thyroidectomy Flashcards
what are the indications of thyroidectomy?
- thyrotoxicosis
- if medical treatment fails
- to relieve pressure symptoms
- cosmetic
- benign or malignant tumors
- solitary nodular goiter on patient’s demand
- to establish a definitive diagnosis of a mass within thyroid
what part of the thyroid is kept in a subtotal thyroidectomy?
small posteromedial part in both sides
what is Dunhill’s procedure?
total on 1 side and subtotal on the other side
What procedure is used to remove one thyroid lobe & the isthmus?
Hemithyroidectomy or thyroid lobectomy
What is a near total thyroidectomy?
leaving smaller portion of posteromedial part of the thyroid
What procedure is used in obstructed airway?
isthmectomy (dividing the isthmus)
what are the preoperative treatments done before a thyroidectomy?
- vocal cord assessment
- in thyrotoxicosis cases treat patient with inderal and Lugol’s iodine
which vein should be ligated first during surgery?
middle thyroid vein first
ligate superior as close to gland as possible
ligate inferior as far from gland as possible
What are the post thyroidectomy complications?
1-hemorrhage 2-injury of nerves 3-injury of inferior jugular vein 4-injury of trachea 5-hypocalcemia 6-thyroid crisis: unprepared patient 7-keloid formation: not leaving 2cm above sternal notch 8-hypothyroidism 9-recurrent hyperthyroidism
What are the type of hemorrhage caused by thyroidectomy?
PRIMARY
- within operation
- just ligate bleeding vessel
SECONDARY due to infection
- after 1 week post-op
REACTIONARY due to increased blood pressure
- slipped suture
- dislodged thrombus
- up to 24hrs post-op
What are the nerves that could be injured during thyroidectomy?
- external laryngeal nerve –> cricothyroid –> loss of high pitched voice
- internal laryngeal nerve –> mucous membranes above vocal cords –> recurrent choking
- recurrent laryngeal nerve –> all muscles of larynx except cricothyroid
What are the types of recurrent laryngeal nerve injury?
COMPLETE (adductor)
- will affect voice
- unilateral: voice fatigue
- bilateral: aphonia
PARTIAL (abductor)
- will affect breathing
- unilateral: dyspnea on exertion
- bilateral: stridor
what could cause injury due to the inferior jugular vein during thyroidectomy?
uncareful ligation of middle thyroid vein
could cause air embolus due to negative intrathoracic pressure
What are the causes of hypocalcemia post-op? What is the manifestation seen?
hypoparathyroidism (injury to parathyroid gland)
ischemia of parathyroid gland
NUMBNESS around oral cavity
carpopedal spasm
What is the cause of respiratory obstruction post thyroidectomy?
- hemorrhage
- laryngeal edema
- recurrent laryngeal nerve injury
- injury of trachea
