Observations on 300 Consecutive Thyroidectomies

THE place for thyroidectomy in the treatment of disease of the thyroid gland is now well established. It has for long been practised by surgeons to relieve the pressure symptoms caused by simple non-toxic goitres, but it was not until the end of the first decade of this century that its use in the treatment of thyrotoxicosis was first described. Mayo, in 1907, reported on 110 operations for thyrotoxicosis with nine deaths. Dunhill, in 1910, published a remarkable series of 199 operations for severe thyrotoxicosis with only three deaths. Up until after the First World War the majority of physicians in this country looked upon operation with disfavour, a view supported by the high mortality at that time. From a study of the Royal Victoria Hospital records the earliest surgical procedure described in the treatment of thyrotoxicosis was carried out by Mr. Kirk. On 11th July, 1904 (i.e., in the first year of the Royal Victoria Hospital's existence on its present site), he operated on a young woman for serious exophthalmic goitre and tied the right inferior thyroid artery; six weeks later he tied both superior thyroid arteries, but no thyroid tissue was removed. One thyroidectomy for simple non-toxic goitre was performed in the same year by Mr. A. B. Mitchell. On the 23rd November, 1907, Mr. Robert Campbell performed what I believe was the first thyroidectomy for thyrotoxicosis. The operation performed was a partial right lobectomy, the patient a young woman with severe exophthalmus, a pulse rate of 110 and with so much loss of flesh that she weighed only five stones. She was discharged improved three weeks later. In the year ending 31st December, 1954, 99 thyroidectomies are recorded by the surgeons of the Royal Victoria Hospital. This paper is a review of 300 consecutive operations carried out by myself between 1st July, 1948, and 30th June, 1954. With the exception of 13 cases who could not be traced, all have been re-examined in the past few months, representing a follow-up of 96 per cent.