THYROID GLAND. Surgery Management-finalpptx.pptx

Surgery

1. THYROID GLAND Dr. Rema Devi Greek: Thyreos -oblong shield

2. CASE STUDY 1 A 50 year old lady C/o gradual weight gain of 10 Kilos in 1 year, fatigue, postural dizziness, loss of memory, slow speech, deep voice, dry skin, constipation, and cold intolerance. Exam: General: Pulse, BP, Weight Looked for pitting edema Patient was asked to swallow Deep tendon reflexes checked Asked about voice change Physical examination : PR- 58/min , regular; moderately obese ; slow speech ; hoarse voice; puffy face; cool, dry, and thick skin . DTR time is delayed. DIAGNOSIS: HYPOTHYROID Why asked to swallow? Why voice changes? How to palpate thyroid gland? What DTRs do you examine? What lab investigations to ask?

3. LEARNING OBJECTIVES Coverings Gross features & relations Blood supply Lymphatic drainage Nerve supply Applied aspects Thyroid swellings

4. GROSS LOCATION Against C5-T1 vertebrae, over upper part of trachea PARTS 2 lobes Connected by an Isthmus ( Pyramidal lobe ) – projects upward from isthmus ( levator glandulae thyroidea ) – fibro muscular band between thyroid gland and hyoid bone

5. BASICS… Length x width x thickness= 5x3x2cm Wt- 25gms (WOMEN????) Peculiarities - superficial location - depends on external envt . for raw material - secretions stored - rich blood flow

6. GROSS: COVERINGS True Capsule & False capsule True Capsule Capillary plexus beneath it False Capsule ( Pretracheal fascia) Anterior-thick Posterior – thin (swelling compressing vital tubes) Suspensory ligament of Berry

7. PRETRACHEAL FASCIA Movt during deglutition Enlargement  dysphagia

8. PRESENTING PARTS LOBES Apex Base- opposite 4 th & 5 th tracheal rings 2 borders- ant. & post. 3 surfaces -superficial , medial & posterolateral Butterfly shaped ISTHMUS

9. PRESENTING PARTS

10. Apex Base

11. RELATIONS: APEX Superior:- oblique line of thyroid cartilage – attachment of sternothyroid M Superior thyroid A. Ext.larngal N. Ligature of superior thyroid artery – close to the gland

12. RELATIONS: BASE Extends upto 5-6 tracheal rings Inferior thyroid A Recurrent laryngeal N Inferior thyroid A & Recurrent laryngeal N – variable relation Ligature away from gland

13. SUPERFICIAL (LATERAL) SURFACE Strap Ms ( SH/OH /ST) Sternomastoid M SH ST TH OH SM

14. 1. trachea 2. oesophagus 3.Cricothyroid M 4. Inferior Constrictor M 5. ext.laryngeal N 6. rec. laryngeal N MEDIAL SURFACE Rule of 2- 2 tubes: trachea,oeso 2 muscles: cricothyroid, inf. Constrictor- pharynx 2 nerves :Ext.laryngeal , Rec. laryngeal. 2 cartilages : Thyroid, cricoid 7. thyroid 8. cricoid

15. RELATIONS: POSTERO-LATERAL (POSTERIOR) SURFACE

16. ANTERIOR BORDER

17. POSTERIOR BORDER Arterial anast .

18. ISTHMUS ANTERIOR SURFACE: Sternohyoid & sternothyroid Ms Ant. Jugular V.s POSTERIOR SURFACE: 2-4 tracheal rings UPPER BORDER: Sup. Thyroid A.s (anterior branches) LOWER BORDER: Inf. Thyroid V.s At 2-4 tracheal rings, lower part of the lobes SURFACES: ant / post BORDER : upper/ lower

19. ARTERIAL SUPPLY Sup. Thyroid A (ECA) [ext. laryngeal N] NEAR 2. Inf. Thyroid A (thyrocervical A) [rec. laryngeal N] AWAY 3. Throidea Ima A (Arch of aorta/ brachiocephalic trunk)

20. VENOUS DRAINAGE Superior Thyroid V  IJV Middle Thyroid V  IJV Inferior Thyroid V Lt. brachiocephalic V 4 th Thyroid V (Kocher’s V)  IJV Kocher’s V.

21. BLOOD VESSELS AND RELATED NERVES

22. LYMPHATIC DRAINAGE Upper part of the gland Upper deep cervical nodes Lower part of the gland Lower deep cervical nodes Prelaryngeal LN Pretracheal LN Paratracheal LN

23. NERVE SUPPLY Through the sympathetic trunk Middle, superior and inferior cervical ganglia Vasoconstrictor in function

24. APPLIED ANATOMY

25. APPLIED ANATOMY Thyroidectomy: removal of thyroid gland Relation of the artery and nerves- during surgical removal Malignant growth of thyroid- pressure symptoms – 3D- Dyspnea/Dysphagia/ Dysphonea Thyroid gland moves with swallowing Downward extension of thyroid and not an upward extension