I decided to do a bilateral functional neck dissection (post triangles
included) rather than node picking because there seemed a lot of fibrosis
and the nodes were difficult to define clearly, also it seems to me to
remove all nodes and associated tissue gives the best chances of a full
I did a total thyroidectomy , taking one recurrent laryngeal nerve which was
involved with the tumour, and managed to identify two parathyroids,
preserving one and a half of them. The tumour was densely adherent to the
trachea and had to be removed by sharp dissection. All this took about 7
hours (including a lunch break). Phew - I'm glad I don't have these ops
We hoped to get away without a trache, but on extubation a week later he
struggled to breath and so we left him with a trache for 2 further weeks. We
removed it today and I'm pleased to say that though he is hoarse he can
phonate, and maintains a good airway whilst running round the ward at 90
miles an hour.
No signs at any stage of hypocalcaemia.
We have left him off T4 since the op and intend to send him for a profile
scan soon, prior to radioiodine and then commencing him on his T4.
Histology failed to comment on features of vascular invasion but commented
that in many nodes tumour had invaded into surrounding fat. It does
therefore seem to be quite an aggressive tumour.
Would anyone add local neck irradiation?