USMLE Internal Medicine Review 12 05 Subtotal Thyroidectomy

USMLE Internal Medicine Review 12 05 Subtotal Thyroidectomy

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Let’s start our USMLE Review with Hypothyroidism and Hyperthyroidism from the Gold Standard USMLE Foundations of Medicine Audio Review program.

 

Play USMLE Audio MP3 12 05 Subtotal Thyroidectomy Below

 

Begin 12 05 Subtotal Thyroidectomy Transcription

The second major treatment option for Graves’ disease is surgery.

What is the procedure of choice for patients with very large glands or multinodular goiters?

  • Subtotal thyroidectomy.

There are 2 preparatory measures which should occur pre-thyroidectomy.

What is the first measure involving preparation with drugs?

  • The patient is prepared with antithyroid drugs until euthyroid, usually taking about 6 weeks.

And second starting about 2 weeks before the operation.

The patient is given what saturated solution in order to diminish the vascularity of the gland and simplify surgery? 

  • Two weeks before subtotal thyroidectomy the patient is given saturated solution of potassium iodide 5 drops twice daily.

There is some disagreement about how much thyroid tissue should be removed.

Total thyroidectomy is usually not necessary unless the patient has which severe progressive visual organ condition?

  • Severe progressive ophthalmopathy.

Conversely, leaving behind too much thyroid tissue presents what risk?

  • The risk of relapse.

About how many grams of thyroid tissue do most surgeons leave on either side of the neck?

  • In subtotal thyroidectomy most surgeons leave 2-3 grams of thyroid tissue on either side of the neck.

What are 2 complications of thyroidectomy suffered by about 1% of patients?

  • Hypoparathyroidism and Recurrent Laryngeal nerve injury are rare complications of thyroidectomy. It should be noted that many patients will require thyroid supplementation following thyroidectomy for Graves’ disease.

Student doctor please pause the tape and summarize surgical treatment of Graves’ disease. Please include the procedure of choice, pre-surgery preparation, amount of tissue to be removed, and complications of surgery.

  • The second major treatment option for Graves’ disease is subtotal thyroidectomy, an especially affective choice for patients with very large glands or multinodular goiters. There are 2 preparatory measures which should occur prethyroidectomy. The patient is prepared with antithyroid drugs until euthyroid, usually taking about 6 weeks, and starting about 2 weeks before the operation. The patient is given saturated solution of potassium iodide 5 drops twice daily in order to diminish the vascularity of the gland and to simplify surgery. There is some disagreement about how much tissue should be removed. Total thyroidectomy is usually not necessary unless the patient has severe progressive ophthalmopathy. On the other hand, leaving behind too much thyroid tissue presents the risk of relapse. In subtotal thyroidectomy most surgeons leave about 2-3 grams of thyroid tissue on either side of the neck. Two rare complications of thyroidectomy suffered by about 1% of patients are hypoparathyroidism and recurrent laryngeal nerve injury. It should be noted that many patients will require thyroid supplementation following thyroidectomy for Graves’ disease.

****END OF TRANSCRIPTION****

 

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