①Thyroxine requirements ↑ (activity, pregnancy, growth and development, cold) ② Thyroxine synthesis disorder ③Iodine deficiency

① Huge goiter affects the appearance and causes compression symptoms: trachea, esophagus, blood vessels, and nerve compression ②Retrosternal goiter ③Secondary hyperthyroidism ④Suspicious malignant transformation

It is more common in female patients aged 20-40 years. The gland is diffusely and symmetrically enlarged, and is often accompanied by exophthalmos, also known as exophthalmos goiter. Elevated thyroid-stimulating receptor antibodies.

Less commonly, patients first have nodular goiter or thyroid tumors for many years, and then gradually develop symptoms of hyperfunction. The age of onset is mostly over 40 years old. The glands are nodular and swollen, with symptoms on both sides and no exophthalmos. Myocardial damage is prone to occur.

Even rarer, without exophthalmos, there are single or multiple autonomous high-functioning nodules in the gland, and thyroid tissue atrophy around the nodules

Indications: secondary hyperthyroidism or high-functioning adenoma, moderate or above primary hyperthyroidism, compression symptoms, recurrence after internal medicine or iodine 131 treatment, early and second trimester pregnancy Contraindications: Hyperthyroidism in adolescents, mild hyperthyroidism, the elderly or patients with severe organic diseases

Preoperative preparation

Surgery and post-operative precautions

Causes: Hematoma compression (common), laryngeal edema, tracheal collapse, bilateral recurrent laryngeal nerve injury

Clinical manifestations: difficulty breathing, neck swelling, bleeding from the incision

Treatment: open the incision, remove the hematoma, and strictly stop bleeding. If ineffective, tracheotomy will be performed.

Prevention: Improve hemostasis during surgery, and prepare a tracheotomy bag next to the bedside after surgery.

Reason: cutting, suturing, clamping, pulling Location: Entry into the throat, intersection of lower A, lower pole

Clinical manifestations: hoarseness, dyspnea (bilateral injury)

Treatment: nothing special, the healthy side will compensate after 6 months Prevention: Preserve the back of the gland, stay away from the thyroid gland when handling A, and expose the thyroid segment of the recurrent laryngeal nerve throughout the process.

Special situation: larynx does not return

Reason: When treating the upper blood vessels, the upper vessels were not tightly connected and were ligated together. Clinical manifestations: choking (inner branch damage), low pitch (outer branch damage) Treatment: nothing special, gradually the healthy side compensates Prevention: stick to the upper pole and perform ligation separately

Cause: Inadvertent removal of parathyroid glands, destruction of blood supply Clinical manifestations: Numbness of the face, lips, hands and feet occurs 1 to 3 days after the operation, and in severe cases, twitching of the hands and feet occurs, and compensation occurs after 2 to 3 weeks; blood calcium↓ Treatment: Calcium supplementation, vitD3, dihydrotachysterol, postoperative allogeneic transplantation Prevention: Keep the back of the gland, keep it close to the back, avoid excessive traction, parathyroid autotransplantation

Reason: Insufficient preoperative preparation, surgical stress Clinical manifestations: high fever, rapid pulse, irritability, profuse sweating, vomiting and diarrhea, and in severe cases, shock. Treatment: Adrenergic blocking agents: reserpine, propranolol, iodine, corticosteroids, sedatives, cooling, support, digitalis