A technique for thyroidectomy.

For several decades following the turn of the century, most thyroid surgery was necessary because of endemic goiter and Grave's disease. A lack of safe anesthesia and an inability to control hyperthyroidism preoperatively necessitated a rapid operating technique. This often meant blind resection of the bulbous anterior and lateral portions of the gland, resulting in considerable hemorrhage and injury to the recurrent laryngeal nerve in a significant number of cases. With the subsequent introduction of iodine into food and the use of radioactive iodine and the antithyroid drugs, surgery for these conditions was largely eliminated. Nevertheless, the thyroid surgeon of today still has a role in surgery of thyroid cysts, nodular goiter, and multinodular goiter either for cosmetic reasons or because of tracheal or esophageal obstruction. In addition, surgery is still required for nodular goiter with hyperthyroidism and thyroid cancers. Modern anesthetics and preoperative control of thyrotoxic patients afford the surgeon an opportunity for anatomic dissection of the thyroid. This article deals with an evolving technique for thyroidectomy individualized according to the pathophysiologic requirements of each case. The illustrations apply to a patient with a right lobe thyroid nodule. The variations in technique required for different thyroid disorders will be reviewed.