Hyperthyroidism surgical

Hyperthyroidism, that is, the overproduction of thyroid hormones, is usually treated by surgical removal of the thyroid gland. Before such a procedure is undertaken, the hyperthyroidism is usually first brought under control by treatment with so-called antithyroid agents. 

Antithyroid drugp or thyroid antagonists are used to treat hyperthyroidism. In addition to the antithyroid drugs, hyperthyroidism may be treated by the administration of strong iodine solutions, use of radioactive iodine (131I), or by surgical removal of some or almost all of the tiiyroid gland (subtotal thyroidectomy). 

It is used in hyperthyroidism due to Graves disease, prior to surgical treatment of hyperthyroidism i.e., thyroidectomy. It is also used in the treatment of paroxysmal tachycardia and intractable congestive cardiac failure. 

The three primary methods for controlling hyperthyroidism are antithyroid drug therapy, surgical thyroidectomy, and destruction of the gland with radioactive iodine. 

A major type of headache that must be considered in differential diagnosis is that caused by underlying disease intracranial disturbances (e.g., vascular anomalies, infections, tumors, trauma) diseases involving the head and neck but not the brain (e.g., cervical osteoarthritis disorders of eye, ear, nose, sinuses, and throat cranial neuralgias) and systemic diseases (e.g., sudden and severe hypertension, hyperthyroidism). These headaches usually can be relieved by specific therapy for the underlying disorder (e.g., surgical correction of tumors, antibiotics for infections, antiarthritic drugs for osteoarthritis). 

Third, many physical disorders also affect mental attitudes and behavior. Hyperthyroidism as well as overdoses of thyroid hormone can increase anxiety, irritability, and other emotions that the individual would not ordinarily experience and that can lead to behavioral abnormalities. There are, of course, many similar examples involving hormones such as testosterone and cortisone. More to the point, accidental brain injury to the frontal lobes and surgical lobotomy usually impair judgment, ethical restraint, and self-reflection. The character of the injured individual is often viewed as changed and worsened. 

Preparation of hyperthyroid patients for surgery can be satisfactorily achieved by making them euthyroid with one of the above drugs plus a P-adrenoceptor blocker for comfort (see below) and safety, and adding iodide for 7-10 days before operation (not sooner) to reduce the surgically inconvenient vascularity of the gland. 

In patients with hyperthyroidism, potassium iodide is used in the treatment of thyrotoxicosis and to decrease the vascularity of the thyroid before the thyroid gland is surgically removed. Potassium iodide is... 

Palliative treatment of hyperthyroidism adjunct to ameliorate hyperthyroidism in preparation for surgical treatment or radioactive iodine therapy... 

Serial measurement of Tg is most useful in detecting recurrence of DTC following surgical resection or radioactive iodine ablation. Tg determination is used as an adjunct to ultrasound and scanning. Assessment of serum Tg also aids in the management of infants with congenital hypothyroidism, All patients with hyperthyroidism should have elevated Tg low concentrations of Tg may be an indication that thyrotoxicosis factitia is present. 

Hyperthyroidism may be treated with antithyroid drugs such as propylthiouracil (PTU) or methimazole (MMI), radioactive iodine (RAI e.g., I), or surgical removal of the... 

The antithyroid drugs are used in the treatment of hyperthyroidism in the following three ways (1) as definitive treatment, to control the disorder in anticipation of a spontaneous remission in Graves disease (2) in conjunction with radioactive iodine to hasten recovery while awaiting the effects of radiation and (3) to control the disorder in preparation for surgical treatment. 

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. 

Toxic goiter— The most commonly used treatments for hyperthyroidism are antithyroid drugs which block the synthesis of thyroid hormones, surgical removal of part of the thyroid gland, and therapy with radioiodine which destroys the cells of the thyroid. It is sometimes necessary to balance these treatments with oral doses of thyroid hormones in order to prevent the effects of hypothyroidism. Administration of large excesses of iodine for the purfXKe of hormone synthesis is no longer used since the effect is only temporary. 

U patients with solitary autonomously functioning nodules were examined. None was removed surgically. 7 of these patients were also hyperthyroid and in 5 of these the toxic nodule had measurable iodine stores with count rates ranging from 400 to 1000 per 100 seconds. The other 2 toxic nodules had undetectable stable iodine stores despite good radioiodine uptake. On the other hand, the contralateral suppressed lobe had detectable iodine stores in 3 but not in 4 of the toxic patients. 

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