Total thyroidectomy with lymph node dissection

In some thyroid cancers, tumour cells can reach the lymph nodes of the neck. The operation then combines complete removal of the thyroid with a lymph node dissection, meaning the systematic removal of the lymph nodes in a given area of the neck. Central neck dissection concerns the lymph nodes around the windpipe, between the two carotid arteries. Lateral neck dissection concerns the lymph nodes along the large blood vessels of the neck, on one or both sides. The extent of the dissection is decided according to the type of cancer, the ultrasound findings, needle biopsy of suspicious nodes and discussion of the case at a multidisciplinary meeting. The operation is performed under general anaesthesia. The incision is horizontal at the base of the neck; it may be slightly longer when a lateral dissection is needed. The surgeon preserves the recurrent laryngeal nerves, the parathyroids, and the important nerves and vessels of the neck. The removed lymph nodes are analysed to determine how far the disease has spread and to guide further treatment. After surgery, lifelong hormone treatment is needed, and additional treatment with radioactive iodine may be offered depending on the results. At Clinique Pasteur Tunis, care is coordinated with the endocrinologist and the other specialists involved.