Total thyroidectomy and thyroid lobectomy | UCLA Endocrine Center

Summary

In this video, endocrine surgeons at UCLA discuss two treatment options for thyroid cancer: total thyroidectomy and lobectomy. Total thyroidectomy removes the entire gland, treats cancer, allows for recurrence monitoring, and may require radioactive iodine therapy. It carries risks like nerve damage and lifelong hormone replacement. Lobectomy removes only the affected half, minimizes surgical risks, but may require additional surgery and lacks thyroglobulin monitoring. The choice depends on patient preferences and risk factors.

Takeaways

• 🏥 Kyle and James Wu are endocrine surgeons at the UCLA Endocrine Center.
• 🔍 They discuss two treatment options for thyroid cancer: total thyroidectomy and thyroid lobectomy (partial thyroidectomy).
• 📏 Total thyroidectomy is suitable for tumors less than four centimeters in size.
• 💉 Total thyroidectomy benefits include cancer removal, recurrence monitoring, radioactive iodine therapy eligibility, and prevention of second surgery.
• ⚠️ Risks of total thyroidectomy include nerve damage, hypoparathyroidism, and lifelong thyroid hormone replacement.
• 💊 Thyroid lobectomy is an alternative for patients who want to minimize surgical risks and may not require lifelong thyroid hormone supplements.
• 🔄 Lobectomy involves removing only the affected half of the thyroid gland.
• 🔎 Lobectomy risks include the possibility of needing a completion thyroidectomy and lack of thyroglobulin blood test for monitoring.
• 👨‍⚕️ The choice of treatment should be made in consultation with the endocrine care team.
• 🌐 For more information, patients can visit the UCLA Endocrine Center's website or request a consultation.

Q & A

What are the two treatment options for thyroid cancer discussed in the script?

The two treatment options for thyroid cancer discussed are total thyroidectomy and thyroid lobectomy or partial thyroidectomy.

What is the size of the thyroid tumor that might be eligible for either treatment option?

A thyroid tumor that is less than four centimeters in size, or about the size of a walnut or an Oreo cookie, might be eligible for either treatment option.

What are the benefits of a total thyroidectomy?

The benefits of total thyroidectomy include treating the cancer by removing it, monitoring for recurrence with a thyroglobulin blood test, administering radioactive iodine ablation therapy if the tumor shows high-risk factors, and preventing the need for a second surgery.

What are the risks associated with total thyroidectomy?

The risks of total thyroidectomy include injury to the recurrent laryngeal nerve, permanent hypoparathyroidism, and the need for lifelong thyroid hormone replacement therapy.

Who might be a good candidate for total thyroidectomy?

Total thyroidectomy is a good choice for patients already taking thyroid hormone and those who want the added assurance of being able to monitor for the return of thyroid cancer with a simple blood test and an ultrasound if needed.

What is a thyroid lobectomy or partial thyroidectomy?

A thyroid lobectomy or partial thyroidectomy involves the removal of only the affected half of the thyroid gland, leaving the other half intact.

What are the benefits of a thyroid lobectomy?

The benefits of a thyroid lobectomy include the removal of cancer, the possibility of normal thyroid function with only half of the thyroid, reduced risk to the recurrent laryngeal nerve, and no risk of low parathyroid hormone.

What are the downsides of undergoing a thyroid lobectomy?

The downsides of a thyroid lobectomy include the possibility of needing a completion thyroidectomy if high-risk features are found after the surgery, and the inability to monitor thyroid cancer using the thyroglobulin blood test.

Who might be a good candidate for a thyroid lobectomy?

A thyroid lobectomy is a good operation for patients who want to minimize the risk of surgical complications, hope to not take extra thyroid hormone supplement after surgery, and are okay with the possibility of needing to come back for a second surgery.

What is the likelihood of needing a second surgery after a thyroid lobectomy?

There is about a 50% chance that a patient might need to come back for a completion thyroidectomy after a thyroid lobectomy if high-risk features of thyroid cancer are found after the initial surgery.

How can patients get more information about thyroid disease and surgery?

Patients can get more information by visiting the UCLA endocrine center's website, checking out their other videos, or by scheduling an in-person or telemedicine consultation.

Outlines

00:00

🏥 Thyroid Cancer Treatment Options

Kyle Zanaco and James Wu, endocrine surgeons at the UCLA Endocrine Center, discuss two treatment options for thyroid cancer: total thyroidectomy and thyroid lobectomy (partial thyroidectomy). They explain that for tumors less than four centimeters, patients have a choice based on risk factors and personal needs. Total thyroidectomy involves removing the entire thyroid gland and has benefits such as treating cancer, monitoring recurrence with a blood test, administering radioactive iodine therapy for high-risk tumors, and preventing the need for a second surgery. However, it carries risks like nerve damage, hypoparathyroidism, and the necessity for lifelong thyroid hormone replacement. Thyroid lobectomy, on the other hand, removes only the affected half of the thyroid, reducing the risk of surgical complications and the need for hormone supplements, but it may require a completion thyroidectomy if high-risk cancer features are found post-surgery.

05:03

🌐 Resources for Thyroid Patients

The script encourages viewers to visit the UCLA Endocrine Center's website for more information on thyroid disease and surgery. They also invite viewers to watch other related videos. For those interested in a consultation, either in-person or via telemedicine, they can submit a request online or call the clinic. The message concludes with a thank you for watching.

Keywords

💡Thyroid Cancer

Thyroid cancer is a type of cancer that starts in the thyroid gland, which is located at the base of the neck. It is a relatively common type of cancer, and its incidence has been increasing. The video discusses treatment options for thyroid cancer, emphasizing the importance of selecting the right procedure based on the size of the tumor and the presence of risk factors.

💡Total Thyroidectomy

A total thyroidectomy is a surgical procedure in which the entire thyroid gland is removed. This procedure is recommended for thyroid cancer patients with tumors that are less than four centimeters in size. The video explains that this surgery has several benefits, including the removal of cancerous tissue, the ability to monitor for recurrence with a blood test, and the option for radioactive iodine ablation therapy if needed.

💡Thyroid Lobectomy

A thyroid lobectomy, also known as a partial thyroidectomy, is a surgical procedure that involves the removal of only one half (lobe) of the thyroid gland. This is another treatment option discussed in the video for thyroid cancer patients. It is considered less invasive than a total thyroidectomy and may be suitable for patients who wish to minimize surgical risks.

💡Thyroglobulin

Thyroglobulin is a protein that is produced by the thyroid gland and is used as a blood test to monitor thyroid cancer. The video mentions that this test is only useful if the entire thyroid is removed, which is why it is particularly relevant after a total thyroidectomy. It helps in detecting any recurrence of the cancer.

💡Radioactive Iodine Ablation Therapy

Radioactive iodine ablation therapy is a treatment used after surgery for thyroid cancer to destroy any remaining thyroid tissue or cancer cells. The video explains that this therapy can be administered after a total thyroidectomy, especially if the tumor shows high-risk factors such as growth outside the thyroid or spread to the lymph nodes.

💡Recurrent Laryngeal Nerve

The recurrent laryngeal nerve is a nerve involved in the function of the larynx, which is essential for speech. The video discusses the risk of injury to this nerve during thyroid surgery, which can result in voice changes. This risk is a consideration in deciding between a total thyroidectomy and a lobectomy.

💡Hypoparathyroidism

Hypoparathyroidism is a condition where the parathyroid glands produce insufficient amounts of parathyroid hormone, leading to low calcium levels in the blood. The video mentions that this is a potential risk of thyroid surgery, particularly a total thyroidectomy, and can require lifelong calcium supplementation.

💡Thyroid Hormone Replacement Therapy

After a total thyroidectomy, patients must take thyroid hormone replacement therapy for the rest of their lives because the thyroid gland, which produces these hormones, has been removed. The video explains that this is a necessary step to maintain normal bodily functions.

💡Endocrine Surgeons

Endocrine surgeons are specialized medical professionals who perform surgeries on the endocrine system, including the thyroid gland. The video is presented by endocrine surgeons from the UCLA Endocrine Center, emphasizing their expertise in treating thyroid cancer.

💡Risk Factors

Risk factors are attributes or conditions that increase the likelihood of developing a disease or condition. In the context of the video, risk factors for thyroid cancer might include the size of the tumor, its growth outside the thyroid, or spread to the lymph nodes. These factors influence the decision between a total thyroidectomy and a lobectomy.

💡Completion Thyroidectomy

A completion thyroidectomy refers to the removal of the remaining half of the thyroid gland after an initial lobectomy. The video mentions that there is a chance that patients who have had a lobectomy may later require a completion thyroidectomy if high-risk features of the cancer are discovered.

Highlights

Two treatment options for thyroid cancer: total thyroidectomy and thyroid lobectomy.

Total thyroidectomy is suitable for tumors less than four centimeters.

Thyroid lobectomy is an option for patients wanting to minimize surgical risks.

Total thyroidectomy treats cancer by removing the entire thyroid gland.

Thyroglobulin protein monitoring is possible only after total thyroidectomy.

Radioactive iodine ablation therapy is an option post-total thyroidectomy for high-risk tumors.

Risks of total thyroidectomy include injury to the recurrent laryngeal nerve.

Permanent hypoparathyroidism is a risk with total thyroidectomy.

Lifelong thyroid hormone replacement is necessary after total thyroidectomy.

Thyroid lobectomy removes only the affected half of the thyroid gland.

Many patients maintain normal thyroid function after a lobectomy.

Thyroid lobectomy reduces the risk of nerve damage and hypoparathyroidism.

There's a 50% chance of needing a completion thyroidectomy after lobectomy.

Thyroglobulin blood test is not valid after lobectomy; ultrasound is used for surveillance.

Thyroid lobectomy is suitable for patients who want to minimize the risk of surgical complications.

Patients considering lobectomy should be okay with the possibility of a second surgery.

For more information, visit the UCLA Endocrine Center's website.

In-person or telemedicine consultations are available through the clinic's website or by phone.

Transcripts

hi i'm kyle zanaco hi i'm james wu we

are endocrine surgeons at the ucla

endocrine center

today we'd like to talk to you about two

treatment options for thyroid cancer the

total thyroidectomy and the thyroid

lobectomy or partial thyroidectomy

if you've been diagnosed with a thyroid

tumor that is less than four centimeters

in size or about the size of a walnut or

an oreo cookie then you have a couple of

choices regarding your treatment

of course your choice will also depend

on any risk factors you might have and

the treatment that best suits your needs

this is a decision you will make

together with your endocrine care team

first let's talk about total

thyroidectomy which is the removal of

the entire thyroid gland

the benefits of total thyroidectomy are

one

it treats the cancer by removing it

two

it allows us to monitor for a recurrence

with the thyroglobulin protein which is

a simple blood test that is only really

useful if the entire thyroid is removed

three

after a total thyroidectomy radioactive

iodine ablation therapy can be

administered if your tumor displays high

risk factors such as growth of the tumor

outside of the thyroid or spread to the

lymph nodes

and four a total thyroidectomy prevents

the risk of having to come back for a

second surgery

as with any surgery there are risks and

side effects to total thyroidectomy

the important risks include number one

temporary or permanent injury to the

recurrent laryngeal nerve which can

result in a temporary or permanent horse

voice

and can occur around five percent of the

time as a temporary injury and up to one

percent of the time is a permanent

injury

two permanent hypoparathyroidism which

results in permanently low calcium

requiring calcium supplementation and

occurs up to one percent of the time

with these surgeries

and three you will absolutely have to go

on a lifelong thyroid hormone

replacement therapy after a total

thyroinectomy

a total thyroidectomy is a good choice

for patients who are already taking

thyroid hormone and who would like the

added assurance of being able to watch

for the return of thyroid cancer with a

simple blood test and an ultrasound if

needed

so the other treatment option for your

thyroid cancer is to undergo a thyroid

lobectomy or partial thyroidectomy what

are the benefits of thyrobectomy well

number one

it will still remove the cancer

completely we don't treat the thyroid

cancer anymore by removing the normal

half of the thyroid gland

number two

many patients have normal thyroid

function even with only half of their

thyroid

the issue though is that for patients

with thyroid cancer we like to make sure

they get a little extra thyroid hormone

to keep the body's demand for thyroid

hormone low to prevent stimulation of

growth of the remaining thyroid cells

because of that about 50 to 60 percent

of their cancer patients still need to

take some thyroid hormone after a

lobectomy

number three when we limit surgery to

just one half of the thyroid only one

recurrent original nerve is put at risk

instead of two

and number four

there is no risk of low parathyroid

hormone after a thyroid lobectomy

because one half of the neck has not

been operated on

so what are the risks or downsides of

undergoing a thyroid lobectomy well

number one is that if we only remove

half the thyroid there's about a 50

chance that we may call you back and

tell you that you need a completion

thyroidectomy removal of the other half

of the thyroid this usually occurs when

we find high risk features of the

thyroid cancer

after the fact and we want to give

patients radioactive iodine therapy

which is only possible again if you have

the entire thyroid removed

number two

when you've only had a thyroid lobectomy

we are not able to monitor the thyroid

cancer using the thyroglobulin blood

test which is only valid after a total

thyroidectomy so for surveillance we

perform just frequent neck ultrasounds

to watch for thyroid cancer occurrence

so who is thyroid lobectomy a good

operation for it's a good operation for

patients who want to absolutely minimize

the risk of surgical complications

it's good for people who hope to have a

chance to not take extra thyroid hormone

supplement after surgery and number

three it's good for patients who are

okay with the possibility of needing to

come back for a second surgery if even

if that risk is 15

for more information about thyroid

disease and thyroid surgery please visit

our website shown below

and check out our other videos

if you'd like to have an in-person

consultation or via telemedicine you can

submit a request online on our website

or call our clinic

thanks for watching