The different thyroid surgical procedures

 

Partial thyroidectomies are distinguished

which will preserve part of the parenchyma

normal thyroid and total thyroidectomies

(or almost total) which will remove the entire

(or almost) of the gland.

Removal of lymph nodes by the neck

is very often associated with thyroid removal

in case of confirmed cancer or strong suspicion of cancer.

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-Partial, “conservative” thyroidectomies:

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.lobectomy is the ablation of one of the 2 lobes

.isthmectomy is the removal of the median gland strip which connects the 2 lobes

.lobo-isthmectomy is the ablation of a lobe and the isthmus in continuity

.partial lobectomyis the removal of part of a lobe (taking away the nodule)

.subtotal thyroidectomy is the removal of a large part of the gland on both sides but with preservation of a significant quantity  thyroid tissue; post-operative hormonal treatment will complement the production of natural hormones by the gland

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-Thyroidectomies total and almost total:

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.total thyroidectomy is the removal of the entire "visible" thyroid gland; microscopic remnants may persist either in areas where the thyroid adheres to the trachea, or along the embryological migration path of the gland (between the tongue and the lower part of the neck)

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.near total thyroidectomy is the removal of almost the entire gland; visible (macroscopic) fragments are left in place in dangerous areas where continuing the surgery would run a great risk of complications, particularly in contact with the lower laryngeal nerve (synonyms: recurrent nerve or vocal cord nerve); This operation is most often performed in cases of reoperation for cancer. It can also be chosen by the surgeon in certain Graves' diseases or in certain large goiters, depending on the findings made during the operation, in application of the principle  Hippocratic:Primum non nocere (first do no harm).

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In cases where a total or near-total thyroidectomy is performed, hormone replacement treatment of the gland will be necessary and this treatment must be taken for life.

 

-Removal of lymph nodes:

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Lymph nodes (often called lymph nodes) drain fluid called lymph that comes out of different organs;

lymphatic drainage of the thyroid is important;

lymphatic vessels and nodes are part

of the immune system and play an essential role

in the body's defense mechanisms

particularly against infections and cancers.

In case of cancer the cancer cells will be

blocked at the level of the lymph nodes; the latter enlarged

then(adenopathy).

The aim of lymph node surgery (dissection) is therefore

to determine if the lymph nodes are affected and to

remove diseased lymph nodes.

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Removal of lymph nodes may only concern

lymph nodes located around and in contact with the gland:

This is the cleaning of the central compartment.

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The ablation can be extended to the lymph nodes located along the large vessels of the neck (carotid artery and internal jugular vein):

It is the cleaning of theside compartment.

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When there are diseased lymph nodes detected by imaging examinations (ultrasound, scanner, PET, scintigraphies)  We are talking aboutcurative cure ; when lymph node removal is carried out as a preventative measure; and to allow us to have as much information as possible on the progressive stage of the cancer and its risks, we speak ofprophylactic cleaning.

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