30 year old female presents to OPD with complaints of palpitations, increased appetite but with significant weight loss.She also gives history of large neck swelling for which she has never been tested before . Her thyroid function tests showed raised T3,T4 and supressed TSH . Her TSH receptor antibody test was negative . On USG neck , multiple nodules were seen in the gland . Increased Radioactive Iodine Uptake (RAIU) . After achieving her euthyroid state , what shall be the best definitive step in management ?
Toxic Multinodular goiter C/F- Palpitations Weight loss Increased appetite. Ix - | T3 ,T4 , | TSH Negative TSH-R ab. USG - Multiple nodules Isotope scan- Several areas of increased uptake. Rx After achieving euthyroid state , Near total thyroidectomy is preferred Near total Thyroidectomy- Leaving < 1 gram of thyroid tissue adjacent to recurrent laryngeal nerve at ligament of berry. Only in elderly ,subtotal thyroidectomy is done.
Continue antithyroid medication
Sub-total thyroidectomy
Radioactive iodine
Near- total thyroidectomy
Thyroid