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VMS4001 SEM 2 > Thyroid Surgery > Flashcards

Thyroid Surgery Flashcards

(35 cards)

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1
Q

What are the main surgical diseases of the thyroid glands?

A
  • Hyperthyroidism
  • Mass lesions -> Adenomas (cats) & carcinomas, adenoCs (older dogs)
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2
Q

Describe the anatomy of the thyroid glands?

A
  • Lateral and slightly ventral to 2
    nd & 5th tracheal cartilage
  • rings
  • Right more cranial
  • Right gland
  • carotid artery, internal jugular vein and
    vagosympathetic trunk
  • Left gland
  • oesophagus
  • Recurrent laryngeal nerves pass dorsal to glands
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3
Q

Where can thyroid ectopic tissue be found?

A
  • along trachea
  • thoracic inlet
  • Thoracic portion of aorta
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4
Q

What hormones does the thyroid secrete?

A
  • Thyroxin (T4)
  • Tri-iodothyroxine (T3)
  • Calcitonin - Ca2+ homeostasis
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5
Q

How do these hormones work?

A
  • Controls metabolism
  • T4→T3 in tissues
  • High in Iodine
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6
Q

What usually causes Feline hyperthyroidism?

A
  • Most common endocrine disorder in middle-aged or older cats
  • Bilateral
  • Adenoma
  • 2% carcinoma
  • Adenoma →carcinoma
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7
Q

CS of Feline hyperthyroidism?

A
  • CS: weight loss, polyphagia, polyuria, polydipsia, increased vocalization, agitation, increased activity,
    tachypnoea, tachycardia, vomiting, diarrhoea, an unkempt hair coat
  • +/- palpable goitre
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8
Q

What might we also see in hyperthyroid cats ?

A

» Concurrent Chronic Renal Insufficiency
* masks chronic kidney disease (CRI)
* once euthyroid, CRI becomes apparent

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9
Q

What options for tx of feline hyperthyroidism?

A
  • Oral medication (thiamazole/carbimazole)
  • Transdermal gel
  • Iodine Restricted Diet
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10
Q

Describe medical option for hyperthyroidism?

A
  • fast effect (two to four weeks),
  • no anaesthesia
  • no hospital stay
  • Life long medication→£££
  • difficulty with administration, daily/twice daily
  • side effects, anaemia, neutropenia and facial pruritus
  • conversion of a thyroid adenoma (benign) to a thyroid carcinoma (malignant)
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11
Q

Describe transdermal gel ?

A
  • As above but easier to administer
  • Difficulty with precise dosing
  • Not licensed
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12
Q

What is the gold standard treatement for hyperthyroidism?

A

Radioactive iodine therapy

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13
Q

Describe radioactive iodine therapy?

A
  • All tissues treated – ectopic
  • 1 in 5 have multiple and/or intrathoracic thyroid tissue
  • Permanent
  • Specialist facility needed
  • Human safety concerns
  • Traditionally involved long hospital stay in isolation
  • Now some centres only hospitalise for five days
  • High upfront cost
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14
Q

Make a table with advantages and disadvantages of all tx options for hyperT?

A
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15
Q

What might be some periop considerations in hyperthyroid cats?

A
  • Cardiomyopathy - tachyC, murmur, HCM -> investigate prior
  • CRI -> up to 40% masked -> attempt trial anti-tyroid for weeks prior to more permanent tx
  • Hypokalaemia -> in 32% -> parenteral IVFT supplementation
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16
Q

Periop consideraitons of hyperthyroid cats pt2?

Study These Flashcards
A
  • avoid jugular venepuncture prior to surgery
  • Send gland for histology
  • Recurrence higher with unilateral thyroidectomy
  • Positioning super important -> dorsal with neck hyperextended and forelimbs pulled caudally
17
Q

What is a modified extracapsular thyroidectomy ?

Study These Flashcards
A
  • PReserves cranial thyroid artery
  • Lower risk of damage to parathyroid -> low hypoCa rate
  • Low recurrence rate
18
Q

Management of hypoparathyroidism?

Study These Flashcards
A

Serum Ca2+ measured daily for 4-7 days in bilateral sx

19
Q

acute hypoparathyroidism management?

Study These Flashcards
A
  • 10% Calcium gluconate IV slowly to effect
  • Follow with CRI
  • ECG to monitor for bradycardia/arrhythmia
20
Q

Maintenance of hypoparathyroid tx?

Study These Flashcards
A
  • Oral vitamin D and calcium administration
  • calcium lactate
  • dihydrotachysterol or calcitriol
  • can sometimes be hard to source and expensive
21
Q

What are some top tips for thyroidectomy?

Study These Flashcards
A
  • If RAI is feasible then best option
  • Prep for anaesthetic as best possible
  • Consider staged bilat sx
  • Send for histo
  • Communicate risks clearly
  • Can be cheaper tha. medical management
22
Q

How do canine thyroid tumours usually present?

Study These Flashcards
A
  • commonly in older, large breed dogs -> mass in cervical region
    >Compress trachea -> dyspnoea, coughing
    >compress oedophagus gagging, dysphagia
    >recurrent larungealn dysphonia, dyspnoea
    >sympathetic nerve, horner’s
23
Q

T/F majority of canine thyroid tumours are malignant ?

Study These Flashcards
A

True > rarely produce excess hormones, most euthyroid
-> most > 3 cm when detected and >85% malignant

24
Q

Diagnostics for canine tumours?

Study These Flashcards
A
  • Palpation –firmly attached, freely
    moveable
  • Cervical and thoracic rads
  • Abdo US
  • CT
  • Biochem, haem, coagulation, serum
    T4
  • FNA – often blood contaminated
    and non diagnostic
  • (care with biopsy)
25
Tx for canine thyroid tumours?
* Surgical removal, if possible * Removal can be difficult - Invade local blood vessels; jugular veins & carotid artery, recurrent laryngeal nerve, trachea, oesophagus - Haemorrhage likely and can require transfusion * Likely to require suction drain * Partial surgical debulking, rarely indicated due to risk of haemorrhage * Radiation or chemotherapy for masses that are non-resectable
26
PRognosis for thyroid tumour removal?
Guarded -> best of moveable <3cm non metastatic (1-3 yr survival)
27
Anatomy fo the canine thyroid?
28
What complications of thyroidectomy might we see?
- Haemorrhage / seroma - Laryngeal paralysis (nerve damage) - Hypopararthyroidism -> damage to hyperP BS or parathyroidectomy (hypoCa 2-5 days postop & facial or muscle twitching) - Incomplete excision/reocurrence (ectopci tissue)
29
Describe primary hyperparathyroidism?
* Uncommon in dogs, rare in cats * Parathyroid adenomas (carcinomas reported) * HyperCa2+, low phos * PU/PD, vomiting, weakness, constipatio
30
Diagnosis of primary hyperparathyoridism?
* Imaging rarely helpful * Serology - PTH with HyperCa2+ and normal renal function - Rule out neoplastic causes of hyperCa2+
31
Tx for primary hyperparathyroidism?
Parathyroidectomy? +/- thyroidectomy
32
what are some other endocrine surgical procedures to be aware of?
- Adrenelectomy -> for adrenal Tumours not for PDH! - Hypophysectomy (transsphenoidal) -> removal of pituitary gland in acromegaly cats (70% diabetic remission) or for PD HAC in dogs
33
Describe Insulinoma?
* Seen most commonly in dogs * 95% malignant * Travel to regional lymph nodes * Low blood glucose causes weakness seizures, ataxia muscle tremors
34
What is the Whipples Triad?
- Presence of hypoglycaemic signs (often neuro) - Fasting blood often less than 2mmol/L - Releif of clinical signs after glucose admin or feeding
35
What can we do for insulinoma?
Pancreatectomy

VMS4001 SEM 2 (28 decks)

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