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British Journal of Medicine & Medical Research

19(8): 1-5, 2017; Article no.BJMMR.25568


ISSN: 2231-0614, NLM ID: 101570965

SCIENCEDOMAIN international
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Subtotal Thyroidectomy for Giant Goiters under


Local Anesthesia: Experience with 15 Nigerians
B. A. Eke1, B. A. Ojo2*, W. T. Yongu1, C. Ahachi1, P. Denen-Akaa1,
V. I. Ugwu3, P. Abayol4 and E. O. Umobong5
1
Department of Surgery, College of Health Sciences, Benue State University, Makurdi, Nigeria.
2
Department of Histopathology, College of Health Sciences, Benue State University, Makurdi, Nigeria.
3
Department of Pathology, National Orthopaedic Hospital, Enugu, Nigeria.
4
College of Health Science, Benue State University, Makurdi, Nigeria.
5
Department of Laboratory Medicine, State House Clinic, Abuja, Nigeria.

Authors’ contributions

This work was carried out in collaboration between all authors. Author BAE performed the surgery,
author BAO designed the study, wrote the protocol and the first draft of the manuscript. Authors WTY
and CA managed the literature searches. Authors PDA and VIU proofread the final draft of the
manuscript. All authors read and approved the final manuscript.

Article Information

DOI: 10.9734/BJMMR/2017/25568
Editor(s):
(1) E. Umit Bagriacik, Department of Immunology, Gazi University, Turkey.
Reviewers:
(1) Alexander E. Berezin, Medical University of Zaporozhye, Ukraine.
(2) Pietro Giorgio Calò, University of Cagliari, Italy.
(3) Jose Francisco de Sales Chagas, Medical School Catholic University Campinas, Brazil.
Complete Peer review History: http://www.sciencedomain.org/review-history/17737

th
Received 9 March 2016
th
Original Research Article Accepted 24 September 2016
Published 7th February 2017
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ABSTRACT

Thyroid surgery is performed by majority of surgeons using general anaesthesia with endotracheal
intubation. In resource poor countries, the paucity of equipment and Anaesthetists limits such
procedure needing endotracheal intubation. We describe our experiences with 15 Nigerians who
presented with giant goitres and were operated using local anaesthesia. We concluded that
subtotal thyroidectomy under local anaesthesia is safe and cost effective. It should be encouraged
in resource poor countries and save the patients from living with the stigmata of goitres when they
were not able to pay their ways to centres that use general anaesthesia with endotracheal
intubation for such procedure.

_____________________________________________________________________________________________________

*Corresponding author: E-mail: babarindeo87@gmail.com, babarideo87@gmail.com;


Eke et al.; BJMMR, 19(8): 1-5, 2017; Article no.BJMMR.25568

Keywords: Thyroid surgery; local anaesthesia; giant goitres.

1. INTRODUCTION were put in supine positions with sandbag under


the shoulder and neck extended on a head ring.
Thyroid surgery is performed using general Cleaning and draping done. Local anesthesia
anesthesia by the majority of surgeons in current was infiltrated along proposed line of incision.
practice. In many resource poor countries, non- The anesthesias consist of 20mls of 2% plain
availability of anesthetists, anesthetics drugs and xylocaine with double dilution with equal volume
equipment limit such procedure that requires of water for injection. The local infiltration was
general anesthesia endotracheal intubation. done repeatedly as the surgery progressed.
Patients are then left with the alternative of Maximum volume used was 40mls of now 1%
travelling over long distances to hospitals where plain xylocaine.
the waiting periods are long or to live with the
social stigma if they cannot afford the expenses The collar incision is depended to the investing
of travelling to such hospitals [1]. layer of deep cervical fascia with upper and lower
flaps raised. The investing layers were incised
It is a known fact that such surgical care is longitudinally to expose the strap muscles. The
insufficient or non-existent in many regions of the strap muscles were opened in the midline along
world accounting for a high number of disability- their fibers. Pretracheal fascia was incised to
adjusted life years (DALY) [2]. WHO estimates expose the thyroid gland. The thyroid gland was
that 2 billion people have no access to basic mobilized completely from its bed. The inferior
surgical care and that surgery could be used to thyroid arteries were tied in continuity away from
cure 11% of the global burden of disease [3]. the gland. The superior thyroid arteries were also
ligated close to the gland. The thyroid gland was
Thyroidectomy can be done under local excised living behind about 1/8th of its original
anesthesia, it is safe with acceptable results [4]. size. Neither of the recurrent laryngeal nerves
Thyroidectomy using local anesthesia is safe and was sought for as the patients were talking with
applicable to a wide range of patients, including us throughout the operation and nerves carefully
those who pose a general anesthetic risk or avoided using an understanding of their
require a more complex procedure when anatomy. In case of its injury, the patient voice
performed by an experienced surgeon [5]. will become hoarse or stop talking if the two
nerves were involved. Homoeostasis secured
This work represents a retrospective study of our and drain inserted into the empty bed of the
experiences with 15 Nigerians who presented thyroid gland. Hematomas are known
with giant goiters at a private hospital (Holy complication of thyroid surgery, we guide against
Trinity Specialist Hospital), Makurdi, Nigeria. We this by securing homoeostasis and adequately
are of the opinion that it is a safe and cost monitoring the patent post op.Patient with
effective procedure and should be encouraged in hematomas usually presents with respiratory
all resource poor environments like ours. distress, sweating, dyspnea and restlessness.
With hypoparathyroidism, patient present with
twitching. Few stitches were applied to the strap
2. MATERIALS AND METHODS muscles and skin closed with subcuticular
stitches using nylon 1. Dressing was applied and
All 15 consecutive cases of subtotal immediate post op conditions were generally
thydroidectomy done under local anesthesia for satisfactory. Average blood loss ranged from 150
giant goiters at Holy Trinity Specialist Hospital, to 300mls. The post-op management included;
Makurdi, Nigeria between March, 2005 and monitoring of vital sign, infusion and analgesics.
February, 2016 were included in the
retrospective study. Toxic and malignant goiters Figs. 1 and 2 shows patient pre-op and the mass
were excluded. The major indication for surgery removed during one of the surgeries
is cosmetics. The procedures were thoroughly respectively.
explained to the patients and informed consents
obtained. Minimal but essential pre-op
investigation includes Packed Cell Volume and 3. RESULTS
Blood Sugar. Two units of blood were cross
matched for each patient and an intravenous All 15 consecutive cases of giant goiter that
infusion in place. In the operating room, patients consented to subtotal thyroidectomy under local

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Eke et al.; BJMMR, 19(8): 1-5, 2017; Article no.BJMMR.25568

anesthesia between March 2005 and February, The weight of the removed gland ranged from
2016 were included in the study. 500 gm to 1,200 gm. The procedure of subtotal
thyroidectomy was well tolerated by all the
The duration of symptoms was between 2 years patients. The duration of the procedure lasted
and 20 years with a mean of 11.8 years. They between 120 and 180 minutes. None of the
were all females aged between 33 to 60 years patient had blood transfusion after the procedure
with a mean age of 44.8 years. Table 1 shows and all patients had postoperative analgesia and
the clinical details of the patients. No ketamine infusion for the first 24 hours post- op.The mean
was given. post- operative hospital stay was 3 days and
patients were followed up, up to 4 to 10 years
with no relapse. There was no mortality and
surgical pathology revealed colloid goiters for the
entire specimens.

Fig. 1. Showing patient pre-op


Table 1. Clinical data

Clinical Data Result


1 Total number of 15 Fig. 2. showing mass removed during
patients thyroidectomy
2 Age (years) range 33-60 years
3 Mean age (Year) 44.8 years 4. DISCUSSION
4 Duration of neck 2-20 years
swelling (year) Diffuse nontoxic goiter causes enlargement of
5 Mean duration of 11.8years the entire gland without producing nodularity.
neck swelling (year) Because the enlarged follicles are filled with
6 Duration of 120-180 colloid, the term colloid goiter has been applied
procedures minutes to this condition [6].
(minutes)
7 Mean post-operative 3 days Giant goiter is an enlargement of the thyroid
hospital stay(days) gland not less than 10 gm/ kilogram body weight
8 Weight of glands 500-1,200 [4]. The terminology “Simple Giant Goiter
removed (grams) gm Syndrome” [7] was first applied to these giant
range goiter in patients having simple goiters weighing

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Eke et al.; BJMMR, 19(8): 1-5, 2017; Article no.BJMMR.25568

not less than 10 gm/kilo body weight and usually a thyroid mass because they are not versed in
with a history of not less than 10 years duration. local anesthesia usage for such a procedure.
The mean weight for the entire subtotal
thyroidectomy specimens in this work was CONSENT
820gram with average duration of symptoms of
11.8 years. Olurin [7] posited again that the We have consent from all patients.
patients are predominantly peasant women
about 41-50 years living in rural endemic areas. ETHICAL APPROVAL
Our patients’ age ranged between 30 to 60 years
and patients were predominantly peasant women It is not applicable.
living in rural areas.
COMPETING INTERESTS
Thyroid surgery is performed using general
anesthesia with endotracheal intubation by the Authors have declared that no competing
majority of surgeons in current practice [5]. In interests exist.
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© 2017 Eke et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.

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