Comprehensive study of Thyrotoxicosis

INTRODUCTION: Thyrotoxicosis is a syndrome which is caused by excessive secretion of thyroid hormone. Goitre is derived from the Latin word Guttur which means throat. The thyroid gland is first documented by Italians of the renaissance period. The term Thyroid (Greek Thyreoeides, Shield Shaped) is attributed to Thomas Wharton. Bernard courtois discovered iodine in the ash of burnt seaweed.The first accounts of thyroid surgery dates back to Roger Frugardi in 1170. The most notable thyroid surgeons were Emil Theodor Kocher (1841 – 1917) & Theodor Billroth (1829 – 1894). Emil Theodor Kocher of Berne is regarded by many as Father of Thyroid Surgery. In 1909, Kocher Received The Nobel Prize for medicine in recognition “for his works on physiology , pathology , & surgery y of thyroid gland. AIM OF THE STUDY: 1. Review the data regarding the prevalence of Thyrotoxicosis & its association with standard variables. 2. Discuss the various clinical presentations of thyrotoxicosis. 3. Discussion of etiopathogenesis in thyrotoxicosis. 4. Discussion of various treatment modalities. 5. Evaluate a cost effective treatment for a country like ours. 6. Discuss the complications of treatment & follow up. MATERIALS AND METHODS: This is a prospective study of randomly selected patients who presented with hyperthyroid symptoms, toxic goiter who were diagnosed & treated at Kilpauk Medical College Hospital, Chennai during the period of September 2004 – September 2006. Each patient’s symptoms & signs were entered in proforma with detailed clinical examination in relation to thyroid. All the patients were subjected to basic investigations like complete hemogram, blood sugar, urea, urine analysis, chest X-ray. Thyroid profile TotalT4, TotalT3, TSH done for all the patients. X – ray neck, E.C.G. were taken for the cases. Ultrasonogram of thyroid & Radio Isotope study was not done since the facility is not available in our hospital. Since Radio Iodine ablation therapy is not available in our hospital, our patients were treated with either antithyroid drugs or surgery. Surgery was the mode of treatment offered to all the patients. But out of 50 cases, surgery was done for only 45 cases & for rest of the 5 patient surgery was deferred due to various reasons & those five patients were treated with antithyroid drugs only. The 45 patients who were planned for surgery were put on anti thyoird drugs as part of pre operative preparation to euthyroid status & to prevent thyrotoxic crisis. They were monitored by daily sleeping pulse chart, periodic 50 weight monitoring, & by symptomatic improval. Surgery was done after pre operative preparation to euthyroid state with anti thyroid drugs. Pre Op Preparation : Most of our patients required an average dose of Carbimazole 10 mg 8th hourly. And propranolol was also given in a dose of 40 mg 12th hourly for patients with severe toxic symptoms. And 10 days prior to surgery, Lugol’s iodine 5 – 10 drops 8th hourly was given to patients. Few patients were given Colloidal iodine instead of Lugol’s iodine. Night sedation was given with Dizepam or Alprazolam. SURGERY in the form of → SUBTOTAL or NEAR TOTAL or TOTAL THYROIDECTOMY was done. Post operative complications were analysed & the patients regularly followed up. The patients in whom surgery was deferred were treated with antithyroid drugs. Total T4 level 3 months after surgery (for 45 patients)& Total T4 level 3 months after medical therapy (for 5 patients) were measured & analysed. All the observations were analysed & compared with standard results. CONCLUSION: In this study a comprehensive account of history , anatomy, physiology with a detailed account of the clinicopathological aspects, presentations & various modalities of treatment of thyrotoxicosis have been dealt with. 50 cases of thyrotoxicosis have been dealt with. From the evidence, it is clear that after adequate control of toxicity with anti thyroid drugs, surgery is the modality of treatment that can be safely offered to patients with thyrotoxicosis in our set up. This present study confirms the observation made by the reputed authors & emphasizes the importance of perfect & sufficient pre operative preparation, meticulous surgical technique, detailed knowledge about anatomy of thyroid, parathyroid & associated nerves assures complete remission with negligible morbidity & nil mortality