thyroid surgery
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Transcript of thyroid surgery
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Surgery of the thyroidIndications for operation Simple diffuse goiter :
cosmetic reasons or pressure symptoms
Nodular goiter : Additional reasons – may undergo toxicity, malignant change.
Solitary nodule : more chance of malignancy
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Indications for operation (contd.) Primary thyrotoxicosis : 1)
Lack of response to medical treatment 2) Relapse after apparent cure 3) Toxicity of the drugs 4) Large size of the gland or retrosternal extension.
Toxic nodular goiter
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Preoperative treatment Vocal cord assessment Medical treatment with
antithyroid drugs for cases of thyrotoxicosis , Lugol`s iodine 0.3 ml three times daily 10 days prior to surgery,Propranolol if needed
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Subtotal thyroidectomy Both for simple and toxic goiter –
the amount of gland removed varies
Premedication and Anaesthesia – A good night`s sleep with some sedatives may calm the pt. General anaesthesia with endotracheal intubation advised in most of the cases.
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Technique Position – the neck extended by a
sandbag placed in between the shoulders and the head supported on a ring
The skin incision – the “collar” incision 2 to 3 cms. Above the sternum extending to the lateral borders of the sternomastoids.
The flaps are reflected upwards and downwards – upper flap up to the level of thyroid cartilage,lower down to the sternum
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Other surgical procedures Hemithyroidectomy
(lobectomy)
Total thyroidectomy
Excision of the isthmus
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Complications of thyroidectomy Haemorrhage Respiratory obstruction Recurrent laryngeal nerve
paralysis Hypoparathyroidism Hypothyroidism Recurrent thyrotoxicosis