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Thyroid Surgery Guidelines

Gtgt THE 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 WE DECIDED IT BEST TO GO WITH SOMEONE WHO IS VERY SPECIFIC IN PERFORMING THAT TYPE OF SURGERY, AND REALLY, IF WE WERE GOING TO DO THAT, WE HAD TO COME HERE AT CHOP. gtgt I WAS REALLY SCARED AT FIRST,.

BUT THEN WHEN I MET DR. ADZICK, AND HE SAT ME DOWN AND TALKED ABOUT EVERYTHING, I FELT MORE COMFORTABLE KNOWING THAT MY LIFE WAS GOING TO BE IN HIS HANDS. AND IT WAS ALL BASICALLY THE DOCTORS THEMSELVES, MEETING THEM HELPED A LOT. gtgt THERE ARE MANY DIFFERENT APPROACHES TO PATIENTS WITH THYROID DISEASE WHO NEED SURGERY. FOR INSTANCE, THERE ARE THOSE PATIENTS WITH GRAVES’ DISEASE, WITH LARGE GOITERS WHO, FOR WHATEVER REASON, NEED AN OPERATION, USUALLY BECAUSE THEY CAN’T BE CONTROLLED WELL MEDICALLY, AND THOSE CHILDREN REQUIRE A TOTAL THYROIDECTOMY.

Gtgt SO WE REMOVE 98 PERCENT OF THE THYROID GLAND, 99 PERCENT OF THE THYROID GLAND WITH THE HOPES THAT WE MAKE THE PATIENT HYPOTHYROID. WE WANT TO REMOVE AS MUCH OF THE THYROID GLAND AS SAFELY POSSIBLE SO THAT THEY NEED TO BE PUT ON THYROID HORMONE REPLACEMENT. gtgt HI, GOOD MORNING I’M FROM ANESTHESIA, HOW ARE YOU gtgt THE ANESTHESIOLOGY TEAM IS VERY CRUCIAL BEFORE SURGERY, AS WELL AS DURING SURGERY. CALMING THE PATIENT’S FEARS, EXPLAINING EVERYTHING SO THAT THEY REALLY UNDERSTAND WHAT’S GOING ON, AS WELL AS PROVIDING THE APPROPRIATE ANESTHESIA.

Thyroid Surgery in Children and Adolescents Pediatric Thyroid Center at CHOP 4 of 9

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 AND 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’RE CALLED THE RECURRENT LARYNGEAL NERVES. THERE’S ONE ON EACH SIDE, AND THEY RUN RIGHT IN THE GROOVE BETWEEN THE WINDPIPE, WHICH IS CALLED THE TRACHEA, AND THE ESOPHAGUS, WHICH IS 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 ANGEL HAIR PASTA STRAND, AND THEY’RE VERY DELICATE. AND, FREQUENTLY, IT WILL ABUT THE THYROID GLAND, SO 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 THE 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 INTEREST 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 CAN BE ANATOMIC VARIABILITY AS FAR AS WHERE.

THEY ARE. THEY FREQUENTLY SHARE BLOOD SUPPLY WITH THE THYROID GLAND. AND THEY SOMETIMES NEED TO BE PEELED OFF THE THYROID GLAND. FOR SURGEONS WHO OPERATE ON CHILDREN WITH THYROID DISEASE, IT’S IMPORTANT TO HAVE A SORT OF HANDINGLOVE RELATIONSHIP WITH THE PEDIATRIC PATHOLOGIST. gtgt 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 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 HEALS, 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, HEAL BEAUTIFULLY. INITIALLY, THEY MAY BE A LITTLE RED AND A LITTLE RAISED AND A LITTLE FIRM, BUT THAT’S NORMAL BECAUSE THAT’S THE HEALING RIDGE THAT OCCURS WITH ANY WOUND. LONG TERM, IN SIX TO NINE MONTHS,.

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