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

INDICATIONS FOR operation

• NEOPLASIAFNAC +VE Clinical suspicion, includingAgemale sexHard textureFixityRecurrent Laryngeal nerve PalsyLymphadenopathy

• RECURRENT CYST• TOXIC ADENOMA• PRESSURE SYMPTOMS• COSMESIS• PATIENT’S WISHES

SURGICAL OPTIONS

• ALL THYROID OPERATIONS CAN BE ASSEMBLED FROM THREE BASIC ELEMENTS:

• TOTAL LOBECTOMY• ISTHMUSECTOMY• SUBTOTAL LOBECTOMY

• TOTAL THYROIDECTOMY = 2× TOTAL LOBECTOMY +ISTHMUSECTOMY

• SUBTOTAL THYROIDECTOMY= 2× TOTAL LOBECTOMY +ISTHMUSECTOMY

• LOBECTOMY=TOTAL LOBECTOMY +ISTHMUSECTOMY

• NEAR TOTAL THYROIDECTOMY= SUBTOTAL LOBECTOMY+TOTAL LOBECTOMY

+ISTHMUSECTOMY

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

Choice of thyroid operations

• DIAGNOSIS• RISK OF THYROID FAILURE• RISK OF RLN INJURY• RISK OF RECURRENCE• GRAVE’S DISEASE• MULTINODULAR GOITRE• DIFFERENTIATED THYROID CANCERS• RISK OF HYPOPARATHYOISM

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.

• 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.

• 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.

• 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

THYROID NEOPLASMS

BENIGN MALIGNANT

Follicular Adenoma Primary secondary

Metastatic Follicular epitheliumPara follicular cells

medullaryLymphoid cellLYMPHOMA

Differentiated Un differntiatedAnaplastic

PAPILLARY

FOLLICULAR

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

MALIGNANT TUMOURS

1.PAPILLARY CARCINOMA:Most common histologic variety of thyroid malignancy. Complex papillary projections are present with a fibrovascular

core. Psammoma bodies are seen

2.FOLLICULAR Carcinoma

Occur 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.

Medullary Thyroid Carcinoma

Tumours of Parafollicular cells

Solid histologic pattern with amyloid in its stroma and calcification seen.

Elevated levels of serum calcitonin are usually present in MTC and form a reliable marker for the presence of occult MTC in familial cases, and recurrent MTC in previously treated patients.

Anaplastic CarcinomaAn uncommon thyroid malignancy effecting older patientsMay arise in a well differentiated thyroid carcinoma.