Journal of Nippon Medical School: Vol.70 No.1 page.034

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ArticleTitle Surgical Therapy in Hashimoto's Thyroiditis

AuthorList Kazuo Shimizu, Yuki Nakajima, Wataru Kitagawa, Haruki Akasu, Keisuke Takatsu, Ritsuko Ishii, Shigeo Tanaka

Affiliation Department of Surgery II, Nippon Medical School

Language EN

Volume 70

Issue 1

Year 2003

Page 34-39

Received August 20, 2002

Accepted September 13, 2002

Keywords Hashimoto's thyroiditis, surgical therapy, compression symptom, diffuse goiter

Abstract
Hashimoto's thyroiditis (HT) is usually considered to be manageable by levothyroxine (L-T4) administration, which can reduce the thyroid volume and supplement the lack of hormone. However, we sometimes encounter a huge goiter that has not shrunk in response to L-T4therapy. These goiters continue to produce symptoms of compression and an unsightly appearance. Here we discuss the surgical indication and procedure for HT.
Thirteen patients with clinically diagnosed Hashimoto's thyroiditis involving a huge diffuse goiter that produced pressure symptoms or nodular lesions were treated with surgery. The gender, age distribution, total dose and period of L-T4 administration prior to the operation, and clinical symptoms caused by the large goiter were evaluated in each case.
The titer of antibodies was extremely elevated in 8 HT patients with a diffusely enlarged goiter. The total period of L-T4 medication ranged from 6 to 25 years. A subtotal thyroidectomy in which a small amount of thyroid was left in the posterior area of the bilateral lobes was performed in the 8 cases of diffusely enlarged goiter. Pressure symptoms and the unsightly appearance caused by the goiter were relieved by the surgery in all cases. No surgical complications developed.
In conclusion, the surgery is an effective therapy for HT patients who have persistent compression symptoms and/or an unsightly neck appearance due to a large goiter despite long-term L-T4 treatment.

Correspondence to Kazuo Shimizu, MD, FACS, Department of Surgery II, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
kshimizu@nms.ac.jp

ArticleTitle	Surgical Therapy in Hashimoto's Thyroiditis
AuthorList	Kazuo Shimizu, Yuki Nakajima, Wataru Kitagawa, Haruki Akasu, Keisuke Takatsu, Ritsuko Ishii, Shigeo Tanaka
Affiliation	Department of Surgery II, Nippon Medical School
Language	EN
Volume	70
Issue	1
Year	2003
Page	34-39
Received	August 20, 2002
Accepted	September 13, 2002
Keywords	Hashimoto's thyroiditis, surgical therapy, compression symptom, diffuse goiter
Abstract	Hashimoto's thyroiditis (HT) is usually considered to be manageable by levothyroxine (L-T4) administration, which can reduce the thyroid volume and supplement the lack of hormone. However, we sometimes encounter a huge goiter that has not shrunk in response to L-T4therapy. These goiters continue to produce symptoms of compression and an unsightly appearance. Here we discuss the surgical indication and procedure for HT. Thirteen patients with clinically diagnosed Hashimoto's thyroiditis involving a huge diffuse goiter that produced pressure symptoms or nodular lesions were treated with surgery. The gender, age distribution, total dose and period of L-T4 administration prior to the operation, and clinical symptoms caused by the large goiter were evaluated in each case. The titer of antibodies was extremely elevated in 8 HT patients with a diffusely enlarged goiter. The total period of L-T4 medication ranged from 6 to 25 years. A subtotal thyroidectomy in which a small amount of thyroid was left in the posterior area of the bilateral lobes was performed in the 8 cases of diffusely enlarged goiter. Pressure symptoms and the unsightly appearance caused by the goiter were relieved by the surgery in all cases. No surgical complications developed. In conclusion, the surgery is an effective therapy for HT patients who have persistent compression symptoms and/or an unsightly neck appearance due to a large goiter despite long-term L-T4 treatment.
Correspondence to	Kazuo Shimizu, MD, FACS, Department of Surgery II, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan kshimizu@nms.ac.jp