Goiters surgery

Radioiodine treatment is particularly well-suited for toxic adenoma and multinodular toxic goiter. Surgery is... 

Subtotal thyroidectomy is indicated in patients with very large goiters and thyroid malignancies and those who do not respond or cannot tolerate other therapies. Patients must be euthyroid prior to surgery, and patients often are administered iodide preoperatively to reduce gland vascularity. The overall surgical complication rate is 2.7%. Postoperative hypothyroidism occurs in 10% of patients who undergo subtotal thyroidectomy. 

III.b.1.6. Radioactive iodine. Radioactive iodine (Iodine-131) is a radioactive isotope of iodine, usually taken in an oral solution formulation as sodium 1. Given orally as sodium I, radioactive iodine is rapidly absorbed, concentrated and stored in the thyroid follicles. The therapeutic effect depends on beta-ray emission and destruction of thyroid parenchyma manifests some weeks after treatment. It is relatively safe, cheap, painless and avoids side effects associated with surgery. It is widely regarded as the treatment of choice in adults with toxic multinodular goiter, toxic nodule and people who relapse after a course of antithyroid medication. 

Surgery is usually a near-total thyroidectomy, with main indications being suspected coexistent thyroid carcinoma, solitary toxic nodule, large goiter, failed medical treatment, patient preference and occasionally in pregnancy if adverse effects from antithyroid dmgs occur. 

Despite the predominantly antithyroid effects of lithium, thyrotoxicosis continues to be described during treatment and after withdrawal (642-644). In a retrospective review of 201 patients taking lithium (mean duration 6.4 years), hypothyroidism requiring supplemental thyroxine developed in 10% (3.4% of men, 15% of women) after a mean duration of 56 months. Women over 50 years of age tended to have an earlier onset. Two patients developed goiter requiring surgery and two others developed thyrotoxicosis (631). 

Surgery Rapid, effective treatment, especially in patients with large goiters Most invasive Potential complications (recurrent laryngeal nerve damage, hypoparathyroidism) Most costly Permanent hypothyroidism Pain, scar Potential in pregnancy if major side-effect from antithyroid Useful when coexisting suspicious nodule present Option for patients who refuse radioiodine... 

Yusho and Yu-Cheng Exposures. In a case-control study of the Taiwan Yu-Cheng cohort, 795 exposed subjects and 693 sex- and age-matched controls were interviewed for information about health and medical history (Guo et al. 1999). The odds ratio (OR) for goiter (men and women combined) was 2.8 (Cl, 1.2-7.1) and 4.0 (Cl, 1.5-13.9) for goiter that was treated with medication or surgery. The ORs for hypothyroidism or hyperthyroidism were not significant (males, 0.95 females, 1.7). 

Radioiodine therapy may be employed for the second time if the first administration is insufficient, which usually happens in cases of severe hyperthyroidism or large goiter. Also, prior administration of radioiodine does not preclude surgery, if necessary at a later stage. 

Surgery is indicated for large and obstructive goiters or nodules and also for hypofunctioning cold nodules for which radioiodine is not available as a treatment option at all (Table 81.3). 

Note Main criteria for surgery inciude mechanicai probiems caused by the size of the goiter or noduie and suspicion of maiignancy. 

The choice of treatment is discussed by the specialist and the patient. In the absence of one of the indications for surgery, we would suggest radioiodine treatment as the first choice. In case of overt hyperthyroidism, pretreatment with antithyroid drugs may be necessary. Optimum treatment modalities including the presence of a suppressed TSH in toxic adenoma or multinodular goiter should be established. On the one hand, patient s fears regarding radiation exposure and, on the other hand, possible surgical complication often infiuence the decision and have to be addressed. 

Post-operatory hypothyroidism is a consequence of partial or total thyroidectomy in patients with nodular goiters or thyroid tumors. This etiology was found in about one fourth of our patients. Patients with surgical procedures in the neck may also develop thyroid hypofunction, especially in cases in which surgery is combined with radiotherapy (Griffin, 1990). 

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