What are the indications for thyroidectomy?

Updated: May 08, 2018
  • Author: Neerav Goyal, MD, MPH; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Various indications for thyroidectomy exist. One of the major indications is a diagnosis of thyroid cancer, usually biopsy-proven by fine-needle aspiration of a nodule.

Although the full range of thyroid nodule histology is beyond the scope of this chapter, the histology can have significant ramifications as to chosen operative management. In patients with all but the most minimal (low-risk) biopsy-proven papillary thyroid cancer, and all medullary thyroid cancer, a total thyroidectomy is indicated. Patients with a fine-needle aspiration showing either Hürthle cells or follicular neoplasm require at least a thyroid lobectomy of the side ipsilateral to the nodule and possibly a total thyroidectomy if the permanent operative specimen shows signs of malignancy. In addition to these malignancies, anaplastic thyroid cancer can occasionally be an indication for thyroidectomy, if no significant extension and infiltration into the surrounding structures is found. [4]

Beyond malignancies, thyroidectomy is also a viable option for patients with symptomatic thyroid masses or goiters. Patients who have compressive symptoms including dysphagia, dyspnea, shortness of breath, and/or hoarseness due to a large goiter should undergo a thyroidectomy. Usually dysphagia to solids is the earliest presenting symptom. Aesthetic concerns due to a goiter may be an indication for thyroidectomy. Another indication includes patients with medically refractory Graves disease or hyperthyroidism. [5]


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