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PubMed1988

[A study of transfer of cefbuperazone into postoperative exudates in patients with cancer mastectomy or thyroidectomy].

Cefbuperazone (CBPZ) at a dose of 2 g was administered postoperatively by intravenous drip infusion to 9 patients subjected to radical mastectomy and 10 others subjected to thyroidectomy then levels of CBPZ in postoperative exudates were measured and its prophylactic effect on postoperative infections was determined. 1. Serum CBPZ levels in the patients after cancer mastectomy and thyroidectomy on postoperative day 1 were similar to those in healthy adults. 2. Levels of CBPZ in the postoperative exudates in patients subjected to cancer mastectomy reached a mean peak value of 66.3 micrograms/ml (range: 26.0-99.6 micrograms/ml) in 0-3 hours after administration, and the mean CBPZ level at 6 hours after administration was 33.3 micrograms/ml (range: 19.1-54.1 micrograms/ml). 3. As compared to the cases of cancer mastectomy, levels of CBPZ in postoperative exudates in patients subjected to thyroidectomy varied considerably from a patient to another: a mean peak level of 76.4 micrograms/ml (range: 31.3-128 micrograms/ml) appeared in 0 to 6 hours after administration. 4. There was no correlation between CBPZ levels in the exudate and hemoglobin levels or hematocrit values. 5. Likely because of the CBPZ administration at 4 g/day for 2 to 6 days postoperatively to 19 patients, postoperative infection was absent and no side effect attributable to this drug occurred in any of the patients. Because levels of CBPZ in postoperative exudates in patients subjected to cancer mastectomy or thyroidectomy were greater than MICs for principal Gram-positive and Gram-negative bacteria, it is likely that this drug is a useful agent for prophylaxis against postoperative infections in patients undergoing cancer mastectomy or thyroidectomy.

Adult↗
PubMed1987

Detrimental effect of recent thyroidectomy on hemorrhagic shock and resuscitation.

Shatney and coworkers, in 1984, reported that recent thyroidectomy in dogs improved survival following hemorrhagic shock induced by reservoir bleeding to a mean pressure (MAP) of 60 torr for 60 min. Since thyroidectomy reduces preshock MAP, their control dogs had a relatively greater fall in MAP during hemorrhage. To circumvent this inequity, this study was designed to elucidate the effects of recent thyroidectomy in 20 splenectomized dogs subjected to acute hemorrhagic shock induced by phlebotomy of a predetermined volume of blood independent of resultant MAP. During splenectomy, ten dogs had thyroidectomy with parathyroid preservation and ten dogs had sham neck operation; 12 days later, hemorrhagic shock was induced by the stepwise bleeding of 35 ml/kg body weight over 75 min. Parameters measured at preshock (baseline), postshock (PS), postresuscitation (PR), and day 2 included MAP, cardiac output (CO), wedge pressure (PCWP), T3, T4, TSH, and hematocrit (Hct). Hypothyroidism was confirmed by low T3 and T4. Baseline and PS hemodynamic parameters were similar for both groups; PR data showed a significant rise in CO (6.7 liter/min vs 3.9 liter/min) and a fall in PCWP (13.2 mmHg vs 18.6 mmHg) in the euthyroid dogs compared to the hypothyroid dogs. Increased CO persisted through day 2 in the euthyroid dogs (3.14 liter/min vs. 1.95 liter/min). Four thyroidectomized dogs died during shock compared to one control dog. Contrary to prior data, this study shows that recent thyroidectomy reduces the survival and compensatory response to hemorrhage. The mechanism leading to this impaired response needs to be defined.

Animals↗
PubMed1983

Influence of thyroidectomy and prolactin suppression on the growth of N-nitrosomethylurea-induced rat mammary carcinomas.

Mammary carcinomas were induced in female Sprague-Dawley rats with N-nitrosomethylurea. Thyroidectomy increased the serum prolactin and reduced serum growth hormone levels of 17 rats without affecting tumor growth. Pergolide mesylate, 80 micrograms twice daily for 7 days, suppressed the serum prolactin of another 17 animals; seven of 17 tumors continued to grow, four became static, and six (35%) underwent partial regression. Treatment with pergolide mesylate plus thyroidectomy reduced both serum prolactin and growth hormone in all of 14 rats, caused regression of ten of the 14 tumors (71%), while two became static, and two continued to grow. Five of the ten regressions were complete. Only the combined thyroidectomy-pergolide treatment group showed a significant difference in posttreatment surface area compared with the controls (p less than 0.001). Ovine growth hormone, 40 micrograms/hr delivered by s.c. osmotic minipumps for 7 days, stimulated regrowth of six of seven tumors undergoing regression in response to thyroidectomy plus pergolide; the other one became static. Thyroxine, 2 micrograms/100 g body weight, stimulated regrowth of the tumors in another six thyroidectomized rats despite continued suppression of prolactin by pergolide. Thus, regression of N-nitrosomethylurea-induced mammary tumors produced by thyroidectomy plus pergolide is due to the combined suppression of circulating growth hormone and prolactin.

Animals↗
PubMedDate not supplied

[Clinical study of residual function and recurrences in patients after partial thyroidectomy for non-toxic nodular goiter].

The different surgical chances for the treatment of non toxic nodular goiter led the Authors to study the residual function after partial thyroidectomy. A variable rate of recurrences and hormone deficiency was shown in patients who underwent sub-total thyroidectomy, lobectomy and enucleation. It depended on the amount of residual gland and the different methods they used. Recurrences occurred more in patients studied by ultrasonography. After sub-total thyroidectomy the Authors noted a more reduced number of recurrences than after lobectomy and enucleation. There was a meaningless connection between high plasmatic levels of TSH and recurrences. Subclinical hypothyroidism was higher in patients who underwent subtotal thyroidectomy than in patients treated with lobectomy and enucleation. These clinical data show that recurrences could depend on growth factors (EGF, IGF) in thyroid tissues and not only on TSH action. Therefore the surgical attitude of the authors in the treatment of nodular goiter consists in total thyroidectomy.

Aged↗
PubMed1993

The effect of thyroidectomy on growth hormone regulation in the ovine fetus.

To test the hypothesis that growth hormone gene messenger RNA abundance in the fetus is subject to the same effects of thyroid hormone previously demonstrated in other situations, we evaluated the effect of thyroidectomy on pituitary GH mRNA content at three gestational ages in the ovine fetus. One of each twin pair of fetal lambs underwent thyroidectomy at 90, 100 or 110 days gestation. Fetal pituitaries were collected 25-30 days later. Plasma GH and IGF-I were measured as well as pituitary GH mRNA content. Serum growth hormone in the thyroidectomy group was less than in the control twins (129.8 vs 187.6 micrograms/l, P = 0.0. GH mRNA was likewise decreased in pituitaries of thyroidectomy fetuses compared to controls (1.01 vs 1.80 units, P = 0.0006). Serum IGF-I and body weight were similar in the thyroidectomy and control twins. We conclude that the ovine fetus in the final trimester of gestation exhibits effects of thyroid hormone on serum GH and mRNA abundance similar to those seen in postnatal animals.

Actins↗
PubMed1994

[Predictive factors of nodular recurrence after thyroidectomy for goiter].

We report a retrospective series of 44 recurrences of nodular goitre following 430 partial thyroidectomies over a 10 years period. There were 40 women and 4 men with a mean age of 43 and 37 years respectively. Twenty-four recurrences were from our institution (6%) and 20 were referred to us. The median follow-up of primary thyroidectomies was 8.5 years for patients with recurrence and 4 years for patients free of recurrence (p < 10(-6)). The incidence of recurrence was analysed in a statistical and actuarial model considering clinical intra-operative and post-operative variables. The following risk-factors for recurrence were found: age < 50 years (p < 0.01), family history of goitre (p < 0.04), unilateral multinodularity (p < 0.0002), diffuse and bilateral distribution of nodules (p < 0.02), atypical resections with conservation of isthmus (p < 0.0001), scintigraphically "warm" nodules (p < 0.001). Interestingly, sex, heterogeneous thyroid parenchyma without macroscopic nodules and the use of post-operative levothyroxine did not modify the risk of recurrence. Thirty-three patients were non symptomatic. Thirty-four patients underwent re-operation. Three primary non suspected carcinomas were found. There was no mortality related to re-operation. There were not definitive vocal cord paralysis or hypocalcemia. There was no significant difference in vocal or parathyroid morbidity when total thyroidectomy for primitive goitre was compared to total thyroidectomy as re-operation. Long-term and periodic follow-up is necessary to detect non-symptomatic recurrences in a high-risk population. Total thyroidectomy is the treatment of choice for bilateral multinodular goitre.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1993

Iodine therapy for thyroidectomy patients exhibiting high thyroid-stimulating hormone values: a randomised study.

After thyroidectomy there is an appreciable incidence of hypothyroidism as judged by FT4I estimates. Pharmacological doses of iodine (10-300 mg/day) usually suppress, whereas physiological doses of iodine (< 5 mg/day) have been reported to both decrease and increase thyroid function. The value of iodine supplementation in preventing post-thyroidectomy hypothyroidism was assessed in a prospective randomised trial. A series of 55 patients with a TSH > 6 mU/l 1 month after bilateral subtotal thyroidectomy or unilateral lobectomy for benign disease were randomised to receive either chloroform water 5 ml/day (placebo) or chloroform water 5 ml/day with 1 mg of iodine to be taken for 20 weeks. With placebo, 62% of bilateral subtotal thyroidectomies were euthyroid at 6 months on no thyroid replacement, while with iodine all were hypothyroid as judged by FT4I. After bilateral subtotal thyroidectomy, the recovery of remnant function is delayed by an iodine supplement of 1 mg/day.

Adult↗
PubMed1995

111In-pentetreotide scintigraphy in the post-thyroidectomy follow-up of patients with medullary thyroid carcinoma.

Local and lymphnodal recurrences of medullary thyroid carcinoma (MTC) in thyroidectomy patients with elevated plasma levels of calcitonin and/or CEA can be detected using 111In-pentetreotide (Octreoscan: OCT) scintigraphy, although the sensitivity of this technique in localizing an intrathyroid recurrence of tumor is affected by the low target/non-target uptake ratio. The survival rate of patients with MTC, who have undergone thyroidectomy and who show evidence of a rise in plasma levels of calcitonin and/or CEA is closely linked to the number and localization of the metastases. However the role of conventional imaging techniques (X-rays, US, CT, and MR) in the follow-up after thyroidectomy is controversial. Numerous radiocompounds are currently being used to detect local and distant recurrences of MTC. The present study evaluated OCT and pentavalent 99mTc-dimercapto-succinic-acid (99mTc-DMSA-V) scintigraphy performed in 13 patients with a histologic diagnosis of MTC and in one with MEN 2A, all of whom had undergone thyroidectomy between 3 months and 15 years before. The patients also underwent 123I (NaCI) scintigraphy to evaluate the sites and extension of thyroidal remnants. 111In-pentetreotide scintigraphy was positive in 9/14 patients (64%); the 99mTc-DMSA-V was positive in 5/14 patients (35%). 111In-pentetreotide scintigraphy recognized 18 sites of abnormal uptake (12 in the neck); 9mmTc-DMSA-V detected 9 MTC recurrences in the same patients. In conclusion, 111In-OCT scintigraphy represents, in the authors' experience, a useful method, more sensitive than 9mmTc-DMSA-V, to detect MTC recurrences in patient follow-up post-thyroidectomy.

Adult↗
PubMed2004

The role of intraoperative rapid parathyroid hormone monitoring for predicting thyroidectomy-related hypocalcemia.

OBJECTIVE: To determine if the intraoperative rapid parathyroid hormone (PTH) assay can be used to accurately predict postoperative calcium levels following total or completion thyroidectomy. DESIGN: A prospective study. SETTING: Tertiary care referral center. PATIENTS: One hundred four patients following a total or completion thyroidectomy.Intervention Intraoperative rapid plasma PTH levels were determined for patients undergoing a total or completion thyroidectomy. MAIN OUTCOME MEASURES: Parathyroid hormone levels were recorded after the induction of anesthesia, before excision, and 5, 10, and 20 minutes after thyroidectomy. Postoperative calcium levels were monitored every 6 hours until hospital discharge. Intraoperative PTH levels were correlated with postoperative calcium levels and clinical symptoms of hypocalcemia. RESULTS: Twenty-two patients (21.2%) required short-term postoperative calcium supplementation, and 2 (1.9%) required long-term calcium replacement. There was a statistically significant difference between those patients requiring calcium replacement and those who did not require calcium supplementation, for postoperative total calcium level (7.2 vs 8.1 mg/dL [1.8 vs 2.0 mmol/L]; P<.001) and ionized calcium level (3.76 vs 4.36 mg/dL [0.94 vs 1.09 mmol/L]; P<.001). In addition, the PTH changes from baseline demonstrated statistically significant differences at 5, 10, and 20 minutes after the excision between the 2 groups (P<.005). In those patients requiring calcium supplementation, 14 (64%) of 22 demonstrated a change in PTH level at 20 minutes of greater than 75% from baseline, and in those patients who did not require postoperative calcium supplementation, 61 (74%) of 82 demonstrated a change in PTH level of less than 75% from baseline (P<.005). CONCLUSION: Intraoperative PTH monitoring may be a useful tool in identifying patients who will not require postoperative calcium supplementation following total or completion thyroidectomy.

Adolescent↗
PubMed2006

Randomized controlled trial of harmonic scalpel use during thyroidectomy.

OBJECTIVE: To compare operative factors, postoperative outcomes, and surgical complications of thyroidectomy when using the harmonic scalpel (HS) vs conventional hemostasis (CH). DESIGN: Single-blind, randomized controlled trial. SETTING: Department of Surgery, S. Chiara Hospital, University of Pisa, Pisa, Italy. PATIENTS: One hundred patients undergoing thyroidectomy. MAIN OUTCOME MEASURES: Postoperative pain, drainage volume, hypocalcemia, nerve injury, and operative time. INTERVENTION: Patients underwent total thyroidectomy in which either the HS or CH was used. RESULTS: We found no significant differences between the HS and CH groups at baseline. Postoperative pain was reduced in the HS group at 24 hours (mean visual analog scale score, 3.90 vs 5.30; P<.001) and 36 hours (2.27 vs 3.95; P<.001). Drainage volume was significantly lower in the HS group (40.1 mL vs 75.4 mL; P<.001). Transient hypocalcemia was significantly lower in the HS group (5 patients [10%] vs 16 [32%]; P=.01). No patients experienced nerve injury or permanent hypocalcemia. Mean operative times were shorter in the HS group (40.0 vs 46.7 minutes, P<.001). CONCLUSIONS: Use of the HS may reduce postoperative pain, drainage volume, and transient hypocalcemia in patients undergoing thyroidectomy. Shorter operative times and improved outcomes might justify the cost of the HS compared with that of CH.

Adult↗
PubMed2001

Parathyroid autotransplantation during thyroidectomy: documentation of graft function.

HYPOTHESIS: Biochemical function of normal parathyroid tissue grafted during thyroidectomy can be documented. DESIGN: An intervention study in which devascularized or inadvertently removed parathyroid glands are reimplanted in forearm muscle pockets during thyroidectomy. Postoperative serum parathyroid hormone levels were evaluated by venous sampling from both forearms on postoperative days 1, 3, 14, 28, 56, and 84. SETTING: Tertiary care teaching hospital. PATIENTS: Seven patients undergoing thyroidectomy at risk for postoperative hypocalcemia. RESULTS: A 1.5-fold gradient of parathyroid hormone measurements between grafted and nongrafted arms was demonstrated in all patients on postoperative day 28. A maximal parathyroid hormone gradient was reached on day 56, and biochemical function persisted in 6 patients on day 84. CONCLUSIONS: Biochemical function of parathyroid glands reimplanted during thyroidectomy can be demonstrated objectively. The application of parathyroid autotransplantation may preserve parathyroid function for inadvertently removed or devascularized parathyroid glands during thyroid surgery.

Female↗
PubMed2004

Complication of thyroidectomy in patients with radiation-induced thyroid neoplasms.

HYPOTHESIS: The complication rate for thyroidectomy is the same in patients with and without a history of radiation exposure. DESIGN: Retrospective medical record review of 171 consecutive patients who had a previous history of radiation treatment and had undergone a thyroid operation from 1961 to 1999. SETTING: University of California, San Francisco, Medical Center and affiliated hospitals. PATIENTS: We selected 107 patients with a history of radiation exposure who had undergone thyroid operations (81 total thyroidectomies) and 107 control patients who underwent comparable operations but had no history of radiation exposure. RESULTS: Among patients with a history of radiation exposure (mean age, 47.2 years), there was 1 recurrent nerve injury, 1 external nerve injury, 20 patients with transient hypocalcemia, and 1 patient with a hematoma. Among patients without a history of radiation exposure (mean age, 47.5 years), there were 2 recurrent nerve injuries, 18 patients with transient hypocalcemia, and 1 patient with a hematoma. All cases of hypocalcemia and recurrent nerve injury in both groups were transient. One patient had a permanent superior laryngeal nerve injury. In patients who underwent operations since January 1, 1990, duration of hospitalization was 1.2 days in patients with a history of radiation exposure (65 patients) and 1.1 days in patients without (101 patients). CONCLUSIONS: Our data document that the risk of transient and permanent complications after total thyroidectomy is similar in patients with and without a history of radiation exposure. The relatively low long-term complication rate supports prophylactic total thyroidectomy for patients with thyroid nodules and a history of radiation exposure.

Female↗
PubMed1993

Total lobectomy and total thyroidectomy in the management of thyroid lesions.

OBJECTIVE: To study an unselected consecutive series of patients undergoing thyroidectomy for tumors to establish the complication rates of total lobectomy with isthmectomy and total thyroidectomy. DESIGN: Retrospective study. PATIENTS: Two hundred eight consecutive, unselected patients were operated on by one surgeon from 1980 to 1990. One hundred nineteen patients (57%) had a total lobectomy and isthmectomy and 85 patients (41%) had total thyroidectomy. Four patients (2%) had partial excision for technical reasons, two with anaplastic cancers and two with advanced thyroiditis. RESULTS: Forty-two malignant lesions (20%) were diagnosed with a mean follow-up of 5 years. Malignant lesions were diagnosed in 15 (31%) of 48 males and 27 (17%) of 160 women. Ten patients (5%) had parathyroid adenomas. Long-term follow-up revealed that there were no deaths, permanent hypocalcemia, or recurrent laryngeal nerve damage. One patient was returned to the operating room to control bleeding. CONCLUSION: This study suggests that total thyroid lobectomy with isthmectomy and total thyroidectomy are both safe procedures in the management of thyroid tumors.

Adenocarcinoma↗
PubMed1986

Operative strategy for thyroid cancer. Is total thyroidectomy worth the price?

The authors conducted a retrospective analysis with 5- to 30-year follow-up on 109 patients in order to determine the optimum management of nonmedullary thyroid cancer. Results of total thyroidectomy were compared to partial thyroidectomy, among patients well matched for prognostic indicators. No differences in cancer mortality or recurrence rates were evident. However, there were significantly more complications when total thyroidectomy was employed. In view of these results, partial thyroidectomy is recommended as the treatment of choice for nonmedullary thyroid cancer.

Adult↗
PubMed1989

Near-total thyroidectomy for carcinoma of the thyroid.

There is controversy about the most appropriate treatment for patients with thyroid cancer. This study analyses our experience with 206 cases of thyroid cancer from an endemic goiterous area. There were 100 males and 106 females; patients presented at an earlier age with a short history. Thyroid cancers demonstrated an aggressive biological behaviour with an advanced stage at presentation (overt cancers in 51 per cent) and a relentless course with a mortality rate of 24.2 per cent for the well-differentiated tumours. Near-total thyroidectomy was performed in 126 patients. Multicentric foci of tumour were seen in 17.2 per cent of the well-differentiated cancers and 25.2 per cent of the cases of well-differentiated cancers who underwent near-total thyroidectomy developed loco-regional recurrence. Hemithyroidectomy was performed in 35 patients who refused completion total thyroidectomy at a second stage; 16.7 per cent of these patients developed a recurrence in the remaining contralateral lobe. Thus in our patients from an endemic goiterous area, near-total thyroidectomy is the treatment of choice particularly because of the frequent occurrence of follicular and anaplastic cancers (in 44.2 per cent) and because the course of the disease is more virulent.

Adenocarcinoma↗
PubMed2002

Very early detection of RET proto-oncogene mutation is crucial for preventive thyroidectomy in multiple endocrine neoplasia type 2 children: presence of C-cell malignant disease in asymptomatic carriers.

BACKGROUND: Multiple endocrine neoplasia type 2 (MEN 2) is an inherited disease caused by germline mutations in the RET proto-oncogene, and is responsible for the development of endocrine neoplasia. Its prognosis is dependent on the appearance and spread of medullary thyroid carcinoma (MTC). Relatives at risk can be identified before clinical or biochemical signs of the disease become evident. METHODS: Twenty-one families with MEN 2 (16 families with MEN 2A and 5 families with MEN 2B) were studied. Peripheral blood DNA was amplified by polymerase chain reaction. DNA sequence or restriction enzyme analysis was performed to detect mutations of RET proto-oncogene exons 10, 11, and 16. Molecular analysis was carried out in all index patients as well as in 98 relatives of MEN 2A patients (60 juveniles, ages 6 months to 21 years, and 38 adults, ages 22 to 81 years) and in 13 relatives (6 juveniles ages 10 to 21 years, and 7 adults ages 41 to 66 years) from MEN 2B families. RESULTS: Molecular studies showed a mutation at codon 634, exon 11 in all MEN 2A patients. All MEN 2B patients showed an ATG to ACG (Met918Thr) mutation. In MEN 2A families, 42 out of 98 relatives were affected. Total thyroidectomy was performed in 18 juvenile carriers ages 17 months to 21 years. Histopathologic studies of the glands revealed parafollicular cell (C-cell) hyperplasia in all of these carriers, medullary thyroid carcinoma in 15 carriers, and only one carrier with lymph node metastases. CONCLUSIONS: The consistent finding of C-cell disease in all the juvenile carriers who underwent preventive thyroidectomy emphasizes the relevance of early screening in children at risk of developing MTC. The presence of MTC in the specimen of prophylactic thyroidectomy from a 17 month old girl highlights the importance of thyroidectomy as soon as the molecular diagnosis is confirmed.

Adolescent↗
PubMed2005

Safety of video-assisted thyroidectomy versus conventional surgery.

BACKGROUND: Thyroid gland manipulation, surgical stress response, and postoperative outcome in cases of video-assisted thyroidectomy (VAT) and conventional thyroidectomy were compared to verify the safety of VAT. METHODS: Twenty consenting patients were randomly assigned to undergo VAT or conventional thyroidectomy. Serum thyroglobulin levels were monitored as indicators of thyroid manipulation, and C-reactive protein and white blood cell count were monitored to assess surgical stress response. Thyroid capsule integrity and the presence of spilled cells in the thyroid bed were verified. RESULTS: No significant differences were found in the indicators of thyroid gland manipulation and surgical stress response between groups. No thyroid capsules ruptured, and no spilled thyroid cells were found. Patients who had VAT experienced less pain, required fewer analgesics, and were more satisfied with the cosmetic result and the surgical outcome. CONCLUSIONS: VAT is as safe as conventional thyroidectomy and is characterized by a less painful postoperative course and by better cosmetic results and postoperative outcome.

Adult↗
PubMed2006

Total thyroidectomy for differentiated thyroid cancer.

There has been a long debate about the optimal surgical management of differentiated thyroid cancer. It has focused on the extent of thyroidectomy, with recommendations ranging from thyroid lobectomy to total thyroidectomy. There is no randomized prospective trial addressing this issue; such a trial would be prohibitive, since differentiated thyroid cancer has a good prognosis and a long natural history. Instead, there is heavy reliance on retrospective analyses, as well as consensus expert opinion and experience. We review this evidence, along with recent recommendations from several professional associations. We believe that total or near-total thyroidectomy followed by (131)I ablation and thyroid hormone suppression are most appropriate for the majority of patients with differentiated thyroid cancer, as retrospective analyses have shown that they reduce the risk of cancer recurrence, address the chance of multifocal intrathyroidal cancer, and facilitate use of surveillance scans and thyroglobulin monitoring for post-operative recurrence. This recommendation comes with the caveat that total thyroidectomy must be performed safely, since there is evidence that surgeon volume is associated with patient outcomes.

Adenocarcinoma, Follicular↗