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HeadNeckPA

ENT Pic of the Day 3-30-11

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The picture below is of a total thyroidectomy that was removed for symptomatic dysphagia. Thyroid function tests were within normal limits.

 

Based on this picture and the brief history, what is your diagnosis?

 

Besides recurrent laryngeal nerve injury, what is the other major potential complication of a total thyroidectomy?

 

Goiter.jpg

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It looks like multinodular thyroid, but the normal hormones are throwing me off.

 

as for occurences around the surgery:

Hypothyroid symptoms, accidental parathyoidectomy, both of

which necessitates hormone replacement in most cases. Along those lines?

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Yep- HypoPTH could cause hypocalemia (check trousseaus/chvosteks signs (not sure on spelling of either of those). I'd throw in hematoma, which could become large/compromise airway.

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It looks like multinodular thyroid, but the normal hormones are throwing me off.

 

as for occurences around the surgery:

Hypothyroid symptoms, accidental parathyoidectomy, both of

which necessitates hormone replacement in most cases. Along those lines?

 

You are correct, this is a multinodular goiter, but this one is "non-toxic"....i.e. it does not produce excessive thyroid hormone. This is also often referred to as endemic goiter in iodine-deficient parts of the world. In the United States there is rougly a 5% incidence of sporadic, non-toxic goiter. Many of these patients, as in this case, become symptomatic and may even have tracheal deviation / compression and therefore require surgery.

 

Hypoparathyroidism is what I was looking for. Great care is taken to preserve not only the parathyroids during a total thyroid, but also to preserve their blood supply, which can be a painstaking process in some cases. Many of the first thyroid surgery patients developed tetany and died!

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Aha! I didn't even think of non-toxic! Duh! My endo prof would be very upset! But thanks for the clarity, it all makes perfect sense. And I am aware that the surgeon and his team needs to try and preserve the pth glands, but isn't that very difficult?! Would preserving 1 or 2 and their subsequent blood supplies be enough?

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