Outcome of thyrotoxicosis treatment with 3 different modalities

To assess the efficacy of 3 different treatment modalities for thyrotoxicosis and a comparison of their cost effectiveness. The case records of 100 patients treated for thyrotoxicosis at King Khalid National Guard Hospital in Jeddah were reviewed, during the period January 1992 through to January 2000. Their various treatments and responses were recorded as well as their thyriometabolic status, one year following the last treatment. The treatment consisted of an average of 9 months of antithyroid medication, thyroidectomy or treatment with radioactive iodide. Cure was defined as a patient being euthyroid or hypothyroid for a minimum period of at least one year. Cost-effectiveness was calculated as the total cost of treating the patient in a specific treatment modality, divided by those who were considered to be cured. For the remainder, the cost could not be definitively determined. The mean age was 41 +/- 15.7 years, with female to male ratio of 6:1. Grave's disease was the underlying cause in 76% of cases, toxic multinodular goiter in 13% and toxic nodule in 1%. Ninety-one patients, who were treated with anti-thyroid medication for an average of 9 months, had a success rate of 11%. The success rate with surgery was 54.5%, while of 68 patients treated with radioactive iodide 65 [96%] were cured. Radioactive iodide was the most cost effective modality of treatment costing 1700 Saudi Riyals, followed by surgery at 40,000 Saudi Riyals. Medical treatment was the most expensive at 135,000 Saudi Riyals per cure. A treatment of thyrotoxicosis with radioactive iodine is much more efficacious than medical or surgical modalities. Furthermore, it is by far the most cost effective and has no harmful effects

Hipertiroidismo y su tratamiento / Hyperthyroidism and its treatment

El hipertiroidismo afecta el 0,5 a 1,0 por ciento de la población general, siendo 10 veces más frecuente en la mujer que en el hombre. El 85 por ciento de los casos corresponde a enfermedad de Basedow-Graves de naturaleza autoinmune. El 15 por ciento restante se debe a bocio multinodular y adenoma tóxico, tiroiditis de Quervain, etc. Hay casos iatrogénicos tales como los debido a administración de amiodarona. El cuadro clínico es una combinación de manifestaciones de tirotoxicosis, bocio y oculopatía y de compromiso muscular y cardíaco. El tratamiento consiste en administración de drogas antitiroídeas (propiltiouracilo); yodo radioactivo y/o resección quirúrgica según los casos

Is the postoperative hypocalcemia after subtotal thyroidectomy for thyrotoxicosis considered a surgical complication?

This study included sixty patients who had subtotal thyroidectomy for thyrotoxicosis. Serum calcium was calculated for every patient preoperatively and on the second postoperative day. PTH level was also measured for every patient on the second postoperative day. Fourteen patients developed postoperative biochemical hypocalcemia and five patients had manifest tetany. PTH and postoperative serum calcium showed insignificant relation. There was no permanent hypocalcemia in this series. The results suggested that the postoperative serum calcium in patients subjected to subtotal thyroidectomy for thyrotoxicosis is directly related to the period of preparation of thyrotoxic patient [the shortest the period the more liability for postoperative hypocalcemia], the level of preoperative serum calcium [the more hypercalcemia, which was due to severe thyrotoxic osteodystrophy, the more liability for postoperative hypocalcemia]. There is no clear evidence for a radical change in surgical teaching from the lateral ligation of the inferior thyroid arteries to protect the recurrent laryngeal nerve

Tratamiento de la tirotoxicosis / Treatment of thyrotoxicosis

En una serie de 53 pacientes operados por tirotoxicosis en los últimos ocho años se analizaron retrospectivamente: etiología, duración del tratamiento preoperatorio, indicaciones del tratamiento quirúrgico, operaciones más frecuentemente realizadas, complicaciones posoperatorias (sobre todo hipoparatiroidismo y parálisis de las cuerdas vocales), seguimiento con especial énfasis en las recidivas y el hipotiroidismo y por último la mortalidad. Se compararon estos datos con los suministrados por la bibliografía internacional. Se concluye en nuestra serie: 1. excesiva duración del tratamiento médico preoperatorio; 2. ausencia de recidivas de la tirotoxicosis pero alto porcentaje (72,7 por ciento) de hipotiroidismo en la cirugía de la enfermdad de Graves-Basedow; 3. morbilidad: hipoparatiroidismo 0, parálisis de una cuerda vocal 3,7 por ciento, 4. mortalidad 0

Intraoperative hypertension during thyroidectomy for Graves' disease.

Hyperthyroidism is well known to be associated with cardiovascular manifestations. The authors have noted that patients of well controlled Graves' Disease often pose problems due to intrapoperative cardiovascular instability. Retrospective analysis of 137 case records of patients with Graves' disease (n = 35), toxic nodular goitre (n = 42) and those with euthyroid benign goitre (n = 60) were studied. In Graves' disease cardiovascular instability was found in the form of hypertension (n = 9) associated with tachyarrhythmia (n = 8) and bradycardia (n = 3). The incidence of first 2 of the above mentioned 3 problems was significantly higher in Graves disease (n = 9/35 patients) in contrast to a comparable group of patients with toxic nodular in (3/42 patients; P value 0.05) and euthyroid goiter (2/60 patients; P value < 0.001). Certain parameters such as high T3, T4 at the time of presentation were associated with higher incidence of these complications, in spite of very well controlled thyrotoxicosis. Whether heightened receptor sensitivity to catecholamines and higher renin-angiotensin activation explain these findings in Graves' disease, remains to be ascertained.