eMentorSurgery

Dear students, This is only for your revision and NOT A FULL TEXT.

Thyroidectomy

Removal of Thyroid Gland

3 Types

            Hemi-thyroidectomy

            Sub-TotalThyroidectomy

            TotalThyroidectomy

Important Structures In Relation to Thyroid

Superior Thyroid Artery & Vein

Middle Thyroid Vein

Inferior Thyroid Artery  & Vein

Recurrent Laryngeal Nerve

Parathyroid Glands

Indications

Hemithyroidectomy

            SolitaryNodule Thyroid or    Adenoma

Sub-Total Thyroidectomy

            ColloidGoitre            

            MultinodularGoitre

            PrimaryThyrotoxicosis (Grave’s)

Total Thyroidectomy

            CarcinomaThyroid

Near Total Thyroidectomy is similar to TotalThyroidectomy for Indications, but complications are less.

General principles

Preoperative Preparation

Needed for Thyrotoxicosis

Uncontrolled Thyrotoxicosis if Operated leads to

THYROID STORM (THYROID CRISIS)

 Control Thyrotoxicosis by

Neomercazole ( Carbimazole)

Propranolol

Takes 4 – 6 weeks to control

1 – 2 weeks before operation give-Lugol’s Iodine

            Lugol’sIodine reduces          vascularity of thegland

Anaesthesia is always G.A.

Position of patient : Head end Up (Same as in tracheastomy position)

(Reduces Venous stagnation & lessens bleeding)

Head kept extended

A pillow beneath shoulders

Horizontal incision above suprasternal notch.

Main steps

Ligate the Middle Thyroid Vein

Ligate & Divide SuperiorThyroid

            VesselsClose to Thyroid

Ligate In Continuity Inferior Thyroid

Artery away from Thyroid

Ligate & Divide Inf. Thyroid Veins

Remove Thyroid Gland

Isthmus & Lobe - Hemithyroidectomy

7/8th of Each lobe for Subtotal Thyroidectomy

OR Gland tissue in the Tracheo-Oesophageal Grove.

Or Equivalent to a Phalanx Left remaining on each side

 Complications

Immediate

            Bleeding(Slipping Of Ligature )

            ThyroidStorm

            Injuryto Nerves

                        Sup.Laryngeal

                        RecurrentLaryngeal

            ParathyroidRemoval

Laryngeal Oedema

Hypo-Thyroidism

Bleeding

            On Table from an Artery

            Postoperatively

            Haematoma deep to deep Fascia

            Causes Stridor

Immediately Remove Stitches

Heamostasis in Operation Theatre

Thyroid Storm

            Resultsif operated on a patient without adequate control of Toxicity

Dangerous condition with high mortality

Can manifest soon after operation is finished and some time during surgery.

Due to release of Thyroxine from the gland while handling

Features : Tachycardia

            Hyperpyrexia

            Diarrhoea

            Sweating& Dehydration

            Restlessness& Tremors

Treatment 

Sedation,         Antipyretics

Cold Sponging            ,           IV Fluids

Iodides(Sodium or Potassium)

Propranolol& Neomercazole

Corticosteroids

Complications …cont….

Recurrent Laryngeal Nerve Injury

            Unilateral  - Hoarseness Voice

            Bilateral-  Stridor

Requires Tracheostomy

Hypo-Parathyroidism

            Tetany (Hypocalcaemia)

            TreatmentCalcium Gluconate I.V.