Abstract
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.
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References
Li Y, Li Y, Zhou X. Total thyroidectomy vs bilateral subtotal thyroidectomy for bilateral multinodular nontoxic goiter: a meta-analysis. ORL J Otorhinolaryngol Relat Spec. 2006;78:167–75.
Ku CF, Lo CY, Chan WF, et al. Total thyroidectomy replaces subtotal thyroidectomy as the preferred surgical treatment for graves’ disease. ANZ J Surg. 2005;75:528–31.
Tekin K, Yilmaz S, Yalcin N. What would be left behind if subtotal thyroidectomy were preferred instead of total thyroidectomy? Am J Surg. 2010;199:765–9.
Skilbeck C, Leslie A, Simo R. Thyroid isthmusectomy: a critical appraisal. J Laryngol Otol. 2007;121:986–9.
Perros P, Colley S, Boelaert K, et al. British thyroid associated guidelines for the management of thyroid cancer. Clin Endocrinol. 2014;81:1–122.
Palit TK, Miller CC, Miltenburg DM. The efficacy of thyroidectomy for Graves’s disease: a meta-analysis. J Surg Res. 2000;90:161–5.
Maser C, Donovan P, Udelsman R. Thyroid Isthmusectomy: a rarely used but simple, safe and efficacious operation. J Am Coll Surg. 2007;204:512–4.
Perez-Ruiz L, Ros-Lopez S, Gudelis M, et al. Isthmectomy: a conservative operation for solitary nodule of the thyroid isthmus. Acta Chor Belg. 2008;108:699–701.
Goldfarb M, Rodgers S, Lew JI. Appropriate surgical procedure for dominant thyroid nodules of the isthmus 1cm or larger. Arch Surg. 2012;147:881–4.
Nixon IJ, Palmer FL, Whitcher MM, et al. Thyroid isthmusectomy for well-differentiated thyroid cancer. Ann Surg Oncol. 2011;18:767–70.
Wang J, Sun H, Gao L, et al. Evaluation of thyroid isthmusectomy as a potential treatment for papillary thyroid carcinoma limited to the isthmus: a clinical study of 73 patients. Head Neck. 2016;38:1510–4.
Park H, Harries V, McGill MR, et al. Isthmusectomy in selected patients with well-differentiated thyroid carcinoma. Head Neck. 2019;1-7:43.
Karatzas T, Charitoudis G, Vasileiadis D, et al. Surgical treatment for dominant malignant nodules of the isthmus of the thyroid gland: a case control study. Int J Surg Lond Engl. 2015;18:64–8.
Lee YS, Jeong JJ, Nam KH, et al. Papillary carcinoma located in the thyroid isthmus. World J Surg. 2010;34:36–9.
Lei J, Zhu J, Li Z, et al. Surgical procedures for papillary thyroid carcinoma located in the thyroid isthmus: an intention-to-treat analysis. Onco Targets Ther. 2016;9:5209–16.
Song CM, Lee DW, Ji YB, et al. Frequency and pattern of central lymph node metastasis in papillary carcinoma of the thyroid isthmus. Head Neck. 2016;38:E412–6.
Vasileiadis I, Boutzios G, Karalaki M, et al. Papillary thyroid carcinoma of the isthmus: total thyroidectomy or isthmusectomy? Am J Surg. 2018;216:135–9.
Haughan BR, Alexander EK, Bible KC, et al. Management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Associated Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26:1–133.
Hubbard JGH, Inabnet WB, Lo CY. Endocrine surgery: principles and practice. Springer; 2009.
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Black, K., Hubbard, J. (2024). Isthmusectomy and Subtotal Thyroidectomy. In: Simo, R., Pracy, P., Fernandes, R. (eds) Atlas of Head and Neck Surgery . Springer Surgery Atlas Series. Springer, Cham. https://doi.org/10.1007/978-3-031-36593-5_45
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DOI: https://doi.org/10.1007/978-3-031-36593-5_45
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