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The aim of surgical treatment in hyperthyroidism is to reduce the excessive
secretion of thyroid hormones by removal of thyroid tissue. Subtotal or
near-total thyroidectomy is performed in Graves' disease and toxic multinodular
goiter, while lobectomy is the procedure of choice in toxic adenoma[2-4].
Restoration of euthyroidism before surgery is mandatory. The classical
approach combines a course of thionamide treatment to restore and maintain
euthyroidism, and the preoperative administration of iodide for approximately
10 days in order to induce involution of the gland. Care must be taken
not to discontinue or decrease the dose of antithyroid drugs when iodide
is added. We do not favor a preoperative program only based on the use
of a beta-adrenergic antagonist associated with iodide. Euthyroidism is
not restored in these patients, since iodide alone normalizes the concentration
of thyroid hormones in serum only a few days before operation, but does
not produce "tissue” euthyroidism. Furthermore, the risk of thyroid storm
is not completely prevented even when high dose propranolol is administered
for several days after surgery.
Possible complications of thyroid surgery include thyroid storm, that nowadays is extremely rare, bleeding, injury to the recurrent laryngeal nerve, and hypoparathyroidism. In particular, the risk of laryngeal nerve injury and hypoparathyroidism cannot be disregarded. Although an incidence of these complications lower than 2 % is reported from clinics with wide experience in thyroid surgery, much higher figures up to 10-15 % are encountered in some series. These complications are of course less frequent when lobectomy for toxic adenoma is performed. |
