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!
References:
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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