Isthmusectomy and Subtotal Thyroidectomy

The standard approach to most thyroid surgery (total thyroidectomy or hemithyroidectomy) involves complete resection of one or both lobes, along with the isthmus. This requires exposure of the tracheo-oesophageal groove, which poses a risk to the recurrent laryngeal nerve and the parathyroid glands, leading to potential post-operative complications of hoarseness and hypocalcaemia. A more limited resection, such as isthmusectomy or subtotal thyroidectomy, may decrease the risk of such complications. An isthmusectomy involves resection of the central part of the thyroid anterior to the trachea and is most appropriate for a solitary nodule located in this region. A subtotal thyroidectomy involves resecting the majority of the thyroid gland, while leaving a remnant in situ posteriorly and therefore not exposing the recurrent laryngeal nerve. This may be considered for benign thyroid disease such as Grave’s disease or multinodular goitres. This chapter will discuss these two techniques in further detail.