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中毒性 甲狀腺腫 130例에 對한 外科的 治療成績

Surgical Treatment of Thyrotoxicosis

대한외과학회지 1963년 5권 1호 p.31 ~ 38
신요철,
소속 상세정보
신요철 (  ) - 서울대학교 의과대학 외과학교실

Abstract


The result of surgical treatment of 130 cases of thyrotoxicosis, operated during the 4-year period from December 1958 to August 1962 at the Department of General Surgery, N. M. C., is reported. Follow up examinations have been done up to the present time.
The standard technique used in most cases was subtotal bilateral thyroidectomy. No fatal cases have occurred. In 7 cases an immediate post-operative tetany developed which subsided after a few days treatment with calcium. In one case a persistent hypothyroidism developed. In two cases the hyper-thyroidism recurred, but only one of the patients complained of clinical symptoms. Otherwise no complications have occurred. The patients received pre-operative iodine treatment for 3 weeks. Hospitalization for surgical treatment lasted about one week. Post-operative iodine treatment was usually continued for about 4 to 7 days.
The sex distribution was it females and 19 males, making a female/male ratio of 5.8: 1. Histopathological examination showed diffuse toxic goiter in 93% and °adenomatous -goiter in 7 of the cases.
The most frequent clinical symptoms were: palpitations, tremor, exophthaimus, profuse sweating and nervousness-in that order.
The B.M.R. prior to iodine medication ranged from +15% to +74%, after medication from 0% to +44%, and post-operatively from +15% to +29%.
Serum Cholesterol varied from 100 to 250 mgr % before operation and from 115 to 280 mgr after operation. The interesting fact is, however, that the large majority of the cases prior to the operation had a serum cholesterol level below the average of 170 in Korea. Post-operatively this was reversed, so that only 30 cases, or 23%, were below the average. This change may be considered as sufficiently significant to serve as a guide for the effectivity of treatment.In view of the existing shortness of hospital facilities in Korea, surgical treatment of thyrotoxicosis is recommendable in most cases, because only one week´s hospitalization is required. The pre-operative iodine medication can be given under sufficient control in the out-patient department. Based on four years of experience the opfrative risk seems negligible.

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