Partial Thyroidectomy

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  • Extensive multinodular disease
  • Hyperthyroidism
  • Thyroid cancer larger than 2 cm in size without palpable lymph nodes
  • Palpable adenopathy an indication for a neck dissection in conjunction with a total thyroidectomy
  • Poor candidate for surgery
  • Anaplastic thyroid cancer in selected patients
  • Standard thyroidectomy set
  • Mahorner retractor
  • The two lateral lobes are joined at the midline by an isthmus, the superior edge of which is situated at or just below the cricoid cartilage.
  • The pyramidal lobe may be a prominent structure that can extend from the midline of the isthmus to as far cephalad as the hyoid bone.
  • The recurrent laryngeal nerves ascend on either side of the trachea.
    • Each lies just lateral to the ligament of Berry.
  • The superior laryngeal nerve separates from the vagus nerve at the base of the skull and descends toward the superior pole of the thyroid along the internal carotid artery.
  • The superior thyroid artery courses medially onto the surface of the inferior pharyngeal constrictor muscle and enters the apex of the superior pole.
  • The inferior thyroid artery ascends into the neck on either side behind the carotid sheath and then arches medially and enters the thyroid gland posteriorly, usually near the ligament of Berry.

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  • Calcium assay performed within 24 hours of surgery
    • If no signs of hypocalcemia are present, no calcium supplementation may be necessary.
    • If symptoms occur or if the surgeon is concerned about the patient's parathyroid status, daily supplements of 1500 to 3000 mg of elemental calcium may be started.
  • Postprocedure hypocalcemia secondary to devascularization of the parathyroid
  • Hoarseness caused by recurrent laryngeal nerve injury induced by either traction or division
  • Unilateral injury to recurrent laryngeal nerve with a paralyzed vocal cord with loss of movement from the midline

Most patients with papillary carcinoma can expect an excellent prognosis, with the 10-year survival rate approaching 95% for the most favorable stages.

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