1. anatomy• •Light brown, firm organ• •15 – 20 gms in weight• •Two lateral lobes connected by an isthmus• •4 x 2 cm in dimension; 20 – 40 mm thickness• •Pyramidal lobe present in 80% of normal persons; usually left of midline• •Four parathyroid glands closely related• •Recurrent laryngeal nerves on both sides• •Within the superficial and deep layers of the deep cervical facsia
2. INDICATIONS FOR operation• NEOPLASIA FNAC +VE Clinical suspicion, including Age male sex Hard texture Fixity Recurrent Laryngeal nerve Palsy Lymphadenopathy• RECURRENT CYST• TOXIC ADENOMA• PRESSURE SYMPTOMS• COSMESIS• PATIENT’S WISHES
4. • ALL THYROID OPERATIONS CAN BE ASSEMBLED FROM THREE BASIC ELEMENTS:• TOTAL LOBECTOMY• ISTHMUSECTOMY• SUBTOTAL LOBECTOMY• TOTAL THYROIDECTOMY = 2× TOTAL LOBECTOMY +ISTHMUSECTOMY
5. • SUBTOTAL THYROIDECTOMY= 2× TOTAL LOBECTOMY +ISTHMUSECTOMY• LOBECTOMY=TOTAL LOBECTOMY +ISTHMUSECTOMY• NEAR TOTAL THYROIDECTOMY= SUBTOTAL LOBECTOMY+TOTAL LOBECTOMY +ISTHMUSECTOMY
6. Indications• Total Thyroidectomy■ Thyroid carcinoma.■ Graves’ disease.■ Hashimoto thyroiditis.■ Multinodular goiter.■ Substernal goiter.• Thyroid Lobectomy■ Unilateral toxic nodule.■ Solitary adenoma or cyst.• Sub Total Thyroidectomy Toxic nodular goiter
7. Choice ofthyroidoperations• DIAGNOSIS• RISK OF THYROID FAILURE• RISK OF RLN INJURY• RISK OF RECURRENCE• GRAVE’S DISEASE• MULTINODULAR GOITRE• DIFFERENTIATED THYROID CANCERS• RISK OF HYPOPARATHYOISM
8. Technique of thyroidectomy• General anesthesia is administered through an endotracheal tube and good muscle relaxation is obtained.• The patient is supine on the operating table with the table tilted up 15 degree at the head end.• Curved skin crease incision is made midway between the notch of the thyroid cartilage and the suprasternal notch.
9. • Flaps of skin , SC Tissue and platysma are raised upwards to the superior thyroid notch and downwards to the suprasternal notch.• Deep Cervical fascia is divided in the midline and strap muscles are divided or retracted.
10. • The middle thyroid vein is identified, ligated and divided .• The superior thyroid vessels are ligated on the thyroid capsule of the superior pole to avoid inadvertent injury to the external branch of the superior laryngeal nerve.• Recurrent Laryngeal nerve is identified.
11. • Parathyroid gland is identified• subtotal resection of each lobe is carried out leaving a remnant of 4-5 g on each side.• In total thyroidectomy complete incision of the gland is carried out with preservation insitu or autotransplantation of parathyroid gland.• Pretracheal muscle and cervical fascia are sutured and the wound closed
13. BENIGN TUMOURS• PRESENT CLINICALLY AS SOLITARY NODULES.• DISTINCTION BETWEEN FOLLICULAR CARCINOMA AND AN ADENOMA CAN ONLY BE MADE BY HISTOLOGICAL EXAMINATION.• TREATMENT IS THERFORE BY WIDE EXCISION i.e LOBECTOMY
14. MALIGNANTTUMOURS1.PAPILLARY CARCINOMA:Most common histologic variety of thyroid malignancy.Complex papillary projections are present with a fibrovascular core. Psammoma bodies are seen2.FOLLICULAR CarcinomaOccur in older patients typically at age 40-60, Female: Male probably nearly equal ,Propensity for angioinvasion and hematogenous spread. Differentiate from follicular adenoma by capsular, vascular, or stromal invasion.
15. Anaplastic Carcinoma An uncommon thyroid malignancy effecting older patients May arise in a well differentiated thyroid carcinoma.Medullary Thyroid CarcinomaTumours of Parafollicular cellsSolid histologic pattern with amyloid in its stroma andcalcification seen.Elevated levels of serum calcitonin are usuallypresent in MTC and form a reliable marker for thepresence of occult MTC in familial cases, andrecurrent MTC in previously treated patients.