medical

1. MANAGEMENT OF
GOITRE

2. MULTINODULAR GOITRE
• Subtotal Thyroidectomy
- Right and left lobe and entire isthmus removed in flush with tracheal surface
- Leaving behind little tissue in TE groove
- Done to protect Recurrent Laryngeal Nerve & PT gland
• Total Thyroidectomy
- Is the choice provided complications (RLN paralysis & hypocalcemia d/t removal of
PT gland) can be avoided
• Medicine
- Tab Thyroxine (Eltroxin) 0.1-0.2 mg/day for small nodules

5. RETROSTERNAL GOITRE
• Neck Incision & Removal
• Sternal split rarely necessary

6. PRIMARY THYROTOXICOSIS
• Antithyroid drugs
• Subtotal thyroidectomy – thyroid tissue left as small as tip of
little finger on both sides
• Total thyroidectomy – young patients of small-sized gland
• Radioiodine therapy – alternative to surgery for >30

9. SECONDARY THYROTOXICOSIS
• Radioiodine therapy when op risk is unacceptable (elderly)
• Given antithyroid drugs 48h later, continued till 6w
• Subtotal thyroidectomy done when patient is fit for
surgery & anaes. (Gland left size of distal phalanx of
patient’s thumb)

10. PAPILLARY CA
• Treatment of primary
- Total thyroidectomy
- Lobectomy/hemithyroidectomy – removal of one lobe and entire isthmus
• Treatment of secondaries in lymph node
- Functional block dissection (Berry picking means removal of enlarged lymph
nodes only)
• Suppression of TSH
- Papillary CA is a TSH dependent tumour
- Thyroxine 0.3 mg/day is given in post op to prevent hypothyroidism and to
supress TSH

13. REFERENCES