiodine therapy for Graves' disease, those with toxic multinodular goiter (Plummer's disease), and those with toxic adenomas. For the most part, goiter is a benign process, responsive to iodine repletion therapy. However, subtotal or total thyroidectomy is conventional therapy for hyperthyroidism and symptomatic goiter, particularly for patients with ophthalmopathy, or when airway compromise is present. Thyroid lobectomy is generally reserved for benign thyroid nodules or other, appropriately selected clinical circumstances.