Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Thyroidectomy


Related Terms

  • Partial Thyroidectomy
  • Subtotal Thyroidectomy
  • Total Thyroidectomy

Specialists

  • Endocrinologist
  • General Surgeon
  • Otolaryngologist

Comorbid Conditions

  • Chronic conditions (e.g., diabetes and heart or lung disease)
  • Immune system disorders, including immunosuppression as in AIDS
  • Metastatic cancer involving the lymphatic system

Factors Influencing Duration

The underlying diagnosis for which this procedure was performed, extent of the surgery, as well as the presence of complications may influence length of disability.

Medical Codes

ICD-9-CM:
06.39 - Thyroidectomy, Other Partial; Isthmectomy; Partial Thyroidectomy NOS
06.4 - Thyroidectomy, Complete
06.50 - Substernal Thyroidectomy, Not Otherwise Specified
06.51 - Partial Substernal Thyroidectomy
06.52 - Complete Substernal Thyroidectomy

Overview

A thyroidectomy is the partial or complete removal of the thyroid gland. Partial thyroidectomy (lobectomy) is used to treat individual, localized nodules or tumors, whereas complete (total) thyroidectomy may be performed in cases of thyroid enlargement, metabolic dysfunction, and primary cancer of the thyroid.

The decision to perform a partial or complete thyroidectomy is dependent on the size of the lesion, whether the lesion is cancerous (malignant) or noncancerous (benign), and the age of the individual ("Thyroid Cancer Treatment").

Source: Medical Disability Advisor



Reason for Procedure

The thyroid gland may be removed for a number of reasons. Both benign and malignant tumors can develop in the thyroid, and thyroidectomy may be required to remove the tumors or the entire thyroid gland.

Thyroidectomy also is done to treat an overactive thyroid (thyrotoxicosis or Graves' disease), especially in women who are pregnant or trying to become pregnant; thyroiditis, thyroid nodules, and to relieve breathing difficulties (airway obstruction) or blood vessel obstruction caused by an enlarged thyroid gland (goiter). Thyroid dysfunction, either causing elevated (hyperthyroidism) or decreased function (hypothyroidism), is found in 6% of the general population in the US and may require thyroidectomy if the condition cannot be controlled with medication ("Thyroidectomy").

Source: Medical Disability Advisor



How Procedure is Performed

A thyroidectomy may involve partial or total removal of the thyroid gland. This surgical procedure is performed in the operating room under general anesthesia. A curved incision is made on the front of the lower neck above the breastbone (sternum), muscles are moved aside (retracted), the carotid arteries are protected, blood vessels are tied off or rerouted, the area is suctioned, and the thyroid gland is located (Khatri). All or part of the thyroid gland is then removed (resected). Parathyroid glands and their blood-supply should be identified and preserved. When the blood-supply has been damaged, a parathyroid autotransplantation should be done, usually into several sites of the sternocleidomastoid muscle. The neck incision is closed with stitches. The individual usually stays in the hospital for 1 day after minimally invasive thyroidectomy (Terris) and 3 to 5 days after total thyroidectomy (Rafferty). Follow-up thyroid and parathyroid function tests are required after thyroidectomy to evaluate functioning of any remaining thyroid tissue and of the parathyroid glands.

A minimally invasive form of the surgery (hemi-thyroidectomy, endoscopic thyroidectomy) can sometimes be performed for individuals with less severe thyroid conditions. The surgery requires only a small incision and uses videoscopic technique to guide the surgical instruments and view the procedure.

Source: Medical Disability Advisor



Prognosis

Following partial thyroidectomy, thyroid function returns to normal in 90% to 98% of cases, although up to 50% of individuals may experience hypothyroidism during the first year after surgery (“Thyroidectomy”). Thyroidectomy for well-differentiated thyroid cancer has a 21% recurrence rate, with 7% of individuals ultimately dying from the disease (Ruggiero).

The prognosis of a thyroidectomy is excellent, with a mortality rate of almost 0% (“Thyroidectomy”).

All individuals undergoing a total thyroidectomy, and some of those undergoing a partial thyroidectomy, will require lifelong treatment with thyroid hormone replacement.

Source: Medical Disability Advisor



Complications

Total thyroidectomy is associated with complications such as low blood calcium levels (hypocalcemia) in up to 40% of individuals, unintentional removal of the parathyroid glands (9%), temporary or permanent paralysis of the laryngeal nerve that controls the larynx (2.0% to 3.3%, respectively), permanent hypoparathyroidism (3.3%), and rare deaths (0.08%) (Rafferty, Bansal). Minimally invasive thyroidectomy results in an overall complication rate of 8% (Terris), with permanent laryngeal nerve injury in up to 2.8% of cases, and permanent hypocalcemia in up to 1.0% of cases (Choh).

Injury to the parathyroid glands will require treatment with vitamin D and supplemental calcium, which may be necessary throughout the individual’s lifetime. Injury to the recurrent laryngeal nerves results in either temporary or permanent hoarseness. Bleeding under the skin (hematoma) and hemorrhage are rare but may be life threatening, and wound infection also may occur with either partial or complete thyroidectomy.

Rarely, a medical emergency called thyroid storm may occur following thyroidectomy, in which the individual experiences increased heart rate (tachycardia), fever, chest pain, anxiety, weakness, and heart failure (Alshanti).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Hoarseness, sore throat, or difficulty speaking may require work accommodations. If the individual has cancer, radiation treatment may be required after surgery, requiring frequent absences from work.

Source: Medical Disability Advisor



References

Cited

"Thyroid Cancer Treatment." Natonal Cancer Institute. 6 Feb. 2009. U.S. National Institutes of Health. 18 Aug. 2009 <http://www.cancer.gov/cancertopics/pdq/treatment/thyroid/HealthProfessional/page5/print>.

"Thyroidectomy." Surgery.com. 2009. 18 Aug. 2009 <http://www.surgery.com/procedure/thyroidectomy#Information>.

Alshanti, Mohammed, and Moshen S. Eledrisi. "Thyroid Storm." eMedicine Health. 30 Dec. 2005. WebMD, LLC. 18 Aug. 2009 <http://www.emedicinehealth.com/thyroid_storm/article_em.htm>.

Bansal, Arvind, Jeffrey Miskoff, and Ronald J. Lis. "Otolaryngologic Critical Care." Critical Care Clinics 19 1 (2003): 55-72. MD Consult. Elsevier, Inc. 8 Oct. 2004 <http://home.mdconsult.com/das/journal/view/41461313-2/N/12920764?sid=305345245&source=MI>.

Choh, Mark S. , and Jeffrey Miskoff. "The Role of Minimally Invasive Surgical Treatments in Surgical Oncology." Surgical Clinics of North America 89 1 (2009): 53-77. PubMed. <PMID: 19186231>.

Khatri, Vijay, et al. "Chapter 1: Thyroidectomy." Operative Surgery Manual. 1st ed. Saunders Elsevier, 2003. MD Consult. Elsevier, Inc. 18 Aug. 2009 <http://www.mdconsult.com/das/book/body/154957224-3/876589431/1278/6.html#4-u1.0-B0-7216-7864-5..50005-5_6>.

Rafferty, Mark A., et al. "Completion Thyroidectomy versus Total Thyroidectomy: Is There a Difference in Complication Rates? An Analysis of 350 Patients." Journal of the American College of Surgeons 205 4 (2007): 602-607.

Ruggiero, Francis P., and Fred G. Fedok. "Outcomes In Reoperative Thyroid Cancer." Otolaryngologic Clinics of North America 41 6 (2008): 1261-1268. PubMed. <PMID: 19040984>.

Terris, David J., and Jonathan Opraseuth. "Minimally Invasive Reoperative Surgery." Otolaryngologic Clinics of North America 41 6 (2008): 1199-1205.

Source: Medical Disability Advisor






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