The management of the enlarged thyroid.

Goitre is common in the south-west sector of Sri Lanka. The clinical features of 200 patients who underwent surgery for thyroid enlargement at the General Hospital, Colombo, reflect the pattern of presentation of various types of goitre, particularly endemic goitre. Thyroxine therapy controls endemic goitre in the early stages. Subtotal thyroidectomy is required for multinodular goitre causing cosmetic or pressure effects. A previous multinodular goitre antedates the onset of hyperthyroidism in 20 per cent of thyrotoxic patients. Reduction of spirometry time and utilising a linear gradient in analysis enhances the reliability of basal metabolic rate estimation. Subtotal thyroidectomy, carbimazole and radioiodine therapy are used in the management of toxic goitre. A study of 50 clinically solitary thyroid nodules revealed 7.3 per cent of cold nodules to be malignant. Hemithyroidectomy is recommended for solitary nodules. 9.5 per cent of patients undergoing surgery for thyroid enlargement had thyroid carcinoma. The follicular: papillary carcinoma ratio was 1:0.9. Total thyroidectomy for the former and hemi-thyroidectomy with nodal excision for the latter are followed by thyroxine therapy. Thyroidectomy technique includes prethyroid muscle division, recurrent laryngeal nerve identification and separate division of superior thyroid vessel branches. Laryngeal oedema and hypocalcaemia are important postoperative complications.