الفهرس 
PhysiologyOnly 14 pages are availabe for public view
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Abstract
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1- Twenty-one cases of reoperation on the thyroid are discussed.
Eight patients are desCribed in details. Technical difficulties
encountered at reoperation and the danger of injuring
thteruur-ecurrent laryngeal nerve are stressed.
2- Early/recurrence (~ - l~ years) 1s usually malignant; while
late recurrence (more than 3 years) is usual~ benign.
3- The main reason for reaurrence is inadequacy of the first
operation.
4- Recurrence following adequate excision of non toxic goitre
is the result of continued growth of minute nodules which
were small and unrecognized during the first operation.
5- Principles in the technique of primary operationson the
thyroid are suggested which if submitted will reduce the
incidence of recurrence to negligible proportions, these
are:
Total exposure of both thyroid lobes is essential even
though a nodule is palpable clinically in one lobe, a
lobe should only be left in situ if it feels completely
normal.
Always look for a pyramidal lobe, and when present,
:remove it en toto, dissecting it up or even beyond the
hyoid bone. A partial tby:roidectomy Leavi.ng behind t he
pyramidal lobe undoubtedly results in its rapid enlargment.
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- The inferior thyroid arteries are always sought and
ligated.
Postero-medial projections of the thyroid are not uncommon
and usually give rise to pressure on the trachea and
oesophagus, these projections are only discovered when
the gland has been dislocated anteromedially. These
projections are a potent source of recurrence.
6- Thyroid sUppression based on excellent theoretical grounds,
plays an important role as a pre and post-operative therap,y
in non toxic goitre to prevent a recurrent goitre and
eventual cancer development.