A STUDY ON SURGICAL MANAGEMENT OF THYROTOXICOSIS
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2019, Vol 8, Issue 21
Abstract
BACKGROUND Thyrotoxicosis refers to a clinical condition that results from high thyroid hormone action in tissues generally due to high tissue thyroid hormone levels1 Hyperthyroidism refers to over activity of the thyroid gland leading to high synthesis and excessive production of thyroid hormones1. The underlying problem in patients with thyrotoxicosis is acceleration of many physiological processes, and the clinical manifestations reflect that acceleration. We wanted to study the clinical pattern of presentation of patients with thyrotoxicosis, indications for surgery in thyrotoxicosis patients, functional results, and quality of life following the surgical treatment. METHODS This is a prospective study in the surgical department of the ACSR Govt. Medical College and Hospital, from December 2017 to December 2018. Totally thirty patients with varied clinical presentations, confirmed to be suffering from the thyrotoxicosis, and after tests were appropriately evaluated, thyrotoxicosis controlled, consenting patients were operated. Clinical details were entered onto a proforma specification. Data was entered in a Microsoft excel, computers read sheet and analysed by using WHO epidemiological information package. RESULTS Surgical management of hyperthyroidism provides effective endocrinal control if surgery is complete. Patients should be fully informed of all possible postoperative complications that could occur, especially vocal cards. Long-term follow-up is necessary to detect recurrence, which can occur more than 20 years after partial thyroidectomy surgery. Total thyroidectomy is reserved for patients with severe disease or very large goiters in which recurrences will be highly problematic, but has an increased risk of hyperparathyroidism and laryngeal nerve damage. CONCLUSIONS Thyrotoxicosis occurs due to rise in thyroid hormone synthesis, its secretion by the thyroid gland, and its consequences on various systems with altered biochemical levels. This most commonly manifests as Diffuse Toxic Goiter and Toxic Multinodular Goiter. The management of thyrotoxicosis is mainly on three treatment modalities, anti-thyroid medication, radioactive iodine ablation or surgery. Surgery plays an important role in the management of thyrotoxicosis with immediate and cost-effective treatment with minimal morbidity and mortality. Total thyroidectomy is the surgery of choice in Graves’ disease, while a total thyroidectomy or thyroid lobectomy are performed in patients with toxic nodular goiters. Although thyroid surgery can be associated with significant complications, in many operative centers, surgery provides effective long-time resolution of hyperthyroidism and hence should be considered an integral part of treatment rather than the last choice for clinicians. Surgery should be considered as an immediate and completely effective solution for thyrotoxicosis, especially when compared with long duration medical therapy, because it can provide an observable improvement in the quality of life (QOL) of the patients.
Authors and Affiliations
Lakshmi Meena Jasti, Obed Ahmed Shaik, Beenaboina Venkata Ramana Murthy, Padala Chandra Mohan
Keywords
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- EP ID EP619185
- DOI 10.14260/jemds/2019/376
- Views 53
- Downloads 0
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