SUMMARY: The pathogenesis of postoperative hypoalbuminaemia remains a controversial and poorly understood topic. In the present study the changes in the plasma albumin level following laparotomy have been investigated by immunological methods and correlated with the concentrations of extravascular albumin in the operation wound site and in the liver. There was a fall in the plasma albumin level, accompanied by an increase in the extravascular albumin concentration at the laparotomy wound site, with no alteration in the concentration of albumin in the liver. This work confirms that postoperative hypoalbuminaemia is due to accumulation of albumin in the wound site. Increased capillary permeability is suggested as a cause of the excessive loss of plasma albumin into the surgically injured site. The role and subsequent fate of the extravascular albumin in the wound area are also discussed.
METHODS: Sixty-six consecutive patients who had primary thyroid surgery were prospectively included in the present study between late January and early August 1998.
RESULTS: A total of 96 capsular dissections were performed at thyroid surgery. Grades two and three ZT were recognized in 77 (80.2%) dissections. In general 49 (63.6%) of them were associated with significant pressure symptoms. In 43 (87.8%) of the dissections with pressure symptoms, grade 3 ZT was observed (mean weight of goitre: 154.8 g). Interestingly in this group, 16 (37.2%) patients with pressure symptoms had a goitre that was < 100 g and in one patient it was only 21 g.
CONCLUSIONS: The pressure symptom of the thyroid gland does not always appear to be due to the large size of the goitre. In a relatively small-size goitre the ZT may cause significant pressure symptoms. Observations in the present study supported a strong association of enlarged ZT with pressure symptoms. We believe this is unlikely to be simply a coincidence but rather a consequence of the enlarged tubercle. Nonetheless a prospective randomized study is called for to allow meaningful and objective evidence to be drawn.