a brief class project on surgical removal of thyroid

1. THYROIDECTOMY
Vaibhav Shriya
IX Semester

2. Indications
1. Therapy for Thyrotoxicosis
2. Benign or Malignant tumours in thyroid
3. Alleviate pressure (Dysphagia,
Respiratory Distress, etc.) d/t thyroid
enlargement
4. Cosmetic purpose
5. Establish Definitive Diagnosis of a mass
w/i thyroid (esp. if FNAC is either Non-
diagnostic or indeterminate)

3. Pre-Op Preparation
1. ABO – Rh grouping
2. Indirect Laryngoscopy  Pt. says “E”  check
for B/L ABDUCTION of vocal cords
3. S. Ca+2
4. S. TSH, T3, T4
5. Anti-Thyroid Abs.
6. ECG (esp. Toxic Goiter)
7. Lugol’s I2 10 days prior to surgery  gland
becomes less vascular  firm gland

4. Types
1. Hemithyroidectomy
2. Subtotal Thyroidectomy
3. Partial Thyroidectomy
4. Near Total Thyroidectomy
5. Total Thyroidectomy
6. Hartley-Dunhill Operation

5. Hemithyroidectomy

6. Subtotal Thyroidectomy

7. Partial Thyroidectomy

8. Near Total Thyroidectomy

9. Total Thyroidectomy

10. Hartley Dunhill Operation

12. Procedure

15. Strap mm. are retracted (often AJV’s ligated with
3-0 vicryl)
Pre-tracheal fascia opened vertically
MTV ligated immediately with 2-0 vicryl (first
vessel to be ligated) & divided
Gland mobilized medially by peanut dissection &
bipolar cautery

16. STA & STV (Superior Pedicle) individually ligated &
divided with 2-0 vicryl
• ELN enters cricothyroid mm.
• Dissection done in an avascular plane b/w
cricothyroid mm. & gland
Parathyroids identified & dissected
• Sup. Parathyroid – above & dorsal to junction of
ITA & RLN
• Inf. Parathyroid – below & ventral

17. RLN identified (Riddle’s triangle)
• Generally – (ITA) Artery is Anterior to RLN
• RLN is in close proximity to Ligament of Berry
• Dissect gland with bipolar cautery ONLY along
the path of RLN
Capsular ligation of ITA  retains blood supply to
parathyroids (which lie w/i false capsule)
Mobilized gland is removed

18. THANK YOU