This document discusses the management of thyroid neoplasms. It outlines different types of thyroidectomies including total, subtotal, and hemithyroidectomies. It describes the steps of thyroid surgery and discusses when different procedures are used based on tumor type. Post-operative complications are outlined along with treatments. Guidelines are provided for postoperative management including use of thyroid hormone suppression and radioactive iodine treatment based on tumor histology.
This document discusses the management of thyroid neoplasms. It outlines different types of thyroidectomies including total, subtotal, and hemithyroidectomies. It describes the steps of thyroid surgery and discusses when different procedures are used based on tumor type. Post-operative complications are outlined along with treatments. Guidelines are provided for postoperative management including use of thyroid hormone suppression and radioactive iodine treatment based on tumor histology.
This document discusses the management of thyroid neoplasms. It outlines different types of thyroidectomies including total, subtotal, and hemithyroidectomies. It describes the steps of thyroid surgery and discusses when different procedures are used based on tumor type. Post-operative complications are outlined along with treatments. Guidelines are provided for postoperative management including use of thyroid hormone suppression and radioactive iodine treatment based on tumor histology.
This document discusses the management of thyroid neoplasms. It outlines different types of thyroidectomies including total, subtotal, and hemithyroidectomies. It describes the steps of thyroid surgery and discusses when different procedures are used based on tumor type. Post-operative complications are outlined along with treatments. Guidelines are provided for postoperative management including use of thyroid hormone suppression and radioactive iodine treatment based on tumor histology.
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MANAGEMENT OF THYROID
NEOPLASMS - ALAMELU AL Dr. VIJAYALAKSHMI MA’AM UNIT, KMC SURGERY THYROIDECTOMY TYPES: • Total thyroidectomy – entire lobe is removed • Subtotal thyroidectomy – leaving 3 to 4 g of tissue on either side • Hemi thyroidectomy – removing a lateral lobe along with isthmus • Hartley dunhill – small quantity of tissue retained in lower pole or in the trachea-esophageal groove • Near total thyroidectomy – 1 gram of tissue is retained to safeguard recurrent laryngeal nerve and parathyroid gland. Total Subtotal Hemi
In our hospital – Total and Hemithyroidectomy
STEPS OF THYROIDECTOMY • For papillary carcinoma, medullary carcinoma and follicular neoplasm involving both the lobes– total thyroidectomy • For follicular neoplasm involving one lobe – do hemithyroidectomy and look for capsular invasion in frozen section. • If found to be follicular carcinoma – total thyroidectomy • For anaplastic carcinoma- palliative isthumectomy or tracheostom if the patient has respiratory difficulties NECK NODE DISSECTION • For papillary carcinoma – if neck nodes found to be positive - MODIFIED RADICAL NECK DISSECTION • Remove level two, three, four and five group of nodes are removed, preserving internal jugular vein, sternocleidomastoid muscle and spinal accessory nerve. • For medullary and hurthle carcinoma – BILATERAL CENTRAL NECK DISSECTION should be performed routinely – nodes medial to carotid sheath are removed. COMPLICATIONS: • Hemorrhage • Respiratory obstruction – hematoma, tracheomalacia/endotracheal intubation, laryngeal edema • Recurrent laryngeal nerve palsy – treat by steroid and speech therapy • Hypoparathyroidism – decreased serum calcium – perioral numbness, trousseau and chvostek sign. • Calcium gluconate – 10ml i.v., oral calcium carbonate 500 mg 8th hourly • Thyroid storm – occurs when the patient is inadequately prepared • Treat thyroid storm using steroids, antithyroid drug, beta blocker, tepid sponging, i.v. fluids, electrolyte management, cardiac monitoring, lugols iodine and ventilator support. • External laryngeal nerve injury • Hypothyroidism • Wound infection, stitch granuloma, keloid recurrence POST OPERATIVE MANAGEMENT • For papillar carcinoma which is TSH dependent give suppressive thyroxine of dose 0.3 mg and maintain TSH Less that 0.1 mU/L
• For follicular carcinoma – give maintenancce TSH dose of 0.1 mg
• After thyroidectomy – Radioisotope I 123 scan is done and look for metastasis • If distant metastasis is found – stop thyroxine 6 weeks prior and start therapeutic dose I 131 (50 to 150 m curie) • Post-ablation isotope scanning is done in 8 days. Follow up body scan is done once in 6 months. Serum thyroglobulin estimation is done for 6-12 months, later once in 6 months; • Secondaries in bone are treated by external radio therapy. Internal xation should be done whenever there is pathological fracture. • There is no role of chemotherapy for follicular carcinoma thyroid. • For anaplastic carcinoma- Treatment is external radiotherapy. Adriamycin as chemotherapy. • For medullary carcinoma - External beam radiotherapy for residual tumour disease. Somatostatin/octreotide for diarrhoea. Adriamycin is the drug used as chemotherapy with limited results. • No role of suppressive hormone therapy or radioactive iodine therapy. • If there is associated phaeochromocytoma it should be treated surgically by adrenalectomy rst and later only total thyroidectomy is done. • All family members of the patient should be evaluated for serum calcitonin and if it is high they should undergo prophylactic total thyroidectomy
