Subtotal thyroidectomy

Subtotal thyroidectomy may be applicable in selected patients with benign thyroid goitres and differentiated cancers who cannot undergo total thyroidectomy due to lack of access to thyroid or calcium monitoring and replacement.

The Dunhill procedure involves complete removal of one thyroid lobe with preservation of the superior and posterior thyroid on contralateral side.  The posterior thyroid tissue near the cricothyroid joint is preserved, with the intent of not disturbing the recurrent laryngeal nerve, although failure to identify the nerve does potentially increase risk of injury.  Similarly, the intent of preservation of the superior and posterior thyroid tissue is to increase the likelihood of preservation of the superior parathyroid glands, which are generally located along the posterosuperior aspect of the gland.

Risks (Compared to thyroid lobectomy/total thyroidectomy)

  • Haemorrhage
  • Potential increased risk of recurrent laryngeal nerve injury (if RLN not identified)
  • Parathyroid glands are generally not specifically identified
  • Uncertainty whether sufficient functioning thyroid tissue preserved to render  patient euthyroid
  • Risk of recurrence of a goitre
  • Revision surgery more difficult

Index: Clinical Practice Guidelines for Thyroid