Thyroid surgery

Question 1

Indications

Answer 1

Pressure symptoms
Relapse hyperthyroidism (>1 failed drug Rx)
Cosmesis
Carcinoma

Question 2

Practicalities

Answer 2

Render euthyroid pre-op ̄c antithyroid drugs
Stop 10 days prior to surgery (they ↑ vascularity) Alternatively just give propronalol
Check for phaeo pre-op in medullary carcinoma
Laryngoscopy: check vocal cords pre- and post-op

Question 3

Procedure

Answer 3

Collar incision

Question 4

Complications - early (5)

Answer 4

Reactionary haemorrhage → haematoma
Laryngeal oedema
RLN plays
HypoPTH
Thyroid storm

Question 5

Complications - haematoma

Answer 5

Can → airway obstruction.
Call anaesthetist and remove wound clips
Evacuate haematoma and re-explore wound

Question 6

Laryngeal oedema

Answer 6

Damage during intubation or surgical manipulation

Can → airway obstruction

Question 7

RLN palsy

Answer 7

Right RLN more common (oblique ascent)
Damage to one → hoarse voice
Damage to both → obstruction needing
trachyostomy

Question 8

HypoPTH

Answer 8

→ ↓ Ca2+ → Chvostek’s and Trousseau’s

Question 9

Thyroid storm

Answer 9

Severe hyperthyroidism
Rx: propranolol, antithyroid drugs, Lugol’s iodine
and hydrocortisone sodium succinate

Question 10

Late complications (3)

Answer 10

Hypothyroidism

Recurrent hyperthyroidism Keloid scar