الفهرس 
Introduction
Anatomy of thyroid glandOnly 14 pages are availabe for public view
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Abstract
This study we conducted on 60 patients complaining of thyroid diseases who were admitted to General Surgery department in Assiut University Hospitals over span of six month (from June 2017 to December 2017 ).
The patient’s age ranged from 15 to 60 years. There were 49 females (81.7 %) and 11 males (18.3%).The female to male ratio was 4.45:1.
Family history of thyroid diseases was positive in 5 patients (8.3%).
17 patients (28.3%) had history of thyrotoxic manifestations which were controlled with anti-thyroid medications ( in the form of mehimazole or carbimazole and a beta-blocker as propanolol ). Iodine deficiency was reported in 9 patients (15%).
Vitally, the heart rate was in the range of 70-90 beats/min. It was noticed that 9 (15%) patients were hypertensive and it was controlled on therapy.
Most of the studied patients had bilateral multinodular thyroid enlargement ( 43 patients 71.7%). Only 4 patients (6.7%) had diffuse goiter which was proved to be Grave’s disease. Soitary nodular goiter was found in 13 patients (21.7%). Regarding thyroid consistency , the majority of patients had firm cosistency (91.7%).
Thyroid surgery (in the form of total thyroidectomy, subtotal thyroidectomy or unilateral lobectomy and isthumsectomy) was performed in euthyroid patients complaining of : (1)pressure symptoms to trachea (dyspnea) or oesophagus (dysphagia) (45.2%) , (2) bad cosmosis (25.7%), or (3)non-compliance to long-term medical treatment (as development of complicatios to anti-thyroid medications) (30.2%).
Pre-operative assessement with cervical ultrasonography was done in all patients to find 38 (63.4%) patients had multiple thyroid nodules, 4 (6.7%) on the right lobe only and 34 (56.7%) patients had bilateral nodules. Out of 38 (63.4%) patients with multiple thyroid nodules, 4 (6.7%) of them had retrosternal extension while 11 (18.3%) patients had lymphadenopathy. Single thyroid nodule presented in 16 (26.7%) patients, 12 (20%) of them presented in the right lobe. Diffuse thyroid enlargement presented in 6 (10%) patients.
Pre-operative Fine Needle Aspiration Cytology (FNAC) was done in 41(68.3%) patients. Simple nodular goiter presented in 20 (33.3%) patients while colloid goiter, follicular adenoma and hyperplasia presented in 11 (18.3%), 8 (13.3%) and 2 (3.3%) patients respectively.
All patients were subjected to pre-operative laryngoscopic examination and ENT consultation for assessment of vocal cords mobility (mainly for medicoloegal purposes).
Regarding the type of operation , it was found that total thyroidectomy was performed in 43 (71.7%) patients while 10 (16.7%) and 7 (11.7%) patients had subtotal thyroidectomy and unilateral lobectomy with isthmusectomy respectively.
The most frequent complications post-operatively were hoarseness of the voice and choking occurred in 18 (30%) and 16 (26.7%) patients respectively. Injury of RLN occurred in 5 (8.3%) patients.
Total thyroidectomy was associated with more post-operative complications and less recurrence rates than subtotal thyroidectomy and unilateral lobectomy. It was noticed that post-operative complications in those patients had total thyroidectomy where hoarseness of the voice, chocking and injury of recurrent laryngeal nerve occurred in 13 (30.2%), 12 (27.9%) and 5 (11.6%) patients respectively. In case of subtotal thyroidectomy 4 (40%) patients had choking and 4 (40%) patients had hoarseness of the voice. Only one patient from those had unilateral thyroidectomy had post-operative complication in form of hoarseness of the voice. Most of these complications were transient and showed dramatic response with medical treatment.
All patients received post-thyroidectomy thyroid replacement therapy in the form of L-thyroxin (except those who were subjected to unilateral lobectomy.).
Follow up thyroid function tests were performed regularly and dose adjustment of replacement therapy was done accordingly.
Histopathological examination post-thyroidectomy revealed that colloid and hyperplasia occurred in 21 (35%) and 17 (28.3%) patients respectively. Papillary carcinoma presented in only one (1.7%) patient ,simple nodular goiter in 3 patients (5%), fibroepithelial nodules in 3 patients (5%),follicular adenoma in 7 patients (11.7%), and Hashimoto thyroiditis in 2 patients (3.3%).
Incidentaloma was found in one patient which was suspected pre-operatively to be follicular adenoma by FNAC. post-operatively , histopathological examination revealed it as papillary carcinoma. This patient was managed postoperatively (after total thyroidectomy) with follow up only as C.T. examination of the neck and metastatic work up were negative.
When we compared our department management to the guidelines, it was observed that:
1-Neck U/S was performed in all cases.
2-FNAC was performed in suspicious cases of malignant goiter.
3-Thyoid surgery was performed for the same indications as standard guidelines once euthyroidism is achieved.
4-Near-total thyroidectomy was not performed (according to standard guidelines, it may de done for patients with controlled toxic goiter).
5-Unilateral lobectomy with ismuthsectomy was done for unilateral goiter proven pre-operatively to be benign.
6-Post-operative complications (hypocalcemia, recurrent laryngeal nerve injury, chocking…etc) were minimal.
7-Regular follow up thyoid function tests were recommended for all patients.
8-Some defect in counselling patients regarding adherence and method of intake of thyroid replacement therapy was noticed.