Surgical hyperthyroidism: Epidemiological aspect and management difficulties in the visceral surgery department of the Donka National Hospital

Introduction: The aim of this study was to assess the epidemiological aspect and the difficulties associated with the surgical management of hyperthyroidism in our context. Hyperthyroidism is an over function of the thyroid gland resulting in thyrotoxicosis. Thyroidectomy is one of the Main treatments. It also uses synthetic antithyroid drugs, radioactive iodine. Methodology: We carried out a descriptive 6-year retrospective from January 1, 2011 to December 31, 2017 inclusively. Our study variables were qualitative and quantitative, Results: During our study, 26 cases were collected between January 2011 and August 2017 with a predominance of 73% female and an average age of 52, 78 years. The clinic was dominated by the signs of thyrotoxicosis which were found in all patients. The exploration identified 14 cases of toxic multi-hetero nodular goiter, ie 53.84%; 9 cases of basal disease 34, 66% and 3 cases of toxic adenoma 11, 54%. Medical preparation was required in all our patients Total thyroidectomy was performed in one patient, i.e. 4%, and Lobo isthmectomy in 24 patients, ie 96%. Postoperatively, complications were collected: 1 case of intraoperative hemorrhage 20%; 1 case of postoperative hematoma 20%; 1 case of dysphonia 20%. Conclusion: Surgery for toxic goiter known to be hemorrhagic and adherent should be performed after obtaining euthyroidism and double vigilance to minimize the morbidity represented mainly by laryngeal paralysis and hyperparathyroidism

Thyrotoxicosis treatment with lithium corbanate. Cases reported

Treatment of thyrotoxicosis caused by Graves’ disease or multinodular toxic goiter, is not difficult, in most cases, since the prescription of thionamides allows to normalize the level of thyroid hormones quickly and safety. But in a number of cases this therapy might be associated with serious side effects (agranulocytosis, toxic hepatitis, cholestasis), severe allergic reactions and also individual intolerance on thionamides. In such cases lithium carbonate is used, especially in severe thyrotoxic syndrome. It is known, that lithium can accumulate in the thyroid gland at a concentration 3–4 times higher than in the plasma. Perhaps, lithium uses Na+/I- ions. It can inhibit the synthesis and secretion thyroid hormones of thyroid gland. The article presents the cases reported the use of lithium carbonate in thyrotoxicosis treatment before thyroidectomy. Administering low doses of carbonate lithium (900 mg/ per day) renders significant decrease or normalization of thyroid hormones concentration within 7–14 days, thus it let perform thyroidectomy on the patients. No side effects have been identified with such a short course of lithium carbonate treatment.

Surgical treatment of recurrent goiter

The causes of postoperative goiter recurrence and the tactics of their treatment have not yet been sufficiently studied. The frequency of relapses of diffuse toxic goiter varies widely (O. V. Nikolaev and F. A. Agafonov, 1957 - 0.2%; E. S. Drachinskaya, 1954 - 2%; N. I. Truten, 1956 - 1, 5%), According to the combined statistics of 60 authors, concerning 43818 operations for goiter (F.A.Agafonov, 1948), the recurrence rate is 6.4.

Immediate complications after surgery for toxic goiter

The direct complications were studied in 260 patients with thyrotoxicosis who were operated on in our clinic; in addition, the data on 16 patients who died after subtotal strumectomy in various medical institutions of the Altai Territory were analyzed.

Analysis of complications of surgical treatment of patients with autoimmune thyroiditis

Aim — to study the frequency and structure of specific complications in surgeries for autoimmune thyroiditis AIT associated with benign nodules in comparison with operations for multinodular non-toxic goiter. Materials and methods. The analysis of complications of thyroidectomy was performed for 237 patients operated for AIT (main group) and 261 for multinodular non-toxic goiter (control group). The evaluation was done to assess thesurgeryduration, the frequency of laryngeal paresis, postoperative hypoparathyroidism, thoracic duct damage, intense neck hematomas, dysphagia and changes in voice tone. Results. More complications were found in patients of the main group — 33 against 20 in the control group. The structure and number of individual complications from their total number in both groups was the same, and the frequency of the number of operated patients was significantly higher in the group of patients with AIT. The duration of thyroidectomy in AIT was (174.3 ± 4.2) min and depended on the severity of inflammatory changes in the gland and tissues around it, and in cases of multinodular non-toxic goiter — (127.0 ± 4.7) min (p < 0.01). Conclusions. Thyroidectomy for AIT compared to multinodular non-toxic goiter is accompanied by a greater number of complications and duration of surgery. There is an increased risk of developing hypoparathyroidism, laryngeal paresis, thoracic duct injuries, severe neck hematomas, dysphagia and changes in voice tone.

Characteristics of patients with a lipoprotein(a) assessment – a health insurance claims database analysis

Background Elevated lipoprotein(a) [Lp(a)] has been established as marker of cardiovascular [CV] risk, however, it is not commonly assessed. Purpose The aim of the study was to characterize patients who underwent their first Lp(a) testing regarding sociodemographic characteristics and clinical outcomes. Methods A retrospective analysis was performed on data from 4 million individual patients in a local database that provides complete, longitudinal, anonymized claims data. The data are representative of the German population in terms of age and gender. Lp(a) billing codes documented in the ambulatory setting were used to identify adult patients in 2015 to 2018 (index quarter defined as the first Lp(a) test in the respective year). These patients must not have had any Lp(a) test in the year prior to the index quarter. Patient data needed to be available for at least 1 year before and 1 year after the Lp(a) test or until death, whichever came first. Patients were followed for a maximum of four years. Results Within the four-year period, 36.609 patients (0.83% of the analysis set) had an Lp(a) test, of whom the majority (58%) were women. 50% of the women (median age 49 years) and 32% of the men (median age 56 years) were younger than 50 years. The most prevalent comorbidities (based on International Classification of Diseases, version 10, German modification) at index were: dyslipidemia (E78) 46%, essential hypertension (I10) 46%, dorsalgia (M54) 25%, overweight/obesity (E66) 18%, chronic ischemic heart disease (I25) 16%, type 2 diabetes mellitus (E11) 15%, other coagulation defects (D68) 14%, depressive episodes (F32) 14%; disorders of refraction and accommodation (H52) 13%, somatoform disorders (F45) 13%, other non-toxic goiter (E04) 13%, other hypothyroidism (E03) 13%, and chronic kidney disease (N18) 11%. The rates of cardiovascular events and procedures are listed in the table below. Conclusions Lp(a) tests are rarely performed in Germany. Women are more often tested than men, and in women this is done at a younger age. The data suggest that CV events/ CV hospitalizations frequently trigger the first Lp(a) assessment. The population tested displayed a high prevalence of cardiovascular comorbidities. The data identify an opportunity to better characterize the CV risk by testing Lp(a) once in a lifetime independent of prior CV events as recommended by current European Society of Cardiology/European Atherosclerosis Society guidelines. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): The analysis has been funded by Novartis Pharma GmbH, Nuremberg.

Changes of hematological indices in patients with diffuse toxic goiter

Objective. To reveal the incidence of various morphological types and degrees of the anemia severity in patients with diffuse toxic goiter. Materials and methods. Data of medical histories of 157 patients, operated for diffuse toxic goiter in 2012 yr were analyzed. In accordance to hematological indices estimated there were outlined two Groups of patients: Group I – 98 patients with diffuse toxic goiter and mild anemia, average age (39.4 ± 1.4) yrs old, 57 (58.2%) women and 41 (41.8%) men, and Group II – 59 patients with diffuse toxic goiter and middle degree of the anemia severity, average age (41.1 ± 1.7) yrs old, 48 (81.4%) women and 11 (18.6%) men. Levels of hemoglobin, hematocrit, quantity and average volume of erythrocytes, average content of hemoglobin in one erythrocyte, average concentration of hemoglobin in the erythrocytes were determined in the blood analysis. Results. Microcytic type of anemia was noted in 89.8% of patients with anemia of middle degree of severity, while a normocytic one – in 10.2%; in mild anemia – in 87.8 and 12.2% patients, accordingly. Hypochromic and normochromic types of anemia with equal rate were revealed in mild anemia and anemia of middle degree of severity: hypochromic – in 94.9%, normochromic – in 5.1% patients. Conclusion. Diffuse toxic goiter is characterized by more frequent development of mild (62.4%), microcytic (88.5%), hyperchromic (94.9%) anemia, caused by iron deficiency.

TRANSORAL THYROIDECTOMY AND PARATHYROIDECTOMY: SERIES OF CASES

Objective. To present the results of the author’s own series of transoral operations in patients with pathology of the thyroid and parathyroid glands. Methods. Transoral surgery was performed in women (n=20) and (n=1) man. All patients were operated on for the primary disease and met the selection criteria based on ultrasound and cytological examinations, hormonal levels, and somatic status. Indications for surgery were: nodular goiter in 17 cases, diffuse toxic goiter - in 2 cases, parathyroid adenoma - in 2 cases. The surgical technique included a three-port approach in the lower fornix of the vestibule of the mouth and a gas technique for maintaining the working cavity. Standard laparoscopic instruments and an energy based ultrasonic device were used for the operation. In the postoperative period, patients underwent a test for subjective assessment of the aesthetic result of the operation using the survey of thedermatology life quality index. Results. Thyroidectomy was performed in 4 patients, hemithyroidectomy - in 15 patients and parathyroidectomy - in 2 patients. In one patient, transoralparathyroidectomy was performed as a part of a simultaneous operation for multiple endocrine neoplasia type 1 syndrome. Papillary cancer T1N0M0 was verified in two patients after surgery. The mean operation time was 196.1 min (range 110 - 300 min). Average blood loss - 3 9.5 ml (range 10 - 300 ml). The nineth operation required the conversion due to severebleeding. In one case, the temporary recurrent laryngeal nerve(RLN)injury was reported, in one case - hematoma. After surgery, the median and average values of thedermatology life quality index were 1 (IQR 0-4) and 2.05, respectively, which indicates an insignificant effect on the quality of life. Conclusion. Transoral endoscopic surgery on the thyroid and parathyroid glands would be thepromising optimal choice in patients to avoid scarring on the neck.

Thyrotoxicosis and dilated cardiomyopathy in developing countries

Background Thyrotoxicosis is the state of thyroid hormone excess. But, in sub-Saharan Africa (SSA), specifically Northern Ethiopia, scientific evidence about thyrotoxicosis and its cardiac complications like dilated cardiomyopathy is limited. Therefore, this study aimed to explore the thyrotoxicosis presentation and management and identify factors associated with dilated cardiomyopathy in a tertiary hospital in Northern Ethiopia. Methods An institution-based cross-sectional study was conducted in Ayder Comprehensive Specialized Hospital from 2017 to 2018. Data from 200 thyrotoxicosis cases were collected using a structured questionnaire. After describing variables, logistic regression was conducted to identify independent predictors of dilated cardiomyopathy. Statistical significance was declared at p < 0.05. Results Mean age at presentation of thyrotoxicosis was 45 years and females accounted for 89 % of the cases. The most frequent etiology was multinodular toxic goiter (51.5 %). As well, the most common symptoms and signs were palpitation and goiter respectively. Thyroid storm occurred in 6 % of the cases. Out of 89 patients subjected to echocardiography, 35 (39.3 %) of them had dilated cardiomyopathy. And, the odds of dilated cardiomyopathy were higher in patients who had atrial fibrillation (AOR = 15.95, 95 % CI:5.89–38.16, p = 0.001) and tachycardia (AOR = 2.73, 95 % CI:1.04–7.15, p = 0.040). All patients took propylthiouracil and 13.0 % of them experienced its side effects. Concerning β-blockers, propranolol was the most commonly (78.5 % of the cases) used drug followed by atenolol (15.0 %). Six patients underwent surgery. Conclusions In developing countries like Ethiopia, patients with thyrotoxicosis have no access to methimazole which is the first-line anti-thyroid drug. Besides, they greatly suffer from dilated cardiomyopathy (due to late presentation) and side effects of propylthiouracil. Therefore, we recommend that patients should get adequate health information about thyrotoxicosis and anti-thyroid drugs including their side effects. Additionally, hospitals and other concerned bodies should also avail of TSH tests and methimazole at an affordable cost. Furthermore, community awareness about iodized salt and iodine-rich foods should be enhanced.