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 โ Rh grouping
2. Indirect Laryngoscopy ๏ Pt. says โEโ ๏ 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. Lugolโs 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
15. Strap mm. are retracted (often AJVโs 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
โข ELN enters cricothyroid mm.
โข Dissection done in an avascular plane b/w
cricothyroid mm. & gland
Parathyroids identified & dissected
โข Sup. Parathyroid โ above & dorsal to junction of
ITA & RLN
โข Inf. Parathyroid โ below & ventral
17. RLN identified (Riddleโs triangle)
โข Generally โ (ITA) Artery is Anterior to RLN
โข RLN is in close proximity to Ligament of Berry
โข 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