Surgery of the Goiter in the ENT Department of Chu Gabriel Toure: Problematic and Perspective

Abstract

Aims: To describe the diagnostic aspects, surgical indications and post-operative complications of thyroidectomies performed in our department. Materials and method: A descriptive retrospective study that took place in the ENT Department and Cervicofacial Surgery of Gabriel TOURE University Hospital of Bamako. We did a comprehensive sampling of all goiter cases from January 2013 to December 2018. Were included in the study, the records of patients of all ages and genders, admitted into the ward and scheduled for thyroidectomy (partial or total). The exclusion criteria were incomplete hospitalization records. There were a total of 139 files were retained. Results: In 60 months, 139 cases were collected out of 1720 patients hospitalized for surgery, representing a hospital prevalence of 8.08%. The average age was 46.89 years. (123 women and 16 men). The socio-professional categories were dominated by housewives (68.34%). The reported functional signs were tachycardia, asthenia and other signs of dysthyroidism in 59% as well as signs of compression in 24.46%. In 72 cases or 51.80%, the patients consulted between 2 and 10 years of disease progression. Twenty patients or 14.39% had a history of familial goiter and 2 patients had a history of thyroid surgery. On physical examination the swelling was antero-cervical in 56.83% of cases. In 96 cases or 69.06% the glandular diameter was between 5 and 9 cm. In 2 cases or 1.43% we noted cervical adenopathy in the jugulo-carotid chain. Ultrasound, TSHus and fT4 were performed first-line and systematically in all our patients. Ultrasound objectified an appearance of multinodular goiter in 106 cases or 76.26%. In 60.43% of cases the patients were TI classes RADS 3, they were TI RADS 4A in 16 cases or 11.51%. CT scans were performed in 3 patients or 2.15% to specify the loco-regional extension, to look for possible lymph node invasion, and to compress or dipping the goiter. Surgical indication was placed in front of a multinodular goiter (GMN) in 106 cases or 76.26%, a single goiter in 11 cases or 7.9%, a single nodule greater than 3 cm in 17 cases or 12.23%, Basedow disease in 4 cases or 2.88% and a recurrence in one case 0.72%. We performed a lobo-isthmectomy in 56.11%, a total thyroidectomy in 20.14% of cases, subtotal in 20.86% of cases and total thyroidectomy with mediation-recurrent lymph node curage and bilateral jugulo-carotidien in 4 cases or 2.87%. Recurrent nerves were systematically searched and seen in all cases. Replacement therapy was indicated in all patients who underwent a total thyroidectomy. Complications recovered were 1 case of compressive hematoma, 6 cases of transient dysphonies and cough, 4 cases of definitive hypocalcemia. 1 case of recurrence, but no deaths were observed. Histopathology performed in all of our patients was dominated by vesicular and colloid adenoma. Conclusion: Thyroid surgery is a common surgery but not devoid of complications, the most dangerous of which remain recurrent impairment and definitive hypoparathyroidism. The experience of all surgical teams in the vasculo-nervous anatomy of the neck is the best guarantor to reduce and prevent complications.