Benign thyroidectomy: Things to note

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Benign thyroid nodules is a common disease in women with signs of tumors in the neck causing discomfort or even difficulty breathing or swallowing. The majority of thyroid nodules are benign, but there are also rare cases that progress to thyroid cancer.

1. Are thyroid nodules dangerous?

Thyroid adenoma is a tumor (also called a tumor) that exists in the form of solid or liquid. Benign thyroid tumor that forms and grows in the thyroid gland - an endocrine gland that plays an important and largest role in the human body, originating from abnormal cells in the inner surface of the thyroid gland , causing endocrine disruption, leading to tumor formation.
According to statistics, about 5% of patients with thyroid nodules are malignant tumors (thyroid cancer). The prevalence of thyroid disease increases with age and is more common in women (5 women/1 male). Because there are almost no symptoms in the early stages, thyroid diseases are often overlooked.

2. Thyroid nodules should be operated?

Most benign thyroid nodules do not require surgery. Only in really necessary cases are there indications to resort to the method of resection of benign thyroid nodules. Benign thyroid nodules do not need surgery when the tumor is small, and even large, but does not cause difficulty breathing or swallowing. When benign thyroid nodules are small and cause no discomfort, there is usually no need for treatment and follow-up with routine follow-up visits every 1-2 years. You need to actively seek medical attention immediately if there are changes in the neck area or abnormalities in the body.
Benign thyroid tumor requires surgery in case
Malignant thyroid nodule (cancerous): Diagnosis of malignant nodule by biopsy. Non-malignant biopsies of thyroid nodules but suspected malignancy (cytologic or on thyroid ultrasonography). Thyroid nodules with a direct family history of thyroid (K) cancer. The thyroid tumor is large enough to cause compression and cause symptoms for the patient. Symptoms of the disease are caused by a benign thyroid tumor, not the patient suffering from other diseases such as: pharyngitis, cervical spine pain, reflux ...

3. Removal of benign thyroid nodules

3.1. Point

Benign thyroid nodules alone or multinodular but clearly demarcated, easy to dissect Tumor cysts < 4cm in size or polycystic tumor located in the thyroid lobe.

3.2. Contraindications

If the patient has a thyroid tumor, there are signs of hyperthyroidism, hypothyroidism. The patient is too old and weak, suffering from heart failure, severe kidney failure, unable to withstand major surgery.

3.3. Steps to take

Anesthesia: Endotracheal anesthesia. Patient position: The patient lies on his back, head back, pillow under the shoulder to stretch the neck, head high, legs low, face looking straight up to the ceiling so that the incision goes right in the middle of the neck, wrap the hair in a hat. Skin incision: Incision in the shape of a "U", or according to the folds of the neck, the bottom is turned downward, 2cm above the sternum. The two ends of the incision move to the 2 sternoclavicular muscles, extending 3-4 cm to the sides. Incision through the skin surface, subcutaneous tissue, and superficial cervical fascia. Skin flap dissection: Dissection of the skin flap to the superior border of the thyroid cartilage and down to the sternum. If the tumor is large, it can be enlarged and raised. Expand the surgical field by suturing the thread pulled upwards or with an automatic ball. Exposing the thyroid gland: It opens along the middle along the sternoclavicular fibers, then the sternothyroid muscle (usually the sternothyroid muscle adheres to the thyroid capsule). If the benign thyroid nodule is too large, it can cut across these muscle fibers. Expose the submandibular thyroid gland with a Farabeuf ball. Forced hemostasis of the anterior jugular veins. The entire thyroid gland is exposed and the lesion can be assessed manually. Stage 1 tumor resection: Locate the tumor Stage 2: Dissect so that the surgical field at the tumor site is large enough for the most convenient resection. Then, clamp and tie the blood vessels at the tumor site. Stage 3: Conduct a benign thyroidectomy, if the tumor is deep in the parenchyma, the thyroid parenchyma can be opened to remove the tumor. Sew the parenchyma after opening the tumor. Hemostasis carefully: Place a drainage tube, close the incision according to anatomical layers. Withdraw drainage after fluid is no longer draining through the drain, typically 72 hours after surgery.

4. Complications and treatment after removal of benign thyroid nodules

4.1. Bleed

After removal of benign thyroid tumor, the patient may bleed from an artery or a vein due to poor hemostasis during surgery. Bleeding usually occurs after surgery within 4-6 hours, the incision is stretched gradually, draining bright red blood, the blood is soaked with the bandage. If bleeding profusely causes compression, acute dyspnea occurs.
Treatment: Immediately cut the sutures, remove the hematoma and immediately bring it to the operating room, do not put an endotracheal tube because at this time the trachea is pushed out and may collapse due to the hematoma, re-operate to stop the bleeding.

4.2. Injury to the recurrent nerve

This complication is determined by seeing if the patient's voice changes after removal of a benign thyroid nodule.
Treatment: If the recurrent nerve is ruptured, surgery is required to reconnect the nerve.
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