Surgical treatment of hyperthyroidism in the north of Iraq: reduction in mortality and morbidity with a planned approach. Results of 544 operations with special reference to pre-operative treatment with carbimazole and thyroid hormones

ABSTRACT

To reduce mortality and morbidity to the lowest levels by a planned preparation of the patient for operation; treatment must be individualized and depends on the patient's age and general state of health, the size of the goitre, the underlying pathological process, and the patient's ability to obtain follow-up. A prospective study. Erbil Teaching Hospital [University Hospital] during the period from January 1994 to September 2004, Erbil-Iraq [population 2 million]. 632 patients with hyperthyroidism. All patients with hyperthyroidism [632] presenting to the department of surgery at Erbil teaching hospital during the period from January 1994 to September 2004; 544 were treated surgically and 88 were treated medically and with radio-iodine. Side effects of the anti-thyroid treatment [Thiocarbamide] were observed in 42 cases [7.7%]. Most patients were treated for an average of between 1 to 6 months. Thus it was possible to operate on the patient at a time suitable for the patient, surgeon and hospital. Carbimazole was the most frequently used anti-thyroid drug in Erbil Teaching Hospital. Surgery resulted in rapid cure of hyperthyroidism in 90% of patients and allowed for rapid relief of compressive symptoms. Frequency of hypothyroidism was similar to that of those treated with radioiodine [15.5%]; 10% developed recurrent thyrotoxicosis [p > 0.054]. Complications included permanent vocal cord paralysis [2.3%], permanent hypoparathyroidism [0.5%], temporary hypoparathyroidism [2.5%], and significant postoperative bleeding [1.4%]. The mortality rate was almost zero. Surgical therapy, in this study, was reserved for young individuals, patients with a large nodule [or nodules] or obstructive symptoms, patients with dominant non-functioning or suspicious nodules, patients who were pregnant, patients in whom radioiodine therapy had failed, or patients who required a rapid resolution of the thyrotoxic state. Sub-total thyroidectomy resulted in rapid cure of hyperthyroidism in 90% of our patients and allowed for rapid relief of compressive symptoms. This planned approach showed that the mortality rate between the years 1985 to 1993 was 7%, while the mortality rate reduced almost to zero between 1994 to 2004; the morbidity was reduced from 17% to about 4% during the same period