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ENT Thyroid and Parathyroid Patholo gy # #, PARATHYROID #, Benign Thyroid…

- - - - Low risk - partial
      - High resik - total
      - Intermediate risk - usually total
      - Total
        
        Advatnages
        
        FAciliates F/U
- - - - Reduce renal stone and improve bone mieral density
    - - Overt clinical manifestations - kidney stones
        Age <50 Severe hyper CA >2.99nm
        Decreased CrCl
        Low bone mineral density
        Patient preference
        Follow up unlikley
    - - Gold standerad
        Four gland exploration
        
        Bilateral exploxartion
      - Minimal invasive (targetted)
        
        Reduced complications
        quicker
        Only if path localcised
        Les
- - - - Anti-thyroid medication
        40-60% sustained remission
        
        Adverse reastions
        
        Mild fever, arthralgia, rash
        Agranulocytosis
    - - Indications
        
        Children
        Female child bearing age
        Concern of cancer
        Massive enlargement
        Failed RAI
        Ophthamopathy - RAI can make it worse
      - Extent
        
        Total thyroidectomy is procedure of choice
        The more thyroid tissue left - higher likely of recurrence
        Best chance of cure / safe
- - - - Not fully understood
        Progressive slow growth 10% per year
        Sudden incraesed in size - pregnanacy, haemorrhage
        Substernal extension
        10% autonomous - thyrotoxic
    - - Stridor
        Dypnoea on exertion
        Cough
        Globus
        Dysphagia
        Asyptomatic with up to 50% tracheal narrowing
        Pembertens test -
    - - CT
      - US usless doesnt go through sternum
    - - Non surgical
        
        Thyroid suppresion
        
        Life long
        
        Concern regarding oesto
        
        Radio iodine therapy
      - Surgical
        
        Indications
        
        Cancer concern / marked enlargement
        
        Upper aero-digestive tract symptoms and no othercause
        
        CT demonstrates airway compromise
        
        Significant substernal extenstion
        
        Thyrotoxic 10%
        
        Surgery
        
        Subtotal thyroidectomy - one side
        
        Total thyroidectomy - two sides
        
        Advantages
        
        Immediate resolution
        Avoids complications with radio-iodine
        Tot
        
        Sternotomy
        
        2-3% require
        
        Concern for malignancy extending into mediastinum
        Post mediatinal goitre 15%
        Recurrent large sub
      - RAI vs Sugery
        
        RAI
        Relative resistant to RAI
  - - - Afib
    - - MEd
        
        Long term medication
        
        Not definitive
      - Surgery
        
        RAI
        
        Sureyr
      - RAI
- - - - Partial thyroidectomy - take the lobe out
- - - - Open the neck open strap muscle - stops oedema of larynx