Thyroid removal

[Chickenandwaffles]

Hey ENT people, I'm wondering if I can ask a quick thyroidectomy question. Typically when someone has a hemithyroidectomy, are any of the muscles cut and/or somehow reattached?

What could create a lump post surgically that was not there before surgery/ Any thoughts? Thanks!

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[OtoHNS]

Hey ENT people, I'm wondering if I can ask a quick thyroidectomy question. Typically when someone has a hemithyroidectomy, are any of the muscles cut and/or somehow reattached?

What could create a lump post surgically that was not there before surgery/ Any thoughts? Thanks!

1. I don't generally cut the strap muscles unless there's a very large nodule underneath. It's usually not hard to retract them laterally when dissecting around the thyroid lobe. For very large nodules, I'll cut the straps horizontally over the thyroid lobe and then suture the muscle back together after removing the lobe.

2. If the strap muscles were cut and then bunched up when they were sutured back together, that could create a palpable lump (though it would probably even out in a few months). A small hematoma or other fluid collection could also create a temporary lump. Also a suture granuloma under the incision.

 

[DrBodacious]

1. Same as OtoHNS

2. Same as OtoHNS. A poorly placed suture could cause the platysmal closure tissues to bunch up and form a lump, apart from the strap closure, but this is pretty hard to screw up.

A couple other possibilities that come to mind, in general, it depends on how far out from the surgery the patient is as to the likely cause of a "lump."

- It is not uncommon to get edema that is more prominent above the incision due to the interrupted lymphatic drainage. This can last for a few weeks or sometimes longer.

- If there is a low grade cellulitis/infection (or especially a wound infection), that can create a firmness that can persist for several weeks.

- If a surgical drain was used, that could have broken off or been caught by a deep suture and a piece retained in the wound.

- Maybe the surgeon did the wrong operation and put a thyroid gland in, rather than removing a thyroid gland.

 

[Chickenandwaffles]

1. Same as OtoHNS

2. Same as OtoHNS. A poorly placed suture could cause the platysmal closure tissues to bunch up and form a lump, apart from the strap closure, but this is pretty hard to screw up.

A couple other possibilities that come to mind, in general, it depends on how far out from the surgery the patient is as to the likely cause of a "lump."

- It is not uncommon to get edema that is more prominent above the incision due to the interrupted lymphatic drainage. This can last for a few weeks or sometimes longer.

- If there is a low grade cellulitis/infection (or especially a wound infection), that can create a firmness that can persist for several weeks.

- If a surgical drain was used, that could have broken off or been caught by a deep suture and a piece retained in the wound.

- Maybe the surgeon did the wrong operation and put a thyroid gland in, rather than removing a thyroid gland.

Not funny. I'm super concerned. Not quite 2 weeks post-op. No infection that I can tell, and I don't think a drain was used. Are drains used during the surgery typically? I've read about them, but don't think that was used. If something did break off during the procedure, would the surgeon have to go back and retrieve it? That seems like a nightmare.

This thing is mostly asymmetrical and on the side of the lobe that was removed. I know this may sound terribly stupid but as a non-ENT I have no clue - is it possible that the trachea was damaged at all and could have deviated? I have never ever had an infection or hematoma or fluid collection that was *this* rock hard. Thanks again!

 

[Winged Scapula]

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