Thyroid surgery

Among surgical procedures that are applied on the thyroid gland, are the following: 1) the enucleation of the nodes, 2) resection of the thyroid gland (volume resection is dictated by the nature of disease and the extent of the pathological process), 3) the extirpation of the thyroid gland or one of its shares, sometimes with the removal of regional lymph nodes.
Patients toxic goiter in connection with the possibility of developing thyroid heart - acute myocardial degeneration, clinically accompanied by symptoms of heart failure, require special preoperative preparation, aimed at improving the activity of the cardiovascular system, the elimination of clinical symptoms of thyrotoxicosis and prevention thyrotoxic crisis.
Thyroid surgery is usually performed under local anesthesia so that you can monitor the status of votes during the operation. Can be applied and modern endotracheal anesthesia, which is shown during operations in children, in patients with recurrent forms of goiter and in persons, panicky afraid of the operation.
Within a few hours after the operation, patients must be in a semi-sitting position with arms chin. In the first two days after the operation appoint liquid food - soup, jelly, alkaline drinking (Borjomi); medications per os only in the form of powders. A strict control over the bandage, temperature, pulse and blood pressure. For impregnation of the bandages blood, the increase in the neck, and the shortness of breath should immediately notify the duty surgeon, because these symptoms may be due to bleeding and lead to asphyxia. Hoarseness, difficulty expectoration, podergivani while drinking testify about the defeat of laryngeal nerve. In these cases, measures should be aimed at prevention of aspiration pneumonia. Paresthesias, positive symptom of Huasteca (at easy this finger in the area between the zygomatic arch and the corner of his mouth appear twitching of the muscles of the mouth, nose, century) and cramps in the legs may occur in case of damage or accidental removal of the parathyroid glands, which requires the appointment of drugs calcium and injection of paratireoidinom. Complex therapy of patients with thyrotoxicosis after the operation should include microdose iodine, sedative preparations and preparations of the adrenal cortex (hydrocortisone, prednisolone, dexamethasone), as in the development of thyrotoxic crisis a major role divert adrenal insufficiency. Tireotoksicski kriz more likely to develop in the first two days after surgery and is characterized by the expressed tachycardia, sometimes with arrhythmia, feeling hot, sharp increase of temperature, humidity the skin, anxiety, rapid breathing, facial flushing, and increased pulse pressure, which can reach up to 140-120 mtrt. Art. (systolic pressure 180-120 and diastolic 40-0 mm RT. Art.). For edema thyrotoxic crisis intravenously injected a 500 - 1500 ml of 5% glucose solution together with a water-soluble hydrocortisone (from 150 to 300 mg), novokainamid, injections of 50% solution of dipyrone under the skin, heart funds. Timely taken measures usually take the patient from a state of crisis.