When subtotal thyroidectomy is not adequate!
Date
2017-09
Authors
Oyemola, A.A
Okunowo, B.O
Fasanmade, O.O
Olopade, O.B
Odeniyi, I.A
Fasanmade, O.A
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
BACKGROUND:
Thyroid nodule could be classified as “hot” or “cold”. Diagnosis of thyroid malignancy on FNAC is rarely encountered in our clinical practice. Treatment for thyroid malignancies is total thyroidectomy and central neck dissection.
AIM:
To highlight the problems associated with subtotal thyroidectomy as a treatment modality for thyroid nodule.
CASE PRESENTATION:
CASE 1: 31 year old woman who presented at EDM clinic on referral from radiotherapy unit on account of three month history of persistent diarrhea. She had some investigations done with SUBTOTAL THYROIDECTOMY at a tertiary health facility 1 year prior to presentation. Histology report of thyroid tissue revealed medullary thyroid carcinoma. She had chemotherapy, placed on Tabs Levothyroxine and awaiting radiotherapy.
Examination revealed chronically ill looking, pale lady; BMI of 13.15kg/m². Anterior neck swelling, (75grams), hard, with micro infiltration on the skin; enlarged, submandibular and anterior cervical lymph nodes. Investigations revealed markedly elevated Calcitonin, hyponatraemia, hypokalaemia, and normal thyroid function test.
CASE 2: 28 year old woman who presented at Surgery outpatient clinic (SOP) with three year history of anterior neck swelling. FNAC was done with finding of follicular lesion suspicious for malignancy and was planned for total thyroidectomy. Patient however defaulted from SOP and had a subtotal thyriodectomy done at a private hospital. Histology revealed medullary thyroid cancer. She was referred back to the SOP on account of histologic finding. She had total thyroidectomy done and placed on L-thyroxine and referred to EDM clinic to achieve thyroid hormone control during pregnancy.
CONCLUSION:
Not all thyroid nodules or tumours are innocent. It is therefore advisable for total thyroidectomy to be preferred above subtotal thyroidectomy so as to avoid a recurrent growth and or missed malignancy
Description
Keywords
thyroid nodules, thyroidectomy, medullary thyroid carcinoma, levothyroxine
Citation
Oyemola AA, Okunowo BO, Fasanmade OO, Olopade OB, Odeniyi IA, Fasanmade OA. When subtotal thyroidectomy is not adequate!. Abstract from 2017 Book of Abstracts, Endocrinology and Metabolism society of Nigeria.