Question

Surgical steps involved in total thyroidectomy and its complications.

Hint:

Careful identification and preservation of the recurrent laryngeal nerve and parathyroid glands are crucial to prevent serious complications in total thyroidectomy.

Answer 1

Surgical Steps in Total Thyroidectomy:
1. Preparation and Anesthesia:
- The patient is placed under general anesthesia. The surgical area is sterilized, and a sterile drape is applied.
2. Incision:
- A horizontal collar incision is made in the lower neck, just above the clavicles. This incision is typically about 4-6 cm in length, depending on the size of the thyroid gland.
3. Dissection:
- The platysma muscle is divided, and the sternocleidomastoid muscle is retracted laterally. The strap muscles of the neck (sternohyoid and sternothyroid) are divided in the midline to expose the thyroid gland.
4. Identification of Critical Structures:
- The recurrent laryngeal nerve (RLN) is carefully identified and preserved. This is a critical structure, as injury can lead to vocal cord paralysis.
- The parathyroid glands are identified and preserved. Care must be taken not to remove or damage the parathyroid glands, as this can lead to hypocalcemia.
5. Removal of the Thyroid Gland:
- The thyroid gland is carefully dissected away from the surrounding structures, including the trachea and esophagus. The gland is removed in total, ensuring complete excision.
- If necessary, central neck dissection is performed to remove involved lymph nodes.
6. Hemostasis:
- The surgical site is checked for bleeding, and hemostasis is achieved using electrocautery or hemostatic agents.
7. Closure:
- The strap muscles are sutured back in place, and the platysma is re-approximated. The skin is closed using absorbable sutures or staples.
Complications of Total Thyroidectomy:
1. Recurrent Laryngeal Nerve Injury:
- Injury to the recurrent laryngeal nerve can result in vocal cord paralysis, leading to hoarseness, airway obstruction, and difficulty swallowing. It is one of the most serious complications.
2. Hypoparathyroidism:
- Removal or damage to the parathyroid glands can lead to hypocalcemia, resulting in tetany and muscle spasms due to low calcium levels in the blood.
3. Bleeding:
- Bleeding from thyroid vessels or the carotid artery can occur, leading to hematoma formation and airway compromise. Careful hemostasis is essential during surgery.
4. Infection:
- Although rare, infection at the surgical site can lead to abscess formation and delayed healing. Proper wound care and prophylactic antibiotics are typically used to prevent infection.
5. Seroma Formation:
- Fluid accumulation in the surgical site can lead to a seroma, which may require drainage.
6. Thyroid Storm:
- A rare but life-threatening complication, thyroid storm can occur due to the release of thyroid hormones during surgery. It can lead to hyperthermia, tachycardia, and arrhythmias.