Surgical indications in endemic goiter. Pre- and postoperative care

The authors express their opinion with respect to anatomo-clinical forms of endemic goiter. First they suggest preoperative thyroid re-equilibration to avoid postoperative complications such as hypothyroidism or recurrence. Then operative indications for endocrine goiter, especially in an endemic area are discussed. Opinions are also expressed with respect to diffuse parenchymatous (endemic) goiter, nodular and polynodular goiter together with the various forms that may have a nodular or polynodular aspect both anatomically and as localization. Extemporaneous examination is viewed by the authors as compulsory in all such goiters, whereas preoperative thyroid puncture is counterindicated. Surgical care of mixed endemic goiter (diffuse hyperplasia with nodules imbedded in the hyperplasia) is also reviewed. It is recommended that each operation be preceded by an adequate preoperative treatment, for which therapeutic schemes are indicated as well as postoperative care directions taking into account the anatomo-clinical form. The surgical approach recommended is subtotal thyroidectomy. The paper also provides some statistical figures concerning surgery in the Institute of Endocrinology in Bucharest.