Thyroid MDS Dr Sami Asfar

Hyperthyroidism “Surgical Aspects” Sami Asfar M.B.,Ch.B., MD (UK), FRCS, FACS Professor & Chairman, Department of Surgery, Faculty of Medicine, Kuwait University Prof. Sami Asfar 1 Surgery for Primary Hyperthyroidism “Graves’ Disease” Indications : • Failure of medical treatment • Remission after medical therapy – Adults after 1 year – Children after 3 months • Non-compliant to medical treatment Prof. Sami Asfar 2 Surgery for Primary Hyperthyroidism “Graves’ Disease” Indications : • Large goiter • Adverse reactions or contraindications to antithyroid drugs • Pregnant (2nd trimester) or Children • Female who wishes to get pregnant within 1 year after treatment Prof. Sami Asfar 3 Primary Hyperthyroidism “Graves’ Disease” Preparation for surgery • Patient should be Euthyroid – Propranolol – Antithyroid drugs – ? Lugol’s iodine solution • (saturated potassium iodide) 7-10 days preoperatively Prof. Sami Asfar 4 Primary Hyperthyroidism “Graves’ Disease” Operative Strategy • Preoperative indirect laryngoscopy (vocal cords) • Subtotal thyroidectomy: – Leaving only 3-4 g of thyroid tissue on each side of trachea – Sparing the parathyroids and recurrent laryngeal nerves Prof. Sami Asfar 5 Primary Hyperthyroidism “Graves’ Disease” Surgical Complications • Mortality • Recurrent laryngeal nerve injury • Hypoparathyroidism – Perioral numbness & tingling – Nervousness & anxiety – Chvostek’s sign & Trousseau sign 0.1% < 2% < 2% Prof. Sami Asfar 6 Primary Hyperthyroidism “Graves’ Disease” Surgical Complications • Bleeding – Airway obstruction • Open the wound & evacuate haematoma • Thyroid Storm – Rare after good preoperative preparation – May be precipitated by surgery – Treatment: Iodine, Propranolol and antithyroid drugs • Hypothyroidism Prof. Sami Asfar 50% 7 Toxic Thyroid Nodule • Lobectomy and Isthmusectomy Prof. Sami Asfar 8