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Thyroid Surgery Cancer

Gtgt THYROID SURGERY IN CHILDREN DOESN’T OCCUR VERY COMMONLY. SO YOU NEED TO GO TO A PLACE THAT HAS A THYROID SURGEON THAT DOES THIS FREQUENTLY. WE DID FIND THAT AS A SURGEON WHO IS PERFORMING THYROID SURGERIES IN CHILDREN AND ADOLESCENT AT LEAST 30 TIMES A YEAR. gtgt THERE ARE MANY DIFFERENT APPROACHES TO PATIENTS WITH THYROID DISEASE WHO NEED SURGERY. FOR INSTANCE, THERE ARE THOSE PATIENTS WITH A THYROID NODULE WHO PROBABLY HAVE HAD A FINE NEEDLE ASPIRANT. AND WE MAY NOT KNOW FOR SURE WHETHER OR NOT THAT.

IS MALIGNANT OR BENIGN AND THEY MAY NEED AN OPERATION, WHICH WOULD INCLUDE A THYROID LOBECTOMY AND ISTHMUSECTOMY, TAKING OUT THE THYROID LOBE THAT’S AFFECTED AND THE MIDDLE PORTION OF THE THYROID. IF THE PATHOLOGIST SAYS, YES, THIS IS CANCER, THEN WE’RE GOING TO GO AHEAD WHILE THAT CHILD IS STILL ANESTHETIZED AND TAKE OUT THE REST OF THE THYROID GLAND AND DO THE LYMPH NODE DISSECTION. IF THE PATHOLOGIST SAYS, THIS LOOKS BENIGN, THEN WE’RE JUST GOING TO STOP AND WE’RE GOING TO CLOSE THE NECK AND WE’RE GOING TO WAIT.

FOR THE FINAL SECTIONS. AND THE FAMILY SHOULD UNDERSTAND THAT THE FINAL SECTIONS MAY STILL SHOW A LITTLE AREA OF CANCER. gtgt IF THE LESIONS ARE ULTIMATELY FOUND TO BE CARCINOMA, A FOLLICULAR THYROID CARCINOMA OR FOLLICULAR VARIANT OF PAPILLARY THYROID CARCINOMA, THEN THE FAMILY AND THE PATIENT HAVE TO UNDERGO A SECOND PROCEDURE, USUALLY FOR A COMPLETION THYROIDECTOMY. gtgt THERE ARE OTHER PATIENTS WHERE, CLEARLY, THERE’S A DIAGNOSIS, NOT ONLY OF A THYROID NODULE, BUT A THYROID CANCER. AND THOSE PATIENTS NEED A TOTAL THYROIDECTOMY, REMOVING THE ENTIRE THYROID GLAND AS WELL AS.

Thyroid NoduleCancer Surgery Pediatric Thyroid Center at CHOP 4 of 9

THE POSSIBLY AFFECTED LYMPH NODES THAT SURROUND THE THYROID. AND THEY’RE THE ONES THAT EXTEND FROM THE UPPER LEVEL OF THE VOICE BOX, ALL THE WAY DOWN TO WHERE THE BREASTBONE IS, AND FROM THE CAROTID ARTERY ON EITHER SIDE. gtgt THE ANESTHESIOLOGY TEAM IS VERY CRUCIAL BEFORE SURGERY AS WELL AS DURING SURGERY. CALMING THE PATIENTS’ FEARS, EXPLAINING EVERYTHING SO THAT THEY REALLY UNDERSTAND WHAT’S GOING ON, AS WELL AS PROVIDING THE APPROPRIATE ANESTHESIA DURING THE SURGICAL PROCEDURE. gtgt ONCE THE PATIENT IS ANESTHETIZED, THE PATIENT IS POSITIONED AT AN ANGLE,.

AS FAR AS YOUR TORSO GOES, AND YOUR HEAD IS BACK AND YOUR NECK IS EXTENDED. AND THE WOUND THAT’S MADE FOR THE OPERATION IS A SIDEWAYS WOUND BECAUSE THAT ALLOWS GOOD EXPOSURE OF THE THYROID GLAND AND IT ALSO FOLLOWS THE SKIN LINES IN THE NECK TO GIVE THE MOST COSMETICALLY APPEALING HEALING PROCESS. AND THEN THERE ARE STRAP MUSCLES IN FRONT OF THE THYROID GLAND AND WE PUSH THOSE MUSCLES ASIDE TO EXPOSE THE BUTTERFLY. IN THE COURSE OF DOING THE OPERATION, IN REMOVING EITHER ONE SIDE OF THE BUTTERFLY.

OR THE ENTIRE BUTTERFLY, IT’S IMPORTANT THAT I FIND AND PROTECT CERTAIN STRUCTURES. FIRST OF ALL, TWO NERVES. THEY ARE CALLED THE RECURRENT LARYNGEAL NERVES. THERE’S ONE ON EACH SIDE. THEY RUN RIGHT IN THE GROOVE BETWEEN THE WINDPIPE, WHICH IS CALLED THE TRACHEA, AND THE ESOPHAGUS, WHICH IS THE FOOD TUBE BEHIND. AND THOSE NERVES COME UP FROM THE CHEST AND THEY RUN UP TO WHERE THE VOCAL CORDS ARE AND THE VOICE BOX, WHICH IS JUST ABOVE THE THYROID GLAND. AND THOSE NERVES ARE ABOUT THE SIZE, DEPENDING ON THE AGE OF THE PATIENT,.

OF AN ANGELHAIR PASTA STRAND. AND THEY’RE VERY DELICATE AND FREQUENTLY WILL ABUT THE THYROID GLANDS AND WE NEED TO PEEL THE THYROID GLAND OFF OF THOSE NERVES, ONE OR BOTH SIDES. gtgt THOSE NERVES ARE NERVES THAT ACTUALLY CONTROL THE VOICE BOX. AND SO IF YOU HAVE DAMAGE ON BOTH SIDES, THEN A PATIENT WILL HAVE SIGNIFICANT BREATHING PROBLEMS TO A POINT THAT THEY WOULD NEED A TRACHEOSTOMY. OR, IF THE DAMAGE IS NOT TO BOTH SIDES, OR A PROBLEM WITH THE NERVE, SOMETIMES IT CAN BE PERMANENT ENOUGH WHERE IT CAUSES HOARSENESS.

Gtgt THAT OCCURS VERY INFREQUENTLY, BUT WHEN IT DOES OCCUR, IT’S A VERY DEBILITATING PROCESS. AND IT’S SOMETHING, AGAIN, THAT SHOULD INCREASE SOMEONE’S CONCERN OF WHO THEY’RE SENDING THE PATIENT TO AS FAR AS SURGERY BECAUSE THAT REALLY NEEDS TO BE AVOIDED IN THE BEST INTERESTS OF LONGTERM CARE FOR THAT PATIENT. gtgt THE SECOND IMPORTANT STRUCTURES ARE PARATHYROID GLANDS. AND THEY ARE USUALLY FOUR IN NUMBER, TWO ARE ON THE TOP, TWO ARE AT THE BOTTOM. THERE COULD BE ANATOMIC VARIABILITY AS FAR AS WHERE THEY ARE. THEY FREQUENTLY SHARE A BLOOD SUPPLY WITH.

THE THYROID GLAND. AND THEY SOMETIMES NEED TO BE PEELED OFF THE THYROID GLAND. gtgt THEY MAY BE DIFFICULT TO IDENTIFY JUST BY LOOKING AT THEM IN THE OPERATIVE FIELD. SO SOMETIMES WE WILL RECEIVE PARATHYROID GLANDS, OR TISSUE THAT IS SUSPICIOUS FOR BEING PARATHYROID, AND WE CAN DO AN INTRAOPERATIVE CONSULTATION, A FROZEN SECTION, TO DETERMINE WHETHER OR NOT THAT’S ACTUALLY WHAT THEY ARE OR WHETHER THEY’RE THYROID OR LYMPH NODES OR CONNECTIVE TISSUE. gtgt FOR SURGEONS WHO OPERATE ON CHILDREN WITH THYROID DISEASE, IT’S IMPORTANT TO HAVE A SORT OF HANDINGLOVE.

RELATIONSHIP WITH THE PEDIATRIC PATHOLOGIST. gtgt WHEN WE RECEIVE TISSUE FROM THE OPERATING ROOM IN THYROID SURGERY, WE WILL BE LOOKING AT THYROID TISSUE FIRST AND FOREMOST, BUT OFTEN THE SURGEON WILL ALSO SEND OTHER TISSUES. FOR INSTANCE, THERE MAY BE SOME LYMPH NODES THAT ARE IN THE AREA WHERE THERE’S A CONCERN AS TO, IF THIS IS A MALIGNANCY, HAS THAT SPREAD TO THE LYMPH NODES AND IT’S ONE OF THE JOBS THAT PATHOLOGISTS TO LOOK AT THOSE LYMPH NODES AND DETERMINE WHETHER OR NOT THERE IS TUMOR IN THE LYMPH NODES.

Gtgt THAT’S VERY IMPORTANT. YOU HAVE TO BE ABLE TO TAKE THAT INFORMATION TO THE BANK BECAUSE IT CAN AFFECT WHAT YOU DO IN THE OPERATING ROOM. ONCE WE’RE FINISHED WITH THE THYROID PORTION OF THE OPERATION, THOSE MUSCLES IN THE FRONT ARE PUT BACK TOGETHER. AND THEN IT’S VERY IMPORTANT TO CLOSE THE WOUND IN LAYERS USING ABSORBABLE SUTURES THAT WILL DISSOLVE ONCE THE CHILD IS HEALED. SO REALLY THE ONLY THING THAT’S ON THE WOUND ARE LITTLE STERISTRIPS RUNNING SIDEWAYS ALONG THE WOUND. AND THYROID WOUNDS, FOR THE MOST PART,.

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