Medical Archive

Historical Perspective

Anatomy

Physiology of the Thyroid Gland

Disorders of Thyroid Metabolism — Benign Thyroid

Disease Evaluation of a Thyroid Nodule

Thyroid Malignancies

Thyroid oncogenesis

Papillary thyroid carcinoma

Follicular thyroid carcinoma

Treatment of differentiated thyroid carcinoma (papillary and follicular)

• Lobectomy + isthmusectomy
  • 1cm ??, ???? ???? ipsilateral, ?? ??? ???(-)? ?? ??.
  • 1~2cm? ?? total hyroidcectomy? ?? ?? ??.
• Total thyroidectomy
  • LN(-): ?? ? ?? ?? + central LND
  • LN(+): ?? ? ?? ?? + modified LND

Medullary thyroid carcinoma

Treatment

Total ± CND (sporadic/MEN ??? ???)

Poorly differentiated thyroid carcinoma

Anaplastic thyroid carcinoma

Thyroid Disease in Pregnancy

Surgical Approaches to the Thyroid

Standard cervical thyroidectomy

• PTC?? ?? ???? ???? ??
  • ?? ??? ??.
  • ?? ? ?????? ??? ??? ? ??? ??
  • 131I ???? ? TG ??? ????? ??.

Postop management

1. 3?? liothyronine(T3) ??
2. T3 ?? TSH ???? 3-4? ???
3. ¹³¹I scan (5-10mCi) – ???? ???? ?? ??
4. ¹³¹I ?? ?? ??? ablation
   1. Indication: ????, ???? ???? ??, ?? ???? ??? ?? 4cm ??? ??.

Follow up

?? ??: lung, bone

• Serology
  • Thyroglobulin level: Tg with TSH titer, anti-Tg Ab titer
  • Calcitonin (medullary ca.)
• ¹³¹I whole body scan (?? ? 6?? ?)
  • ??? ??: 1? ? ???
  • ??? ??: T4 suppression therapy ??? 6-12???? TG ??.
  • ??: therapeutic ¹³¹I.
• Neck sono
• PET ? ?? ??? ????? ??? scan.

Lateral neck dissection

Substernal goiter

Alternative approaches to thyroid surgery

Complications of thyroid surgery

• Hematoma
  • airway obstruction -> immediately wound open, drainage
• Recurrent laryngeal nerve
  • ???? Permanent hoarsness
  • Simmon’s triangle: Common carotid a. & inf. Thyroid a.? ?? ??? 
  • T-E groove? ???, aorta? ?? (Lt.)
  • Rt. Subclavian a.? ??? non-recurrent? ????
• Superior laryngeal nerve
  • To cricothyroid muscle, ext./int.
  • Superior pole ??? ? ?? ?? ??? ??
  • ???? loss of high tone voice quality
• CN11 – Winged scapula
• Brachial plexus – ?? ??
• Horner’s SD – Sympathetic truck ??
• Chyle leakage
  • Thoracic duct injury – ??? ?? ??
  • 500ml/day ??? ? surgical intervention