Surgical thyroid disease
This presentation is the property of its rightful owner.
Sponsored Links
1 / 16

Surgical Thyroid Disease PowerPoint PPT Presentation


  • 88 Views
  • Uploaded on
  • Presentation posted in: General

Surgical Thyroid Disease. Surgical Thyroid disease. Presentation and assessment Indications for surgery Risks of surgery Thyroid cancer / RAI protocol Discussion session. Surgical Thyroid Disease. Anatomical abnormality : goitre / nodule Functional abnormality : over /under active

Download Presentation

Surgical Thyroid Disease

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Surgical thyroid disease

Surgical Thyroid Disease


Surgical thyroid disease1

Surgical Thyroid disease

  • Presentation and assessment

  • Indications for surgery

  • Risks of surgery

  • Thyroid cancer / RAI protocol

  • Discussion session


Surgical thyroid disease2

Surgical Thyroid Disease

  • Anatomical abnormality : goitre / nodule

  • Functional abnormality : over /under active

  • Both : toxic nodule

    graves with big goitre


Common presenting symptoms

Common presenting symptoms

  • Lump in neck

  • Feeling of pressure

  • Feeling of discomfort

  • Feeling of choking

  • Feeling of having to ‘double swallow’

  • Don’t like the appearance and want to know what it is


Lump in neck

Lump in neck

  • Examination

    • Lymph node

    • Thyroid

    • Other


Suggested pathway for lymph node in neck present for 3 6 52 2cm or increasing in size

Suggested pathway for lymph node in neck:present for 3-6/52, >2cm or increasing in size

  • With associated systemic symtoms ; fast track haematology referral

  • Asymptomatic : rapid access neck lump clinic ; same day panedoscopy, USS, FNA, Core cut


If thought to be a thyroid abnormality

If thought to be a thyroid abnormality

  • Helpful if USS requested at same time

  • Single nodule / multinodular / diffuse

  • Likely Benign or Malignant ?

  • What is it that is bothering the patient ?


Discrete palpable nodule

Discrete palpable nodule

  • FNA

    • Cyst : if resolves : discharge

    • Solid : Benign ;

      asymptomatic and <4cm : review

      symptomatic, >4cm or clinical anxiety : lobectomy

    • Solid : Follicular ;

      Lobectomy


Discrete palpable nodule1

Discrete palpable nodule

  • FNA

  • Solid : Suspicious :

    • lobectomy

  • Solid : likely Malignant

    • thyroidectomy


  • Indications for surgery

    Indications for surgery

    • Diagnostic uncertainty (clinical or cytology)

    • Discrete lump over 4 cms

    • Cosmetic benefit

    • Relief of pressure symptoms

    • Correction of tracheal deviation /compression

    • Retrosternal extension

    • Thyroid eye disease (graves)


    Thyroid surgery

    Thyroid Surgery

    • Thyroid lobectomy (including isthmus and pyramidal lobe)

    • Total thyroidectomy


    Thyroid surgery1

    Thyroid Surgery

    • Sup laryngeal nerves

    • Cutaneous sensory nerves

    • Recurrent laryngeal nerves

    • Para-thyroid glands

    • Post-operative thyroxine

    • Post-operative calcium replacement


    Thyroid cancer

    Thyroid cancer

    • 8-10 cases per year in Swindon

    • <1% of cancers

    • If managed early favourable prognosis

    • Most symptomatic nodules are not cancer (value of screening?)

    • Following surgery, MDT discussion but further treatments at Churchill Oxford


    Rai treatment protocol and fu

    RAI Treatment protocol and FU

    • After surgery pt on T3; stop 10/7 before admission (ideally TSH >30mU/L)

    • 131I 3.1Gbq (5.5Gbq if known mets)

    • Day 3 uptake scan to check 131I safe for home

    • Home on T3 20mU/l tds

    • 6/52 GP to check TSH (<0.5mU/l)

    • 3 months later ; stop T3 for 10/7

    • Iodine uptake scan 150Mbq 131I


    Rai treatment protocol and fu1

    RAI Treatment protocol and FU

    • If no uptake or <0.05% and thyroglobulin undetectable start T4 (150 – 200 microg /day

    • If uptake >0.25% ; residual thyroid tissue/disease further therapeutic/ ablative dose of 131I and repeat uptake scanning process


    Summary

    Summary

    • Sound bites on some common functional and anatomical thyroid issues.

    • Discussion


  • Login