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PubMed1988

Effect of thyroidectomy on rat T-kininogen.

The thyroid state affects the inflammatory reaction; in general, thyroid hormones increase and hypothyroidism decreases the inflammatory response. T-kininogen is an acute phase protein that inhibits cysteine proteases. The influence of thyroidectomy and 3,5,3'-triiodothyronine (T3)-treatment of thyroidectomized animals was examined on rat plasma T-kininogen concentration. Thyroidectomy increased the T-kininogen level three- to fourfold. A single administration of 10 micrograms T3/100 g body wt in 7-wk postthyroidectomy rats decreased it by approximately 50%. Daily treatment with 0.5 micrograms T3/100 g body wt prevented the increases in T-kininogen. The modifications in plasma T-kininogen concentration were confirmed by high-performance liquid chromatography analysis of the plasma kinins released by trypsin. They demonstrated that T-kinin was greatly and bradykinin slightly increased after thyroidectomy and that T-kinin concentration in T3-treated thyroidectomized animals was almost restored to the control level. The ability of thyroidectomized animals to produce a higher plasma T-kininogen compared with euthyroid animals was further documented when T-kininogen production was stimulated by laparotomy. This procedure resulted in a fourfold increase in T-kininogen in thyroidectomized animals compared with controls. The increase of plasma T-kininogen level after thyroidectomy results from a more active synthesis of the protein, since liver slices from thyroidectomized rats synthesized T-kininogen at a rate about two times higher than normal rats. These data may account at least in part for the diminution of the inflammatory response observed after thyroidectomy.

Animals↗
PubMed1993

Transient hypocalcemia after thyroidectomy.

The causes of transient hypocalcemia after thyroid surgery are not fully understood. In 95 consecutive patients undergoing total thyroidectomy (n = 30), subtotal thyroidectomy (n = 14), or hemithyroidectomy (n = 51), we serially measured total calcium, parathyroid hormone (PTH), and proteins before surgery and 6, 24, 48, 72, and 96 hours after surgery, and we calculated the corresponding ionized calcium levels. In the whole population, there was a statistically significant decrease of PTH, total calcium, and proteins at nearly every time of blood withdrawal, when compared with the preoperative levels. The PTH decreased earlier and total calcium levels were significantly lower after total thyroidectomy than after hemithyroidectomy (at 48, 72, and 96 hours). Ten patients had on 2 occasions serum calcium levels below or equal to 2 mmol/L and were defined as having severe hypocalcemia. Severe hypocalcemia was found in 8 patients after total thyroidectomy, compared with 2 after hemithyroidectomy (p < .05), and was present in 3 of the 5 patients with thyroid carcinoma, compared with 7 of the 90 patients with nonmalignant thyroid diseases (p < .01). Despite careful preservation of the parathyroid glands and their blood supply, thyroidectomy was often followed by transient hypocalcemia, the determinants of which are hypoparathyroidism and hemodilution. No patients had persistent symptoms of hypocalcemia from 2 to 3 months after surgery.

Adult↗
PubMed1992

Completion thyroidectomy in the management of well-differentiated thyroid carcinoma.

Completion thyroidectomy is the removal of any thyroid tissue that remains after less than total thyroidectomy. At our center, completion thyroidectomy is used when, on permanent sectioning, a frozen section diagnosis is revised from benign to malignant. We reviewed our experience with completion thyroidectomy to examine its indications and complications. We found that the carcinoma was misdiagnosed in 32 of 244 (13%) of cases. Twenty-five of these were initially designated follicular adenomas. The completion proved to be no more technically difficult than a routine hemithyroidectomy. There was one case of permanent hypoparathyroidism (3%). Transient vocal cord palsy occurred in one patient (3%) and transient hypocalcemia occurred in five patients (15%). Complete recovery occurred in all six of these patients. Focal areas of residual carcinoma were found in 8 of 32 (25%) of glands removed at completion. We found completion thyroidectomy to be a safe procedure with minimal morbidity. We recommend its use in those instances of well-differentiated thyroid carcinoma in which the frozen section diagnosis differs from the permanent section.

Adenocarcinoma↗
PubMed2004

Rapid rise in serum thyrotropin concentrations after thyroidectomy or withdrawal of suppressive thyroxine therapy in preparation for radioactive iodine administration to patients with differentiated thyroid cancer.

Patients with differentiated thyroid cancer are often treated transiently with T(3) in preparation for radioactive iodine (RAI) therapy. We questioned the value of using T(3) transiently in patients requiring RAI therapy. Two groups of patients requiring RAI therapy were investigated. One group included patients studied immediately after thyroidectomy, whereas the other included those withdrawn from chronic suppressive T(4) therapy that followed thyroidectomy and postoperative RAI ablation. Serum TSH concentrations were serially measured two to three times weekly until they reached more than 30 mU/liter, after which RAI therapy was administered. Serum TSH concentrations reached more than 30 mU/liter 8-26 d (mean +/- sd, 14.2 +/- 4.8) after thyroidectomy or 9-29 (18.1 +/- 4.1) d after T(4) withdrawal. That level of TSH elevation was achieved 18 d after thyroidectomy and 22 d after T(4) withdrawal in more than 95% of patients. Minimal symptoms of hypothyroidism were noted in either group when RAI was administered. Serum TSH concentrations increased rapidly without transient therapy with T(3). To minimize symptoms of hypothyroidism, serum TSH levels should be measured twice weekly, starting 10 d after thyroidectomy or T(4) withdrawal. The data cast doubt about the value and benefits from using T(3) in preparing patients for RAI therapy.

Adult↗
PubMed1978

Place of total thyroidectomy in rhinolaryngologists' surgical treatment of thyroid disease.

Total thyroidectomy is more frequently performed and is becoming more widely accepted as the treatment of choice for more surgical diseases of the thyroid gland. Improvement in anesthesia, presurgical and post-operative care, as well as more meticulous surgical technique, have decreased the complications associated with this operation. As is demonstrated, morbidity and complications of total thyroidectomy are no more frequent nor severe than when subtotal thyroidectomy is performed. This allows boadening of the indications for total thyroidectomy to include more cases which will be better controlled, but for which total thyroidectomy had been withheld because of the fear of increased morbidity.

Goiter, Nodular↗
PubMed1995

Safety of thyroidectomy in residency: a review of 186 consecutive cases.

A retrospective review was performed to assess the surgical complications of thyroidectomy performed by otolaryngology residents under close supervision by faculty. One hundred eighty-six consecutive cases of thyroidectomy performed by the residents in the Department of Otolaryngology--Head and Neck Surgery at the University of Southern California were reviewed. Sixty-nine percent of thyroidectomies were performed for malignant or possible malignant diseases, and 31% were performed for benign conditions. Transient (less than 2 weeks in duration) hypocalcemia occurred in 26% of the patients; the vast majority of cases resolved within the first week. Five percent of the patients developed persistent hypocalcemia requiring prolonged replacement therapy. The incidence of unexpected postoperative permanent vocal cord paralysis was 0.9%. These complication rates are comparable to those in previously published large series on results of thyroidectomy. Thyroidectomy performed in an otolaryngology residency training program is a safe procedure when closely supervised by experienced faculty.

Adolescent↗
PubMed1997

Fractures after thyroidectomy in men: a population-based cohort study.

Bone mass is purportedly reduced by an endogenous or exogenous excess of thyroid hormone or, perhaps, by calcitonin deficiency. Patients who have undergone thyroidectomy could be subject to all of these effects, yet their practical implications in terms of fracture risk are poorly defined. Interpretation is further hampered by the focus on women, where results may be influenced by involutional osteoporosis. Consequently, we assessed the potential for fractures among the 136 Rochester, Minnesota men who underwent thyroidectomy between 1935 and 1979, relative to a group of age-matched control men from the community. With 2194 person-years of follow-up in each group, survival free of any fracture of vertebra, proximal humerus, distal forearm, pelvis, or proximal femur was similar in the two groups (p = 0.23), and the relative risk of any of these fractures for thyroidectomized patients versus their controls was increased only 1.5-fold (95% CI, 0.7-3.2). The difference was entirely accounted for by a statistically significant excess of proximal femur fractures in the men with thyroidectomy. Risk factors for fractures among men with thyroidectomy included greater age at surgery, greater extent of surgery, and the presence of risk factors for secondary osteoporosis. Thus, thyroidectomy, performed mainly for adenoma or goiter, seems to have little overall influence on the risk of age-related fractures in men. However, the association with hip fractures requires further evaluation.

Adult↗
PubMedDate not supplied

Hypocalcemia complicating near-total thyroidectomy in patients with coexisting lipid malabsorption due to biliopancreatic diversion.

BACKGROUND: Patients who have undergone biliopancreatic diversion (BPD) show a high incidence of mild hypocalcemia, which may become symptomatic and life-treating after an extensive thyroid operation. METHODS: 4 cases are reported of women who had undergone BPD, who subsequently underwent near-total thyroidectomy for extensive multinodular goiter. RESULTS: The first patient developed severe symptomatic hypocalcemia with malnutrition in the long-term, that required elongation of the common limb of the BPD. The second and third patients developed severe symptomatic hypocalcemia immediately after the thyroidectomy. In the fourth patient, preventive and continuing intravenous administration of calcium gluconate was started in the early hours after the thyroidectomy and allowed a safe and fast discharge home. CONCLUSION: In patients who are candidates for both thyroid and bariatric surgery, surgeons should carefully evaluate the opportunity to perform the thyroidectomy first. BPD patients who later undergo thyroidectomy should be perioperatively routinely treated with intravenous calcium and, whenever appropriate, intravenous vitamin D, to allow a safe and rapid discharge.

Adult↗
PubMed1978

[Changes in serum thyrotropin, thyroxine and triiodothyronine after complete thyroidectomy (author's transl)].

Changes in serum TSH, T4 and T3 concentrations after complete thyroidectomy were observed for 4 weeks in 9 euthyroid patients with thyroid carcinoma. Completeness of the thyroidectomy was confirmed by a 131 I scintigram performed one or two months after the operation. Serum TSH levels rose progressively during the 4 weeks of observation, and a significant increase was noticed as early as 3 days after the thyroidectomy. Serum T4 and T3 concentrations decreased significantly 3 days and 18 hrs, respectively, after the thyroidectomy. A sharp decrease in serum T3 concentrations within 18 hrs without a significant change in serum T4 levels and possibly without a significant change in the amount of T3 derived from T4 suggests that the amount of T3 secreted from the thyroid is large enough to affect serum T3 concentrations. The rate of decrease of serum T4 (t 1/2: 16 days) or serum T3 (t 1/2: 23 days) after the 3rd day of the thyroidectomy was much slower than the rate of disappearance of labeled T4 or T3 reported previously. The slow decrease rate of serum T3 is probably due to the conversion of T4 to T3 in peripheral tissues, and that of serum T4 may be due to either the decrease in T4 disposal rate in hypothyroidism or due to the release of T4 from peripheral tissues to serum.

Adult↗
PubMed1984

Changes in the multiple components of rat pituitary TSH and TSH beta subunit following thyroidectomy.

Heterogeneity of pituitary TSH was investigated in rats following thyroidectomy. Adult male rats were sacrificed at varying periods (2-28 days) after thyroidectomy. In another experiment, thyroidectomized rats were injected daily with various doses of L-T4 (0.3-7.5 micrograms/100 g body weight, ip) and sacrificed 2 weeks later. The homogenate of the pituitaries was applied on an isoelectric focusing column or a Sephacryl S-200 column. The normal rat pituitary contained 5 major components of immunoreactive (IR) TSH in isoelectric focusing, in which the isoelectric point (pI) ranged from 6.6 to 8.8. The multiple components of IR-TSH beta were observed almost in the same areas as those of IR-TSH. Following thyroidectomy IR-TSH components with more acidic pI, associated with IR-TSH beta, were evident. A large amount of IR-TSH beta in the pituitaries of thyroidectomized rats appeared near the void volume in gel filtration, suggesting the presence of big TSH beta. Supplement of L-T4 minimized these thyroidectomy-induced changes in isoelectric focusing and gel filtration. Furthermore, big IR-TSH beta was little affected by ultracentrifugation and was relatively stable after treatment with 6 M guanidine hydrochloride. We demonstrated that the rat pituitary gland contained multiple components of IR-TSH and IR-TSH beta, both of which became variegated after thyroidectomy. It is suggested that a discernible degree of heterogeneity of TSH, particularly of TSH beta, is dependent upon the increased rate of TSH biosynthesis at the pituitary level.

Animals↗
PubMed1984

Thyroid hormone maintains normal circadian rhythm of blood corticosterone levels in the rat by restoring the release and synthesis of ACTH after thyroidectomy.

The role of thyroid hormone in maintenance of the circadian adrenocortical rhythm was studied in the rat. The amplitude of the circadian rhythm of blood corticosterone levels gradually decreased with time after thyroidectomy, and by 5 weeks the rhythm disappeared. However, the circadian peak elevation constantly occurred just before the onset of the dark period until 4 weeks. Three weeks after thyroidectomy, daily overall treatment with thyroxine (T4) or 3,5,3'-triiodothyronine (T3) completely restored the amplitude of the circadian adrenocortical rhythm to the previous level within 2 weeks. Thyroidectomy did not affect the circadian rhythm in water intake. However, thyroidectomy resulted in a loss of significant difference of plasma adrenocorticotrophin (ACTH) levels between the morning and the evening, by decreasing the evening levels. Similarly, pituitary ACTH content was decreased by thyroidectomy. Replacement of T4 completely restored the decreased ACTH levels to the previous ones. These results suggest that thyroid hormone plays an important role in maintenance of the normal amplitude in circadian adrenocortical rhythm in the rat, by affecting ACTH synthesis.

Adrenal Cortex↗
PubMed1999

Early or prophylactic thyroidectomy in MEN 2/FMTC gene carriers: results in 71 thyroidectomized patients. The French Calcitonin Tumours Study Group (GETC).

BACKGROUND: Once genetic testing accurately identifies MEN 2 gene carriers, affected children are given the opportunity to undergo thyroidectomy at the earliest stages of the C-cell disease. OBJECTIVE: To define reliable parameters by which to identify the best moment for thyroidectomy in patients who are carriers of the MEN 2 gene. PATIENTS AND METHODS: Seventy-one MEN 2/FMTC gene carriers, collected through the national register of the French Calcitonin Tumours Study Group, were evaluated. All the patients included were younger than 20 years of age and underwent total thyroidectomy. Basal and pentagastrin-stimulated calcitonin were assayed using an immunoradiometric method (sensitivity less than 2pg/ml). Calcitonin measurement was evaluated on the basis of histopathological findings in surgical thyroid specimens. RESULTS: We found C-cell hyperplasia or medullary thyroid carcinoma in all the 71 gene carriers - even for the youngest patients - and nodal metastases were present in four cases. Calcitonin measurement (basal or pentagastrin-stimulated) detected C-cell disease preoperatively in all patients. Six of the 71 patients were not surgically cured: one had nodal metastases, one had an advanced staged disease and four had an incomplete nodal dissection or had not undergone lymph node surgery. CONCLUSIONS: Determination of calcitonin forms an integral part of the management of MEN 2 gene carriers. Thyroidectomy is undisputably indicated when basal calcitonin is abnormal. When basal calcitonin is undetectable, a pentagastrin-stimulated increase in calcitonin to more than 10 pg/ml indicates an early thyroidectomy to cure the patient.

Adolescent↗
PubMed2006

Preliminary results from minimally invasive video-assisted thyroidectomy.

CONTEXT AND OBJECTIVE: Minimally invasive video-assisted gasless thyroidectomy (MIVAT) has mainly been described in Italy and has been demonstrated to be a safe procedure with additional advantages regarding cosmetic results and postoperative outcome. The aim of this work is to analyze our preliminary results from minimally invasive video-assisted thyroidectomy. DESIGN AND SETTING: Retrospective study at the Head and Neck Surgery Service of Hospital Ana Costa, Santos. METHODS: Twelve patients underwent hemithyroidectomy and another three underwent total thyroidectomy by means of minimally invasive video-assisted thyroidectomy between June and September 2004. Gender, age, goiter volume, major diameter of the dominant nodule, duration of surgery, pain complaints during the first postoperative day, length of hospital stay, cosmetic result and complications were retrospectively analyzed. RESULTS: All the patients were women, with median age of 34. The median goiter volume was 16.5 ml, and the median major diameter of the nodule was 2.3 cm. Ten patients reported mild pain at the surgical site. The median scar size was 2.0 cm and all patients considered the cosmetic results excellent. The median duration of surgery was 55 minutes, all patients were discharged on the first postoperative day, and there were no complications. CONCLUSIONS: The outcome from minimally invasive video-assisted thyroidectomy is good in terms of cosmetic results, analgesia and postoperative recovery. The scar is shorter than in the conventional procedure.

Adult↗
PubMed2005

[Prophylactic thyroidectomy in children and young people with hereditary medullary thyroid carcinoma: a Chilean experience].

BACKGROUND: With the availability of the RET proto-oncogene genetic testing, it is possible to perform prophylactic total thyroidectomy among carriers of RET mutation. AIM: To evaluate the histological findings and the effects of the prophylactic total thyroidectomy in first-degree relatives of Chilean patients with multiple endocrine neoplasia type 2 (MEN 2) based on the Ret proto-oncogene analysis. SUBJECTS AND METHODS: Nineteen patients belonging to 11 MEN 2 families underwent total thyroidectomy. Of these, 16 either with C cell hyperplasia (CCH) or microscopic medullary thyroid carcinoma (MTC) were selected for the final analysis. RESULTS: The age at the moment of thyroidectomy ranged from 3 to 24 years (median 9.5). The most common mutation was located in codon 634 (69%) followed by codon 620 (25%). Histopathology revealed MTC in 13 patients (81%, youngest 3 years, oldest ones 19 and 24 years) and CCH in 3. A significant correlation was observed between basal preoperative serum calcitonin/tumor size (r = 0.53, P < 0.05) and age/tumor size (r = 0.56, P < 0.03), but not between basal preoperative serum calcitonin and age. Stimulated preoperative calcitonin levels were confounding and not useful for differentiating CCH from MTC. None of patients in whom cervical dissection was done (9/16) presented lymph node metastases, including the oldest ones. All patients but the older ones were biochemically cured after a mean of 5 years of follow-up. CONCLUSION: Prophylactic total thyroidectomy should be done early in life because there is an age-dependent progression from HCC to MTC. MTC often precedes biochemical detection of the disease.

Adolescent↗
PubMed1999

[Total thyroidectomy in surgical treatment of euthyroid goiter].

BACKGROUND AND AIMS: The aim of this study was to compare the experiences and results achieved by a single surgeon using total thyroidectomy and partial exeresis in the treatment of uni- and multinodular euthyroid goiter. METHODS: The results of two groups of operations performed at two different periods were analysed: a more recent group (1995-97) in which management tended to prefer total thyroidectomy, and a retrospective group (1984-1994) in which a more conservative attitude was adopted to benign thyroid pathology. RESULTS: An analysis of the results and complications in each group showed that there were no statistically significant differences between the percentage of recurrent and parathyroid lesions during total thyroidectomy and partial exeresis. In practice, the risk of these lesions is higher during redo surgery for cancer and/or recurrence. The recidivation of goitrogenic pathology is high, amounting to around 29% of total cases. The most significant findings, however, which further justifies the use of total thyroidectomy is the increasingly frequent observation of "occult carcinomas" within the benign pathology, registered in the retrospective group (13.27%) and in the more recent one (12.35%). CONCLUSIONS: On the basis of this analysis, the authors confirm their support for the use of total thyroidectomy on principle as the correct and rational treatment for euthyroid goiter, and reserve the use of conservative treatment for single nodular lesions where it is possible to perform a correct hemithyroidectomy and isthmectomy following the patient's informed choice.

Adult↗
PubMedDate not supplied

[Therapeutic strategies in differentiated cancer of the thyroid: total thyroidectomy].

Differentiated thyroid cancer is peculiar for its prognosis often excellent. The Authors report their experience about 78 patients affected with differentiated thyroid carcinoma, operated between 1976-1999 at the Institute of Surgical Pathology and Surgical Clinic of Cagliari University. 70 (89.7%) patients underwent total thyroidectomy, 6 (7.5%) subtotal thyroidectomy and 2 (2.5%) thyroid lobectomy. In 11 patients total thyroidectomy was performed in two times within 60 days after initial lobectomy. Tumor was found in 2 (18%) of 11 of the reoperations. Lymphadenectomy was performed only in presence of cervical lymph nodal metastases. Following 70 total thyroidectomy the incidence of recurrent nerve palsy was 4.2% and permanent hypoparathyroidism 11.4%. 79% patients received adjuvant postoperative radioiodine therapy to ablate residual functioning tissue or distant suspected metastases. After a mean follow up period of 5.8 years, recurrences developed in 10.2%. Any local recurrences, 5 (6.4%) cervical nodal recurrences, 3 (3.8%) distant metastases were encountered. Two (2.5%) of the three patients with recurrence distant metastases died from thyroid carcinoma. The Authors identify total thyroidectomy as the minimal procedure. Surgical management of the cervical nodes is recommended only in the presence of metastatic lymph-nodes. Post surgical ablation with I131 of microscopic remnants optimize detection and treatment of the recurrence and distant metastases.

Adolescent↗
PubMed2004

Should female patients undergoing parathyroid-sparing total thyroidectomy receive routine prophylaxis for transient hypocalcemia?

Hypocalcemia following parathyroid-sparing total thyroidectomy is frequent and can prolong hospital stay. We undertook this study to identify preoperative predictors of postoperative hypocalcemia useful in the postoperative management of these patients. We examined patients undergoing total thyroidectomy for benign disease with preservation of at least three parathyroids from January 2000 to January 2001. Low serum calcium was considered below 8.0 mg/dL. Age, gender, preoperative serum calcium, thyroid stimulating hormone (TSH), T3, T4, albumin, cholesterol, and tryglicerides were compared in patients with normal and low serum calcium level on the second postoperative day and on discharge day by using chi2 test and a model of logistic regression. Data were reported using their frequency distribution among the two groups of patients. Eighty patients, 60 females (F) and 20 males (M), underwent parathyroid-sparing total thyroidectomy. On second postoperative day, hypocalcemia occurred in 42 patients, and 56 per cent were symptomatic. Only female gender (88% F vs 12% M) (P < 0.05) and TSH <0.27 mUI/mL (38% vs 18%) (P < 0.05) predicted hypocalcemia. Similarly, female gender predicted hypocalcemia in a logistic regression analysis (P < 0.05). On the day of discharge, 22 patients had low serum calcium levels, and 50 per cent were symptomatic. At this time, only TSH value < 0.27 mlU/mL significantly predicted hypocalcemia (48% vs 17%) (P < 0.05). This was confirmed in a logistic regression analysis (P < 0.05). All but one patient (98%) eventually returned to normal serum calium levels. Despite preservation of parathyroids, transient symptomatic hypocalcemia is common after total thyroidectomy. Female gender and low TSH serum level predicted hypocalcemia. Therefore, female patients undergoing total thyroidectomy with preoperative low TSH levels should receive calcium prophylaxis to decrease morbidity, shorten hospital stay, and decrease costs.

Adult↗
PubMedDate not supplied

Usefulness of the ultrasonically activated shears in total thyroidectomy.

Surgical technique of total thyroidectomy is nowadays well known. Technology could determine some improvement of this kind of surgery. Two groups of patients that underwent total thyroidectomy were compared retrospectively. In group 1 we described 105 total thyroidectomies performed with ultrasonically activated shears; in group 2, 76 performed with conventional methods of haemostasis. Comparing the two groups for several parameters, it results that in the total thyroidectomies performed with ultrasonically actived shears, operative time is shorter of 24 minutes compared with conventional method (81 vs 105 minutes), the mean amount of intraoperative blood loss is smaller (70 ml vs 125 ml), the postoperative pain is less, the cosmetic result is better (length of incision 6 cm vs 10 cm) and the costs is not more expensive. Complications of thyroid surgery are similar between the two methods. The use of ultrasonically actived shears in total thyroidectomy is safe (no increase of complications) and useful because it reduces operative time, improves the recovery of the patient (less pain, better cosmetic results) and, finally, is not more expensive than conventional method of haemostasis.

Adult↗