The total thyroidectomy is the surgical procedure in which the entire thyroid gland is removed. With the development of techniques and technologies in thyroid surgery, and the significant improvement in the safety of the operation, the total thyroidectomy has become the most common operation for thyroid diseases. In contrast, the lobectomy or hemithyroidectomy is now less common.

Anesthesia: Η επέμβαση πραγματοποιείται υπό γενική αναισθησία, με την κατάλληλη αναλγησία για ελαχιστοποίηση του μετεγχειρητικού πόνου και με απουσία μυοχαλασης!

Indications: Total thyroidectomy is necessary in cases of malignancy: thyroid cancer or suspected thyroid cancer (Bethesda III and V on FNA). Additional indications are Graves' disease and toxic adenoma, with inability to regulate thyroid hormones. An important indication is multinodular goiter with large nodules and possible tracheal pressure with difficulty breathing and foreign body sensation.

Duration: In most cases, the duration is 60 – 90 minutes. The goal is not speed but safety of the procedure. The time increases in cases of severely enlarged and sunken goiter or in cases where lymph node removal is also required (central or lateral lymph node dissection).

Preoperative examination: Preoperative laryngoscopy by an ENT specialist, για τον έλεγχο λειτουργίας των φωνητικών χορδών, η ενδοκρινολογική εκτίμηση από Ενδοκρινολόγο και εργαστηριακός έλεγχος των θυρεοειδικών ορμονών. Σε περίπτωση υπερθυρεοειδισμού, πρέπει να γίνει ρύθμιση των θυρεοειδικών ορμονών πριν την θυρεοειδεκτομή. Για την ασφάλεια της αναισθησίας συνήθως απαιτείται καρδιολογικός ή πνευμονολογικός έλεγχος ιδιαίτερα σε καπνιστες.

Postoperative follow-up: Nowadays, the postoperative follow-up of patients with total thyroidectomy is less than 24 hours. The patient gets up after 3-4 hours, eats and drinks without restrictions. With appropriate painkillers, there is almost no postoperative pain. In special cases of large goiter or submerged goiter or in patients with coagulation disorders, longer hospitalization may be required and a small drain may be placed.

Postoperative control: Nowadays, with the use of vagus nerve neuromonitoring , we are sure of the good functioning of the vocal cords at the end of the surgery. However, postoperative laryngoscopy is necessary to check the mobility of the vocal cords even if the patient does not have hoarseness. In addition, postoperative measurement of blood calcium and parathyroid hormone is required and the possible administration of Calcium and Vitamin D as a temporary rehabilitation therapy (e.g. CALCIORAL D3® chewable tablet (1000mg+800 iu)/tab). Finally, the endocrinologist will determine the hormonal rehabilitation therapy with T3 or T3.

Aesthetic result: The doctor performs the procedure through a small incision in the neck in a fold of the skin, and with the appropriate plastic suture, ensures an excellent postoperative aesthetic result.