In preparation for the operation, a patient undergoing a subtotal thyroidectomy usually lies back on an operating table with a rolled-up sheet or an inflatable pillow positioned under the shoulders. This helps to tilt the patient’s head back to provide the surgeon with optimal exposure to the thyroid gland and other structures in the neck. The patient is then placed under general anesthesia by an anesthesiologist or anesthetist. When the patient is has gone to sleep, the skin overlying the neck is carefully cleaned with antiseptic solution. Sterile towels are draped around the neck to maintain a field that limits exposure to infection.
Once the neck has been cleaned and draped, a horizontal incision is made through the skin along the front of the neck. The length of this incision may vary depending on the size of the thyroid gland and the amount of work that needs to be done to explore other structures in the neck. After the incision is made, the skin is retracted so that the muscles that run along the front of the neck are visible. A vertical incision is made through a layer of tissue called fascia to provide access to the thyroid gland. Once the thyroid gland has been located, the muscles that run along the front of the neck are retracted outward to provide access to each lobe. If a lobe is markedly enlarged, the muscles overlying it may be cut through the middle to provide greater access. Once each lobe has been carefully inspected, incisions are made to separate the anterior portion of each lobe from a posterior rim of tissue containing the parathyroid glands. Once bleeding has been controlled, these anterior portions are cut away from the larynx and removed. The posterior rim of tissue is left in place.
When the operation is completed, the incision is closed with stitches. If there is any concern about possible bleeding into the site, a drain may left in place. This usually consists of a tube that passes through the incision, connecting to a small suction device that removes collected blood and fluid. After the patient wakes up from anesthesia, careful monitoring is instituted to evaluate the strength of the patient’s voice and the level of calcium in the patient’s bloodstream. In an uncomplicated case, the patient may be discharged home as soon as the following day.