For differentiated thyroid cancer surgery is the primary treatment modality and goals include complete removal of the tumor, minimizing morbidity and providing necessary pathological specimens for adequate staging.

Thyroidectomy is indicated for patients with hyperthyroidism who have local compressive symptoms from a large goiter, suspicious for malignancy thyroid nodules, or moderate to severe ophthalmolopathy from Graves’ disease.

Among patients with Graves’ disease, total thyroidectomy is associated with the lower risk of recurrent hyperthyroidism,, than subtotal thyroidectomy, and is the preferred operation.

With toxic adenoma, thyroid lobectomy may be preferred over radioactive iodine.

Total thyroidectomy rapidly cures hyperthyroidism from Graves’ disease with toxic multinodular  goiter her but results in lifelong need for thyroid hormone replacement therapy.

Appropriate surgery allows the ability to use radioactive iodine ablation, provide long-term followup, and limit recurrent or metastatic disease.

Pre-treatment with anti-thyroid drugs in hyperthyroidism, lowers the risk of thyroid storm at the time of surgery.

Preoperative treatment with high-dose iodine for patients with Graves’ disease decreases thyroid vascularity, and operative blood loss.

Calcium and vitamin D supplementation preoperatively may decrease the risk of postoperative hypocalciumemia.

Total thyroidectomy has less than a 1% risk of permanent hypoparathyroidism or nerve injury.

The most significant complications of thyroidectomy are hypoparathyroidism and recurrent laryngeal nerve injury.

Postoperative hypocalcemia after total thyroidectomy incidence ranges from 1.6% to 50%.

Transient clinical hypoparathyroidism postoperativelyn is common at more than 5%, but persistent in only 0.5% of patients one year later.

Traditionally a 3-5 cm incision for open thyroidectomy is performed, but increasingly minimally invasive video assisted thyroidectomy and robotic thyroidectomy are being utilized with smaller or less obvious incisions.

In bilateral thyroid surgery, peripheral ligation of the inferior thyroid artery at the thyroid capsule is pref2242ed over central ligation and at least two parathyroid glands should be identified and preserved to prevent postoperative hypothyroidism.

Thyroidectomy with cervicocentral and cervicolateral lymphadenectomy associated with palsy of the recurrent nerves from 0.0-3.8% of patients.

With cervicocentral and cervicolateral lymphadenectomy-associated with hypoparathyroidism in 1.9%-17% of patients.

5-10% of patients have transient hoarseness.

Fewer than 4% of patients will have long-term or permanent hoarseness after surgery.

Recent studies suggest 84% of patients report change in one of their voice characteristics and up to 14% persistence of problems may occur.

In a review of thyroid surgery laryngeal injuries are primarily caused by injury to the vocal cords from intubation and to a lesser extent by injury to the laryngeal nerve (Echternach M).

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