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Y3R6: Surgery I 👨‍⚕️ > L5: Thyroidectomy > Flashcards

L5: Thyroidectomy Flashcards

1
Q

Principles of Thyroidectomy

A
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2
Q

Removed Part

Hemithyroidectomy

A
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3
Q

Retained Part Hemithyroidectomy

A
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4
Q

indications

Hemithyroidectomy

A
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5
Q

Removed Part

Subtotal thyroidectomy

A
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6
Q

Retained Part

Subtotal thyroidectomy

A
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7
Q

Indications

Subtotal thyroidectomy

A
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8
Q

Partial thyroidectomy (Its role is controversial)

A

..

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9
Q

Removed Part

Partial thyroidectomy

A
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10
Q

Retained Part

Partial thyroidectomy

A
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11
Q

Indications

Partial thyroidectomy

A
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12
Q

Removed Part

Near total thyroidectomy

A
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13
Q

Retained Part

Near total thyroidectomy

A
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14
Q

Indications

Near total thyroidectomy

A
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15
Q

Removed Part

Total thyroidectomy

A
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16
Q

Retained Part

Total thyroidectomy

A
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17
Q

Indications

Total thyroidectomy

A
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18
Q

Removed part

Hartley Dunhill procedure

A
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19
Q

Retained Part

Hartley Dunhill procedure

A
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20
Q

Indications

Hartley Dunhill procedure

A
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21
Q

Indications

Isthmectomy

A
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22
Q

Isthmus should be removed in entirety in any type of thyroid ectomy, WHY?

A

If it is retained partially → it gets adherent to wound in front creating a cosmetically poor scar.

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23
Q

Pre-Operative Preparation for thyroid surgery

A
  • The patient should be euthyroid at operation.
  • Preparation is outpatient and rarely need admission to hospital.
  1. Antithyroid Drug
  2. BB
  3. Iodine
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24
Q

Drug of choice for preparation

A

Carbimazole

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25
Q

Dose of carbimazole

Pre-Operative Preparation for thyroid surgery

A
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26
Q

MOA of BB

Pre-Operative Preparation for thyroid surgery

A
  • These act on the target organs and not on the gland itself.
  • Propranolol also inhibits the peripheral conversion of T4 to T3.
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27
Q

Dose of Propranolol

Pre-Operative Preparation for thyroid surgery

A

Propranolol 40 mg three times a day.

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28
Q

Notes of BB

Pre-Operative Preparation for thyroid surgery

A
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29
Q

Iodine

Pre-Operative Preparation for thyroid surgery

A
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30
Q

Check the steps of thyroidectomy in notes

A

..

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30
Q

Pre-operative investigations to be carried out and recorded before thyroidectomy

A
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31
Q

Anasethia

Thyroidectomy

A

General

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32
Q

Positioning

Thyroidectomy

A
  • Patient is put in supine position with neck hyperextended by placing a sandbag under shoulder.
  • with table tilt of 15-degree head up.
33
Q

Incision

Thyroidectomy

A

KOCHER’S THYROID INCISION

  • Horizontal crease incision is done, two finger breadth above the sternal notch, from one sternomatoid to the other.
34
Q

Flaps

Thyroidectomy

A
  1. Skin & platysma are incised (subplatysmal plane).
  2. Upper flap raised up to thyroid cartilage, Lower flap up to sternoclavicular joint.
35
Q

Deep fascia dissection

Thyroidectomy

A

Deep fascia is opened vertically in the midline.

36
Q

Ligation of Vessels

Thyroidectomy

A
37
Q

Characters of Parathyroid Gland

A
38
Q

Site of both superior & Inferior Parathyroids

A
39
Q

Cautrey

Thyroidectomy

A

One should not use monopolar cautery here; only bipolar cautery should be used carefully.

40
Q

Course of Inferior Thyroid Artery

Thyroidectomy

A

Nerve usually crosses the inferior thyroid artery from deeper aspect; but variations are common.

41
Q

Zuckerkandl tubercle

Thyroidectomy

A
  • Posterior extension of lateral thyroid lobes close to berry’s ligament is called as zuckerkandl tubercle which is seen in 40% of cases.
  • Nerve runs upwards in a fissure between zuckerkand tubercle and trachea or main thyroid gland.
42
Q

RLN & Ligament of Berry

Thyroidectomy

A

Recurrent laryngeal nerve is in close contact with suspensory ligament of berry.

43
Q

Ligation of Inferior Thyroid artery

Thyroidectomy

A
44
Q

Critical points of recurrent laryngeal
nerve injury

Thyroidectomy

A
  • At the entry of inferior thyroid artery and crossing the nerve,
  • At suspensory ligament of Berry,
  • At lower pole of the gland.
45
Q

Suction Drain

Thyroidectomy

A
  • Traditionally suction drain is placed which is brought out through a separate stab incision or one of the ends of the main wound.
  • Drain should pass under the strap muscles to reach the thyroid fossa.
46
Q

Suturing

Thyroidectomy

A
  • Strap muscles are approximated using interrupted 3 zero vicryl sutures.
  • Platysma is sutured using 3 zero vicryl interrupted sutures.
  • Subcuticular absorbable 3 zero monocryl suture is used skin.
47
Q

what is MIVAT?

A
  • Minimally Invasive Video-Assisted Thyroidectomy is becoming popular for small nodules and gland without thyroiditis.
  • But it is costly
48
Q

Post-Operative complications of thhroidectomy

A
49
Q

Causes of Hge

Complications of Thyroidectomy

A

May be due to slipping fligatures either of superior thyroid artery or other pedicles or small veins.

50
Q

CP of Hge

Complications of Thyroidectomy

A
  • Tachycardia, hypotension.
  • Dyspnea and compression over trachea may cause severe stridor, respiratory obstruction due to tension hematoma Obstruct.
51
Q

Managment of Hge

Complications of Thyroidectomy

A
52
Q

respiartory Obstruction

Complications of Thyroidectomy

A
53
Q

Types of Recurrent laryngeal nerve palsy (Positions of Vocal Cord Types)

Complications of Thyroidectomy

A
54
Q
  • Paralyzed Muscle?

Unilateral Recurrent Nerve Palsy

Complications of Thyroidectomy

A
55
Q
  • Vocal Cord Position

Unilateral Recurrent Nerve Palsy

Complications of Thyroidectomy

A
56
Q
  • CP

Unilateral Recurrent Nerve Palsy

Complications of Thyroidectomy

A
57
Q
  • Management

Unilateral Recurrent Nerve Palsy

Complications of Thyroidectomy

A
58
Q
  • Paralyzed Laryngeal Muscle

Bilateral Recurrent Nerve Palsy

Complications of Thyroidectomy

A
59
Q
  • Vocal Cord Position

Bilateral Recurrent Nerve Palsy

Complications of Thyroidectomy

A
60
Q
  • CP

Bilateral Recurrent Nerve Palsy

Complications of Thyroidectomy

A
61
Q
  • Managment

Bilateral Recurrent Nerve Palsy

Complications of Thyroidectomy

A
62
Q
  • Paralyzed Laryngeal Muscle

Unilateral Recurrent & Superior Laryngeal Nerve Palsy

Complications of Thyroidectomy

A
63
Q
  • Vocal Cord Position

Unilateral Recurrent & Superior Laryngeal Nerve Palsy

Complications of Thyroidectomy

A
64
Q
  • CP

Unilateral Recurrent & Superior Laryngeal Nerve Palsy

Complications of Thyroidectomy

A
65
Q
  • Managment

Unilateral Recurrent & Superior Laryngeal Nerve Palsy

Complications of Thyroidectomy

A
66
Q
  • Paralyzed Muscle

Bilateral Recurrent & Superior Laryngeal Nerve Palsy

Complications of Thyroidectomy

A
67
Q
  • Vocal Cord Position

Bilateral Recurrent & Superior Laryngeal Nerve Palsy

Complications of Thyroidectomy

A
68
Q
  • CP

Bilateral Recurrent & Superior Laryngeal Nerve Palsy

Complications of Thyroidectomy

A
69
Q
  • Managment

Bilateral Recurrent & Superior Laryngeal Nerve Palsy

Complications of Thyroidectomy

A
70
Q

Incidence of Hypoparathyroidism

Complications of Thyroidectomy

A

Rare (0.5%)

71
Q

Time of Hypoparathyroidism

Complications of Thyroidectomy

A

Mostly it is temporary due to vascular spasm of parathyroid glands, occurs in 2nd -5th postoperative day.

72
Q

Presentation of Hypoparathyroidism

Complications of Thyroidectomy

A
  • Weakness
  • +ve Chvostek’s Sign
  • Carpopedal Spasm
  • Convulsions
73
Q

Management of Hypoparathyroidism

Complications of Thyroidectomy

A
  • Serum calcium estimation is done and then 10 ml of 10% calcium gluconate is give IV 8th hourly.
  • Later supplemented by oral calcium carbonate 500 mg 8th hourly.
  • After 3-6 weeks, patient is admitted, drug is stopped and serum calcium level is repeated.
74
Q

what is the first hypoparathyroidism symptom to appear?

Complications of Thyroidectomy

A

muscle weakness

75
Q

Etiology of Thyrotoxic Crises

Complications of Thyroidectomy

A
  • Occurs in a thyrotoxic patient inadequately prepared for thyroidectomy and often a thyrotoxic patient presents in a crisis following an unrelated operation or stress.
  • Other causes (infection - trauma - preeclampsia - diabetic ketosis - emergency surgery - stress)
76
Q

CP of Thyrotoxic Crises

Complications of Thyroidectomy

A
77
Q

TTT of Thyrotoxic Crisis

Complications of Thyroidectomy

A
78
Q

Prognosis of Thyrotoxic Crisis

Complications of Thyroidectomy

A

It has a high mortality rate with critical period of 72 hours

79
Q

Other Complications of Thyroidectomy

A
80
Q

Recurrent thyrotoxicosis

Complications of Thyroidectomy

A
81
Q

Post thyroidectomy Care

A

Y3R6: Surgery I 👨‍⚕️ (36 decks)

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