THYROID SURGERY

-Thyroid is a butterfly shaped gland in neck which produces thyroid hormone , essential for our body metabolism.

-Thyroid gland has two lobes on either side and connected in centre.

-It is quite common to have lumps in thyroid gland which may be completely benign or cancerous.

-Many patients start noticing swelling in anterior neck with no pain or discomfort.

-These may gradually increase in size and become large lumps overtime.

-Many a times these lumps are multiple and present on both lobes , which can progress to form a large swelling.

-Most of these are non -cancerous and would require surgery for cosmetic reasons or as the size of lumps may cause pressure on surrounding structures like air pipe and food pipe.

Thyroid Surgery

THYROID CANCER

-Most of the times thyroid cancer also present as pain less lump in thyroid which slowly progress in size.

-So its difficult to differentiate from non cancerous ones. However few cases present with

1)rapidly increasing lump in thyroid

2)Enlarged neck nodes due to cancer spread

3)Change in voice

4)Difficulty in breathing

INVESTIGATIONS FOR THYROID LUMP

1)Ultrasound scan of thyroid gland

Based on features of lump we can segregate them into highly suspicious for cancer, borderline or non cancerous lumps.

2)FNAC

Cytology is quick and easy test done after USG . This can pick up cancer in lump or at least guide us with risk of cancer in the sampled lump(BETHESDA CLASSIFICATION)

3)IMAGING

MRI / CT scan are rarely done in patients with large lumps or with ominous symptoms of advanced thyroid cancer.

THYROIDECTOMY

1)HEMI THYROIDECTOMY

Removal of one half of thyroid gland is called hemi thyroidectomy . This is generally done for

-Benign lumps in one thyroid lobe.

-Early stage thyroid cancer.

-Diagnostic for follicular adenoma.

2)TOTAL THYROIDECTOMY-

Removal of complete thyroid gland is called total thyroidectomy. Most common indications are

-Benign nodules in both lobes.

-Thyroid cancer.

3)NECK DISSECTION

Thyroid cancer patients presenting with spread of cancer to neck nodes , requires appropriate neck dissection along with thyroidectomy to completely clear disease.

HOW SAFE IS THYROID SURGERY

In experienced hands thyroidectomy is a completely safe surgery.

Three structures of concern during surgery are

-Recurrent laryngeal nerve which supplies muscles of vocal cords.

-External branch of superior laryngeal nerve which also supply to muscle of vocal cord.

-PARA THYROID glands which maintain calcium levels in blood.

Thyroid Surgery in Hyderabad

(In the above picture blue arrow indicates Recurrent laryngeal nerve and yellow marks parathyroid gland).

All these nerves and parathyroid glands are dissected meticulously and preserved during surgery so that patients doesn’t have long term surgery morbidity.

HOW DO WE MAKE THYROID SURGERY SAFE

-EXPERIENCE OF SURGERY TEAM- With our experience of more than a decade operating on thyroid lumps and cancers , operative complications are rare.

-ANAESTHESIA – Hypotensive anaesthesia prevents bleeding during surgery and enable surgeon to delicately separate nerves and gland.

- NERVE MONITORING – Continuous nerve monitoring of RLN and EBSLN will warn surgeon of any nerve injury due to stretching of nerve.

Thyroid Surgery in India

White arrow-Recurrent laryngeal nerve.Yellow- para thyroid gland

Thyroid Surgeon in Hyderabad

White arrow-Recurrent laryngeal nerve.Yellow- para thyroid gland

THYROID CANCER SURGERY

Wite arrow -External branch of superior laryngeal nerve(EBSLN) during total thyroidectomy for thyroid cancer.

Thyroid Surgeon in India

WHITE ARROW -EXTERNAL BRANCH OF SUPERIOR LARYNGEAL NERVE

Thyroid Surgery

WHITE ARROW -EXTERNAL BRANCH OF SUPERIOR LARYNGEAL NERVE

-We routinely do locally advanced thyroid surgeries with neck nodal enlargement, tumour infiltrating into surrounding structures and extension into chest

-Huge thyroid mass extending into chest. Chest bone is split to remove the mass.

Thyroid Surgery in Hyderabad

RADIO IODINE THERAPHY

-Advanced cancers of thyroid (papillary and follicular) require post surgery Radio iodine theraphy to ablate metastatic disease.

NECK SCAR IN THYROID SURGERY

-Well placed neck scar for thyroidectomy heals well and allign with neck folds so that it is not visible obviously after 4 months of surgery.

-Steps taken to produce a fine thyroidectomy scar

1)Incision placed in natural neck fold.

2)Sub-cutaneous suturing done with absorbable sutures so that scar is thin.

Thyroid Surgery in India

-This patient underwent thyroidectomy with neck dissection on both side of neck with 10 cm incision which is well healed.

-Another fine thyroidectomy with neck dissection scar for cancer of thyroid.

Thyroid Surgeon in Hyderabad

SCARLESS THYROIDECTOMY/ ROBOTIC THYROIDECTOMY

-Robotic thyroidectomy can be done from mouth called trans oral thyroidectomy vestibular approach(TORTVA) or from behind the ear called retro auricular approach.

-In TORTVA three small incisions are made in lower lip for robotic arms to enter into neck and thyroid gland is removed from mouth.

-Excellent cosmetic results with no visible scar in neck.

-In post aural robotic thyroidectomy incision is given behind hairline behind the ear for access into neck.

-So scar is actually concealed and not visible in neck.

WHO CAN UNDERGO ROBOTIC THROIDECTOMY

1)Non cancerous lump in thyroid.

2)Size less than 4 cm.

3)No involvement of neck nodes.

ADVANTAGE

-No visible scar in neck

DISADVANTAGE

-Increased surgery time-Expensive when compared to open surgery

Thyroid Surgeon in India

TORTVA

Thyroid Surgery

POST AURAL ROBOTIC THYROIDECTOMY

MANAGEMENT OF COMPLICATIONS OF THYROID SURGERY

-We are experienced in management of recurrent nerve injury.

-Voice change can be treated with THYROPLASTY and injection laryngoplsty.

-LASER CORDECTOMY is done in patients with injury to both side recurrent laryngeal nerves with breathing difficulty .

CONSULT US FOR HOLISTIC MANAGEMENT OF THYROID LUMPS AND CANCER.

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