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General Surgery
Safe Thyroidectomy in Low- and Middle-Income Countries
Built from Atlas of Thyroid Surgery
What’s inside
6 sections · 62 slides
Overview
- Essentials of LMIC thyroid care
- Principles for missions and referral
The case
A young patient with advanced thyroid carcinoma
- A young woman with a large neck swelling
- Examination findings
- Why limited surgery was chosen
- Recovery and follow-up plan
- Advanced thyroid carcinoma in the neck
Low- and Middle-Income Countries
Terminology, income groupings and healthcare restraints
- Terms and definitions
- How the World Bank groups economies
- Healthcare restraints in LMICs
- Poverty and access to care
- Working as a thyroid surgeon in LMICs
- Progress and remaining gaps
Surgical Missions
The burden of surgical disease and how missions should work
- 16.9 M
- Surgical disease outranks other killers
- Most surgical need is basic
- Short-term missions: strengths and gaps
- Five conditions for a sustainable mission
- Vision and reporting
- Local partnership and aftercare
- Long-term financing
- Partnerships are the benchmark
Thyroid Surgery in LMICs vs HICs
Pathology, diagnostics, surgery and follow-up
- Four pillars that shape thyroid surgery
- Late presentation of disease
- Goitre in iodine-deficient regions
- Large goitre before and after surgery
- Two main causes of thyrotoxicosis
- Recognising thyrotoxicosis without labs
- Medical treatment comes first
- Thyroid cancer patterns
- Managing nodules without FNAB
- Thyroid abscess
- Diagnostics vary by setting
- Clinical signs of malignancy
- Ultrasound in low-resource settings
- Ultrasound caution and referral
- When cytology is available
- Indications mirror HICs
- Perioperative capacity and anaesthesia
- Locoregional anaesthesia for thyroid surgery
- Equipment and haemostasis
- Nerve identification
- Why less extensive surgery is preferred
- Extent of thyroid resection
- Avoiding subtotal resection
- When total thyroidectomy is justified
- Thyroid pathology management algorithm
- Total versus limited thyroidectomy in LMICs
- Minimum equipment and palliative care
- Outcome standards are achievable
- Post-operative monitoring challenges
- Airway emergencies after thyroidectomy
- Managing post-operative haemorrhage
- Recovery and long-term hypothyroidism
- Follow-up shapes treatment choices
Take-Home Messages
Practical rules for safe thyroidectomy in low-resource settings
- Evaluate before you treat
- Partner with local teams
- Prefer limited surgery
- Advanced carcinoma needs palliation
- References
- References (continued)
- Atlas of Thyroid Surgery