Mental symptoms are the first manifestations of hyperthyroidism. They include anxiety, dysphoria, irritability, emotional lability, sleep disorders, intellectual dysfunction, mania or depression. Anxiety is the main symptom and requires more detailed study.

The objective was to determine symptomatology of anxiety in patients with hyperthyroidism and compare with euthyroid patients.

The study included 56 patients with hyperthyroidism (high free T3 and free T4, suppressed TSH) and 32 euthyroid patients (normal free T3, free T4 and TSH) of the control group. For psychiatric assessment State-Trait Anxiety Inventory [STAI], Hamilton Depression Rating Scale [HAM-D], and Hamilton Anxiety Rating Scale [HAM-A] were used.

Total scores obtained from STAI, HAM-D and HAM-A were significantly greater in the hyperthyroidism group than that of the euthyroid group (p<0.05). The level of state anxiety in patients with hyperthyroidism was 51.39 ± 0.95 (high level) compared with 41.59 ± 2.41 (moderate level) in the control group. The level of trait anxiety in patients with hyperthyroidism was 46.86 ± 0.69 (high level), and 44.16 ± 2.17 (moderate level) in the control group. Psychomotor agitation (HAM-D # 9), psychic anxiety (HAM-D # 10), insomnia (HAM-A # 4) and weight loss (HAM-D # 16) were typical for patients with hyperthyroidism, while in the control group predominate the feelings of fatigue, weakness and loss of interest in working (HAM-D # 7).

The prevalence of anxiety in patients with hyperthyroidism is significantly more frequent compared to euthyroid patients. Anxiety and other psychiatric symptoms should be considered by both endocrinologists and psychiatrists.

No significant relationships.

Total thyroidectomy can be used as a definitive treatment modality for thyrotoxicosis. This study assessed the outcomes of patients treated with surgery at a single secondary care site.

A retrospective cohort study was conducted analysing consecutive patients who underwent thyroid surgery for thyrotoxicosis between 24 November 2000 and 26 April 2019 (n = 595).

Total thyroidectomy was performed in 95.4 per cent of patients. Two-thirds of patients had Graves’ disease histology. Of patients, 22.8 per cent became transiently hypothyroid whilst on levothyroxine (thyroid hormone replacement therapy). Transient and persistent hypocalcaemia was present in 23.3 per cent and 2.8 per cent of patients respectively. Recurrent laryngeal nerve palsy was transient and persistent in 3.6 per cent and 0.3 per cent respectively. Of patients, 2.5 per cent developed post-operative haematomas that required surgical evacuation in the operating theatre.

The overall complication rate for thyroid surgery is higher in thyrotoxic than in euthyroid patients. Compared to other treatment modalities, total thyroidectomy appears to be the most effective, definitive means of managing Graves’ disease.

The role of total thyroidectomy in the management of patients with Graves' disease remains controversial. However, there is increasing evidence to support the role of the procedure as a safe and definitive treatment for Graves' disease.

Patients were identified from a prospective thyroid database of the multidisciplinary thyroid clinic at Hull Royal Infirmary. All case notes were independently reviewed to confirm the data held on the database.

Over a 7-year period, the senior author has performed 206 total thyroidectomies for Graves' disease. The incidence of temporary recurrent laryngeal nerve palsy and hypoparathyroidism was 3.4 per cent and 24 per cent respectively. There was one case of permanent unilateral recurrent laryngeal nerve palsy, and 3.9 per cent of patients developed permanent hypoparathyroidism. There has been no relapse of thyrotoxicosis.

In the context of a multidisciplinary thyroid clinic, total thyroidectomy should be offered as a safe and effective first-line treatment option for Graves' disease.

Struma ovarii is a rare, monodermal, ovarian teratoma. The common presentation is abdominal, with pelvic mass and pain, traditionally managed by gynaecologists. The malignant form is extremely rare and consists of differentiated thyroid cancer. It is rare for struma ovarii to present with features of hyperthyroidism. We present two unusual cases of struma ovarii and discuss the role of the thyroid surgeon in their management.

The first case involved a 40-year-old woman with a two-month history of swelling in the lower abdomen. Investigations revealed a mass arising from the left ovary. Surgery revealed a follicular carcinoma arising in a struma ovarii. She underwent a total thyroidectomy prior to radio-iodine therapy. The second case involved a 60-year-old woman who underwent thyroidectomy for thyrotoxicosis. Three months post-operatively, she remained thyrotoxic despite stopping thyroxine. A whole body radio-iodine scan revealed high uptake in the left ovary. Histological analysis of the resected ovary showed benign struma ovarii.

These two cases highlight the diagnostic and therapeutic role of thyroid surgeons in the management of benign and malignant forms of struma ovarii.

Amiodarone can induce severe hyperthyroidism that justifies its withdrawal and the introduction of antithyroid drugs. Continuing amiodarone use, failure to control hyperthyroidism and poor clinical progress may require thyroidectomy. This study aimed to evaluate patients’ post-operative development and mid-term outcome after thyroidectomy for amiodarone-associated thyrotoxicosis.

Prospective case series.

Tertiary care centre.

We prospectively collected cases of amiodarone-associated thyrotoxicosis requiring thyroidectomy due to failure of antithyroid treatment, despite amiodarone discontinuation. Post-thyroidectomy complications were compared immediately, 30 days and one year post-operatively, and also for scheduled versus emergency surgery cases.

Of 11 total cases, nine scheduled thyroidectomy cases had no morbidity after elective surgery. Two cases required emergency surgery for multiple organ failure and cardiac problems. Immediate post-operative complications (mostly haemodynamic) occurred in both cases (emergency vs routine surgery, p = 0.018).

In such cases, pre-operative medical treatment is vital to limit peri- and post-operative complications, but surgery should not be delayed if the haemodynamic status deteriorates. Surgery, with careful anaesthesia, is the cornerstone of the treatment.

Ectopic thyroid tissue in the submandibular region is exceptionally rare. Nevertheless, the treating physician should consider this condition within the differential diagnosis of a submandibular mass.

Case report of ectopic thyroid tissue presenting as a submandibular mass in a patient with hyperthyroidism, together with a review of the English-literature concerning ectopic thyroid tissue.

To our knowledge, this is the first report of ectopic thyroid tissue presenting as a submandibular mass and causing hyperthyroidism. Removal of the submandibular mass resulted in normalisation of thyroid function, and subsequent reduction in the patient's antithyroid medication dosage. Ectopic thyroid tissue should be suspected in any patient with a submandibular mass. Prior to resection of such a lesion, it is essential to ensure that normal, functioning thyroid tissue is present elsewhere. Ectopic thyroid tissue can also present with pathology similar to that affecting the normal thyroid gland.

We present a patient with a rare combination of amiodarone-induced thyrotoxicosis and Eisenmenger's syndrome.

Case report and review of the world literature regarding the morbidity and mortality of surgical management of amiodarone-induced thyrotoxicosis and the potential hazards of non-cardiac surgery in patients with Eisenmenger's syndrome.

Failure of maximal medical therapy necessitated surgical management to treat amiodarone-induced thyrotoxicosis which, in this particular patient, carried significant risks. Total thyroidectomy was performed leading to rapid resolution of thyrotoxicosis, and the patient made an uncomplicated recovery. We present this case because of its rarity and the potentially hazardous nature of surgical intervention in patients with Eisenmenger's syndrome. The pathogenesis of amiodarone-induced thyrotoxicosis and the differing approaches of medical and surgical management are discussed.

Based on our findings, we propose that surgical management should be considered earlier in the treatment algorithm (or possibly as first-line therapy) for amiodarone-induced thyrotoxicosis.