1. 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

2. 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

3. 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

4. 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.

5. 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

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

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