Thyroid Surgery

Question 1

When taking a thyroid lump history what do you ask about?

Answer 1

Timing of appearance: rapid growth makes you think malignant (anaplastic lymphoma)

Change in voice: due to invasion of the recurrent laryngeal nerve by the cancer

Family history

Exposure to radiations

Dyspnoea / stridor due to compression of the trachea

Dysphagia

Question 2

What are the most common types of thyroid cancer?

Who does this affect?

Answer 2

Papillary and follicular

counts for 80%

Tends to affect younger population and prognosis is good

Question 3

Thyroglossal Cyst

Examination findings

Answer 3

Rises with protrusion of the tongue

Thyroglossal ysts can be higher up than thyroid

Question 4

How do you investigate a goitre?

Answer 4

Bloods: TFTs

Imaging: Ultrasound scan
(Can do specialist scintigraphy scan if thyrotoxicosis - rare)

Fine Needle Aspiration Biopsy

Question 5

Treatment for Thyroid Goitre

Answer 5

Radioactive Iodine: is contraindicated in those with Thyroid eye disease

Surgery

Question 6

What are the complications of thyroid surgery?

Answer 6

General:

• effects of general anaesthesia
• DVT
• Infection

THYROID SPECIFIC
Immediate: haemorrhage, bilateral vocal cord palsy (due to damage of both recurrent laryngeal nerves and becomes obvious when you extubate and the patient turns blue)

Early: haemorrhage, hypocalcaemia, vocal cord palsy

Late: Hypothyroidism