Thyreoidektomie

Thyreoidektomie, or thyroidectomy, is a surgical procedure that removes all or part of the thyroid gland. It is performed for a range of conditions, including benign goiter with compressive symptoms, hyperthyroidism, and differentiated thyroid cancer, as well as for diagnostic evaluation when nodules have suspicious features.

Indications commonly include large or symptomatic goiters, toxic hyperthyroidism not adequately controlled by medical therapy or radioactive iodine, and suspicion or confirmation of thyroid cancer. Preoperative assessment typically includes thyroid function tests, neck imaging (usually ultrasound, and CT or MRI in selected cases), and fine-needle aspiration cytology when indicated. The anatomy of the recurrent laryngeal nerves and parathyroid glands is carefully reviewed, and calcium and vocal cord function are monitored postoperatively.

Types of thyroidectomy range from lobectomy (hemithyroidektomie), removing one lobe and the isthmus, to total thyroidectomy, removing the entire gland. Subtotal or near-total resections are used in specific circumstances. The chosen operation depends on disease extent, histology, and patient factors. Procedures are usually performed through a low cervical incision (Kocher incision) under general anesthesia, with identification and preservation of the recurrent laryngeal nerves and parathyroid glands when possible. Hemostasis is achieved carefully to minimize bleeding, and a drain may be used in some cases.

Postoperative care focuses on airway monitoring, assessment of voice, and calcium homeostasis. Hypocalcemia and temporary or permanent hypoparathyroidism are possible, as are recurrent laryngeal nerve injuries. Total thyroidectomy often necessitates lifelong thyroid hormone replacement therapy.

Outcomes are generally favorable for appropriately selected patients, with high cure rates for differentiated thyroid cancer and relief of compressive symptoms in benign disease.