Multinodular Thyroid Gland with Cervical Lymphadenopathy Followed by Total Thyroidectomy

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Author: Ali Akhtar
Specialties: Otolaryngology
Schools: Army Medical College
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Purpose of procedure: To remove enlarged multinodular thyroid gland which was causing airway obstruction along with feeding difficulties.

Landmarks: Two horizontal collar incision with skin crease above 2 finger breadths above the sternal notch.


1. A horizontal incision of 2 finger breadth was made above the sternal notch and silk sutures were used for retraction of skin flaps. Subcutaneous flaps and platysma were divided and subplatysmal dissection was made above the incision up to the level of thyroid cartilage above and the sternal notch.

2. Strap muscles were separated with the help of retractor, exposing anterior surface of thyroid.

3. Thyroid gland was rotated medially to and middle thyroid vein was ligated.

4. Superior laryngeal artery was also ligated and external laryngeal nerve was spared during procedure.

5. Superior parathyroid was spared and identified at upper two third of thyroid at 1cm above crossing point of recurrent laryngeal nerve and inferior thyroid artery.

6. Similarly, inferior parathyroid was identified and spared which was located on the posterolateral surface of the lower pole of the thyroid.

7. Recurrent laryngeal nerve was preserved which was located between the common carotid artery laterally, the oesophagus medially, and the inferior thyroid artery superiorly.

8. Sternocleidomastoid was resected to explore the area adjacent to the lymph nodes involved.

9. Cervical lymph node involved was also removed, whereas the carotid artery, jugular vein, phrenic nerve, sympathetic ganglia, brachial plexus, were spared.

10. Eventually, thyroid gland was dissected and neck was sutured.

Conflict of Interest and Source of Funding: none

Acknowledgments: Author thanked the patient and surgeons later.


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