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Surgical Anatomy > Thyroid > Flashcards

Thyroid Flashcards

1
Q

Largest endocrine gland in the body is ?

A

Thyroid gland

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2
Q

Shape of thyroid gland?

A

Butterfly shape

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3
Q

Weight of thyroid gland?

A

Around 20gm ( 8 + 4 + 8)

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4
Q

Measurement of thyroid gland?

A

4 * 2.5 * 2 cm

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5
Q

Importance of knowing measurement ?

A

In subtotal thyroidectomy we leave part measuring as normal

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6
Q

Site of thyroid?

A

Lower part of the front of neck opposite the 5th 6th and 7th cervical vertebrae

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7
Q

Where does the apex and base of thyroid gland lie?

A

Apex lies on the thyroid cartilage below the oblique line

Base lies at the level of 6th tracheal ring

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8
Q

Site of isthmus of thyroid?

A

Opposite the 2nd 3rd and 4th tracheal rings

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9
Q

Whats the value of thyroid and tracheal rings ?

A

Cause goiter causes dysnea but its should be severe in order to compress the c shaped rings.

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10
Q

Capsules of the thyroid gland?

A

True capsule from the stroma of the gland

False capsule from pre tracheal fascia

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11
Q

Attachment of pretracheal fascia?

A

Attach to hyoid bone and thyroid cartilage superiorly. To carotid sheath from sides and to fibrous pericardium and arch of aorta inferiorly

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12
Q

Why does the thyroid gland moves up and down with deglutination?

A

Cause it is inside pretracheal fascia. Pretracheal fascia attached to hyoid bone. And digastric ms moves the hyoid bone superiorly during deglutination

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13
Q

What are the contents of pretracheal fascia?

A
  1. Thyroid gland
  2. Parathyroid gland
  3. Thyroglossal cyst (if present)
  4. Lymph node (Delphi)
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14
Q

Superficial relations of thyroid gland?

A
  1. Skin
  2. SC tissue (yellow)
  3. Platysma muscle
  4. Investing layer of deep cervical fascia
  5. Stenomastoid ms
  6. Strapmuscles
  7. Pretracheal fascia
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15
Q

Value of strap muscles in thyroid surgery?

A

supplied by ansa cervicalis from below cut ms as high as possible

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16
Q

Action and nerve supply of sternomastoid?

A

If 1 ms – face to opposite side
If both flexion of neck
N supply spinal part of accessory nerve

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17
Q

What are the strap muscles?

A

Sternothyroid
Sternohyoid
Omohyoid

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18
Q

Medial relations of thyroid gland?

A
  1. Lower part ( trachea, esophagus with recurrent laryngeal N in between)
  2. Upper part (cricoid and thyroid cartilage, crycothyroid ms and inf constrictor of the pharynx (pharynx and larynx)
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19
Q

Surgical importance of relations of thyroid gland?

A
  1. Dysphagia and dysnea may occur with its enlargement due to its relation to trachea and osophagus
  2. Pyramidal lobe must be removed in sistruck’s operation
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20
Q

What causes the thyroid to enlarge retrosternally?

A

Sternothyroid ms

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21
Q

Posterior relations of thyroid gland?

A

Sympathetic chain and Carotid sheath which contain:

  1. Carotid artery
  2. Internal jugular vein
  3. The vagus
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22
Q

Ansa means?

A

Neck

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23
Q

Origin of platysma muscle?

A

Penniculus carnosus ( the whole body covered by it durin embryogenesis only 3 ms left)

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24
Q

What are the reminants of penniculus carnosus?

A
  1. Platysma ms
  2. Dartos ms (in scrotum)
  3. Corrigator cutis ani
25
Q

Nerve supply of platysma muscle?

A

Cervical br of facial nerve

26
Q

Surgical importance of platysma muscle?

A

It should be sutured separately with no attachment sup or deep to it or else ugly scar

27
Q

11 steps of subtotal thyroidectomy ?

A
  1. Supine position
  2. Pillow interscapular area
  3. Ring under head for support
  4. Elevate bed 15°
  5. Sterilize from mandible to nipple(betadine)
  6. Collar incision 2 cm above suprasternal notch
  7. Retractors to sternomastoid
  8. Cut strap ms as high as possible
  9. Ligate middle thyroid V
  10. STA ligate within gland
  11. ITA ligate away from gland
28
Q

Why do you put pillow in interscapular region for ?

A

Hyperextension of neck

29
Q

Why do you elevate bed 15°?

A

Well drainage of the vessels

30
Q

How long is the collar incision?

A

From post border of sternomastoid to post border of sternomastoid

31
Q

Why do u incise 2 cm superior to supra sternal notch?

A

Healing is not so good with excessive granulation tissue causing post operative keloid

32
Q

Why middle thyroid V is the first vein to be ligated?

A

It is the shortest

33
Q

What to keep in mind while ligating middle thyroid V?

A

Congenital anomaly… non RLN in 1 to 2% people

34
Q

Why STA is ligated within gland?

A

To avoid injury to EXT laryngeal N

35
Q

From where does external laryngeal n comes?

A

From superior laryngeal nerve. It gives both internal LN and external LN

36
Q

Injury to Ext laryngeal n leads to?

A

Loss of high pitched voice and voice fatigue (opera singers)

37
Q

Why ITA is ligated away from gland?

A

To avoid injury to RLN

38
Q

RLN injury leads to?

A 
Complete paralysis (voice)
Incomplete paralysis (respiration)
39
Q

Complication of subtotal thyroidectomy?

A
  1. Bleeding
  2. Injury to n and vessels
  3. Keloid if …
  4. Tetany if parathyroid excised
  5. Respiratory obst ( if too tight suture or bleeding into it)
40
Q

Arterial supply of thyroid?

A
  1. Superior thyroid artery
  2. Inferior thyroid artery
  3. Thyroid ima artery (present in some ppl)
  4. Accessory tracheal & esophageal arteries
41
Q

Ima means?

A

Aorta

42
Q

Superior thyroid artery is from?

A

1st br of ext carotid A. related to external laryngeal n.

43
Q

Inferior thyroid artery is from?

A

From thyrocarvial trunk which is a br of 1st part of subclavian A.its terminal br near the gland are in close relation to RLN( inbetween above or below terminal branches)

44
Q

Thyroid ima artery is from?

A

Arch of aorta or innominate artery present in 1 to 3% people (may cause severe

45
Q

Accessory tracheal and osophageal arteries ?

A

In ligament of berry’s

46
Q

What is ligament of berry?

A

Thickened part of the pretracheal fascia that joins trachea to the thyroid gland

47
Q

What supplies the thyroid gland after subtotal thyroidectomy ?

A

Accessory tracheal and osophageal arteries

48
Q

Surgical importance of STA?

A

Should be ligated within the gland to avoid injury to the ext laryngeal nerve

49
Q

Surgical importance of ITA?

A

Should be ligated away from the gland to avoid injury to RLN and also should be ligated in continuity, do not cut (slippery of ligature – stump falls in chest – hemothorax) if occurred ttt by thoracotomy

50
Q

Branches of thyrocervical trunk?

A
  1. Inferior thyroid artery
  2. Transverse cervical artery
  3. Supra scapular artery
51
Q

What is the venous drainage of the thyroid gland?

A
  1. Superior thyroid vein
  2. Middle thyroid vein
  3. Inferior thyroid (10 to 12 veins)
52
Q

Drainage of superior thyroid vein?

A

To internal jugular vein or common facial vein

53
Q

Drainage of middle thyroid vein?

A

It crosses the common carotid to join internal jugular vein

54
Q

Drainage of inferior thyroid veins ?

A

From the isthmus over the front of the trachea to join the left innominate vein

55
Q

Surgical importance of middle thyroid vein?

A

Shortest vein so first to be tied and cut in surgery

56
Q

Lymphatics drainage of thyroid gland?

A
  1. Peripheral part to upper and lower deep cervical LN
  2. Medial parts of both lobes
    a. Prelaryngeal LN over cricothyroid membrane
    b. Pretracheal LN
    c. Deep cervical LN – paratracheal LN (mediastinal)
57
Q

Another name for pre laryngeal LN ?

A

Gland of Poirier

58
Q

The structure of thyroid gland?

A

Formed of follicles likes with cuboidal epithelium( which is the parynchyma) and vascular CT stroma. No basement membrane

Surgical Anatomy (4 decks)

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