Thyroid Surgery

Question 1

What is the imaging of choice for the thyroid? What is it NOT helpful for?

Answer 1

ULTRASOUND
-nodule is solid or cyctic
-identify # of nodules
-nodule characteristics

RARELY helpful for graves or toxicosis

Question 2

What is the treatment of graves disease?

Answer 2

medical blockade of thyroid hormone

Question 3

If nodules are benign >

Answer 3

medical tx, follow up

Question 4

If nodules are malignant or suspicious >

Answer 4

surgery

Question 5

Tx for goiter/thyroiditis

Answer 5

medical tx
if large can cause sx > surgery

Question 6

In which conditions would you perform a total/near thyroidectomy?

Answer 6

graves disease
toxic multinodular goiter

Question 7

When would you do a lobectomy?

Answer 7

for a singlular nodule

Question 8

T/F general anesthesia is required for total/near total thyroidectomy, lobectomy

Answer 8

TRUE

Question 9

What are early and later complications of surgery?

Answer 9

early:
hemorrhage
airway compromise
recurrent laryngeal nerve injury
-unilat = hoarseness
-bilat=inspiratory stridor

later:
wound infection/cellulitus
flap necrosis
hypocalcemia
hypothyroidism

Question 10

What are the indications for surgical intervention in patients with hyperthyroidism? What is the surgical treatment?

Answer 10

failed medical therapy or radioactive iodine, supicious or malignant nodule
The sx treatment is TOTAL THYROIDECTOMY

Question 11

What is the indication for surgical intervention in patients with a thyroid nodule? What is the surgical treatment?

Answer 11

cancer, rule out/suspicious, compression, HYPERTHYROID, large size, comesis

the sx treatment is LOBECTOMY or TOTAL THYROIDECTOMY

Question 12

What is the indication for surgical intervention in a goiter? What is the surgical treatment?

Answer 12

to relieve pressure symptoms or rule out cancer

the sx tx is TOTAL THYROIDECTOMY

Question 13

What is the surgical treatment for malignancy?

Answer 13

lobectomy or total thyroidectomy

Question 14

Hyperparathyroid:

Treatment:
Primary:
Secondary:
Tertiary:

What is the workup for surgery?
What is the surgery performed?
What needs to be monitored?
How many glands removed?

Answer 14

primary- surgery
secondary- mainly medical, surgery in EXTREME CASES
tertiary- surgery

workup- ultrasound- look for enlarged glands, sestamibi scan- identify overactive gland
4D CT Scan with sestamibi

surgery- focused parathyroidectomy
monitor intraop PTH- levels can return to normal within 10 mins of removing affected gland

subtotal- 3.5 of 4 glands removed, cryopreserved tissue can be reimplanted later