Comparison of total thyroidectomy, bilateral subtotal thyroidectomy and Dunhill operations in the treatment of benign thyroid disorders.

AIM: The surgical treatment of benign thyroid disease is still controversial. Many treatment modalities have been described for the surgical management of various thyroid diseases, including excision, bilateral subtotal thyroidectomy (BST), near-total thyroidectomy, and total thyroidectomy (TT). METHODS: Hospital records were reviewed for 2863 patients who underwent thyroid surgery for presumed multinodular goiter (MNG) between 1990 and 2009. However, due to the inefficiency of the hospital archive system, we were able to access detailed personal and surgical information for only 803 patients. RESULTS: Of the 803 patients, 227 (28.3%) underwent DP, 228 (28.4%) BST and 348 (43.3%) TT operations. While there were no complications in 683 (85.1%) of the 803 operations, complications developed with 120 (14.9%). A definite difference between TT and the other (BST and DP) types of operation in relation to complications. The duration of hospital stay was 2.2±0.4 days for the BST group, 2.2 ± 0.4 days for the DP group and 2.3 ± 0.7 days for the TT group. There was a significant difference among all three groups. Recurrence rates of the operations performed were 35 (15.3%), 20 (8.8%) and 4 (1.15%), respectively, for BST, DP and TT. There was significant difference between the recurrence rates of TT and BST, and between TT and DP. CONCLUSION: When the frequency of complications in recurrent operations and the malignity possibility of the thyroid tissue left behind are taken into consideration, we believe that TT will be more beneficial in the surgical treatment of benign thyroid disorders.

The effect of growth hormone on 24-h urinary creatinine levels in burned patients.

Catabolism is increased in burned patients. Creatinine excreted in urine is accepted as an indicator of catabolism of muscle mass. Growth hormone (GH) is one of the most potent anabolic agents. We investigated the effect of GH on 24-h urinary creatinine levels as an indicator of catabolism of muscle mass in burned patients. In 20 patients with severe burns, 24-h urinary creatinine levels were investigated for 3 days following hospitalisation. Then the patients were divided into two groups of 10. In the study group, following investigation of 24-h urinary creatinine levels for 3 days, GH 0.1 mg/kg was injected subcutaneously three times in a week. Following the last dose of GH, 24-h urinary creatinine levels were investigated for 3 days again. In the control group, an equal volume of isotonic saline solution was injected at the same times instead of GH, and 24-h urinary creatinine levels were investigated for 3 days again. Mean burn size and age were not significantly different between the groups. 24-h urinary creatinine level obtained in the early period was 48.5+/-16.6 mg/day in the study group and 49.9+/-11.3 mg/day in the control group. There was no statistical difference between these two values (p>0.5). 24-h average urinary creatinine level obtained in the late period was 36.6+/-16.4 mg/day in the study group and 50.6+/-9.9 mg/day in the control group, and the difference was statistically significant (p<0.05). In the comparison of early and late 24-h urinary creatinine levels in the study group, there was a statistically significant difference between these two values (p<0.05). In the control group, there was no difference between early and late 24-h urinary creatinine levels (p>0.5). We concluded that GH is effective in decreasing urinary creatinine excretion. This decrease in urinary creatinine excretion may be associated with diminished muscle catabolism.