Diseases of the thyroid: some practical considerations from a surgical view point

The physiology of the thyroid gland and the basic principles underlying diagnostic tests have been outlined, and need to be understood if diseases of the thyroid are to be managed efficiently. In the choice of therapy for the thyrotoxic patient, consideration should be given to such features as safety, convenience, age, available skill and economics as well as the more obvious factors fo gland size, pressure effects and potential malignancy. Non toxic goitre is often a physiological process, and early institution of thyroxine replacement therapy may prevent the development of changes in the gland requiring surgery. However, the diffusely enlarged gland may be the site of a variety of disease processes, such as anaplastic malignancy or autoimmune thyroiditis. The singly throid nodule is potentially neoplastic, and surgical exploration is mandatory without clear evidence to the contrary. Free Thyroxine Index and Serum TSH levels are the best guide to thyroxine replacement therapy, and TSH release should be blocked in the long term after removal of hormone dependent thyroid tumours. Lifelong follow-up is essential after treatment of any thyroid disease, with the particular aim of determining thyroid function in the long term.