Toxic multinodular goiter surgery

Jump to navigation Jump to search

Toxic multinodular goiter Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Toxic multinodular goiter from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Toxic multinodular goiter surgery On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Toxic multinodular goiter surgery

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Toxic multinodular goiter surgery

CDC on Toxic multinodular goiter surgery

Toxic multinodular goiter surgery in the news

Blogs on Toxic multinodular goiter surgery

Directions to Hospitals Treating Toxic multinodular goiter

Risk calculators and risk factors for Toxic multinodular goiter surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S[2],Sunny Kumar MD [3]

Overview

Surgery is the mainstay of treatment for toxic multinodular goiter. Almost all multinodular goiters can be surgically removed through a collar incision. Usually, subtotal thyroidectomy is performed but unilateral thyroid lobectomy can also be performed in selected cases.

Surgery

Surgery is the mainstay of treatment for toxic multinodular goiter.[1][2][3][4][5][6]

Indications

Indications of surgery for multinodular goiter (MNG) includes:

Surgical procedures

Almost all multinodular goiters can be surgically removed through a collar incision. An additional thoracotomy is very rarely necessary.

  • If surgery is chosen as treatment for TMNG or TA, patients with overt hyperthyroidism should be rendered euthyroid prior to the procedure with MMI pretreatment, with or without beta-adrenergic blockade. Preoperative iodine should not be used in this setting.[1]

Total thyroidectomy

Benefits of total thyroidectomy include:[7]

  • Adequate removal of the diseased gland
  • Prevention of recurrence
  • Avoidance of completion surgery in case of malignancy

Subtotal thyroidectomy

Bilateral subtotal thyroidectomy includes total lobectomy on the dominant lobe and subtotal lobectomy on the contralateral lobe. Bilateral subtotal thyroidectomy is effective in the treatment of multinodular goiter (with hot or cold nodules).[7]
Benefits of Subtotal thyroidectomy:

Unilateral Lobectomy

A unilateral thyroid lobectomy may be performed if only one thyroid lobe is enlarged.

Side effects of surgery

The side effects associated with thyroidectomy include:[8][9][10]

Radioactive iodine therapy

The indications of radioactive iodine therapy includes:

  • Advanced patient age
  • Significant comorbidity
  • Prior surgery or scarring in the anterior neck
  • Small goiter size

References

  1. 1.0 1.1 Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, Rivkees SA, Samuels M, Sosa JA, Stan MN, Walter MA (2016). "2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis". Thyroid. 26 (10): 1343–1421. doi:10.1089/thy.2016.0229. PMID 27521067.
  2. Hurley DL, Gharib H (1996). "Evaluation and management of multinodular goiter". Otolaryngol. Clin. North Am. 29 (4): 527–40. PMID 8844728.
  3. "www.bprcem.com".
  4. "Thyroid nodules: pathogenesis, diagnosis and treatment - Best Practice & Research Clinical Endocrinology & Metabolism".
  5. Moalem J, Suh I, Duh QY (2008). "Treatment and prevention of recurrence of multinodular goiter: an evidence-based review of the literature". World J Surg. 32 (7): 1301–12. doi:10.1007/s00268-008-9477-0. PMID 18305998.
  6. 7.0 7.1 "Comparison of the Complications of Subtotal, Near Total and Total Thyroidectomy in the Surgical Management of Multinodular Goitre".
  7. Pelizzo MR, Bernante P, Toniato A, Fassina A (1997). "Frequency of thyroid carcinoma in a recent series of 539 consecutive thyroidectomies for multinodular goiter". Tumori. 83 (3): 653–5. PMID 9267482.
  8. "Complications after Total ThyroidectomyOtolaryngology-Head and Neck Surgery - Larry J. Shemen, Elliot W. Strong, 1989".
  9. "Morphological and functional polymorphism within clonal thyroid nodules | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic".

Template:WH Template:WS