For Residents & Trainees
Residency Resources
A curated hub for residents rotating through endocrine surgery. Access OR preferences, patient care protocols, and mentorship resources below.
About the Rotation
Residents on the endocrine surgery service will participate in a high-volume practice covering thyroid, parathyroid, and adrenal surgery. Emphasis is placed on operative decision-making, intraoperative teaching, and evidence-based postoperative management.
Mentorship & Opportunities
Dr. Michelakos actively mentors residents interested in endocrine surgery, surgical research, and academic careers. Research opportunities in cancer immunology are available for motivated trainees. Reach out directly to discuss.
🔪 Thyroidectomy
Pre-op
| Consent | Usually done in office |
| H&P — document | If voice is abnormal/hoarse; last anticoagulation dose |
| Marking | Ted will draw skin creases |
| Pregnancy test | Per protocol |
| Antibiotics | Only if diabetic / immunocompromised / recent infection or abx / re-operative. None otherwise. |
| Heparin | No |
| Foley | No, unless neck dissection |
| Voiding | Patient must void before case |
Have in the OR
| Loupes | Bring yours |
| Imaging | Ultrasound, linear probe |
| Thyroid bag | Inflatable pressure bag (alt: gel pad, fluid pressure cuff, or rolled blankets) |
| Head board | Positioned toward head; able to flex down |
| ETT | NIM endotracheal tube — 6.5 or 7.0 for most patients (per anesthesia) |
| NIM system | ✓ |
| Bovie | Needle tip, set to 17/17 |
| Bipolar | Jeweler's tip or yellow racing bipolar |
| PT Eye | For total thyroidectomy and parathyroidectomy |
| Wound protector | Alexis, extra small and extra extra small available |
| Hemostasis | Surgicel Fibrillar (4×4 or 2×4 in); hemostatic sealant (Surgiflo / Vistaseal / Tisseel) — available, do not open preemptively |
Positioning
| Position | Mild Tommy Bahama; extend headboard if needed |
| Thyroid bag | In place |
| Arms | Padded and tucked (beer cans) |
| Foley | No, unless neck dissection |
| NIM electrodes | Red and green to chest — red = left; cover with Tegaderm |
| DVT prophylaxis | Pneumoboots |
| Warming | Bair Hugger |
Intra-op
| Platysma | 3-0 Vicryl |
| Deep dermal | 4-0 Monocryl (if needed) |
| Skin | 5-0 Monocryl, knotless subcuticular |
| Closure | Skin glue; pressure on neck while extubating |
Post-op
| Admission |
- Total thyroidectomy → overnight
- Any cardiovascular issue → overnight
- >1 hr drive from home → overnight
- Lobectomy → 4 hrs in PACU, then home
|
| Labs | Total thyroidectomy: calcium, iCa, PTH. Lobectomy: none. |
| Ice pack | OK if not wet |
| Diet | Clears and crackers in PACU; ad lib on floor |
| Analgesia | Tylenol; oxycodone script — 3 pills |
| Discharge | Team must see patient before d/c |
| Anticoagulation | Eliquis / Plavix / Xarelto / Coumadin → restart POD #2. Aspirin → do not stop. |
🔬 Parathyroidectomy
Same setup as thyroidectomy above. Additional specifics below.
Pre-op
| Pre-op labs | Not needed unless no recent labs in Rush system |
Intra-op
| Baseline PTH | After parathyroid exposure |
| PTH checks | At 5, 10, and 15 minutes after resection |
Post-op
| Disposition | Home if no other issues (see thyroidectomy); stay if Ca < 7 |
| Labs in PACU | PTH, ionized calcium, calcium |
| Calcium supplementation | Everyone gets Calcium carbonate 1,000 mg (2 Tums) TID |
| If PTH < 15 | Add Calcitriol (Rocaltrol) 0.25 μg BID + labs (PTH, Ca, iCa) in 1 week |
Patient Instructions — Hypocalcemia
If you have numbness or tingling of your fingertips or around your mouth, take 2 Tums. If the problem persists after 30 minutes, take another 2 Tums. If it still persists after another 30 minutes, give us a call.