Post on 24-Jan-2017
Dr. MTD Lakshan
MBBS MS(Oto) DOHNS(Eng) FEB ORL-HNS (Europe)FRCSEd ORL-HNS (UK)
Consultant ENT and Head and Neck Surgeon
ThyroidectomyHead and Neck Surgeon’s point of View
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4
1. Malignancy
2. Function
3. Compression
4. Cosmetic / Concerns
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4
1. Hypoechogenicity
2. Irregular/microlobulated margins
3. Microcalicifications
4. Taller - than - wide
Kim, E.K et al. (2002) New sonographic criteria for recommending fine-needle aspiration biopsy of non-palpable solid nodules of the thyroid. American Journal of Roentgenology, 178, 687–691.
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5
U1 - Normal
U2 - Benign
U3 - Indeterminate/Equivocal
U4 - Suspicious
U5 - Malignant
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5
Thy1 - Non-Diagnostic - Thy1C - Cystic
Thy2 - Non-Neoplastic - Thy2C - Cystic
Thy3 - Neoplasm possible Thy3A, Thy3F
Thy4 - Suspicious
Thy5 - Malignant
Royal College of Pathologists 2009LearnENT.NET
"Thyroid papillary carcinoma histopathology (3)" by No machine-readable author provided. KGH assumed (based on copyright claims). - No machine-readable source provided. Own work assumed (based on copyright claims).. Licensed under CC BY-SA 3.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/
File:Thyroid_papillary_carcinoma_histopathology_(3).jpg#/media/File:Thyroid_papillary_carcinoma_histopathology_(3).jpg
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5
Geographical distance
Transport difficulties
Opportunity Cost
Time
Willingness
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5
Extent - Terminology
Lymph Node Dissection
Tips
Scar Management
Clear Pathway
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3Total Thyroidectomy
Lobectomy and Isthmusectomy
Near Total Thyroidectomy
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2Prophylactic
• Central Compartment• Lateral
Therapeutic • Central Compartment• Lateral
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5
1. Classical PTC
2. <45 years
3. Uni focal disease
4. <4cm
5 No extra thyroidal extension on US
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Microsurgery 2004; 24 (1) : 39-42.Total thyroidectomy is improved by loupe magnification.Mario Testini, Michele Nacchiero, et al
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–G. Rainey Williams
“ENT stands for Ear, Nose and Throat. The “T” doesn’t stand for thyroid”
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Guidelines BTA 2014 ATA 2015
Clinical Features
Imaging USS U1-U5 Classification
FNAC Thy Classification
Multi Disciplinary Team
Surgery including neck dissections
RRA
Audit and CPD
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“The extirpation of the thyroid gland for goiter .. provide(s) perhaps more than
other operations the supreme triumph of the surgeons art”
William Stewart Halsted
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“The extirpation of the thyroid gland for goiter .. provide(s) perhaps more than
other operations the supreme triumph of the surgeons art”
William Stewart Halsted
LearnENT.NET