Subtotal thyroidectomy is the treatment of choice in:
- Failure of medical treatment.
- Presence of malignancy, here we must do total thyroidectomy except if it is singles nodule.
- Huge thyroid gland.
- Multinodular goiters.
- Infection or hemorrhage in the gland.
Potential Complications from Surgery:
- Bleeding (may rapidly induce death)
- Laryngeal nerve damage (airway obstruction)
- Permanent hypoparathyroidism.
- Permanent hypothyroidism
- Hypocalcemia 1-7 days post-op
- Induction of labor (especially in 1st and 3rd trimester)
- Do not refer to an inexperienced surgeon!!!!!
Hyperthyroidism (Treatment)
Surgery (sub-total thyroidectomy) ***Need to be euthyroid prior to surgery ***
- To ↓ the risk of arrhythmias during induction of anesthesia
- To ↓ the risk of thyroid storm post operatively
- ATD’s + β-blockers
Preparation of Patient for Thyroidectomy
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Neomercazole: 7-10 weeks, before operation to decrease hormone levels of until euthyroid state.
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K iodide: saturated solution 5 drops twice daily is given 7 - 10 days before operation to decrease the size and vascularity of gland and simplify surgery.
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B-blocker: is given to decrease H.R.
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Phenobarbitone: is given to decrease anxiety. 50 - 60% of patients will require thyroid supplementation following surgery.