Overview of Isthmusectomy

An isthmusectomy is a procedure to treat thyroid tumors in the center of your thyroid gland. It preserves more of your thyroid tissue than more invasive procedures.

An isthmusectomy is a type of thyroid gland surgery that removes the bridge between the left and right lobes of your thyroid gland. Surgeons use it to treat small tumors in the central part of your thyroid gland, which is called the isthmus.

Doctors sometimes recommend an isthmusectomy over more extensive procedures to minimize the side effects of thyroid surgery.

Read on to learn more about isthmusectomy, including when a doctor may suggest it, its effectiveness, and potential side effects.

Thyroid isthmusectomy purpose

The purpose of an isthmusectomy is to treat small tumors in the area between the two lobes of your thyroid gland. This area is called the isthmus. A surgeon may combine it with a partial thyroidectomy to remove the center of your thyroid and either the left or right lobe.

Isthmusectomy side effects and risks

Like all surgeries, isthmusectomy comes with a risk of side effects. The main side effects include:

• infections
• bleeding
• injury to the nerves that help you speak
• injury to your parathyroid glands

Because a surgeon removes only a small part of the thyroid gland during an isthmusectomy, there’s a smaller chance of needing to take replacement hormones than with more invasive thyroid surgeries .

Even people who have a partial thyroidectomy, where a surgeon removes half the thyroid gland, don’t usually need to take replacement hormones.

According to the American Thyroid Association, 80% of people who have a partial thyroidectomy don’t need to take medications unless they’re already taking them for low thyroid levels.

How effective is isthmusectomy?

The most common type of thyroid cancer is papillary carcinoma . According to a 2022 study, about 1% to 9.2% of these cancers arise in the isthmus.

The role of isthmusectomy in the management of papillary carcinoma is controversial since there’s limited research comparing its effectiveness with other procedures.

In the same 2022 study, researchers examined the outcomes of 65 people who had an isthmusectomy to treat solitary papillary thyroid tumors in China between 1985 and 2015. Two people experienced recurrence in the median follow-up period of 78 months. The 10-year overall survival was 98.3%, and the 10-year disease-specific survival was 100%.

In a 2020 study , researchers found that isthusectomy may be effective in treating well-differentiated thyroid carcinoma in selected people with features of nonaggressive cancer.

Isthmusectomy steps

Here’s a general idea of what to expect before, during, and after a thyroid surgery.

Before the procedure

You’ll receive a general anesthetic before your procedure to put you to sleep. You’ll receive the anesthetic through a mask on your face or through a medication injected into a vein, often in your hand or wrist.

Once you’re unconscious, you’ll receive a breathing tube, and a healthcare professional will connect you to monitors to check your vitals.

During the procedure

Once you’re unconscious, your surgeon will:

1. Make an incision across the front of your neck, above your collarbone.
2. Locate important structures around your thyroid gland, like nerves and your parathyroid glands, to avoid damaging them during your procedure.
3. Detach the central part of your thyroid gland and remove it.
4. Close your wounds with stitches.

After the procedure

You’ll wake up after your surgery in a recovery room, where your healthcare professional will monitor you for complications. You may have a drain in your neck to help drain your wound. You’ll likely be able to eat and drink shortly after your surgery.

Preparing for isthmusectomy

Your surgical team can give you specific instructions on how to prepare for your procedure.

If you’re receiving a general anesthetic, you’ll need to stop eating and drinking hours before. You may also need to stop taking certain medications or supplements that thin your blood.

Recovering from isthmusectomy

Following your surgical team’s instructions gives you the best chance of recovering quickly without complications.

You might have swelling around your wound for up to 6 days after your procedure, according to the National Health Service (NHS) of the United Kingdom.

The NHS also suggests that you won’t be able to drive for at least 2 weeks after your procedure, and most people need up to 2 weeks to return to work.

Isthmusectomy recovery time

Everybody’s recovery process is different, but here’s a general idea of the typical recovery timeline :

• During the week after your procedure, you can start doing light activities, like cooking and walking around the house.
• In your second week, you can go for longer walks, and you may be able to start jogging for 15 to 30 minutes at a time.
• In your second to fourth weeks, you may be able to start doing more strenuous activities, like picking up weight up to 11 pounds.
• By 6 weeks, most people can gradually return to their normal activities.

Are there any alternatives to isthmusectomy?

Alternative surgeries for thyroid tumors include:

• Lobectomy: A lobectomy is a procedure to remove one side or lobe of your thyroid gland. It’s also called a hemi-thyroidectomy or a partial thyroidectomy.
• Near-total thyroidectomy: A near-total thyroidectomy is surgery to remove most of the thyroid gland, but it leaves a little so that your body can still produce some thyroid hormone.
• Total thyroidectomy: A total thyroidectomy is a procedure to remove your entire thyroid gland. It’s the most common surgery for thyroid cancer.
• Neck dissection: Surgeons do neck dissection to remove lymph nodes and tissue from your neck. They may combine it with a thyroidectomy.

How much does isthmusectomy cost?

The cost of your procedure can vary depending on factors like:

• your insurance coverage
• where you live
• the extent of your procedure

For reference, the nonprofit FairHealth estimates that 80% of procedures to remove a thyroid gland lobe in Buffalo, New York, cost less than $4,535 without insurance.

There might also be other costs, such as $13,511 for outpatient hospital fees or $2,040 for the anesthetic.

Frequently asked questions about isthmusectomy

Here are some frequently asked questions people have about isthmusectomy.

What is the isthmus of the thyroid gland?

The isthmus is the central part of your thyroid gland, between the left and right lobes.

Is the isthmus removed in thyroidectomy?

Surgeons often combine isthmusectomy with a partial thyroidectomy to remove the center and one lobe of your thyroid.

What happens when the thyroid is removed?

If a surgeon removes your entire thyroid gland, you’ll need to take medications to replace the thyroid hormone this gland normally produces. You may not have to take medications if your surgeon only removes part of your thyroid gland.

Takeaway

An isthmusectomy preserves more of your thyroid tissue than more invasive procedures, like a partial or a total thyroidectomy.

Your doctor is most likely to recommend an isthmusectomy for small tumors that are unlikely to be aggressive. They can advise you about whether you’re a candidate for an isthmusectomy.