Surgery of the thyroid Indications for operation Simple diffuse goiter : cosmetic reasons or pressure symptoms Nodular goiter : Additional reasons – may undergo toxicity, malignant change. Solitary nodule : more chance of malignancy

Indications for operation (contd.) Primary thyrotoxicosis : 1) Lack of response to medical treatment 2) Relapse after apparent cure 3) Toxicity of the drugs 4) Large size of the gland or retrosternal extension. Toxic nodular goiter

Preoperative treatment Vocal cord assessment Medical treatment with antithyroid drugs for cases of thyrotoxicosis , Lugol`s iodine 0.3 ml three times daily 10 days prior to surgery,Propranolol if needed

Subtotal thyroidectomy Both for simple and toxic goiter – the amount of gland removed varies Premedication and Anaesthesia – A good night`s sleep with some sedatives may calm the pt. General anaesthesia with endotracheal intubation advised in most of the cases.

Technique Position – the neck extended by a sandbag placed in between the shoulders and the head supported on a ring The skin incision – the “collar” incision 2 to 3 cms. Above the sternum extending to the lateral borders of the sternomastoids. The flaps are reflected upwards and downwards – upper flap up to the level of thyroid cartilage,lower down to the sternum

Other surgical procedures Hemithyroidectomy (lobectomy) Total thyroidectomy Excision of the isthmus

Complications of thyroidectomy Haemorrhage Respiratory obstruction Recurrent laryngeal nerve paralysis Hypoparathyroidism Hypothyroidism Recurrent thyrotoxicosis