thyroidectomy

Question 1

what are the indications of thyroidectomy?

Answer 1

• 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

Question 2

what part of the thyroid is kept in a subtotal thyroidectomy?

Answer 2

small posteromedial part in both sides

Question 3

what is Dunhill’s procedure?

Answer 3

total on 1 side and subtotal on the other side

Question 4

What procedure is used to remove one thyroid lobe & the isthmus?

Answer 4

Hemithyroidectomy or thyroid lobectomy

Question 5

What is a near total thyroidectomy?

Answer 5

leaving smaller portion of posteromedial part of the thyroid

Question 6

What procedure is used in obstructed airway?

Answer 6

isthmectomy (dividing the isthmus)

Question 7

what are the preoperative treatments done before a thyroidectomy?

Answer 7

• vocal cord assessment

- in thyrotoxicosis cases treat patient with inderal and Lugol’s iodine

Question 8

which vein should be ligated first during surgery?

Answer 8

middle thyroid vein first

ligate superior as close to gland as possible
ligate inferior as far from gland as possible

Question 9

What are the post thyroidectomy complications?

Answer 9

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

Question 10

What are the type of hemorrhage caused by thyroidectomy?

Answer 10

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

Question 11

What are the nerves that could be injured during thyroidectomy?

Answer 11

• 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

Question 12

What are the types of recurrent laryngeal nerve injury?

Answer 12

COMPLETE (adductor)

• will affect voice
• unilateral: voice fatigue
• bilateral: aphonia

PARTIAL (abductor)

• will affect breathing
• unilateral: dyspnea on exertion
• bilateral: stridor

Question 13

what could cause injury due to the inferior jugular vein during thyroidectomy?

Answer 13

uncareful ligation of middle thyroid vein

could cause air embolus due to negative intrathoracic pressure

Question 14

What are the causes of hypocalcemia post-op? What is the manifestation seen?

Answer 14

hypoparathyroidism (injury to parathyroid gland)
ischemia of parathyroid gland

NUMBNESS around oral cavity
carpopedal spasm

Question 15

What is the cause of respiratory obstruction post thyroidectomy?

Answer 15

• hemorrhage
• laryngeal edema
• recurrent laryngeal nerve injury
• injury of trachea