Thyroidectomy: Techniques, Adjuncts, and Potential Complications

Thyroidectomy involves removal of the entire thyroid gland, either one lobe or both lobes with or without the isthmus, while preserving the parathyroid glands, recurrent laryngeal nerves, and superior laryngeal nerves. Common indications for hemi-thyroidectomy (lobectomy) or total thyroidectomy include symptomatic benign nodules, hyperthyroidism (either autonomously functioning nodules or Graves’ disease), indeterminate nodules, or thyroid cancers. Thyroidectomy may be performed using open or remote access techniques. The most commonly used technique is the minimally invasive open technique through a small transverse cervical incision. Many forms of remote access techniques have been described, such as transaxillary and transoral approaches, to circumvent the need for a cervical incision. Intraoperative adjuncts including nerve monitoring and parathyroid gland identification systems such as autofluorescence may be used to aid in the identification and preservation of the recurrent laryngeal nerves and parathyroid glands. Potential complications following thyroidectomy include nerve injury, hypocalcemia, bleeding, and infection. The diagnosis and treatment of these complications are primarily symptom-focused.