Surgery of the thyroid

Indications for operation

Simple diffuse goiter : cosmetic
reasons or pressure symptoms
Nodular goiter : Additional
reasons may undergo toxicity,
malignant change.
Solitary nodule : more chance of
malignancy
Indications for operation
(contd.)
Primary thyrotoxicosis : 1) Lack of
response to medical treatment 2)
Relapse after apparent cure 3)
Toxicity of the drugs 4) Large size
of the gland or retrosternal
extension.
Toxic nodular goiter
Preoperative treatment
Vocal cord assessment
Medical treatment with antithyroid
drugs for cases of thyrotoxicosis ,
Lugol`s iodine 0.3 ml three times
daily 10 days prior to
surgery,Propranolol if needed
Subtotal thyroidectomy
Both for simple and toxic goiter the
amount of gland removed varies
Premedication and Anaesthesia A
good night`s sleep with some sedatives
may calm the pt. General anaesthesia
with endotracheal intubation advised in
most of the cases.
Technique
Position the neck extended by a
sandbag placed in between the
shoulders and the head supported on a
ring
The skin incision the collar incision 2
to 3 cms. Above the sternum extending
to the lateral borders of the
sternomastoids.
The flaps are reflected upwards and
downwards upper flap up to the level
of thyroid cartilage,lower down to the
sternum
Other surgical procedures
Hemithyroidectomy (lobectomy)

Total thyroidectomy

Excision of the isthmus
Complications of
thyroidectomy
Haemorrhage
Respiratory obstruction
Recurrent laryngeal nerve
paralysis
Hypoparathyroidism
Hypothyroidism
Recurrent thyrotoxicosis