Official reprint from UpToDate®
www.uptodate.com ©2018 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Initial thyroidectomy

Tracy S Wang, MD, MPH
Melanie L Richards, MD, MHPE
Julie Ann Sosa, MD, MA
Section Editor
Sally E Carty, MD, FACS
Deputy Editor
Wenliang Chen, MD, PhD


Over the last century, thyroid surgery has evolved from a dangerous and bloody undertaking to a safe operation with favorable outcomes but few major risks, especially when performed by experienced surgeons [1-5].

Thyroid surgery is performed for a number of benign and malignant conditions, which are discussed in detail elsewhere (see 'Indications' below). In this topic, we discuss various surgical aspects of thyroidectomy, including preoperative evaluation and preparation, operative management, postoperative care, and complications.


Thyroidectomy may be performed for a number of benign and malignant conditions, including:

Thyroid nodules (see "Diagnostic approach to and treatment of thyroid nodules")

Hyperthyroidism (see "Surgical management of hyperthyroidism", section on 'Indications')

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Dec 2017. | This topic last updated: May 04, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2018 UpToDate, Inc.
  1. Rogers-Stevane J, Kauffman GL Jr. A historical perspective on surgery of the thyroid and parathyroid glands. Otolaryngol Clin North Am 2008; 41:1059.
  2. Loyo M, Tufano RP, Gourin CG. National trends in thyroid surgery and the effect of volume on short-term outcomes. Laryngoscope 2013; 123:2056.
  3. Kandil E, Noureldine SI, Abbas A, Tufano RP. The impact of surgical volume on patient outcomes following thyroid surgery. Surgery 2013; 154:1346.
  4. Adkisson CD, Howell GM, McCoy KL, et al. Surgeon volume and adequacy of thyroidectomy for differentiated thyroid cancer. Surgery 2014; 156:1453.
  5. Adam MA, Thomas S, Youngwirth L, et al. Is There a Minimum Number of Thyroidectomies a Surgeon Should Perform to Optimize Patient Outcomes? Ann Surg 2016.
  6. Mirallié E, Rigaud J, Mathonnet M, et al. Management and prognosis of metastases to the thyroid gland. J Am Coll Surg 2005; 200:203.
  7. Nixon IJ, Whitcher M, Glick J, et al. Surgical management of metastases to the thyroid gland. Ann Surg Oncol 2011; 18:800.
  8. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009; 19:1167.
  9. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26:1.
  10. Stang MT, Armstrong MJ, Ogilvie JB, et al. Positional dyspnea and tracheal compression as indications for goiter resection. Arch Surg 2012; 147:621.
  11. Ukkat J, Gimm O, Brauckhoff M, et al. Single center experience in primary surgery for medullary thyroid carcinoma. World J Surg 2004; 28:1271.
  12. Schulte KM, Machens A, Fugazzola L, et al. The clinical spectrum of multiple endocrine neoplasia type 2a caused by the rare intracellular RET mutation S891A. J Clin Endocrinol Metab 2010; 95:E92.
  13. American Thyroid Association Guidelines Task Force, Kloos RT, Eng C, et al. Medullary thyroid cancer: management guidelines of the American Thyroid Association. Thyroid 2009; 19:565.
  14. Wong KP, Lang BH, Ng SH, et al. A prospective, assessor-blind evaluation of surgeon-performed transcutaneous laryngeal ultrasonography in vocal cord examination before and after thyroidectomy. Surgery 2013; 154:1158.
  15. Sinclair CF, Bumpous JM, Haugen BR, et al. Laryngeal examination in thyroid and parathyroid surgery: An American Head and Neck Society consensus statement: AHNS Consensus Statement. Head Neck 2016; 38:811.
  16. Shaha AR. Revision thyroid surgery - technical considerations. Otolaryngol Clin North Am 2008; 41:1169.
  17. Randolph GW, Kamani D. The importance of preoperative laryngoscopy in patients undergoing thyroidectomy: voice, vocal cord function, and the preoperative detection of invasive thyroid malignancy. Surgery 2006; 139:357.
  18. Steurer M, Passler C, Denk DM, et al. Advantages of recurrent laryngeal nerve identification in thyroidectomy and parathyroidectomy and the importance of preoperative and postoperative laryngoscopic examination in more than 1000 nerves at risk. Laryngoscope 2002; 112:124.
  19. Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid 2016; 26:1343.
  20. Erbil Y, Ozluk Y, Giriş M, et al. Effect of lugol solution on thyroid gland blood flow and microvessel density in the patients with Graves' disease. J Clin Endocrinol Metab 2007; 92:2182.
  21. Oltmann SC, Brekke AV, Schneider DF, et al. Preventing postoperative hypocalcemia in patients with Graves disease: a prospective study. Ann Surg Oncol 2015; 22:952.
  22. Lefevre JH, Tresallet C, Leenhardt L, et al. Reoperative surgery for thyroid disease. Langenbecks Arch Surg 2007; 392:685.
  23. Levin KE, Clark AH, Duh QY, et al. Reoperative thyroid surgery. Surgery 1992; 111:604.
  24. Tan MP, Agarwal G, Reeve TS, et al. Impact of timing on completion thyroidectomy for thyroid cancer. Br J Surg 2002; 89:802.
  25. Uruno T, Masaki C, Suzuki A, et al. Antimicrobial prophylaxis for the prevention of surgical site infection after thyroid and parathyroid surgery: a prospective randomized trial. World J Surg 2015; 39:1282.
  26. Avenia N, Sanguinetti A, Cirocchi R, et al. Antibiotic prophylaxis in thyroid surgery: a preliminary multicentric Italian experience. Ann Surg Innov Res 2009; 3:10.
  27. Leaper DJ, Melling AG. Antibiotic prophylaxis in clean surgery: clean non-implant wounds. J Chemother 2001; 13 Spec No 1:96.
  28. Gagliardi AR, Fenech D, Eskicioglu C, et al. Factors influencing antibiotic prophylaxis for surgical site infection prevention in general surgery: a review of the literature. Can J Surg 2009; 52:481.
  29. Fry DE. Surgical site infections and the surgical care improvement project (SCIP): evolution of national quality measures. Surg Infect (Larchmt) 2008; 9:579.
  30. Bratzler DW, Houck PM, Surgical Infection Prevention Guidelines Writers Workgroup, et al. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis 2004; 38:1706.
  31. Braxton CC, Gerstenberger PA, Cox GG. Improving antibiotic stewardship: order set implementation to improve prophylactic antimicrobial prescribing in the outpatient surgical setting. J Ambul Care Manage 2010; 33:131.
  32. Worni M, Schudel HH, Seifert E, et al. Randomized controlled trial on single dose steroid before thyroidectomy for benign disease to improve postoperative nausea, pain, and vocal function. Ann Surg 2008; 248:1060.
  33. Lang BH, Ng SH, Wong KP. Pain and surgical outcomes with and without neck extension in standard open thyroidectomy: a prospective randomized trial. Head Neck 2015; 37:407.
  34. Rosato L, Avenia N, Bernante P, et al. Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg 2004; 28:271.
  35. Brunaud L, Zarnegar R, Wada N, et al. Incision length for standard thyroidectomy and parathyroidectomy: when is it minimally invasive? Arch Surg 2003; 138:1140.
  36. Barczyński M, Konturek A, Hubalewska-Dydejczyk A, et al. Five-year follow-up of a randomized clinical trial of total thyroidectomy versus Dunhill operation versus bilateral subtotal thyroidectomy for multinodular nontoxic goiter. World J Surg 2010; 34:1203.
  37. Wilhelm SM, McHenry CR. Total thyroidectomy is superior to subtotal thyroidectomy for management of Graves' disease in the United States. World J Surg 2010; 34:1261.
  38. Bilimoria KY, Zanocco K, Sturgeon C. Impact of surgical treatment on outcomes for papillary thyroid cancer. Adv Surg 2008; 42:1.
  39. Grant CS, Stulak JM, Thompson GB, et al. Risks and adequacy of an optimized surgical approach to the primary surgical management of papillary thyroid carcinoma treated during 1999-2006. World J Surg 2010; 34:1239.
  40. Olson JA Jr, DeBenedetti MK, Baumann DS, Wells SA Jr. Parathyroid autotransplantation during thyroidectomy. Results of long-term follow-up. Ann Surg 1996; 223:472.
  41. Carnaille BM, Pattou FN, Oudar C, et al. Parathyroid incidentalomas in normocalcemic patients during thyroid surgery. World J Surg 1996; 20:830.
  42. Carter WB, Uy K, Ward MD, Hoying JB. Parathyroid-induced angiogenesis is VEGF-dependent. Surgery 2000; 128:458.
  43. Randolph GW, Dralle H, International Intraoperative Monitoring Study Group, et al. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope 2011; 121 Suppl 1:S1.
  44. Terris DJ, Chaung K, Duke WS. Continuous Vagal Nerve Monitoring is Dangerous and Should not Routinely be Done During Thyroid Surgery. World J Surg 2015; 39:2471.
  45. Suh I, Yingling C, Randolph GW, Duh QY. A Novel Method of Neuromonitoring in Thyroidectomy and Parathyroidectomy Using Transcutaneous Intraoperative Vagal Stimulation. JAMA Surg 2016; 151:290.
  46. Angelos P. Recurrent laryngeal nerve monitoring: state of the art, ethical and legal issues. Surg Clin North Am 2009; 89:1157.
  47. Grubbs EG, Rich TA, Li G, et al. Recent advances in thyroid cancer. Curr Probl Surg 2008; 45:156.
  48. Dralle H, Sekulla C, Haerting J, et al. Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery 2004; 136:1310.
  49. Chan WF, Lang BH, Lo CY. The role of intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy: a comparative study on 1000 nerves at risk. Surgery 2006; 140:866.
  50. Pisanu A, Porceddu G, Podda M, et al. Systematic review with meta-analysis of studies comparing intraoperative neuromonitoring of recurrent laryngeal nerves versus visualization alone during thyroidectomy. J Surg Res 2014; 188:152.
  51. Vasileiadis I, Karatzas T, Charitoudis G, et al. Association of Intraoperative Neuromonitoring With Reduced Recurrent Laryngeal Nerve Injury in Patients Undergoing Total Thyroidectomy. JAMA Otolaryngol Head Neck Surg 2016; 142:994.
  52. Barczyński M, Konturek A, Cichoń S. Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg 2009; 96:240.
  53. Sarı S, Erbil Y, Sümer A, et al. Evaluation of recurrent laryngeal nerve monitoring in thyroid surgery. Int J Surg 2010; 8:474.
  54. Dionigi G, Boni L, Rovera F, et al. Neuromonitoring and video-assisted thyroidectomy: a prospective, randomized case-control evaluation. Surg Endosc 2009; 23:996.
  55. Al-Qurayshi Z, Randolph GW, Alshehri M, Kandil E. Analysis of Variations in the Use of Intraoperative Nerve Monitoring in Thyroid Surgery. JAMA Otolaryngol Head Neck Surg 2016; 142:584.
  56. Bergenfelz A, Salem AF, Jacobsson H, et al. Risk of recurrent laryngeal nerve palsy in patients undergoing thyroidectomy with and without intraoperative nerve monitoring. Br J Surg 2016; 103:1828.
  57. Brajcich BC, McHenry CR. The utility of intraoperative nerve monitoring during thyroid surgery. J Surg Res 2016; 204:29.
  58. Thomusch O, Sekulla C, Walls G, et al. Intraoperative neuromonitoring of surgery for benign goiter. Am J Surg 2002; 183:673.
  59. Sturgeon C, Sturgeon T, Angelos P. Neuromonitoring in thyroid surgery: attitudes, usage patterns, and predictors of use among endocrine surgeons. World J Surg 2009; 33:417.
  60. Osamura RY, Hunt JL. Current practices in performing frozen sections for thyroid and parathyroid pathology. Virchows Arch 2008; 453:433.
  61. Chen H, Nicol TL, Udelsman R. Follicular lesions of the thyroid. Does frozen section evaluation alter operative management? Ann Surg 1995; 222:101.
  62. Callcut RA, Selvaggi SM, Mack E, et al. The utility of frozen section evaluation for follicular thyroid lesions. Ann Surg Oncol 2004; 11:94.
  63. Khanna J, Mohil RS, Chintamani, et al. Is the routine drainage after surgery for thyroid necessary? A prospective randomized clinical study [ISRCTN63623153]. BMC Surg 2005; 5:11.
  64. Sanabria A, Carvalho AL, Silver CE, et al. Routine drainage after thyroid surgery--a meta-analysis. J Surg Oncol 2007; 96:273.
  65. Pons Y, Gauthier J, Ukkola-Pons E, et al. Comparison of LigaSure vessel sealing system, harmonic scalpel, and conventional hemostasis in total thyroidectomy. Otolaryngol Head Neck Surg 2009; 141:496.
  66. Upadhyaya A, Hu T, Meng Z, et al. Harmonic versus LigaSure hemostasis technique in thyroid surgery: A meta-analysis. Biomed Rep 2016; 5:221.
  67. Miccoli P, Berti P, Ambrosini CE. Perspectives and lessons learned after a decade of minimally invasive video-assisted thyroidectomy. ORL J Otorhinolaryngol Relat Spec 2008; 70:282.
  68. Miccoli P, Pinchera A, Materazzi G, et al. Surgical treatment of low- and intermediate-risk papillary thyroid cancer with minimally invasive video-assisted thyroidectomy. J Clin Endocrinol Metab 2009; 94:1618.
  69. Kang SW, Lee SC, Lee SH, et al. Robotic thyroid surgery using a gasless, transaxillary approach and the da Vinci S system: the operative outcomes of 338 consecutive patients. Surgery 2009; 146:1048.
  70. Adam MA, Speicher P, Pura J, et al. Robotic thyroidectomy for cancer in the US: patterns of use and short-term outcomes. Ann Surg Oncol 2014; 21:3859.
  71. Hopkins B, Steward D. Outpatient thyroid surgery and the advances making it possible. Curr Opin Otolaryngol Head Neck Surg 2009; 17:95.
  72. Snyder SK, Roberson CR, Cummings CC, Rajab MH. Local Anesthesia With Monitored Anesthesia Care vs General Anesthesia in Thyroidectomy: A Randomized Study. Arch Surg 2006; 141:167.
  73. Snyder SK, Hamid KS, Roberson CR, et al. Outpatient thyroidectomy is safe and reasonable: experience with more than 1,000 planned outpatient procedures. J Am Coll Surg 2010; 210:575.
  74. Tuggle CT, Roman S, Udelsman R, Sosa JA. Same-day thyroidectomy: a review of practice patterns and outcomes for 1,168 procedures in New York State. Ann Surg Oncol 2011; 18:1035.
  75. Phitayakorn R, McHenry CR. Follow-up after surgery for benign nodular thyroid disease: evidence-based approach. World J Surg 2008; 32:1374.
  76. Haugen BR, Cooper DS, Emerson CH, et al. Expanding indications for recombinant human TSH in thyroid cancer. Thyroid 2008; 18:687.
  77. Escobar-Morreale HF, Botella-Carretero JI, Escobar del Rey F, Morreale de Escobar G. REVIEW: Treatment of hypothyroidism with combinations of levothyroxine plus liothyronine. J Clin Endocrinol Metab 2005; 90:4946.
  78. Bellantone R, Lombardi CP, Raffaelli M, et al. Is routine supplementation therapy (calcium and vitamin D) useful after total thyroidectomy? Surgery 2002; 132:1109.
  79. Cayo AK, Yen TW, Misustin SM, et al. Predicting the need for calcium and calcitriol supplementation after total thyroidectomy: results of a prospective, randomized study. Surgery 2012; 152:1059.
  80. Bentrem DJ, Rademaker A, Angelos P. Evaluation of serum calcium levels in predicting hypoparathyroidism after total/near-total thyroidectomy or parathyroidectomy. Am Surg 2001; 67:249.
  81. Sywak MS, Palazzo FF, Yeh M, et al. Parathyroid hormone assay predicts hypocalcaemia after total thyroidectomy. ANZ J Surg 2007; 77:667.
  82. Noordzij JP, Lee SL, Bernet VJ, et al. Early prediction of hypocalcemia after thyroidectomy using parathyroid hormone: an analysis of pooled individual patient data from nine observational studies. J Am Coll Surg 2007; 205:748.
  83. Wang TS, Cheung K, Roman SA, Sosa JA. To supplement or not to supplement: a cost-utility analysis of calcium and vitamin D repletion in patients after thyroidectomy. Ann Surg Oncol 2011; 18:1293.
  84. Carty SE, Doherty GM, Inabnet WB 3rd, et al. American Thyroid Association statement on the essential elements of interdisciplinary communication of perioperative information for patients undergoing thyroid cancer surgery. Thyroid 2012; 22:395.
  85. Tuggle CT, Roman SA, Wang TS, et al. Pediatric endocrine surgery: who is operating on our children? Surgery 2008; 144:869.
  86. Sosa JA, Mehta PJ, Wang TS, et al. A population-based study of outcomes from thyroidectomy in aging Americans: at what cost? J Am Coll Surg 2008; 206:1097.
  87. Boudourakis LD, Wang TS, Roman SA, et al. Evolution of the surgeon-volume, patient-outcome relationship. Ann Surg 2009; 250:159.
  88. Sosa JA, Bowman HM, Tielsch JM, et al. The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg 1998; 228:320.
  89. Stavrakis AI, Ituarte PH, Ko CY, Yeh MW. Surgeon volume as a predictor of outcomes in inpatient and outpatient endocrine surgery. Surgery 2007; 142:887.
  90. Mitchell J, Milas M, Barbosa G, et al. Avoidable reoperations for thyroid and parathyroid surgery: effect of hospital volume. Surgery 2008; 144:899.
  91. Adam MA, Thomas S, Youngwirth L, et al. Is There a Minimum Number of Thyroidectomies a Surgeon Should Perform to Optimize Patient Outcomes? Ann Surg 2017; 265:402.
  92. Bononi M, Amore Bonapasta S, Vari A, et al. Incidence and circumstances of cervical hematoma complicating thyroidectomy and its relationship to postoperative vomiting. Head Neck 2010; 32:1173.
  93. Harding J, Sebag F, Sierra M, et al. Thyroid surgery: postoperative hematoma--prevention and treatment. Langenbecks Arch Surg 2006; 391:169.
  94. Weiss A, Lee KC, Brumund KT, et al. Risk factors for hematoma after thyroidectomy: results from the nationwide inpatient sample. Surgery 2014; 156:399.
  95. Campbell MJ, McCoy KL, Shen WT, et al. A multi-institutional international study of risk factors for hematoma after thyroidectomy. Surgery 2013; 154:1283.
  96. Lee YS, Nam KH, Chung WY, et al. Postoperative complications of thyroid cancer in a single center experience. J Korean Med Sci 2010; 25:541.
  97. Audu P, Artz G, Scheid S, et al. Recurrent laryngeal nerve palsy after anterior cervical spine surgery: the impact of endotracheal tube cuff deflation, reinflation, and pressure adjustment. Anesthesiology 2006; 105:898.
  98. Chan TV, Grillone G. Vocal cord paralysis after laryngeal mask airway ventilation. Laryngoscope 2005; 115:1436.
  99. Cinar SO, Seven H, Cinar U, Turgut S. Isolated bilateral paralysis of the hypoglossal and recurrent laryngeal nerves (Bilateral Tapia's syndrome) after transoral intubation for general anesthesia. Acta Anaesthesiol Scand 2005; 49:98.
  100. Norris BK, Schweinfurth JM. Arytenoid dislocation: An analysis of the contemporary literature. Laryngoscope 2011; 121:142.
  101. Finck C. Laryngeal dysfunction after thyroid surgery: diagnosis, evaluation and treatment. Acta Chir Belg 2006; 106:378.
  102. Teitelbaum BJ, Wenig BL. Superior laryngeal nerve injury from thyroid surgery. Head Neck 1995; 17:36.
  103. Kern KA. Medicolegal analysis of errors in diagnosis and treatment of surgical endocrine disease. Surgery 1993; 114:1167.
  104. Dralle H, Sekulla C, Lorenz K, et al. Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg 2008; 32:1358.
  105. Laccourreye O, Papon JF, Kania R, et al. Intracordal injection of autologous fat in patients with unilateral laryngeal nerve paralysis: long-term results from the patient's perspective. Laryngoscope 2003; 113:541.
  106. Remacle M, Lawson G. Results with collagen injection into the vocal folds for medialization. Curr Opin Otolaryngol Head Neck Surg 2007; 15:148.
  107. Hartl DM, Travagli JP, Leboulleux S, et al. Clinical review: Current concepts in the management of unilateral recurrent laryngeal nerve paralysis after thyroid surgery. J Clin Endocrinol Metab 2005; 90:3084.
  108. Yumoto E, Sanuki T, Kumai Y. Immediate recurrent laryngeal nerve reconstruction and vocal outcome. Laryngoscope 2006; 116:1657.
  109. Paniello RC. Laryngeal reinnervation. Otolaryngol Clin North Am 2004; 37:161.
  110. Crumley RL. Repair of the recurrent laryngeal nerve. Otolaryngol Clin North Am 1990; 23:553.
  111. Lombardi CP, Raffaelli M, De Crea C, et al. Long-term outcome of functional post-thyroidectomy voice and swallowing symptoms. Surgery 2009; 146:1174.
  112. Gohrbandt AE, Aschoff A, Gohrbandt B, et al. Changes of Laryngeal Mobility and Symptoms Following Thyroid Surgery: 6-Month Follow-Up. World J Surg 2016; 40:636.
  113. Cozzaglio L, Coladonato M, Doci R, et al. Horner's syndrome as a complication of thyroidectomy: report of a case. Surg Today 2008; 38:1114.
  114. Roh JL, Kim DH, Park CI. Prospective identification of chyle leakage in patients undergoing lateral neck dissection for metastatic thyroid cancer. Ann Surg Oncol 2008; 15:424.
  115. Chauhan A, Ganguly M, Saidha N, Gulia P. Tracheal necrosis with surgical emphysema following thyroidectomy. J Postgrad Med 2009; 55:193.
Topic Outline