The management of the enlarged thyroid.

Area of Science:

• Endocrinology
• Surgical Oncology
• Otorhinolaryngology

Background:

• Goitre is prevalent in southwestern Sri Lanka, with endemic goitre being a significant concern.
• Clinical presentations of various goitre types, including endemic, multinodular, and toxic goitre, were observed in 200 surgical patients.
• Thyroid nodules present a diagnostic challenge, with a notable percentage of malignancy found in solitary nodules.

Purpose of the Study:

• To describe the clinical features and surgical management of thyroid enlargement in Sri Lanka.
• To evaluate the incidence of thyroid carcinoma in patients undergoing surgery for thyroid enlargement.
• To identify key surgical techniques and postoperative complications associated with thyroidectomy.

Main Methods:

• Retrospective analysis of 200 patients who underwent surgery for thyroid enlargement.
• Clinical assessment and review of surgical outcomes.
• Histopathological examination of thyroid specimens to determine malignancy rates and types.

Main Results:

• Endemic goitre is common; thyroxine therapy is effective in early stages.
• Subtotal thyroidectomy is indicated for cosmetic or pressure effects in multinodular goitre.
• Thyroid carcinoma was found in 9.5% of thyroid enlargement surgeries, with a follicular to papillary ratio of 1:0.9.
• 7.3% of clinically solitary thyroid nodules were malignant, recommending hemithyroidectomy.
• Postoperative complications included laryngeal oedema and hypocalcaemia.

Conclusions:

• Thyroidectomy remains a crucial intervention for symptomatic goitres and thyroid nodules.
• Early diagnosis and appropriate surgical techniques are vital for managing thyroid disorders and associated malignancies.
• Understanding postoperative complications is essential for patient care and improved surgical outcomes.