total thyroidectomy

Total thyroidectomy, which refers to the complete removal of one thyroid gland, is not a complete resection of the two thyroid gland, is a type of thyroidectomy (the other is partial resection). The contralateral side of all or part of the thyroid tissue is often retained to maintain the desired physiological function. Generally applicable to multiple thyroid adenomas on one side of the leaf or large adenomas or cysts occupying one side of the leaf. Treatment of diseases: thyroid nodule nodular goiter thyroid cancer Indication 1. Multiple thyroid adenomas limited to one side of the lobe. 2. Occupy a large adenoma or cyst on one side of the leaf, so that the normal thyroid tissue structure no longer exists. 3. Smaller isolated nodules confirmed by pathology as carcinoma in situ. Contraindications 1. Young people suffering from diffuse goiter are generally not suitable for surgery. 2. Cases of recurrence after surgery. 3. There are other serious diseases. 4. Undifferentiated thyroid cancer, with lymph node metastasis. 5. Thyroid cancer and the trachea, neck and large blood vessels adhesion. Preoperative preparation 1. Control of physical function Hyperthyroidism patients must be treated with anti-thyroid drugs in internal medicine. The basal metabolic rate drops to normal or near normal (less than +15%). After the pulse rate is below 90 beats/min, the anti-thyroid drugs are stopped and the compound iodine is changed. About two weeks, the thyroid gland is significantly reduced and hardened, which is convenient for surgery and reduces intraoperative bleeding. The specific method is oral compound iodine solution (lugol solution), 3 times a day, 5 drops per day on the first day, 6 drops per day on the next day, and then incremented by 1 drop every day until it increases to 15 drops each time, maintaining 3 to 5 Surgery in the future. In recent years, it has been advocated to use presbyopia and compound iodine solution for preoperative preparation. The dosage of the heart is different depending on the condition, and it is 10 to 40 mg once every 6 hours. This pre-operative medication can reduce preparation time. 2. Use of sedative drugs When there is insomnia or restlessness, rumin 0.1g or diazepam 5mg can be used, orally once a night. 3. Necessary preoperative examination Such as cardiovascular function and liver and kidney function tests, basal metabolism measurement, laryngoscopy vocal cord function, x-ray examination of tracheal position and blood calcium, phosphorus determination. Surgical procedure 1. Position, incision, exposure: same as subtotal thyroidectomy. 2. Exposure of the thyroid: After the thyroid is revealed, the thyroid suspensory ligament is separated and cut, the upper thyroid blood vessels are treated, and then the middle and lower thyroid veins are cut and ligated. The lower thyroid artery is treated, placed close to the inside of the carotid artery, ligated, severed, or treated with intracapsular ligation. 3. Cut off the thyroid isthmus and bluntly separate the thyroid isthmus with a curved hemostatic forceps before the trachea and cut it off. 4. Excision of the thyroid lobes, from the upper pole down or from the lower pole up, or from the isthmus cut off the beginning of the thyroid gland. At this time, the recurrent laryngeal nerve and the parathyroid gland should be carefully identified, and the protection should be taken to prevent damage. 5. After stopping bleeding and suturing completely to stop bleeding, place drainage, suture layer by layer, and close the incision. complication Dyspnea and asphyxia are critical complications after surgery, and occur more than 48 hours after surgery. (1) Main reasons: 1 blood pressure forced airway in the operating area; 2 throat edema; 3 the trachea is compressed and softened and collapsed; 4 obstruction of sputum in the trachea; 5 bilateral recurrent laryngeal nerve injury. (2) Treatment: Once the patient is found to have difficulty breathing, immediately rescue the bedside. Main measures: 1 remove the cause: suture removal, open the incision, remove the hematoma; dexamethasone and other hormones to eliminate throat edema; sucking oxygen, etc.; 2 If there is no improvement, the tracheotomy or tracheal intubation is performed immediately; 3 If there is a respiratory heartbeat, the tracheal intubation or tracheotomy should be performed before resuscitation.