61-year-old female who underwent ultrasound-guided fine-needle aspiration of 3 thyroid nodules. 1 of the nodules patholo
Posted: Mon Dec 20, 2021 9:01 am
61-year-old female who underwent
ultrasound-guided fine-needle aspiration of 3 thyroid nodules. 1 of
the nodules pathology revealed atypical cells. Her options were
discussed in detail. She decided in favor of total
thyroidectomy.
Preoperative Diagnosis
Multinodular goiter, hyperparathyroidism
Postoperative Diagnosis
Same, right superior parathyroid adenoma
Operation
Total thyroidectomy, resection of
right superior parathyroid adenoma
They were taken to the operating room
and placed in supine position on the operating table. They were
induced under general endotracheal anesthesia. The neck was prepped
and draped in sterile fashion. Transverse incision was made
overlying the thyroid. Skin and subcutaneous tissues were dissected
down to the level of the platysma. Platysma was divided using Bovie
cautery. Underlying tissue was dissected down to the level of the
fascia. Flaps were raised circumferentially over the fascia. Lone
Star retractor was assembled to aid with visualization. Fascia was
divided along the midline using Bovie cautery. Attention was turned
to the left lobe. Strap muscles were dissected off the anterior
aspect of the left lobe. The inferior pole was then dissected
circumferentially. The vascular pedicle was divided using the
hand-held LigaSure. Attention was turned to the superior pole. It
was dissected circumferentially. Vascular pedicle was divided using
the LigaSure. The lobe was then dissected in a medial to lateral
anterior to posterior fashion rolling the thyroid onto the trachea.
The thyroid was dissected onto the trachea. The isthmus was then
divided at its junction with the right lobe. The left lobe was
marked with a suture at the superior pole. It was passed off for
surgical pathology. The right lobe was treated in identical
fashion. The right lobe was marked with a suture at the superior
pole and passed off for surgical pathology. During the dissection,
an enlarged right superior parathyroid gland was noted. A portion
of it was sent for surgical pathology which confirmed parathyroid
tissue. The right inferior parathyroid gland had been identified
and was normal in appearance. Her most recent parathyroid hormone
level was 157 with the upper normal range of 88. Due to her
elevated parathyroid hormone level and the abnormal appearance of
the right superior parathyroid gland, I decided in favor of
resection. The gland was removed and passed off for surgical
pathology. The right superior was once again inspected and was
normal in appearance. The wound was irrigated with normal saline.
The wound was inspected for hemostasis which was satisfactory.
Fascia was reapproximated along the midline using Vicryl suture in
running fashion. Platysma was reapproximated using Vicryl suture in
interrupted fashion. Dermis was reapproximated using Vicryl suture
in interrupted fashion. The skin was closed using Vicryl suture in
running fashion. The incision was dressed with Mastisol and
Steri-Strips.
ultrasound-guided fine-needle aspiration of 3 thyroid nodules. 1 of
the nodules pathology revealed atypical cells. Her options were
discussed in detail. She decided in favor of total
thyroidectomy.
Preoperative Diagnosis
Multinodular goiter, hyperparathyroidism
Postoperative Diagnosis
Same, right superior parathyroid adenoma
Operation
Total thyroidectomy, resection of
right superior parathyroid adenoma
They were taken to the operating room
and placed in supine position on the operating table. They were
induced under general endotracheal anesthesia. The neck was prepped
and draped in sterile fashion. Transverse incision was made
overlying the thyroid. Skin and subcutaneous tissues were dissected
down to the level of the platysma. Platysma was divided using Bovie
cautery. Underlying tissue was dissected down to the level of the
fascia. Flaps were raised circumferentially over the fascia. Lone
Star retractor was assembled to aid with visualization. Fascia was
divided along the midline using Bovie cautery. Attention was turned
to the left lobe. Strap muscles were dissected off the anterior
aspect of the left lobe. The inferior pole was then dissected
circumferentially. The vascular pedicle was divided using the
hand-held LigaSure. Attention was turned to the superior pole. It
was dissected circumferentially. Vascular pedicle was divided using
the LigaSure. The lobe was then dissected in a medial to lateral
anterior to posterior fashion rolling the thyroid onto the trachea.
The thyroid was dissected onto the trachea. The isthmus was then
divided at its junction with the right lobe. The left lobe was
marked with a suture at the superior pole. It was passed off for
surgical pathology. The right lobe was treated in identical
fashion. The right lobe was marked with a suture at the superior
pole and passed off for surgical pathology. During the dissection,
an enlarged right superior parathyroid gland was noted. A portion
of it was sent for surgical pathology which confirmed parathyroid
tissue. The right inferior parathyroid gland had been identified
and was normal in appearance. Her most recent parathyroid hormone
level was 157 with the upper normal range of 88. Due to her
elevated parathyroid hormone level and the abnormal appearance of
the right superior parathyroid gland, I decided in favor of
resection. The gland was removed and passed off for surgical
pathology. The right superior was once again inspected and was
normal in appearance. The wound was irrigated with normal saline.
The wound was inspected for hemostasis which was satisfactory.
Fascia was reapproximated along the midline using Vicryl suture in
running fashion. Platysma was reapproximated using Vicryl suture in
interrupted fashion. Dermis was reapproximated using Vicryl suture
in interrupted fashion. The skin was closed using Vicryl suture in
running fashion. The incision was dressed with Mastisol and
Steri-Strips.