Abstract
From our knowledge of thyroid pathophysiology and from morphological studies, preoperative treatment of hyperthyroidism should consist of:
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1.
A period of treatment to control hyperthyroidism by giving the patient antithyroid drugs (carbimazole) and, if necessary, propranolol.
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2.
An attempt to keep the patient euthyroid. It seems reasonable to add thyroxine to a relatively high dosage of carbimazole in order to be sure of both euthyroidism and a hormone-free gland.
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3.
Inhibition of all stimulation of the gland by TSH in order to minimize the risk of bleeding. A bloodless operation guarantees the best anatomical dissection, which gives the best results with an absolute minimum of damage to the parathyroid glands or recurrent nerves.
This treatment fulfills the objectives of an ideal preoperative treatment of hyperthyroidism.
Résumé
Les connaissances actuelles de la physiopathologie thyroïdienne et les études morphologiques indiquent que la préparation préopératoire pour chirurgie de l'hyperthyroïdie doit comporter:
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1.
Une phase de contrôle de l'hyperthyroïdie, par antithyroïdiens (carbimazole) et, si nécessaire, propanolol.
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2.
Un essai d'amener le malade à l'euthyroïdie. Il est logique d'associer la thyroxine à des doses élevées d'antithyroïdiens pour atteindre cette euthyroïdie et obtenir une glande dépourvue d'hormone.
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3.
L'inhibition de toute stimulation thyroïdienne par la TSH, pour réduire le risque d'hémorragie. Un champ opératoire sec est la meilleure garantie d'une dissection anatomique, évitant les lésions des parathyroïdes et des récurrents.
Ce traitement satisfait les objectifs d'une préparation préopératoire idéale pour hyperthyroïdie.
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Heimann, P. Choice of preoperative treatment in hyperthyroidism. World J. Surg. 2, 289–291 (1978). https://doi.org/10.1007/BF01561496
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DOI: https://doi.org/10.1007/BF01561496