L5: Thyroidectomy Flashcards
(82 cards)
1
Q
Principles of Thyroidectomy
A
2
Q
Removed Part
Hemithyroidectomy
A
3
Q
Retained Part Hemithyroidectomy
A
4
Q
indications
Hemithyroidectomy
A
5
Q
Removed Part
Subtotal thyroidectomy
A
6
Q
Retained Part
Subtotal thyroidectomy
A
7
Q
Indications
Subtotal thyroidectomy
A
8
Q
Partial thyroidectomy (Its role is controversial)
A
..
9
Q
Removed Part
Partial thyroidectomy
A
10
Q
Retained Part
Partial thyroidectomy
A
11
Q
Indications
Partial thyroidectomy
A
12
Q
Removed Part
Near total thyroidectomy
A
13
Q
Retained Part
Near total thyroidectomy
A
14
Q
Indications
Near total thyroidectomy
A
15
Q
Removed Part
Total thyroidectomy
A
16
Q
Retained Part
Total thyroidectomy
A
17
Q
Indications
Total thyroidectomy
A
18
Q
Removed part
Hartley Dunhill procedure
A
19
Q
Retained Part
Hartley Dunhill procedure
A
20
Q
Indications
Hartley Dunhill procedure
A
21
Q
Indications
Isthmectomy
A
22
Q
Isthmus should be removed in entirety in any type of thyroid ectomy, WHY?
A
If it is retained partially → it gets adherent to wound in front creating a cosmetically poor scar.
23
Q
Pre-Operative Preparation for thyroid surgery
A
- The patient should be euthyroid at operation.
- Preparation is outpatient and rarely need admission to hospital.
- Antithyroid Drug
- BB
- Iodine
24
Q
Drug of choice for preparation
A
Carbimazole
25
Dose of carbimazole
**Pre-Operative Preparation for thyroid surgery**
26
MOA of BB
**Pre-Operative Preparation for thyroid surgery**
- These act on the target organs and not on the gland itself.
- Propranolol also inhibits the peripheral conversion of T4 to T3.
27
Dose of Propranolol
**Pre-Operative Preparation for thyroid surgery**
Propranolol 40 mg three times a day.
28
Notes of BB
**Pre-Operative Preparation for thyroid surgery**
29
Iodine
**Pre-Operative Preparation for thyroid surgery**
30
Check the steps of thyroidectomy in notes
..
30
Pre-operative investigations to be carried out and recorded before thyroidectomy
31
Anasethia
**Thyroidectomy**
General
32
Positioning
**Thyroidectomy**
- Patient is put in supine position with neck hyperextended by placing a sandbag under shoulder.
- with table tilt of 15-degree head up.
33
Incision
**Thyroidectomy**
**KOCHER'S THYROID INCISION**
- Horizontal crease incision is done, two finger breadth above the sternal notch, from one sternomatoid to the other.
34
Flaps
**Thyroidectomy**
1. Skin & platysma are incised (subplatysmal plane).
2. Upper flap raised up to thyroid cartilage, Lower flap up to sternoclavicular joint.
35
Deep fascia dissection
**Thyroidectomy**
Deep fascia is opened vertically in the midline.
36
Ligation of Vessels
**Thyroidectomy**
37
Characters of Parathyroid Gland
38
Site of both superior & Inferior Parathyroids
39
Cautrey
**Thyroidectomy**
One should not use monopolar cautery here; only bipolar cautery should be used carefully.
40
Course of Inferior Thyroid Artery
**Thyroidectomy**
Nerve usually crosses the inferior thyroid artery from deeper aspect; but variations are common.
41
Zuckerkandl tubercle
**Thyroidectomy**
- Posterior extension of lateral thyroid lobes close to berry's ligament is called as zuckerkandl tubercle which is seen in 40% of cases.
- Nerve runs upwards in a fissure between zuckerkand tubercle and trachea or main thyroid gland.
42
RLN & Ligament of Berry
**Thyroidectomy**
Recurrent laryngeal nerve is in close contact with suspensory ligament of berry.
43
Ligation of Inferior Thyroid artery
**Thyroidectomy**
44
Critical points of recurrent laryngeal
nerve injury
**Thyroidectomy**
- At the entry of inferior thyroid artery and crossing the nerve,
- At suspensory ligament of Berry,
- At lower pole of the gland.
45
Suction Drain
**Thyroidectomy**
- Traditionally suction drain is placed which is brought out through a separate stab incision or one of the ends of the main wound.
- Drain should pass under the strap muscles to reach the thyroid fossa.
46
Suturing
**Thyroidectomy**
- Strap muscles are approximated using interrupted 3 zero vicryl sutures.
- Platysma is sutured using 3 zero vicryl interrupted sutures.
- Subcuticular absorbable 3 zero monocryl suture is used skin.
47
what is MIVAT?
- Minimally Invasive Video-Assisted Thyroidectomy is becoming popular for small nodules and gland without thyroiditis.
- But it is costly
48
Post-Operative complications of thhroidectomy
49
Causes of Hge
**Complications of Thyroidectomy**
May be due to slipping fligatures either of superior thyroid artery or other pedicles or small veins.
50
CP of Hge
**Complications of Thyroidectomy**
- Tachycardia, hypotension.
- Dyspnea and compression over trachea may cause severe stridor, respiratory obstruction due to tension hematoma Obstruct.
51
Managment of Hge
**Complications of Thyroidectomy**
52
respiartory Obstruction
**Complications of Thyroidectomy**
53
Types of Recurrent laryngeal nerve palsy (Positions of Vocal Cord Types)
**Complications of Thyroidectomy**
54
- Paralyzed Muscle?
Unilateral Recurrent Nerve Palsy
**Complications of Thyroidectomy**
55
- Vocal Cord Position
Unilateral Recurrent Nerve Palsy
**Complications of Thyroidectomy**
56
- CP
Unilateral Recurrent Nerve Palsy
**Complications of Thyroidectomy**
57
- Management
Unilateral Recurrent Nerve Palsy
**Complications of Thyroidectomy**
58
- Paralyzed Laryngeal Muscle
Bilateral Recurrent Nerve Palsy
**Complications of Thyroidectomy**
59
- Vocal Cord Position
Bilateral Recurrent Nerve Palsy
**Complications of Thyroidectomy**
60
- CP
Bilateral Recurrent Nerve Palsy
**Complications of Thyroidectomy**
61
- Managment
Bilateral Recurrent Nerve Palsy
**Complications of Thyroidectomy**
62
- Paralyzed Laryngeal Muscle
Unilateral Recurrent & Superior Laryngeal Nerve Palsy
**Complications of Thyroidectomy**
63
- Vocal Cord Position
Unilateral Recurrent & Superior Laryngeal Nerve Palsy
**Complications of Thyroidectomy**
64
- CP
Unilateral Recurrent & Superior Laryngeal Nerve Palsy
**Complications of Thyroidectomy**
65
- Managment
Unilateral Recurrent & Superior Laryngeal Nerve Palsy
**Complications of Thyroidectomy**
66
- Paralyzed Muscle
Bilateral Recurrent & Superior Laryngeal Nerve Palsy
**Complications of Thyroidectomy**
67
- Vocal Cord Position
Bilateral Recurrent & Superior Laryngeal Nerve Palsy
**Complications of Thyroidectomy**
68
- CP
Bilateral Recurrent & Superior Laryngeal Nerve Palsy
**Complications of Thyroidectomy**
69
- Managment
Bilateral Recurrent & Superior Laryngeal Nerve Palsy
**Complications of Thyroidectomy**
70
Incidence of Hypoparathyroidism
**Complications of Thyroidectomy**
Rare (0.5%)
71
Time of Hypoparathyroidism
**Complications of Thyroidectomy**
Mostly it is temporary due to vascular spasm of parathyroid glands, occurs in 2nd -5th postoperative day.
72
Presentation of Hypoparathyroidism
**Complications of Thyroidectomy**
- Weakness
- +ve Chvostek's Sign
- Carpopedal Spasm
- Convulsions
73
Management of Hypoparathyroidism
**Complications of Thyroidectomy**
- Serum calcium estimation is done and then 10 ml of 10% calcium gluconate is give IV 8th hourly.
- Later supplemented by oral calcium carbonate 500 mg 8th hourly.
- After 3-6 weeks, patient is admitted, drug is stopped and serum calcium level is repeated.
74
what is the first hypoparathyroidism symptom to appear?
**Complications of Thyroidectomy**
muscle weakness
75
Etiology of Thyrotoxic Crises
**Complications of Thyroidectomy**
- Occurs in a thyrotoxic patient inadequately prepared for thyroidectomy and often a thyrotoxic patient presents in a crisis following an unrelated operation or stress.
- Other causes (infection - trauma - preeclampsia - diabetic ketosis - emergency surgery - stress)
76
CP of Thyrotoxic Crises
**Complications of Thyroidectomy**
77
TTT of Thyrotoxic Crisis
**Complications of Thyroidectomy**
78
Prognosis of Thyrotoxic Crisis
**Complications of Thyroidectomy**
It has a high mortality rate with critical period of 72 hours
79
Other **Complications of Thyroidectomy**
80
Recurrent thyrotoxicosis
**Complications of Thyroidectomy**
81
Post thyroidectomy Care
