Transcript Thyroidectomy - JATC Surgical Technology

THE THYROID
 The thyroid sits anteriorly to the trachea and the esophagus
 Contains two types of hormone-producing cells
 Follicular Cells: produce thyroxine and triiodothyronine
 Parafollicular Cells: produce calcitonin
 The adult thyroid weighs anywhere from 12 to 25 grams
 “H” shaped
 The organ shrinks as you age
 Two lobes
THE PARATHYROIDS

Range from 2 to 6

Small, flat, oval structures that lie on the dorsal side of the thyroid gland

Produce parathormone which maintains the normal relationship between blood
and skeletal calcium

Removal of these glands would result in tetany and death

Care must be taken not to damage these glands during a thyroidectomy
PATHOPHYSIOLOGY OF THE THYROID AND
PARATHYROIDS

Hyperthyroidism (thyrotoxicosis): when the thyroid gland produces too much
thyroxine hormone
 Symptoms: nervousness, tachycardia, sweating, tremors, arrhythmias, hair loss,
and dyspnea

Thyroid Carcinoma: cancer of the thyroid
 Symptoms: hoarseness, may show signs of hyper- or hypothyroidism depending
on tumor type, may be asymptomatic

Hyperparathyroidism: when the parathyroid glands produce an excess of
parathyroid hormone
 Symptoms: asymptomatic in early stages, skeletal damage

Hypoparathyroidism: parathyroid glands don’t produce enough parathyroid
hormone
 Symptoms: anxiety, depression, brittle nails, dry skin, thin hair, tetany (a severe
complication)
DIAGNOSTIC EXAMS AND PREOPERATIVE
TESTING

Patient history and physical

Ultrasound

Laryngoscopy

Biopsy

Scans

Serum levels of TSH
ANESTHESIA AND POSITIONING

Anesthesia is general

The patient is positioned in the supine position with neck extended
SKIN PREP, DRAPING, AND INCISION

Skin is prepped from the point of the chin down to the mid-chest of the patient
and laterally as far as possible

Wadded absorptive towels are placed bilaterally and the thyroid sheet is used

The incision is symmetrical and transverse following the Langer lines over the
thyroid. The size of incision varies, it is generally done two fingerbreadths above
the clavicular head.
SUPPLIES, EQUIPMENT AND INSTRUMENTS
 Basic set, prep set, #10
and #15 blades,
sutures, dressings,
Bovie, basin set
 Thyroid drapes and ¼”
Penrose drain
 Suction, ESU, roll or
thyroid rest for extending
the neck
 Thyroidectomy set,
bipolar forceps with
cord, liga clip appliers
and clips
SPECIAL CONSIDERATIONS
 Great care must
be taken to ensure
that the
parathyroid glands
are spared and
protected
 A Queen Anne’s
dressing or thyroid
collar may be used
along with the
drain
STEP ONE
O PER AT IV E PRO C ED U R E
•
•
The incision is made
and extended
through the
subcutaneous
tissues and the
platysma muscle.
Superior and inferior
flaps are mobilized
and retractors are
placed
TECHNICAL
C O N S ID E R AT IO N S
•
Hemostasis will be
secured as the
procedure progresses
•
Usually via Bovie
•
May clamp and tie some
vessels
•
May use ligating clips
STEP TWO
O PER AT IV E PRO C ED U R E
• The strap muscles are
separated and the
thyroid lobe is exposed.
The middle thyroid vein
is exposed, divided, and
ligated
• Vessels are identified,
divided and ligated
(laryngeal nerves and
superior vessels must be
identified)
TECHNICAL
C O N S ID E R AT IO N S
• Keep fresh, dry
sponges available,
mosquito hemostats
may be used
• Ligation may require
the use of small right
angle clamps and
ligature on a passer
STEP THREE
O PER AT IV E PRO C ED U R E
• Parathyroid glands,
inferior thyroid artery
and recurrent
laryngeal nerve are
identified.
• Parathyroid glands are
mobilized and
vascular supply is
preserved
TECHNICAL
C O N S ID E R AT IO N S
• Keep two clamps,
scissors, and ties
ready
STEP FOUR
O PER AT IV E PRO C ED U R E
• Branches of the
inferior thyroid artery
are divided and
ligated. The superior
connective tissue is
divided. Hemostasis is
achieved with ESU.
(Recurrent nerve must
be spared)
TECHNICAL
C O N S ID E R AT IO N S
• May alternate
between sharp
dissection, blunt
dissection and ESU
STEP FIVE
O PER AT IV E PRO C ED U R E
• The thyroid is
dissected from the
trachea.
TECHNICAL
C O N S ID E R AT IO N S
• If only one lobe is
taken, the isthmus
is divided so that it
is removed with
resected lobe as is
the pyramidal lobe.
STEP SIX
O PER AT IV E PRO C ED U R E
• Hemostasis is
achieved after lobe
or lobes are
removed, a drain
may be placed. The
wound is closed.
TECHNICAL
C O N S ID E R AT IO N S
• Sequence is
irrigation, placement
of wound drain, and
closure.
• Initiate count.
POSTOP CONSIDERATIONS
•
Immediate postoperative care:
• Check voice as soon as possible
• Transport to PACU
• Tracheotomy tray available
• Prognosis
• Return to normal activities
• Medications usually required for life
• Complications:
• Hemorrhage
• Wound Infection
• Damage to nearby structures