Surgical Anatomy of the Thyroid and Parathyroid Glands

Nerve Run Superior Thyroid Artery

The normal adult thyroid gland weighs about 17 g. It is wrapped around the anterolateral portion of the upper tracheal rings and larynx. Each lobe occupies a bed between the trachea and the esophagus medially the carotid sheath posteriorly and the sternocleidomastoid, the sternohyoid, and the sternothyroid muscles laterally and anteriorly. If the sternothyroid and sternohyoid muscles are to be divided transversely, they must be transected high, at the cricoid level, to preserve their motor...

Hypothyroidism after Subtotal or Total Thyroidectomy

Subtotal thyroidectomy is still an excellent form of treatment for patients with Graves' disease, particularly when antithyroid drugs and 1311 therapy are not suitable.51 Surgical approach has three advantages over radioactive iodine therapy. First, the incidence of overt hypothyroidism is considerably less than after radioactive iodine therapy. Second, the incidence of hypothyroidism does not increase as much in later years. Third, patients with Graves' ophthalmopathy are less likely to...

Plummers Disease Toxic Multinodular Adenomatous Goiter

Adenomatous Goiter With Cystic Change

Toxic multinodular goiter was first described in 1913 by Dr. Henry Plummer (see Fig. 7-2), who believed that practically all adenomatous goiters would eventually become toxic given enough time. He noted that the average interval from first detection of the goiter to subsequent development of symptoms was 15 years.45,46 Nodular goiters (Fig. 7-8A) occur when hyperplasia of a small subset of follicular cells with abnormal growth potential occurs at multiple sites in the thyroid gland.10 In...