The Significance and Treatment of Delirium or Confusion Following Thyroidectomy for Hyperthyroidism
The development of either mental confusion or active delirium in a patient on whom thyroidectomy has been performed for hyperthyroidism is an unfavorable prognostic sign. This reaction can be produced by a number of factors as is shown by an analysis of the causes of mental changes in the following thirteen cases of postoperative delirium or confusion. These thirteen cases occurred in a series of 200 consecutive operations on the thyroid gland for hyperthyroidism, an incidence of 6.5 per cent.
Causes of Postoperative Delirium or Confusion
Fifteen years ago, before iodine was used to prepare the patient for thyroidectomy and at a time when acute Grave's disease was much more common than it is today, the postoperative delirium of a typical thyroid crisis was a common occurrence. Today, however, a true thyroid crisis resulting in delirium is unusual. In this series of 200 consecutive thyroidectomies for hyperthyroidism, there were only two instances in which an active stimulated type of delirium was associated with marked elevation of temperature and pulse rate so that a diagnosis of thyroid crisis could be made.
In recent years we have seen relatively more elderly patients with nodular goiters and low-grade hyperthyroidism of long duration. It is in this type of case that we most commonly observe a state of postoperative confusion. Usually the patient is more than sixty years of age, is emaciated, feeble, and has had symptoms of hyperthyroidism for several years. Although cerebral arteriosclerosis is often a potent factor contributing to the mental. . .