Radioiodine treated hyperthyroidism and thyroid carcinoma

External irradiation of the head and neck has been shown to increase the incidence of thyroid carcinoma. Fourteen cases have also been reported of thyroid cancer developing in individuals treated with radioiodine for hyperthyroidism. Another patient's case is reported here to emphasize the possible role of I131 on the genesis of thyroid malignancy and the importance of surgery in the treatment of hyperthyroidism.

The thyroglobulin variations during the thyroid surgery for polynodular goiter, hyperthyroidism and cancer

A radioimmunoassay (RIA) double antibody system for human thyroglobulin (Tgl) was developed with a sensitivity of 2.5 ng/ml T3 and T4 did not interfere in the antibody Tgl binding. The blood was collected pre-, intra- and 24 hrs post-thyroidectomy from 50 females and 4 males diagnosed as polynodular goiter, hyperthyroidism, chronic thyroiditis and thyroid cancer. The ratios of the intra- and post-operatory values versus pre-operatory values were calculated. The basal values in the patients having thyroid troubles varied within very large limits (two orders of magnitude) and these values could not be clearly correlated to the thyroid pathology, However, in untreated hyperthyroid patients the basal values exceeded 100 ng/ml, while in medullary carcinoma they were near the sensitivity limit of the technique. The intra-operatory values varied within the percentual area (thyroid carcinoma), multiplicative area (polynodular goiter and some cases of hyperthyroidism) and the order of magnitude area (hyperthyroid patients and some of the polynodular goiters). The value of the RIA measurement of the Tgl in the serum as an adjuvant in the post-treatment follow up of thyroid patients is discussed.

Propranolol for the preoperative preparation of patients with thyrotoxicosis

Thirty patients with hyperthyroidism were were prepared for subtotal thyroidectomy with propranolol. Rapid control of thyrotoxic symptoms occurred in all, and there were no undesirable drug reactions. There were no instances of post-operative thyroid storm. The drug was as effective and safe in four patients who were pregnant as it was in the other 26 patients discussed. We consider propranolol to be the drug of choice in the preoperative preparation of most patients with thyrotoxicosis.

Propranolol in thyrotoxicosis. Cardiovascular changes during thyroidectomy in patients pre-treated with propranolol

The cardiovascular changes during anaesthesia and thyroidectomy have been studied in seven thyrotoxic patients prepared with propranolol. The heart rate and cardiac rhythm remained very stable throughout surgery. A 20% increase in mean arterial pressure occurred during surgical stimulation. A decrease in cardiac output, due to decreased stroke volume, occurred during surgical stimulation. A decrease in cardiac output, due to decreased stroke volume, occurred during surgery, reaching a maximum of 21% during ligation of the thyroid vessels and returning to pre-operative values by the end of surgery. The fall in cardiac output was accompanied by raised central venous pressure and raised total peripheral resistance.

Thyroid function after surgical treatment of thyrotoxicosis. A report of 100 cases treated with propranolol before operation

We assessed thyroid function for 12 months after subtotal thyroidectomy in 100 tyrotoxic patients treated with propranolol alone before and immediately after operation. The operation proved safe, with low morbidity. Suppression of the hypothalamic-pituitary-thyroid axis, present in the majority one month after operation, was evidenced by normal or low levels of serum total tri-iodothyronine and thyroxine, but absent or subnormal serum thyrotropin response to thyrotropin-releasing hormone. Eighty patients were euthyroid at 12 months. Three patterns of thyroid function were observed in this group between the first and 12th months: normal serum total tri-iodothyronine, thyroxine and thyrotropin levels at all stages (20 patients); normal serum total tri-iodothyronine and thyroxine, but raised thyrotropin levels on one or more occasions (40 patients); and temporary hypothyroidism (20 patients). Of the remaining 20 patients, permanent hypothyroidism developed in 14, and six relapsed. Postoperative thyroid function was related to the estimated weight of the thyroid remnant.

Subtotal thyroidectomy for thyrotoxicosis: a reassessment, including TRH responsiveness

Thyroid function was assessed in patients treated surgically for thyrotoxicosis in Christchurch between 1965 and 1972. Seventy-eight of the 89 thyrotoxic patients were available for reassessment. Seventy-one were clinically and biochemically euthyroid. Seven patients had received radioiodine therapy for post-operative relapse and 10 patients were receiving thyroxine replacement therapy. At the time of the survey five patients were clinically thyrotoxic and two patients were hypothyroid and an additional nine patients had grossly elevated TSH levels. TRH tests performed on 31 clinically euthyroid patients with normal baseline thyroid parameters demonstrated that more than a third had excessive TSH responses consistent with reduced thyroid reserve and only one patient showed a lack of response consistent with persistent thyroid autonomy.

[Anatomoclinical correlations in postoperative acute thyrotoxic crisis]

Analysis of 26 cases with thyreotoxic crisis following surgery on an anatomo-clinical basis shows an extensive lesional polymorphism in the stroma and the parenchyma of the thyroid gland, indicating the absence of morphologic remission after preoperative preparation. Prolonged preoperative treatment, following evident clinical improvement, may avoid the development of postoperative crisis.

Place of total thyroidectomy in rhinolaryngologists' surgical treatment of thyroid disease

Total thyroidectomy is more frequently performed and is becoming more widely accepted as the treatment of choice for more surgical diseases of the thyroid gland. Improvement in anesthesia, presurgical and post-operative care, as well as more meticulous surgical technique, have decreased the complications associated with this operation. As is demonstrated, morbidity and complications of total thyroidectomy are no more frequent nor severe than when subtotal thyroidectomy is performed. This allows boadening of the indications for total thyroidectomy to include more cases which will be better controlled, but for which total thyroidectomy had been withheld because of the fear of increased morbidity.

[Surgery of thyrotoxicosis associated with diseases of the central nervous system]

Studies on 1432 thyrotoxicosis cases attracted the attention to a relatively high incidence (7.7%) of its association with damage to the central nervous system. 27 of 110 patients with combined type of thyrotoxicosis developed malignant exophthalmos. On the grounds of the studies of long-term results of the surgical treatment of these cases one could come to the conclusion, that surgical treatment of combined types of thyrotoxicosis was an efficient method. The clinic recommends complex preoperative management and a postoperative care procedure.

A case of myasthenia gravis with thyrotoxicosis treated by combined subtotal thyroidectomy and total thymectomy

Thyrotoxicosis occurring in conjunction with myasthenia gravis is rare. The usual treatment consists of medical control of the thyrotoxicosis, then thymectomy and later subtotal thyroidectomy. The case reported here concerns a 19-year-old girl who had surgical treatment for both lesions on the same occasion. With proper medical preparation, modern anaesthesia and respiratory care, the surgical treatment of both lesions can be accomplished in one stage.