Symptomatic pleural disease, specifically malignant pleural effusion, refractory benign pleural effusion, and pneumothoraces are common diseases that often require therapeutic interventions. The spectrum of management strategies often includes selection of a chemical pleurodesis agent administered in combination with an indwelling pleural catheter or chest tube.Additionally, there is a role for minimally invasive techniques which include medical thoracoscopy or more advanced video-assisted thoracoscopic approaches. Ongoing clinical trials continue to evolve best practices regarding the optimal sclerosant agents and procedural approaches in the management of these diseases.

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INTRODUCTIONThyroid diseases are the commonest endocrine disorders worldwide and India is no exception. It has been estimated that about 42 million people in India suffer from thyroid diseases.1 Recent population studies have shown that about 12% of adults in India have a palpable goiter and Indian government has earmarked the goiter endemic regions in the country. 2 The nontoxic goiter is divided on the etiological basis as endemic goiter and sporadic goiter. The endemic goiter is defined as one where more than 5% of the population shows thyroid enlargement. 3 The most common cause of goiter in goiter endemic areas is thought to be iodine deficiency but it is very difficult to establish the cause effect relationship in a hospital setting. The present study was carried out in a government notified endemic region to evaluate the nontoxic goiter patients for pattern of presentation, histopathological causes, with its surgical management and post-operative complications. ABSTRACTBackground: Thyroid diseases are the commonest endocrine disorders worldwide and India is no exception. Goiter may be generalized or localized, toxic or nontoxic. The present study is being carried out in a government notified endemic area to study the etiology and surgical management with postoperative complications in patients with nontoxic goiter. Methods: A observational study was carried out at a tertiary care academic hospital. Patients with a clinically diagnosed nontoxic goiter with normal T3, T4 and TSH values were included in the study. The study subjects underwent relevant investigations and surgical intervention. The outcome factors were histopathology of the surgically removed gland and postoperative complications. Results: A total of 67 patients of nontoxic goiter were enrolled. The mean age of the patients was 33.3±11.1 years with female preponderance. The mean duration of the thyroid swelling was 2+/-2 years. Hemithyroidectomy was most common surgery (68.7%) carried out. A majority (88%) of resected thyroid specimens were benign histopathologically as colloid goiter. An intergroup analysis was carried out between metabolic, autoimmune and neoplastic etiologies. Neoplastic etiology was significantly associated with smooth surface and hard consistency of the gland. Autoimmune goiter had significantly less than 12 months duration and painful. The postoperative complications observed were hypothyroidism (22.4%), hypoparathyroidism (10.5%), RLN palsy (6%) and SSI (3%). Conclusions: Benign pathology was commonly seen with nontoxic goiter. Hypothyroidism and Hypoparathyroidism were the most frequent postoperative complications.

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