Toxic multinodular goiter surgery: Difference between revisions
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==Surgery== | ==Surgery== | ||
Surgery is the mainstay of treatment for Toxic multinodular goiter. | Surgery is the mainstay of treatment for Toxic multinodular goiter.<ref name="urlonline.liebertpub.com">{{cite web |url=http://online.liebertpub.com/doi/pdf/10.1089/thy.2016.0229 |title=online.liebertpub.com |format= |work= |accessdate=}}</ref><ref name="pmid8844728">{{cite journal |vauthors=Hurley DL, Gharib H |title=Evaluation and management of multinodular goiter |journal=Otolaryngol. Clin. North Am. |volume=29 |issue=4 |pages=527–40 |year=1996 |pmid=8844728 |doi= |url=}}</ref><ref name="urlTreatment and Prevention of Recurrence of Multinodular Goiter: An Evidence-based Review of the Literature | SpringerLink">{{cite web |url=https://link.springer.com/article/10.1007%2Fs00268-008-9477-0 |title=Treatment and Prevention of Recurrence of Multinodular Goiter: An Evidence-based Review of the Literature | SpringerLink |format= |work= |accessdate=}}</ref> | ||
===Indications=== | ===Indications=== | ||
Indications of surgery for multinodular goiter (MNG) includes: | Indications of surgery for multinodular goiter (MNG) includes: | ||
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===Surgical procedures=== | ===Surgical procedures=== | ||
Almost all multinodular goiters can be surgically removed through a collar incision. An additional thoracotomy is very rarely necessary. | Almost all multinodular goiters can be surgically removed through a collar incision. An additional thoracotomy is very rarely necessary. | ||
====Total thyroidectomy==== | |||
Benefits of total thyroidectomy include: | |||
*Adequate removal of the diseased gland | |||
*Prevention of recurrence | |||
*Avoidance of completion surgery in case of [[malignancy]] | |||
====Subtotal thyroidectomy==== | ====Subtotal thyroidectomy==== | ||
Bilateral [[thyroidectomy|subtotal thyroidectomy]] is effective in the treatment of multinodular goiter (with hot or cold nodules). | Bilateral [[thyroidectomy|subtotal thyroidectomy]] includes total lobectomy on the dominant lobe and subtotal lobectomy on the contralateral lobe. Bilateral [[thyroidectomy|subtotal thyroidectomy]] is effective in the treatment of multinodular goiter (with hot or cold nodules). | ||
Benefits of Subtotal thyroidectomy: | |||
*Comparable to total thyroidectomy | |||
*Low incidence of [[hypoparathyroidism]] | |||
====Unilateral Lobectomy==== | ====Unilateral Lobectomy==== | ||
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*Post-operative [[hypothyroidism]] | *Post-operative [[hypothyroidism]] | ||
*Recurrent [[laryngeal palsy]] | *Recurrent [[laryngeal palsy]] | ||
*[[Hypocalcaemia]] | *[[Hypocalcaemia]] secondary to [[hypoparathyroidism]] | ||
==References== | ==References== |
Revision as of 21:09, 9 October 2017
Toxic multinodular goiter Microchapters |
Differentiating Toxic multinodular goiter from other Diseases |
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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]
Indications
Indications of surgery for multinodular goiter (MNG) includes:
- Rapid enlargement of goiter
- Rapidly enlarging thyroid nodules
- FNAC is positive or suspicious of malignancy
- Compression of trachea, esophagus, and other neck structures
- Substernal thyroid extension
- Co-existence of hyperparathyroidism
- Risk of malignancy
- Suspicious cervical lymphadenopathy
- Radiation exposure
Surgical procedures
Almost all multinodular goiters can be surgically removed through a collar incision. An additional thoracotomy is very rarely necessary.
Total thyroidectomy
Benefits of total thyroidectomy include:
- 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). Benefits of Subtotal thyroidectomy:
- Comparable to total thyroidectomy
- Low incidence of hypoparathyroidism
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:[4][5][6]
- Post-operative hypothyroidism
- Recurrent laryngeal palsy
- Hypocalcaemia secondary to hypoparathyroidism
References
- ↑ "online.liebertpub.com".
- ↑ Hurley DL, Gharib H (1996). "Evaluation and management of multinodular goiter". Otolaryngol. Clin. North Am. 29 (4): 527–40. PMID 8844728.
- ↑ "Treatment and Prevention of Recurrence of Multinodular Goiter: An Evidence-based Review of the Literature | SpringerLink".
- ↑ 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.
- ↑ "Complications after Total ThyroidectomyOtolaryngology-Head and Neck Surgery - Larry J. Shemen, Elliot W. Strong, 1989".
- ↑ "Morphological and functional polymorphism within clonal thyroid nodules | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic".