Hemithyroidectomy is a surgical procedure targeting one side of the thyroid lobe, primarily used to remove diseased thyroid tissue. This surgery is suitable for benign or malignant thyroid conditions, such as nodules, tumors, or functional abnormalities. The procedure preserves the healthy contralateral thyroid lobe to maintain normal thyroid hormone secretion.
Compared to total thyroidectomy, this approach maximizes preservation of thyroid function and reduces the need for long-term hormone replacement therapy postoperatively. Common indications include unilateral thyroid nodules, papillary carcinoma, and Graves' disease, with suitability assessed based on the size and location of the lesion and the patient’s overall health status.
This surgery is divided into traditional open surgery and minimally invasive endoscopic techniques. The traditional approach involves a direct incision in the neck to excise the affected thyroid lobe, while minimally invasive methods utilize endoscopic instruments to reduce tissue damage and scarring. Mechanistically, removing the diseased tissue eliminates tumor threat and preserves the healthy thyroid lobe to continue synthesizing thyroxine (T4) and triiodothyronine (T3).
During surgery, precise protection of the recurrent laryngeal nerve and parathyroid glands is essential to avoid affecting vocal cord function and calcium regulation. The operation typically lasts 1-3 hours under general anesthesia, with postoperative hospitalization for 2-5 days. Pathological analysis of the excised tissue guides subsequent treatment decisions.
It is necessary to exclude cross-lobe disease or multiple nodules; if the lesion invades surrounding tissues, a total thyroidectomy may be required. Preoperative ultrasound, fine-needle aspiration biopsy, and functional assessments are essential to confirm suitability.
The surgical steps include: after general anesthesia, a 3-5 cm transverse incision is made in the neck, followed by dissection of the affected thyroid lobe and surrounding tissues. Vessels are ligated before removing the target lobe. Minimally invasive methods use 2-3 small incisions of 0.5-1 cm with endoscopic instruments.
There is no concept of "dosage," but the extent of resection is adjusted based on the size of the lesion. Postoperative frozen section analysis confirms whether margins are clear; if cancer cells are detected spreading, the resection scope may be expanded. Regular monitoring of thyroid function and calcium levels is required after surgery.
Compared to total thyroidectomy, the incidence of postoperative hypothyroidism can be reduced to 15-20%, significantly improving patient quality of life. Endoscopic techniques can also reduce scars to less than 3 cm, meeting cosmetic demands.
Approximately 5-10% of patients experience transient vocal cord paralysis, which usually recovers within 3-12 months. Bilateral nerve injury may necessitate tracheostomy. Patients with hypocalcemia require calcium and vitamin D supplementation.
Preoperative assessment of cardiopulmonary function is necessary; patients with diabetes or coagulopathies should have their underlying conditions controlled beforehand. Contraindications include:
Postoperative care includes avoiding strenuous activity for 2 weeks and voice therapy to accelerate recovery. For suspected cancer, intraoperative frozen section analysis is performed, and immediate definitive surgery may be necessary.
When combined with radioactive iodine therapy, it is essential to confirm whether the lesion is iodine-sensitive. Patients on anticoagulants should stop medication 5-7 days prior, but novel oral anticoagulants (like Xarelto) can be adjusted according to physician instructions.
If the patient is on immunosuppressants, the risk of surgical infection should be evaluated. Postoperative hormone replacement therapy may interact with other drugs (e.g., calcium channel blockers), requiring monitoring of blood calcium levels.
According to the American Thyroid Association guidelines, over 95% of patients with benign nodules experience symptom relief after hemithyroidectomy. The 5-year survival rate for early thyroid cancer patients can reach 98%, with no significant difference compared to total thyroidectomy.
Cosmetic satisfaction surveys for endoscopic hemithyroidectomy show that 85% of patients find scars inconspicuous. Long-term follow-up indicates a high rate (82%) of normal thyroid function maintenance, demonstrating the procedure’s advantage in functional preservation.
Medication: Anti-thyroid drugs (e.g., PTU) are suitable for early Graves’ disease but may require long-term use with potential hepatotoxicity risks.
Radioactive iodine therapy: Suitable for patients unable to undergo surgery but may cause permanent hypothyroidism.
Observation and follow-up: Benign nodules smaller than 1 cm can be monitored with ultrasound every 6-12 months, but early diagnosis of malignant transformation may be missed.
The surgery may temporarily affect the recurrent laryngeal nerve, causing hoarseness. Most patients recover spontaneously within weeks to months, but if no improvement after 3 months, further examination for nerve injury is needed. Regular voice assessments postoperatively can detect issues early and facilitate intervention.
Are there specific dietary restrictions or nutritional supplements needed after surgery?Postoperative care should avoid excessive iodine-rich foods (such as kelp and seaweed) and regularly monitor blood calcium levels. If the parathyroid glands are removed during surgery, calcium tablets and vitamin D supplements may be necessary. Following a low-iodine, high-calcium diet plan recommended by a nutritionist can help maintain thyroid and calcium metabolism balance.
When can patients resume daily activities or light exercise after surgery?Generally, strenuous activities and lifting heavy objects should be avoided for 1-2 weeks, but light activities like walking can gradually be resumed. Full recovery of daily physical activities usually takes 4-6 weeks. The exact timing should be adjusted based on wound healing and medical advice to prevent bleeding or infection.
What items should be regularly monitored after surgery? How often?Postoperative monitoring includes thyroid function tests (such as TSH, T4), calcium levels, and ultrasound of residual tissue every 3-6 months. If the lesion was malignant, follow-up frequency may increase to every 6 months for over 5 years to detect recurrence early.
What are the potential complications causing muscle cramps after surgery, and how should they be managed?Muscle cramps may indicate hypocalcemia, often due to parathyroid damage affecting calcium metabolism. Immediate blood tests for calcium and phosphorus levels are necessary. Treatment involves calcium and vitamin D supplementation, dietary adjustments, and in severe cases, hospitalization for management.
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