INDICATIONS FOR THYROID SURGERYEXPERIENCE OF THE ENT DEPARTMENTOF MOULAY ISMAIL MILITARY HOSPITAL IN MEKNES (ABOUT 103 CASES)

Introduction: The indications for thyroid surgery are currently well defined and specified in the consensus recommendations for the management of thyroid nodules, which would allow on the one hand to reduce the excessive number of thyroidectomies, and on the other hand would not allow a malignant lesion to evolve. Objectives: Our study aims to evaluate the epidemiological, clinical and paraclinical characteristics of patients who have undergone thyroidectomy and to discuss the different surgical indications. Patients and methods: This is a retrospective study spread over one year, from January to December 2019, involving 103 patients hospitalized for thyroid surgery, in the ENT (ear nose throat) department of Moulay Ismail military hospital in Meknes. Results: The average age of our population was 50.68 years and the sex ratio W/M was 5.86. The time to consultation was more than 2 years in half of the patients. The reason for consultation was cervical swelling in 88 cases, signs of hyperthyroidism in 27 cases and compression in 15 cases. All our patients have benefited preoperatively from a TSH assay and a cervical ultrasound. A cervico-thoracic scan was performed in all patients with plunging and/or compressive goiter. Cytopuncture could only be performed in 10 cases.Surgical indications were retained in case of suspected malignancy (56.31%) hyperthyroidism (26.22%), compressive goiter (14.56%), aesthetic discomfort (1.94%) and recurrent thyroid cyst (0.97%)The surgical procedure consisted of a total thyroidectomy in 81.5% of cases, a lobo isthmectomy in 8.7% of cases and secondary totalization in 9.7% of cases. The pathological study revealed thyroid cancer in 11.65% of cases. Postoperative follow-up was marked by the occurrence of a compressive hematoma in one patient, transient unilateral recurrent paralysis in 2 patients, transient hypoparathyroidism in 6 patients, and tumor recurrence in one case Discussion: Surgical indications have been proposed, primarily in case of suspected thyroid neoplasia, mainly based on clinical and ultrasound criteria. The cancer/benign tumor ratio was 13.2%. It was therefore important to develop the cytopuncture.Autonomous goiters/nodules and compressive and/or plunging goiters were the main other indications for surgery with low morbidity, but at the cost of permanent hypothyroidism. Conclusion: Surgery is the gold standard treatment for symptomatic thyroid goiters/nodules. However, its contribution must be constantly reassessed according to the evolution of new diagnostic procedures and alternative techniques.