Alsaleh Nuha, Albaqmi Kholoud, Alaqel Maram
Department, College of Medicine King Khalid University Hospital King Saud University Medical City King Saud University Riyadh, KSA Po Box 7805, Riyadh, 11472, Saudi Arabia.
Department of General Surgery, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.
Ann Med Surg (Lond). 2021 Feb 20;63:102140. doi: 10.1016/j.amsu.2021.01.088. eCollection 2021 Mar.
This case series describe the efficacy of hemi-thyroidectomy to relieve the compressive symptoms of cases having large multi-nodular goiter with preservation of the thyroid gland function. It's considered as an education tool for surgeons to perform safe hemi thyroidectomy to patients indicated for total removal of the gland. Compressive symptoms like mild/severe dysphagia or dyspnea associated with both benign and malignant thyroid disease. Although total thyroidectomy is currently considered the standard of care, hemi thyroidectomy is another surgical option with more benefits.
This case series was performed in a tertiary university hospital in Riyadh, Saudi Arabia. It included 35 females and 3 males above the age of 18 (mean age 42 years). All the operations were elective hemi-thyroidectomies performed by one surgeon, during 2019. Patients were complaining of; Voice Change, Neck Swelling, Dysphagia, Chocking, SOB, and Orthopnea. 20 of them were medically free and 18 patients had multiple associated comorbidities.
Demographic data, baseline co-morbidities, TSH levels prior to surgery, thyroid gland size, FNA results and pre-operative symptoms were recorded. In addition, compressive symptomatology outcomes from two weeks to two years were recorded. Thirty-two of them (84%) had their symptoms resolve completely and did not need a completion surgery. Out of the 6 who had persistent symptoms, only two needed a completion surgery. Furthermore, only 34.2% required thyroid hormone replacement, 31.6% were euthyroid and 2.6% were hypothyroid preoperatively.
Hemi thyroidectomy was chosen to avoid the risk of hormone replacement, and hypocalcemia. Our results revealed that compressive symptoms were effectively relieved in the majority of our patients. Only 2 patients had to undergo completion thyroidectomy due to compressive symptoms with no perioperative or postoperative complications.
We would recommend hemi thyroidectomy for cases of large multi nodular goiter due to its positive implication on patient outcome particularly if the patient refuse hormonal replacement.
本病例系列描述了半甲状腺切除术在缓解患有巨大结节性甲状腺肿病例的压迫症状同时保留甲状腺功能的疗效。它被视为一种教育工具，供外科医生为适合全甲状腺切除的患者进行安全的半甲状腺切除术。压迫症状如与良性和恶性甲状腺疾病相关的轻度/重度吞咽困难或呼吸困难。尽管目前全甲状腺切除术被视为标准治疗方法，但半甲状腺切除术是另一种具有更多益处的手术选择。
本病例系列在沙特阿拉伯利雅得的一家三级大学医院进行。包括35名女性和3名18岁以上男性（平均年龄42岁）。所有手术均为2019年由一名外科医生进行的择期半甲状腺切除术。患者主诉有声音改变、颈部肿胀、吞咽困难、哽噎感、呼吸急促和端坐呼吸。其中20人无其他疾病，18名患者有多种合并症。
记录人口统计学数据、基线合并症、术前促甲状腺激素水平、甲状腺大小、细针穿刺活检结果和术前症状。此外，记录了从两周到两年的压迫症状学结果。其中32人（84%）症状完全缓解，无需进行补充手术。在6名症状持续的患者中，只有2人需要进行补充手术。此外，术前仅34.2%的患者需要甲状腺激素替代治疗，31.
