Skin Temperature Changes After Total Thyroidectomy

Abstract

As a part of the careful study of patients submitted to the operation of total thyroidectomy for heart disease, we have conducted skin temperature observations before and after the operative procedure. We have utilized the method of Gibbon and Landis. 1 This method has been shown to produce adequate vasomotor dilatation and is far simpler than the other methods of injection of foreign proteins, the induction of a general or spinal anesthetic, or the blocking of sympathetic ganglia or peripheral nerves with novocaine or alcohol.

The operative procedure on all patients was done under local anesthesia, thereby eliminating the variability of blood flow studies as seen after a general anesthesia (Herrick et al. 2 ). The skin temperature determinations were all done in a small room, free from air currents, and having a constant temperature of 68–72°F. and humidity between 40 and 50%. This gives constant findings as shown by Talbot. 3 The patients in all cases were in bed in a semi-Fowler position and the points of election of skin temperature were the tibial tubercle, anterior ankle, and great and small toes of both lower extremities.

According to Morton and Scott, 4 there is a maximum vasodilatation response for normal vessels that has been designated the “normal vasodilatation level”. The lower limit of this maximum level for the surface temperature of the great toe whose vasoconstrictors have been released by general or spinal anesthesia (and the water-bath technique of Gibbon 1 ) is 31.5°C. at a room temperature of 20°C. (69°F.).

Studies of the skin temperature were made on 13 patients before operation and the vasodilator response determined. In these same patients postoperative studies were carried out at varying intervals, as from the fourth postoperative day to about 7 weeks later when the patient was in clinical myxedema, and again after thyroid therapy. The results of these studies in a typical case of angina pectoris are shown in Fig. 1.