갑상선 기능항진증의 수술적 치료

Abstract

Surgical treatment of the hyperthyroidism has many advantages including rapid reversal of the thyrotoxic state, lower occurrence of both early and late hypothyroidism, and usefulness in the first two trimesters of pregnancy. Surgical treatment is indicated in patients with toxic nodular goiter, either single or multinodular, in children and adolescents, in patients who are fearful of radiation, and in patients who have relapsed after an adequate course of antithyroid drug treatment. Patients with huge glands that raise a suspicion of carcinoma should also be treated by a subtotal thyroidectomy. Thus, the surgical treatment in patients with hyperthyroidism has a definite placc.

The medical records, especially the operative summary, of a total of 77 patients with diagnosis of hyperthyroidism who were admitted and surgically treated at the Department of Surgery of the Keimyung University, School of Medicine between January 1980 and August 1985 were reviewed and analysed. The diagnosis was confirmed by typical manifestations of hyperthyroidism, abnormal thyroid function test results, and pathological tissue reports.

The following is the summary of this study.

Of a total of 77 patients, (58 were female, 9 were male and the female to male ratio was 7. 6 : 1.

The age range was between 11 and 58 years with the majority of patients belonging in the age groups of 20s and 30s in both sexes.

Preoperative preparations used included inderal and Lugol's solution in 23 patients (30%), propylthiouracil!, inderal and Lugol's solution in 21 patients (27%), and propylthiouracil and Lugol's solution in 20 patients (26%).

Surgical procedures were performed by 18 certified Kcncral surgeons during the study period of 5 years and 8 months.

Total lobectomies of one side and subtotal lobectomies of the other side were performed in 43 patients (56%), bilateral subtotal lobectomies in 29 patients (38%), and total thyroidectomies in 3 patients (4%).

During the surgery, recurrent laryngeal nerves were identified on both sides in 39 patients (51%), superior laryngeal nerves were identified in 6 paticnts(8%), and in 13 patients (17%) one or two parathyroid glands were identified and preserved or specific efforts were made to preserve the parathyroid glands.

The amount of remaining thyroid tissue after the thyroidectomy was 4 to 6 grams in 24 patients, and in 36 patients there was no record available as to the amount of tissue left behind.

The amount of thyroid tissue resected, as reported by pathologists, was between 10 and 246 grams with the average being 54 grams.

Among the early postoperative complications, hypoparathyroidism was the most frequent. Temporary hypocalcemia was seen in 18 patients (23%), and permanent hypoparathyroidism was observed in 6 patients (7.8%).

Many of the patients were lost for follow up study shortly after surgery and it was difficult to get reliable information regarding late complications. No proven recurrence was observed among patients who could be followed or responded to a questionaire but at least four patients are being treated for postoperative hypothyroidism.

To improve surgical techniques and reduce postoperative complications, it is suggested that surgery should be performed by those well qualified in thyroid surgery through subspecialization in the surgical field.