Thyroid surgery without drainage: 15 years of clinical experience

Drainage in thyroid surgery has been a routine but empirical practice with no scientific evidence to support its benifit. The largest series to date of nondrainage in thyroid surgery is presented, comprising 260 patients over a 15-year perios. No case selection for non-drainage was employed. Two hundred and fifty-nine cases were not drained and included toxic goitres, and bilateral and redo procedures. There was one thyroid storm and two cases of subcantaneous fluid collection, treated by needle aspiration. No cases of recurrent laryngeal nerve injury, airway obstruction or death were recorded. This study strongly demonstrates the safety of non-drainage in routine thyroid surgery (AU)

Autoantibodies and autoimmune disease in Jamaica

This study investigated the repertoire of autoantibodies found in normal healthy Jamaicans as it relates to the efficacy of laboratory diagnosis of autoimmune disease. Clinical, immunological and genetic features of certain autoimmune diseases as they occur in Jamaicans were also examined. A number of immunological techniques were applied. There was no marked female preponderance of thyroid autoantibodies in the normal population although autoimmune thyroid disease was found predominantly in females. This indicates that gonadal hormones may be important in the development of disease. The low frequency and concentrations in which islet cell autoantibodies occur in Jamaican type 1 diabetics (3.2 percent) supports a non-pathogenetic role for these antibodies (Chapter 6). The bimodal clinical distribution of myasthenia gravis found elsewhere was not observed in Jamaicans (Chapter 10). There was no female preponderance in the ocurrence of rheumatoid factors. The frequency of certain ARA criteria were statistically significantly lower in Jamaican systemic lupus erythematosus (SLE) patients compared with American patients. Several HLA associations were found with myasthenia gravis, SLE and rheumatoid arthritis although these were mostly weak. The data obtained herein will contribute to the improvement in diagnosis and management of autoimmune diseases in Jamaica and the lack of understanding of the pathogenesis of autoimmune diseases

Evaluation of thyroid nodules by fine needle aspiration cytology: a prospective study

A prospective study of 200 fine aspiration cytology specimens from 194 patients with thyroid nodules at the University Hospital of the West Indies in Jamaica showed a 95 percent accuracy when the results were compared with histopathology reports of the subsequent thyroidectomy surgical specimens in 86 patients. The false negative rate was 3 percent (for neoplasia), and there was a false positive rate of 10.5 percent. Fine needle aspiration cytology thus proves to be an accurate, specific and sensitive method of assessment of thyroid nodules which ultimately reduces unnecessary surgical intervention (AU)

Thyroid disease in Trinidad

A 5-year review of 460 consecutive thyroidectomy specimens showed goitrous hyperplasia to be the commonest thyroid disease in Trinidad. The incidence of thyrotoxicosis (19) percent is higher than that reported from India and Africa, whereas the occurrence of cancer (4 percent) is one of the lowest reported.(AU)