Pre-operative investigations Full blood count (CBC) Serum Urea, Electrolytes, Creatinine Thyroid Profile: T3, T4, TSH Ultrasound thyroid gland Radio-iodine ( 99m Tc / 131 I) scan of thyroid 2. Pre-operative investigations X-ray neck X-ray chest (Both AP / lateral) Fine Needle Aspiration Cytology (FNAC) of thyroid nodule, if any palpable Indirect laryngoscopy to assess pre-operative function of both vocal cords. 3. INFORMED CONSENT FOR THE SURGERY IS ESSENTIAL 4. Thyroidectomy Steps 1 ² The preliminaries Position of patient : Supine position, Neck slightly extended, Sand bag under shoulder Foot end slightly down 5. Thyroidectomy Steps 1 ² The preliminaries Preparing the part : The entire front of neck, from jaw line to nipples, is cleaned with Cholorhexidine, surgical spirit and Betadine. 6. Thyroidectomy Steps 1 ² The preliminaries Draping :

Some surgeons cover this area with self-adhesive Opsite to enhance sterility. superficial fascia and platysma 8. 1. Thyroidectomy Steps 2² Incision and raising flaps Skin flaps : Two skin flaps raised. Thyroidectomy steps 4 ² Dealing with vessels Arteries before veins (to prevent venous engorgement) . with the nodule (or any pathology) visible.Sterile sheets are draped above.5 cm above manubrium notch Incision is deepened through skin. from one sterno-mastoid to other. one above and below. Thyroidectomy Steps 2² Incision and raising flaps Incision : Size 22 blade on Bard-Parker handle Curvilinear skin incision along neck crease. 7. keeping only neck portion visible. 9. This layer of fascia is also opened and thyroid exposed. below and on either sides of neck. 10. Strict haemostasis (control of bleeding) Essential during entire procedure Achieved by coagulating diathermy and/or ligation using 2-0 Vicryl sutures. Thyroidectomy steps 3 ² Exposing the gland Investing deep cervical fascia is split open Strap muscles of neck divided between clamps This exposes the thyroid gland enclosed in pre-tracheal layer of deep cervical fascia. Held in place with Joll·s retractor. subcutaneous tissue.

Accurate haemostasis is essential. subtotal. This is to safeguard recurrent laryngeal nerve. lobectomy etc) is removed. 11. Thyroidectomy Steps 6 ² Winding up process Strap muscles are sutured with 2-0 Vicryl. Thyroidectomy steps 5 ² Removing the gland proper Cut edge of the gland usually bleeds profusely. Cut edges of deep cervical fascia are also sutured with 2-0 Vicryl. total thyroidectomy. .Vessels clamped. is removed. haemostasis is minutely checked. Thyroidectomy steps 4 ² Dealing with vessels Inferior thyroid artery is similarly dealt with far away from the lower pole of the gland. now more than ever. Thyroidectomy steps 5 ² Removing the gland proper Multiple artery forceps are applied around the thyroid gland Appropriate portion (hemi-. Joll·s retractor. Then superior . Sutured to the skin with 2-0 Silk sutures. 13. Be sure to preserve the excised specimen in Formalin solution for biopsy. 14. 12. which was holding the skin-platysma flaps open. middle and inferior thyroid veins are dealt with in a similar manner. divided and ligated with 2-0 vicryl Superior thyroid artery ligated close to the upper pole of the gland. This is to prevent damage to external laryngeal nerve. at all times. Brought out through a separate stab incision at the side of the neck. Again. This is stopped by under-running with multiple continuous 2-0 Vicryl sutures. 15. Thyroidectomy Steps 6 ² Winding up process Redivac (suction) drain is inserted in the cavity left by the excised thyroid gland.

16. Skin closed with 3-0 Nylon. This may require inspection of suture line. Compatible blood may be transfused if there had been excessive blood loss during surgery. horizontal mattress sutures or subcuticular sutures. 17. usually between 2. BP) chart is maintained. Rise of temperature after 3 rd post-operative day indicates infection. Post-operative management Initial dressing changed after 48-72 hours (to inspect for infection of suture line). 18. Post-operative management Oral intake initiated from next day. Drain removed after 48 hours or when drainage falls to few ml during last 24-hour period. The latter gives a finer scar. going on to ¶free fluids·. Post-operative management Patient is kept NPO/NBM (Nil Per Oral / Nil By Mouth) on the day of surgery.5 to 3 litres. Post-operative management Daily vital (PTR. Antibiotics avoided in clean elective surgeries 19. starting with ¶clear fluids·. finesse and time. 20. when it should be removed earlier. Careful note is made of daily output from Redivac drain. whichever is earlier. Unless there is soakage. Thyroidectomy steps 7 ² Closure Platysma and subcutaneous tissues are closed with 2-0 Vicryl interrupted sutures. Supplemental IV fluid usually given on day of surgery. there is invariably severe pain during first night. but it requires more technical expertise. . then to soft diet and finally to normal diet Analgesics essential in post-operative period.

if suture line is clean and dry.Dry dressings sufficient every alternate day. Sutures usually removed on 5 th post-operative day. 21. This gives minimum scarring. Thyroidectomy ² Possible complications Hemorrhage Respiratory distress or stridor Hoarseness of voice Total vocal cord paralysis ² aphonia Hypocalcemic tetany (due to accidental removal of parathyroid glands during total thyroidectomy) Wound infection: This may manifest after 48 hours of surgery .