Surgery for thyroid goiter in western India. A prospective analysis of 334 cases.

334 consecutive cases of thyroid swellings operated by a single surgical unit over 9 years have been analysed prospectively. There was a female preponderence (4.39:1). The swellings were clinically differentiated into uninodular (39.52%), multinodular (47.31%) and diffuse (13.17%). Hyperthyroidism was manifested in 49 cases (14.67%). Pressure symptoms were present in only 1.5% cases. FNAC detected malignancy in 14 of 162 cases (8.64%). The initial 100 cases were operated upon by standard Lahey's technique and the latter 234 by modified technique described by Bapat et al for benign thyroid disease. Operations performed included nodulectomies (5.39%), hemithyroidectomies (41.92%), partial thyroidectomies (25.75%), subtotal (25.45%) and near total thyroidectomies (1.5%). Post-operative complications were higher in the first group and included unilateral cord palsies-5 (5%). hypocalcemia-4 (4%) hypoparathyroidism-1 (1%) haemorrhage-1 (1%) and mortality-1 (1%) vis a vis cord palsies-2 (0.85%), hypocalcemia-3 (1.28%), hypoparathyroidism-1 (0.43%) and there was no mortality. Histopathology revealed 83 (24.85%) colloid goiters, 193 (57.78%) nodular goiters, 21 (6.29%) follicular adenomas, 7 (2.10%) cases of thyroiditis and 30 (8.98%) malignancies. This study reveals the lower incidence of RLN palsy after modified thyroidectomies, and a low incidence of malignancy.

Menstrual irregularities and lactation failure may precede thyroid dysfunction or goitre.

Menstrual and reproductive history of 178 women referred to the thyroid clinic was compared with 49 healthy controls. Cases were classified as euthyroid, hypothyroid or hyperthyroid after clinical examination and after serum T3, T4, TSH measurements. Reproductive history was related chronologically to symptoms and signs of thyroid dysfunction. Only 31.8% of hypothyroid and 35.3% of hyperthyroid women had normal menstrual pattern in contrast with 56.3% of Euthyroid and 87.8% of healthy controls (p < 0.001). Reproductive failure (infertility, pregnancy wastage, failure of lactation) occurred in 37.5% of hypothyroid and 36.5% of hyperthyroid cases against 16.3% of euthyroid and 16.7% of healthy controls (p < 0.05). Interestingly, in 45% of cases with menstrual abnormality, the anomaly was antecedent to other clinical features by a variable period of two months to ten years. Reproductive failure and lactation failure also preceded thyroid dysfunction or goitre. Reproductive dysfunction may therefore be considered as one of the presenting symptoms of thyroid disorders in women, keeping in mind both menstrual irregularities and lactation failure may also arise from other common or idiopathic origins. Especially in women with menstrual irregularities in the perimenopausal age if thyroid dysfunction is detected, pharmacotherapy may be a superior alternative to surgical interventions like hysterectomy.

Analysis of 105 uninodular goitres.

Data on 105 solitary thyroid nodules, confirmed at surgery to be solitary, is presented. Six (5.7%) were malignant, 4 papillary and 2 follicular. The sensitivity and the specificity of 131I radionuclide thyroid scan (n = 90) were 100% and 24% respectively. Similarly, the sensitivity and specificity of fine needle aspiration cytology (n = 65) was 75% and 100% respectively. In both instances, the "gold standard" was the histopathology of the surgically removed nodule. In order to avoid unnecessary surgery, without missing malignancy, we would recommend the combination of radionuclide thyroid scan and FNAC for investigation of solitary thyroid nodules.

Antipyrine and doxycycline pharmacokinetics in patients with thyroid disorders.

Pathological conditions are known to affect pharmacokinetics of many drugs. Antipyrine half-life is used as a marker of liver microsomal enzyme function. Antipyrine pharmacokinetics, therefore, was investigated in 23 thyrotoxic and 11 euthyroid goitre patients. Of these, 11 thyrotoxic and 9 euthyroid goitre patients also participated in doxycycline bioavailability studies. In thyrotoxic patients, antipyrine half-life and AUCo infinity and doxycycline Cpmax and AUCo infinity were found to be reduced as compared to those of healthy euthyroid normal subjects. Following treatment of thyrotoxicosis, the antipyrine half-life and AUCo infinity returned to normal. Doxycycline AUCo infinity returned to near normal range but Cpmax did not.