Thyroidectomy

a brief class project on surgical removal of thyroid

1. THYROIDECTOMY Vaibhav Shriya IX Semester

2. Indications Therapy for Thyrotoxicosis Benign or Malignant tumours in thyroid Alleviate pressure (Dysphagia, Respiratory Distress, etc.) d/t thyroid enlargement Cosmetic purpose Establish Definitive Diagnosis of a mass w/i thyroid (esp. if FNAC is either Non-diagnostic or indeterminate)

3. Pre-Op Preparation ABO – Rh grouping Indirect Laryngoscopy  Pt. says “ E ”  check for B/L ABDUCTION of vocal cords S. Ca +2 S. TSH, T 3 , T 4 Anti-Thyroid Abs. ECG (esp. Toxic Goiter) Lugol’s I 2 10 days prior to surgery  gland becomes less vascular  firm gland

4. Types Hemithyroidectomy Subtotal Thyroidectomy Partial Thyroidectomy Near Total Thyroidectomy Total Thyroidectomy Hartley-Dunhill Operation

5. Hemithyroidectomy

6. Subtotal Thyroidectomy

7. Partial Thyroidectomy

8. Near Total Thyroidectomy

9. Total Thyroidectomy

10. Hartley Dunhill Operation

11. Procedure

12. Strap mm. are retracted (often AJV’s ligated with 3-0 vicryl ) Pre-tracheal fascia opened vertically MTV ligated immediately with 2-0 vicryl (first vessel to be ligated) & divided Gland mobilized medially by peanut dissection & bipolar cautery

13. STA & STV (Superior Pedicle) individually ligated & divided with 2-0 vicryl ELN enters cricothyroid mm. Dissection done in an avascular plane b/w cricothyroid mm. & gland Parathyroids identified & dissected Sup. Parathyroid – above & dorsal to junction of ITA & RLN Inf. Parathyroid – below & ventral

14. RLN identified ( Riddle’s triangle) Generally – (ITA) A rtery is A nterior to RLN RLN is in close proximity to Ligament of Berry Dissect gland with bipolar cautery ONLY along the path of RLN Capsular ligation of ITA  retains blood supply to parathyroids (which lie w/i false capsule) Mobilized gland is removed

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