Hyperthyroidism
Thyrotoxicosis
Definition
A disease condition resulting from a raised level of circulating thyroid hormones.
Clinical types
Diffuse toxic goitre (Grave's disease)
Toxic nodular goitre
Toxic nodule
Hyperthyroidism due to other causes (rare)
Clinical Features
The symptoms are : -
tiredness
emotional lability
heat intolerance - a recent preference for cold
weight loss - loss of weight inspite of good appetite
excessive appetite
palpitations
The signs are : -
hot moist palms
agitationlid
lag/retraction
exophthalmos - manifestations of thyrotoxicosis not due to hyperthyroidism per se : orbital proptosis, ophthalmoplegia, pretibial myxoedema ,
tachycardia - arrhythmias - multiple extrasystoles - paroxysmal atrial tachycardia, paroxysmal atrial fibrillation, persistent atrial fibrillation, not responsive to digoxin
thyroid goitre and bruit - thrill may be present. remissions and exacerbations common
myopathy - weakness of proximal limb muscels
more common in women
Pre-operative care
Preoperative investigations :
Thyroid function tests
Indirect Laryngoscopy
Thyroid antibodies estimation
Serum Calcium Estimation
An isotope scan in toxic nodular goitre if total thyroidectomy is not planned
Carbimazole 30 to 40 mg / day x 8 to 12 weeks
or
Propranalol 40 mg tds x 2 weeks
may be increased to achieve the euthyroid status upto 80 mg
Iodine may be given with carbimazole or propranalol for the 10 days before the operation to reduce vascularityst
Post-operative care
Look for stridor - bilateral vocal palsy
Look for carpopedal spasm - transient hypoparathyroidism - needs calcium gluvonate injection - estimate serum ionic calcium
Look for bleeding post-operatively - release sutures to avoid strangulation - don't wait for doctor
life long follow up
Complications after surgery
Haemorrhage
A sucutaneous haematoma or serous collection
Respiratory obstruction - rarely due to collapse or kinking of the trachea, due to laryngeal oedema caused by tension haematoma
Recurrent Laryngeal Nerve paralysis
Thyroid insufficiency
Parathyroid insufficiency
Thyrotoxic crisis - (storm)
Wound infection
Hypertrophic scar or formation of keloid
Stitch granuloma
