Endocrine Abstracts

Introduction: The significant increase in the average lifespan of the general population lead to a proportional enhancement in the prevalence of benign and malignant thyroid conditions and equally the number of surgeries for this pathology.

Patients and method: In a personal series of 464 thyroid disorders undergoing surgery over two decades we recorded 51 patients (21.5%) aged over 65 years of which 11 (2.4%) having over 75 years. Demographic, clinical and diagnostic characteristics of these cases were together with indications, management practice and outcome.

Results: There have been recorded 33 females and 18 males (R=1/1) with cIinicaIly, laboratory and histologically confirmed diagnosis in which were 22 (multi)nodular goitres (47%) among 16 six plunging goitres some with compressive phenomena, 18 (35.2%) – two Basedow diseases, nine multinodular toxic goitres and seven toxic adenomas and also nine thyroid carcinomas (17.6%) of which six were differentiated and three anaplastic tumours. Thirty-four total or near-total thyroidectomies of which three with cervical lymphadectomy and l7 conservative exercises were performed. There were not postoperative deaths but we recorded two cases each of prolonged hypocalcaemias, recurrent laryngeal nerve paresis and one recurrence. In all benign cases we obtained a stable in time cure while in obtained in four papillary tumours.

Discussions: Our series as well as literature data emphasises out of increased prevalence of thyroid geriatric disorders underling peculiarities related of sometimes delayed occurrence and prolonged evolution, atypical or imprecise symptomatology with less conclusive bioassays, coexistence of burdensome comorbidity all of them with direct consequences of a possible surgical sanction. In terms of clinical and lesional aspects outside thyroid nodules and especially micro-nodules that can accommodate any substrate, hyperthyroidism are more often (multi)nodular and they have mostly atypical manifestations, ophthalmopathy and hyperkinetic syndrome being sometimes replaced by an ‘apathetic’ presentation with weight loss and predominantly cardiovascular syndrome j arrhythmia and cardiac failure. Finally thyroid carcinomas have increased aggressiveness, accelerated evolution, higher incidence of anaplastic forms. Principles of thyroid surgery in the elderly are the same with those adopted at younger ages also taking into account the pathological load of the subjects and its mandatory preoperative correction.

Conclusions: Despite some difficulties in diagnostic and additional risks related to comorbidity benign and malignant pathology installed in patients over 65 years, may benefit of all types of conservative or radical thyroidectomies in terms of strict monitoring individualised in each case.