Hussain Mohamad, Hisham Abdullah N
Department of Breast and Endocrine Surgery, Putrajaya Hospital, Putrajaya, Malaysia.
Asian J Surg. 2008 Apr;31(2):59-62. doi: 10.1016/S1015-9584(08)60059-7.
Over the years, subtotal thyroidectomy has been the mainstay of treatment for toxic goitre; however, total thyroidectomy is increasingly being considered as the procedure of choice. This study aimed to review our experience with total thyroidectomy in toxic goitre and evaluate the outcome of this procedure.
A total of 67 consecutive patients who were diagnosed with toxic goitres and had total thyroidectomy from January 2003 to February 2005 were included in this prospective open study. The preoperative diagnosis in all patients was benign goitre. The surgical outcomes were reviewed with regard to mortality and morbidity.
A standardized operative technique was adopted and practiced among all surgeons in our department. Of the 67 patients with toxic goitre, 36 (53.7%) patients had toxic multinodular goitre (Plummer's disease) and 31 (46.3%) patients had diffuse goitre (Graves' disease). Although there were no documented injuries to the recurrent laryngeal nerves, one patient had temporary hoarseness of voice. In our series of total thyroidectomy, 18 patients (26.8%) developed transient hypocalcaemia but only one patient (1.5%) had persistent hypocalcaemia. Four (5.9%) patients had occult papillary thyroid cancer and one patient (1.5%) had Hashimoto's thyroiditis discovered on histological examination. There were no other postoperative complications except for wound infection in one patient (1.5%).
Total thyroidectomy should be considered as the procedure of choice for toxic goitres. It is paramount that sufficient attention be paid to the preservation of the laryngeal nerves and the parathyroid glands.
多年来，甲状腺次全切除术一直是毒性甲状腺肿的主要治疗方法；然而，甲状腺全切除术越来越被视为首选术式。本研究旨在回顾我们在毒性甲状腺肿患者中施行甲状腺全切除术的经验，并评估该手术的效果。
本前瞻性开放性研究纳入了2003年1月至2005年2月期间连续67例被诊断为毒性甲状腺肿并接受甲状腺全切除术的患者。所有患者术前诊断均为良性甲状腺肿。对手术死亡率和发病率进行了回顾性分析。
我们科室所有外科医生均采用并实施了标准化手术技术。67例毒性甲状腺肿患者中，36例（53.7%）为毒性多结节性甲状腺肿（普拉默病），31例（46.3%）为弥漫性甲状腺肿（格雷夫斯病）。虽然没有记录到喉返神经损伤，但有1例患者出现暂时性声音嘶哑。在我们的甲状腺全切除系列病例中，18例（26.8%）发生短暂性低钙血症，但只有1例（1.5%）出现持续性低钙血症。4例（5.9%）患者在组织学检查中发现隐匿性甲状腺乳头状癌，1例（1.5%）患者发现桥本甲状腺炎。除1例患者（1.5%）发生伤口感染外，无其他术后并发症。
甲状腺全切除术应被视为毒性甲状腺肿的首选术式。必须充分重视喉返神经和甲状旁腺的保护。
