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William Stewart Halsted
1852-1922
LearnENT.NET
Dr. MTD Lakshan
MBBS MS(Oto) DOHNS(Eng) FEB ORL-HNS (Europe)
FRCSEd ORL-HNS (UK)
Consultant ENT and Head and Neck Surgeon
Thyroidectomy
Head and Neck Surgeon’s point of View
LearnENT.NET
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Sep 2010
Oct 2015 217
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Malignancies
Jan 2012
Sep 2015 96
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Oct 2014
Oct 2015 128
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Clinical
Imaging FNAC
MDT
Surgery
RRAFollow Up
Recurrence
LearnENT.NET
Clinical
Imaging FNAC
MDT
Surgery
RRAFollow Up
Recurrence
LearnENT.NET
Clinical
Imaging FNAC
MDT
Surgery
RRAFollow Up
Recurrence
LearnENT.NET
4
1. Malignancy
2. Function
3. Compression
4. Cosmetic / Concerns
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Thy1 - Non-Diagnostic - Thy1C - Cystic
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Clinical
Imaging FNAC
MDT
Surgery
RRAFollow Up
Recurrence
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Clinical
Imaging
FNAC
MDT
Surgery
RRAFollow Up
Recurrence
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USS
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USS
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4
1. Hypoechogenicity
2. Irregular/microlobulated margins
3. Microcalicifications
4. Taller - than - wide
Kim, E.K et al. (2002) New sonographic criteria for recommending fine-needle aspiration biopsy of non-palpable
solid nodules of the thyroid. American Journal of Roentgenology, 178, 687–691.
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5
U1 - Normal
U2 - Benign
U3 - Indeterminate/Equivocal
U4 - Suspicious
U5 - Malignant
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Clinical
Imaging FNAC
MDT
Surgery
RRAFollow Up
Recurrence
LearnENT.NET
Clinical
Imaging
FNAC
MDT
Surgery
RRAFollow Up
Recurrence
LearnENT.NET
5
Thy1 - Non-Diagnostic - Thy1C - Cystic
Thy2 - Non-Neoplastic - Thy2C - Cystic
Thy3 - Neoplasm possible Thy3A, Thy3F
Thy4 - Suspicious
Thy5 - Malignant
Royal College of Pathologists 2009
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"Thyroid papillary carcinoma histopathology (3)" by No machine-readable author provided. KGH assumed (based on copyright claims). - No machine-readable source
provided. Own work assumed (based on copyright claims).. Licensed under CC BY-SA 3.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/
File:Thyroid_papillary_carcinoma_histopathology_(3).jpg#/media/File:Thyroid_papillary_carcinoma_histopathology_(3).jpg
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Clinical
Imaging FNAC
MDT
Surgery
RRAFollow Up
Recurrence
LearnENT.NET
Clinical
Imaging FNAC
MDT
Surgery
RRAFollow Up
Recurrence
LearnENT.NET
Clinical Excellence Through a Multi Disciplinary Approach
LearnENT.NET
5
Geographical distance
Transport difficulties
Opportunity Cost
Time
Willingness
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19 Nov 2013
23 June 2015 93
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Clinical
Imaging FNAC
MDT
Surgery
RRAFollow Up
Recurrence
LearnENT.NET
Clinical
Imaging FNAC
MDT
Surgery
RRAFollow Up
Recurrence
LearnENT.NET
LearnENT.NET
5
Extent - Terminology
Lymph Node Dissection
Tips
Scar Management
Clear Pathway
LearnENT.NET
3
Total Thyroidectomy
Lobectomy and Isthmusectomy
Near Total Thyroidectomy
LearnENT.NET
2/5 Lymph Node Dissection
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2
Prophylactic
• Central Compartment
• Lateral
Therapeutic
• Central Compartment
• Lateral
LearnENT.NET
5
1. Classical PTC
2. <45 years
3. Uni focal disease
4. <4cm
5 No extra thyroidal extension on US
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Personalized Decision Making
LearnENT.NET
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IIA
VB
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Central Compartment Neck
Dissection
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3/5 Tips
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Microsurgery 2004; 24 (1) : 39-42.
Total thyroidectomy is improved by loupe magnification.
Mario Testini, Michele Nacchiero, et al
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RLN
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RLN - Branching
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RLN - Pasted to the Gland
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External laryngeal Nerve LearnENT.NET
4/5 Scar Management
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5/5 Management Protocol
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Tony’s Story
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–G. Rainey Williams
“ENT stands for Ear, Nose and Throat.
The “T” doesn’t stand for thyroid”
LearnENT.NET
Clinical
Imaging FNAC
MDT
Surgery
RRAFollow Up
Recurrence
LearnENT.NET
RRA
Clinical
Imaging FNAC
MDT
Surgery
Follow Up
Recurrence
LearnENT.NET
Clinical
Imaging FNAC
MDT
Surgery
RRAFollow Up
Recurrence
LearnENT.NET
LearnENT.NET
Guidelines BTA 2014 ATA 2015
Clinical Features
Imaging USS U1-U5 Classification
FNAC Thy Classification
Multi Disciplinary Team
Surgery including neck dissections
RRA
Audit and CPD
LearnENT.NET
“The extirpation of the thyroid gland for
goiter .. provide(s) perhaps more than
other operations the supreme triumph of
the surgeons art”
William Stewart Halsted
LearnENT.NET
“The extirpation of the thyroid gland for
goiter .. provide(s) perhaps more than
other operations the supreme triumph of
the surgeons art”
William Stewart Halsted
LearnENT.NET

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