RISK FACTORS

Bleeding in the neck

As with any operation, there is always a chance of bleeding. The average blood loss for thyroid
operations is usually small and the chance of needing a blood transfusion is extremely rare.

Hoarseness/Voice Change (recurrent laryngeal nerve injury)

There are two sets of nerves near the thyroid gland that help control the vocal cords. These are the
recurrent laryngeal nerve and the external branch of the superior laryngeal nerve. Damage to a
recurrent laryngeal nerve can cause you to lose your voice or become hoarse.

Hypocalcemia (Hypoparathyroidism)

Hypocalcemia (low blood calcium levels) may occur after thyroid and parathyroid surgery because the
parathyroid glands may not function normally right after surgery and temporary
hypocalcemia/hypoparathyroidism is common.

Seromas

Seromas are fluid collections underneath the skin at an incision site that feel like fullness or swelling.

Infection

If a post-operative infection develops, drainage of the infected fluid may be needed and antibiotics may
be necessary. The neck is a clean area and generally does not get infected.

ANATOMY & PHYSIOLOGY

The thyroid gland is a ductless alveolar gland found in the anterior neck, just below the laryngeal
prominence (Adam’s apple). It is roughly butterfly-shaped, with two lobes wrapping around the trachea
and connected in the middle by an isthmus. The thyroid gland is not usually palpable.

Each thyroid lobe is pear shaped with it is apex reaching oblique line of thyroid cartilage. The isthmus
crosses the 2nd ,3rd ,4th tracheal ring and may project upwards forming the pyramidal lobe which
connected to hyoid bone by fibrous band.
Capsules:

1) true fibrous capsule: enveloping the gland.

2)false fascial capsule: derived from pretracheal fascia which attached above thyroid cartilage &hyoid
bone so it allows the gland to move up during deglutition.

The fascia is thickened posteriorly forming the ligament of berry which fixes the back of the gland to
cricoid cartilage.

It is supplied by superior and inferior thyroid arteries, drained via superior, middle and inferior thyroid
veins and has a rich lymphatic system.

The thyroid gland is one of the main regulators of metabolism. T3 and T4 typically act via nuclear
receptors in target tissues and initiate a variety of metabolic pathways. High levels of them typically
cause these processes to occur faster or more frequently. Metabolic processes increased by thyroid
hormones include:

 Basal Metabolic Rate

 Gluconeogenesis
 Glycogenolysis
 Protein synthesis
 Lipogenesis
 Thermogenesis

This is achieved in a number of ways, such as increasing the size and number of mitochondria within
cells, increasing Na-K pump activity and increasing the presence of β-adrenergic receptors in tissues
such as cardiac muscle.

INSTRUMENTS BEING USED

serial Description Quantity

1  Metzenbaum Scissors  2
2  Lovelace Forceps  2
3  Lahey Retractor 1
4  Green Retractor  1
5  Little Retractor  1
6  Cushing Vein Retractor  1
7  Lahey Traction Forceps  6
8  Iris Scissors 2
9  Baby Metzenbaum Scissors 1
10  Plastic Surgery Scissors  1
11  Ragnell Scissors  1
12  Adson dressing forceps 2
13  Brown-Adson Tissue Forceps 1
14  Halsted Mosquito Forceps  4
15  Kelly Forceps  1
16  Crile Foreps  1
17  Gemini-Mixter Forceps  2
18  Backhaus Towel Clamp  8
19  Forster  Sponge Forceps 1
20  Webster Needle holder  1
21  Crile wood N.H. 1
22  Jansen Retractor 1
23  Senn Retractor 2
24  Weitlaner retractor 1
25  Allis tiissue  Forceps 2
26  Frazier Ferguson Suction Tube  1
27  Joseph Skin Hook 2
28  Joseph Skin Hook 2