The Thyroidectomy  Technique
I underwent a nearly Total Thyroidectomy on 2-10-92 to correct a non-resolving
multi-nodular adenomatous goiter secondary to dyshormonogenic hypothyroidism. 
My mother discovered a small swelling in her throat, and was tested. She was asked
by an endocrinologist to take iodine supplements while carrying me prior to my birth. 
Based on the findings and course of treatment, I think she had a small goiter during
her pregnancy. I think her Doctor thought that medication with supplementary iodine
would help.  Meanwhile,  my metabolism may have absorbed the iodine uptake, and
I believe this may have slowed the development of my own thyroid. Being thus "faked
out", my thyroid may have become dyshormonogenic. This is what my current thyroid 
endocrinologist has theorized as being the "hypothetical etiology" (medical cause). 
Years of tests and changes in medication have ultimately failed to shrink the goiter,
therefore it was decided to perform an assessment in the Endocrinology lab to look
for possible existence of tumor activity.  A Thallium Scan followed by a Needle 
Aspiration Biopsy were performed.  The results indicated a need to remove the goiter
to prevent neoplastic changes from occuring in later life.  After consultations were 
conducted with the Pathologist, the Endocrinologist, and the selected surgeon,  followed
by extensive reading I did in the Med School Library near the hospital,  I arranged to 
have this surgery performed.  I also found out more info that boosted my confidence.
The surgeon also had performed these operations quite frequently over a 36 year 
timeframe with no mortality statistics.  I think that's GREAT!  Right man for the job!
A thyroid operation is not simple, and experience and competence of high degree  are
essential to successfully remove the thyroid, and provide adequate closure with cosmesis.

Summarized here are the essential aspects of the Operation:
  1. Recommended Instruments List
  2. Pre-Operative Testing
  3. Preparation of Patient

  4. Patient Positioning

  5. Anesthesia Induction

  6. Marking the Incision

  7. Elevating the Flaps

  8. Exposing the Thyroid Gland

  9. Mobilizing the Thyroid Gland

 10. Dissection of the Recurrent Laryngeal Nerve

 11. Dissection of the Parathyroid Glands

 12. Dissection of the Superior Pole

 13. Division of the Isthmus and Lobe Removal

 14. Wound Closure

 15. Post-Operative Care

 16. Sequelia: Potential Complications

 17. Metabolic Balancing Maintenance Medications

Material above will be addressed in future pages!
Completed pages are hyperlinked!


Stephen A. Falk, W.Bradley Simmons, Eric A. Birken: From "Thyroid Disease,
Endocrinology, Surgery, Surgery, Nuclear Medicine, and Radiotherapy"
edited by SA Falk, c1990, by Raven Press Ltd NY;

Zollinger, "Atlas of Surgical Operations" 5th Ed.

John A. Van Heerden (Mayo Clinic) "Common Problems in Endocrine Surgery"
Pub by Year Book Medical Publishers

OH Beahrs, "Atlas of Surgical Techniques of Oliver H Beahrs" c1985 WB SaundersCo.

"Atlas of Head and Neck Surgery" John M. Lore Jr, 3rd Ed c1988 WB Saunders Co.

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