Feline thyroidectomy techniques

Re: Feline thyroidectomy techniques

Rob Loxley — Tue, 09 Oct 2012 23:27:28 GMT

Modified extracapsular, bilateral only if happy the 1st PT has been preserved, else staged.

I find I'm still doing lots - its a pretty simple and very effective (including cost-effective) solution, though we have many people that decide to stay on meds (and a few going for I-131)

Re: Feline thyroidectomy techniques

Robin Grimmer — Mon, 08 Oct 2012 21:56:18 GMT

[quote user="Emma Middleton"][quote user="Robin Grimmer"]

I try and preserve the capsule. So I open the capsule at the least vascular area - usually ventrocaudal and then use a sterile cotton bud to gently remove the thyroid tissue. I've had no problems with hypocalcaemia using this technique. Even if it's unilateral you need to try and preserve the parathryoids as most cases usually become bilateral.

[/quote] Do you then proceed to remove as much capsule as possible whilst leaving the portion with the parathyroids (if you can identify them clearly) to reduce risk of recurrence of hyperthyroidism in that gland? The literature seems to indicate a high recurrence rate with intracapsular but anecdotally a lot of vets say they don't see many recur at all.

[/quote]

No, I don't remove the capsule. I haven't had any problems with recurrence of the hyperthryoidism, but I would rather have this as a complication than hypocalcaemia. Hypocalcaemia is much harder to manage, you have an unstable patient to deal with and an often p***** off client.

Re: Feline thyroidectomy techniques

Robin Grimmer — Mon, 08 Oct 2012 21:52:05 GMT

[quote user="Hannah Wynne Richards"]

I won't do a second side it's medical treatment or refer if this needs doing

Wynne

[/quote]

that's pretty much admitting that you haven't preserved the parathyroid on your first thyroidectomy.

Re: Feline thyroidectomy techniques

Hannah Wynne Richards — Mon, 08 Oct 2012 17:22:36 GMT

I won't do a second side it's medical treatment or refer if this needs doing

Wynne

Re: Feline thyroidectomy techniques

Simon Neuhoff — Mon, 08 Oct 2012 16:55:53 GMT

As per Robin above. I frequently do bilateral thyroidectomies and always try to preserve the parathyroids even in unilateral as supposedly 70-80% will become bilateral in time. Doing less these days due to the other options now available. To dae not had any go hypocalcaemic - probably luck rather than skill.

Re: Feline thyroidectomy techniques

Emma Middleton — Mon, 08 Oct 2012 16:40:14 GMT

[quote user="Martin Atkinson"]I would expect at least 18 months before the other side starts playing up which would be in about 50% of cases but I rarely do thyroidectomies these days anyway, I control most of them with Felimazole because that is what most clients want and and only really push excision if a goitre is large enough for me to be concerned it is a carcinoma.[/quote] Thanks. Yes, I agree, most clients prefer medical to surgical treatment. We don't do many either, it's mainly just cats that are impossible to tablet. But I do offer it to all new cases as some owners don't like the idea and cost of medicating for the rest of the cat's life.

Re: Feline thyroidectomy techniques

Mark Holmes — Mon, 08 Oct 2012 16:39:16 GMT

You can usually see the parathyroid at the cranial pole and if you tie a ligature between the parathyroid and thyroid tissue it nicely slips in between and divides the two glands.

Re: Feline thyroidectomy techniques

Martin Atkinson — Mon, 08 Oct 2012 16:27:20 GMT

[quote user="Emma Middleton"]ust out of interest Martin, presumably you don't visualise the other (non-enlarged) gland if you are incising directly over the enlarged one. What kind of recurrence rate do you see in these cats? From hyperthyroidism in the remaining gland I mean.[/quote] I'm pretty good at palpating thyroid glands so if I can't feel it I won't see it or find it easily surgically. I would expect at least 18 months before the other side starts playing up which would be in about 50% of cases but I rarely do thyroidectomies these days anyway, I control most of them with Felimazole because that is what most clients want and and only really push excision if a goitre is large enough for me to be concerned it is a carcinoma.

Re: Feline thyroidectomy techniques

Emma Middleton — Mon, 08 Oct 2012 16:21:37 GMT

[quote user="Martin Atkinson"]I incise over the offending gland, bluntly dissect through the sterno-hyoidius muscle usually straight onto the gland, if not milk it around so it pops up, gently dissect off the recurrent laryngeal nerve, ligate caudal pole first and if I can easily see parathyroid tissue attempt to preserve it but chances are I wont so ligate cranial pole then as well. Close muscle over with absorbable suture material (Vicryl Rapide) and skin the same. Job done in 10 minutes. If it was the second side or bilateral I would make more of a concerted attempt to preserve the parathyroids with an intracapsular technique but as posted in another thread I rarely reliably identify them and you didn't ask that question anyway.[/quote] Thanks Martin, great description. This is pretty much how I did my last one and it all went fine. After doing a bit of reading for this one, I was trying to find the value in taking extra time to preserve the capsule when doing a unilateral procedure. The only problem I can see is if the remaining gland eventually also goes hyperthyroid. Then I guess you really have to do everything to preserve the remaining parathyroids. [quote user="Martin Atkinson"]I incise over the offending gland, bluntly dissect through the sterno-hyoidius muscle usually straight onto the gland[/quote] Just out of interest Martin, presumably you don't visualise the other (non-enlarged) gland if you are incising directly over the enlarged one. What kind of recurrence rate do you see in these cats? From hyperthyroidism in the remaining gland I mean.

Re: Feline thyroidectomy techniques

Emma Middleton — Mon, 08 Oct 2012 15:57:39 GMT

[quote user="Robin Grimmer"]

Re: Feline thyroidectomy techniques

Martin Atkinson — Mon, 08 Oct 2012 15:56:46 GMT

I incise over the offending gland, bluntly dissect through the sterno-hyoidius muscle usually straight onto the gland, if not milk it around so it pops up, gently dissect off the recurrent laryngeal nerve, ligate caudal pole first and if I can easily see parathyroid tissue attempt to preserve it but chances are I wont so ligate cranial pole then as well. Close muscle over with absorbable suture material (Vicryl Rapide) and skin the same. Job done in 10 minutes. If it was the second side or bilateral I would make more of a concerted attempt to preserve the parathyroids with an intracapsular technique but as posted in another thread I rarely reliably identify them and you didn't ask that question anyway.

Re: Feline thyroidectomy techniques

Robin Grimmer — Mon, 08 Oct 2012 15:46:55 GMT

Re: Feline thyroidectomy techniques

Hannah Wynne Richards — Mon, 08 Oct 2012 15:41:11 GMT

Take the capsule If it's unilateral then no para thyroid issues It makes the technique easy/fast and these cats are higher than normal anaesthetic risks Also give propanalol before to reduce BP

Wynne

Re: Feline thyroidectomy techniques

Emma Middleton — Mon, 08 Oct 2012 15:29:39 GMT

Wynne, do you take the capsule? Or do you do intracapsular/modified extracapsular?

Re: Feline thyroidectomy techniques

Hannah Wynne Richards — Mon, 08 Oct 2012 15:22:17 GMT

Midline incision Largest thyroid usually pops upat you

Wynne