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Endocrine system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
The addition of colour flow Doppler to the above B-mode technique is useful to delineate blood vessels, assess overall blood flow within the thyroid gland and contribute to the decision-making process of whether to refer focal lesions for FNA. Images should be recorded of the thyroid isthmus in transverse section and both lobes of the thyroid in transverse and longitudinal section. The A-P diameters of both thyroid lobes and any identified focal lesions should be measured.
Upper Airway Obstruction and Tracheostomy
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
A horizontal incision is sited halfway between the sternal notch and the lower border of the cricoid cartilage (Figure 72.7b). Once the skin has been incised, dissection continues through the subcutaneous tissues to the strap muscles, which are retracted laterally, following blunt dissection in the midline to separate them. Following this manoeuvre, the thyroid isthmus should be visible (Figure 72.7c). The isthmus should be clamped, divided and transfixed (Figure 72.7d). At this point the anterior tracheal wall is encountered. It is useful to identify the cricoid cartilage to plan the point of entry into the trachea. Ideally the tracheotomy should be made between the 2nd and 4th tracheal rings. Before entering the trachea, it is important to select an appropriately sized tracheostomy tube and check that the cuff and all connecting equipment works properly, so that ventilation can continue uninterrupted following the tracheostomy. There needs to be good communication between the surgeon and the anaesthetist.
Thyroidectomy
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Ricard Simo, Iain J. Nixon, Ralph P. Tufano
Thyroid isthmusectomy (TI): the excision of the thyroid isthmus, often with the pyramidal lobe of the gland, a procedure that should be reserved for nodules in the isthmus which measure no more than 4 cm in diameter and do not encroach significantly on either lobe.
Surgical Outcomes and Efficacy of Isthmusectomy in Single Isthmic Papillary Thyroid Carcinoma: A Preliminary Retrospective Study
Published in Journal of Investigative Surgery, 2021
Hee Won Seo, Chang Myeon Song, Yong Bae Ji, Jin Hyeok Jeong, Hye Ryoung Koo, Kyung Tae
Differentiated thyroid cancer is the most common malignancy of the endocrine tumor, accounting for about 33% of all head and neck malignant tumors.1 The annual prevalence of differentiated thyroid cancer has been rapidly increasing over the last 20 years, with a female-to-male ratio of 3:1.2 Papillary thyroid carcinoma (PTC) is the most common histologic type of differentiated thyroid cancer, which accounts for 80-85% of cases and has an excellent prognosis with a 10-year survival exceeding 90%.1,3 Although the majority of PTC occurs in the thyroid lobes, approximately 1% to 9% is limited to the thyroid isthmus.4–6 The thyroid isthmus is the central part of the thyroid gland that connects the bilateral thyroid lobes. It is located just anterior to the trachea and just posterior to the strap muscles and skin. Lesions of the thyroid isthmus are known to have a higher incidence of multifocality and local invasion compared to lesions presenting in the thyroid lobes.7
Microwave ablation for papillary thyroid cancer located in the thyroid isthmus: a preliminary study
Published in International Journal of Hyperthermia, 2021
Xiao-Jing Cao, Zhen-Long Zhao, Ying Wei, Li-Li Peng, Yan Li, Jie Wu, Ming-An Yu
The thyroid is an endocrine gland composed of right and left lateral lobes connected by a strip of thyroid tissue called the isthmus. The thyroid isthmus is located anterior to the trachea and is covered by the strap muscles, fascia, and skin in the middle of the neck. Isthmic papillary thyroid cancer (PTC) is defined as thyroid cancer in which the tumor center is located between two lines perpendicular to the surface of the skin from the most lateral points of the trachea [1]. Previous studies have reported incidence rates for PTC arising in the thyroid isthmus of 1–12.3% [2–4]. To date, the American Thyroid Association, National Comprehensive Cancer Network, European Thyroid Association, and British Thyroid Association have not provided specific guidelines for managing isthmic PTC yet. According to previous reports, total thyroidectomy is the mainstream management for isthmic PTC [2,5–7]. However, this treatment is associated with some complications, such as hypothyroidism, hypoparathyroidism, and recurrent laryngeal nerve (RLN) injury, all of which can be detrimental to the patient’s quality of life.
Radiofrequency ablation versus total thyroidectomy in patients with papillary thyroid microcarcinoma located in the isthmus: a retrospective cohort study
Published in International Journal of Hyperthermia, 2021
Qing Song, Hanjing Gao, Ling Ren, Xiaoqi Tian, Yu Lan, Lin Yan, Yukun Luo
The thyroid isthmus is located between the thyroid’s bilateral lobes, connecting both lobes like a bridge. It is generally believed that malignant lesions in the isthmus tend to produce extrathyroidal extension (ETE) due to the small size of the isthmus, but there is no guideline or consensus on the surgical treatment of thyroid carcinoma in the isthmus [9–11]. Some authors suggest that TT should be recommended for patients with PTC in the isthmus because of the high possibility of cervical lymph node metastasis [12]. On the other hand, some authors suggest that isthmectomy might be suitable for selected patients with differentiated thyroid carcinoma [13].