Indications for operation in thyroid swellings:
•
Neoplasia
•
FNAC positive
•
Clinical suspicion, including:
Age
Male sex
Hard texture
Fixity
Recurrent laryngeal nerve palsy
Lymphadenopathy
•
Recurrent cyst
•
Toxic adenoma
•
Pressure symptoms
•
Cosmesis
•
Patient’s wishes
Selection of thyroid procedure
The choice of thyroid operation depends on:
• diagnosis (if known preoperatively);
• risk of thyroid failure;
• risk of RLN injury;
• risk of recurrence;
• Graves’ disease;
• multinodular goitre;
• differentiated thyroid cancer (DTC);
• risk of hypoparathyroidism.
Thyroid operations
All thyroid operations can be assembled from three basic
elements:
■ Total lobectomy
■ Isthmusectomy
■ Subtotal lobectomy
Total thyroidectomy = 2 × total lobectomy + isthmusectomy
Subtotal thyroidectomy = 2 × subtotal lobectomy +
isthmusectomy
Near-total thryroidectomy = total lobectomy +
isthmusectomy + subtotal
lobectomy
Lobectomy = total lobectomy + isthmusectomy