Post Subtotal Thyroidectomy Acute Appendicitis, Elhassaheisa Teaching Hospital, Elhassaheisa, Sudan: 2022

Background: Thyroid hormones have a significant role in modulating immune system.
Methods: A female of twenty-eight years old, presented with anterior neck swelling of five months duration, small in size, increases gradually over time. On examinations: looked well; afebrile. There was diffuse anterior neck swelling move with swallowing, no dilated veins or ulcers, free supra sternal notch. Swelling was soft smooth surface, diffuse, not attached to muscles, and no palpable lymph nodes. Diagnosed as simple diffused goiter and underwent subtotal thyroidectomy for cosmetic. On second day post operatively, she developed acute, central abdominal colicky pain, with no relieving or aggravating factors. On examination: looked unwell, afebrile, normal abdominal contour, move with respiration, free flanks, visible para umbilical swelling, tender and irreducible. Diagnosed as incarcerated para-umbilical hernia and repair was performed. On sixth day from first operation, she developed acute severe continuous right iliac fossa pain, not radiated with no relieving or aggravating factors. On examination: looked unwell, normal abdominal contour; move with respiration, free flanks, tenderness at right iliac fossa with positive rebound tenderness. Diagnosed as acute appendicitis and underwent appendectomy. Discharged in a good condition and came to refer clinic well and free of complains. Conclusion and recommendation: Incarceration of para-umbilical hernia could be due to lifting heavy weight in ward. Development of acute appendicitis may be due to flaring phase of thyroid hormones post thyroidectomy, exaggerating inflammatory response. Evaluation and monitoring of thyroid hormones post operatively, and provision of comforts facilities for such patients, was recommended.