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   2009| September-December  | Volume 6 | Issue 3  
    Online since December 3, 2011

 
 
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REVIEW ARTICLE
Principles of thyroid surgery
CG Nair, P Jacob, R Riju
September-December 2009, 6(3):75-78
Operations on the thyroid glands were considered risky until Theodore Kocher 's masterly expositions of surgical practice on the gland. Thyroid nodules are still noted up to about 5% population even in iodine sufficient area. The evaluation of otherwise asymptomatic nodules is directed towards detecting a hidden malignancy. The role of operation in malignant nodule is unquestioned but the extend of resection is still debated. Though medical management and non-surgical interventions for benign nodules are under trial, thyroidectomy still remains the procedure of choice in most of occasions. The scenario of surgical practice in benign nodule is also changing with the swing towards total extirpation of the gland. Thyroidectomy always carried the risks of laryngeal nerve palsy and hypocalcaemia. The present day practice of surgical procedure, incorporating the principles of identifying external division of superior laryngeal nerve and capsular dissection of lateral lobes, has markedly reduced the rates of complications to less than 1% in large series. Synthetic thyroxine is universally available and cheap since 1950 and so total resection of the gland is acceptable to most of the patients except very few with lack of proper drug compliance.
[ABSTRACT]   Full text not available  [PDF]
  841 197 -
CASE REPORT
Granulocyte colony stimulating factor in the treatment anti-thyroid drug induced agranulocytosis
MP Baruah, SB Bhuyan, SB Das, N Deka, HS Barthakur
September-December 2009, 6(3):84-87
Aim: To report a case with life threatening agranulocytosis induced by anti thyroid drug Carbimazole, which was treated with granulocyte colony stimulating factor (G-CSF) with favorable outcome. Methods: We present the clinical features, laboratory findings, clinical course, relevant monitoring records and outcome of the study patient. Results: A 40 year old lady presented with clinical and biochemical evidence of thyrotoxicosis due to Graves ' disease for eight months. She was being treated with Carbimazole when she started having fever, painful oral ulcers, severe weakness and progressive anemia and agranulocytosis {Absolute Neutrophil Count (ANC) <150cells/ /uL(0.15X10 9 cells/ L)}. There was evidence of ongoing severe sepsis like high fever and elevated serum C-reactive protein. Recombinant-human G-CSF was started at this point and we continued to assess the leukocyte and neutrophil count daily. Both these counts rose insidiously during first 96 hours; however significant response was seen on 5th day after 4 injections with Total Leukocyte Count (TLC) reaching 3,400cells/ /uL (3.4X1 (f cells/L) and ANC 1870cells/juL (1.87 X10 9 cells/L). The counts continued to rise from this point onwards even without G-CSF injections, accompanied by improvement in her general condition. Conclusion: The clinical setting in this patient was suitable for G-CSF treatment. Such a decision was well vindicated by profound leukocytosis and early recovery from clinical symptoms. The shortened window can significantly reduce the risk of potentially fatal outcome.
[ABSTRACT]   Full text not available  [PDF]
  834 189 -
ORIGINAL ARTICLE
Graves' disease: Comparison of treatment effect of three modalities and patient satisfaction
R Menaka, RR Joshi, BS Narendra, M Sehgal, A Bhattacharyya
September-December 2009, 6(3):79-83
Graves 'disease treatment includes anti-thyroid medications followed by one of three: medical regimen (Titration or Block & Replacement (B&R), thyroidectomy, Radioactive Iodine (RAI) ablation. Materials and methods: Patients treated for Graves, small or no goitre, one year after completion of definitive therapy constituted this cohort. Age, thyroid hormone levels at diagnosis, sex, goitre size, duration of therapy & follow up and treatment were recorded. Patient satisfaction for treatment was assessed by anonymous in-house questionnaire survey (5point Likert scale). Results: 85 patients constituted this cohort - 42 treated with B&R, eight underwent thyroidectomy, 35 treated with RAI Cumulative follow up after B&Rw as 882 patient-months, 1036 after RAI, 356 after surgery. Eight relapsed (19%) after B&R. Age & thyroid hormone at presentation, sex, goitre size had no bearing on the relapse. 83% of patients treated by RAI developed hypothyroidism compared to 19% by B&R (p<0.001). Fear of relapse significantly higher in the B&R group (p<0.005), fear of side effects was greater in the RAI group (p<0.01). Conclusion: A good course of medical therapy can be tried as the first line of management for patients with Graves ' disease without a big goiter. The chances of becoming hypothyroid & relapse rate are much less with B&R in comparison to other modalities of treatment.
[ABSTRACT]   Full text not available  [PDF]
  745 193 -
EDITORIALS
Surgery for thyroid eye disease: State of the art
MN Naik
September-December 2009, 6(3):70-74
Full text not available  [PDF]
  412 149 -
OTHERS
Thyroid images
S Shrivastava, R Bharath, AG Unnikrishnan, S Sundaram, PS Sundaram
September-December 2009, 6(3):88-89
Full text not available  [PDF]
  376 173 -
EDITORIALS
Is procalcitonin returning to the thyroidologist ?
AG Unnikrishnan, P Jeyapathy, R Bharath, RV Jayakumar, H Kumar
September-December 2009, 6(3):67-69
Full text not available  [PDF]
  342 170 -
OTHERS
Thyroid watch
MG Pillai
September-December 2009, 6(3):90-91
Full text not available  [PDF]
  324 146 -
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