Anaesthesia for Thyroid and Parathyroid Surgery

44 Pages·2014·0.73 MB·English

Anaesthetic Aspects of Thyroid
and Parathyroid Surgery
Mireille Berthoud
2014
Thyroid disease
Reasons why patients may come to surgery

• Grave’s Disease
• Thyroid nodule
• Thyroid cancer
• Multinodular goitre
• Other more rare conditions
Parathyroid disease
Reasons why patients may come to surgery

• Primary parathyroid disease
• Tertiary parathyroid disease
Physiology of thyroid hormones
Hypothalamus -
TRH
+
- Pituitary Gland
TSH
+
T4 and T3
Thyroid Gland
T4 and T3 FT4 FT3
Peripheral Tissues
T4 T3
What is meant by subclinical disease?
High
Serum TSH Low
Hypothyroidism ? Hyperthyroidism?
Free T4 and Free T3 Free T4 and Free T3
Normal Low Normal High
Sub-clinical
Hypothyroidism Sub-clinical Hyperthyroidism
Hypothyroidism
Hyperthyroidism
The normal for TSH is 0.27 to 4.2 mIU/l, for adults in STH
Grave’s disease
What is it?
• Autoimmune thyroiditis
• Immunoglobulins cause false TSH
stimulation
• Diffuse goitre
• Associated eye disease
• 8x more common in women
• Up to 2% of the population
Grave’s disease
What treatments are available? Why operate?
• Medical management
• Radioiodine
• Surgical management
– Less relapse
– Airway obstruction
– Thyroid eye disease
– Pregnancy
– Patient choice
Euthyroid for surgery
• Anti-thyroid drugs
Carbimazole
Propylthiouracil
• B blockers
• Lugol’s iodine
• Steroids
Famous folk with thyroid eye disease
Thyrotoxic crisis
• I have never seen it
• Saba has seen it twice, in a medical context
• Peri-operative crises are rare now days
• Diagnosis is clinical
• Needs to be managed on ITU, with respiratory
and CVS support available.