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PubMed1997

Post-thyroidectomy haemorrhage: an analysis of critical factors in successful management.

Haemorrhage following thyroidectomy is a well known complication and early intervention is advocated to avoid fatality. Traditionally more emphasis has been given to the amount of drainage, increasing size of the swelling and obvious signs of respiratory obstruction as indications of re-exploration leading to delay, and subtle features of hypoxia like tachycardia, sweating, irritability and confusion resulting from upper airway oedema are usually ignored. The authors described their experience of post-thyroidectomy haemorrhage in 396 thyroidectomies performed during a 6-year period (1989-1995) for various thyroid disorders. All these patients were detected early in the postoperative course based on subtle signs of hypoxia and re-explored. There were 10 cases of post-thyroidectomy haemorrhage and they were successfully managed early in the postoperative period with excellent outcome. Close postoperative monitoring for features of hypoxia rather than external evidence of haemorrhage is the key factor in early detection and successful management of such a fatal complication.

Adolescent↗
PubMed1998

[Morbidity from total thyroidectomy in subjects less than 15 years of age. A multicenter study of 107 cases].

In the MEN II (Multiple Endocrine Neoplasia) setting, genetic screening is currently available with a 98% reliability. Therefore, total thyroidectomy has been recommended as early as at 3 years of age for gene-carriers. A nationwide retrospective survey has been conducted over 5 years, dealing with 107 cases of total thyroidectomy in patients less than 15 years of age to assess the morbidity of this kind of surgery. Currently, permanent morbidity (recurrent nerve palsy and hypocalcemia) amounts to 1 and 1% of cases respectively. It is observed only when node clearance is deemed to be mandatory. Mortality was zero. In published series (4 overall, from 1972 through 1995), rates seemed to be more important: 11 and 13% respectively, with 1% mortality. These numbers relate to surgery with advanced cancers, often locally invasive. Prophylactic total thyroidectomy morbidity draws near the results of our study. These numbers can argue for the interest of a "prophylactic" total thyroidectomy, before advanced thyroid disease, as a treatment for MTC gene-carriers children and teenagers.

Adolescent↗
PubMed2003

[The complications of reoperation for thyroid disease after a thyroidectomy].

OBJECTIVE: To find out the morbidity of reoperation for thyroid disease, and discuss its complications and the risk factors associated with it. METHOD: Retrospective study. Incidence of recurrent laryngeal nerve palsy and hypoparathyroidism. This paper reported 43 cases underwent secondary thyroidectomy during the year from 1997 to 2001 in our hospital. Frozen sections were done in all cases during the operations. RESULT: Of the 43 cases, the initial frozen sections pathologic diagnosis were benign diseases in 30 cases, but their last pathologic diagnosis were malignant change after the first operation. Complications were 6 transient palsy of the recurrent laryngeal nerve, 2 patients developed permanent unilateral palsy and one temporary hypoparathyroidism. CONCLUSION: Frozen section helps to raise the accuracy of diagnosis. Secondary thyroidectomy can be avoided by selecting suitable types of operations. Subtotal thyroidectomy of benign nodular thyroid will be good for preventing recurrence. Secondary thyroidectomy should be safe procedure. Because of the high risk of complications reoperations for thyroid gland disease should be done only if the patient cannot be treated in other ways.

Adolescent↗
PubMed2002

Superior laryngeal nerve identification and preservation in thyroidectomy.

BACKGROUND: Injury to the external branch of the superior laryngeal nerve (EBSLN) can result in detrimental voice changes, the severity of which varies according to the voice demands of the patient. Variations in its anatomic patterns and in the rates of identification reported in the literature have discouraged thyroid surgeons from routine exploration and identification of this nerve. Inconsistent with the surgical principle of preservation of critical structures through identification, modern-day thyroidectomy surgeons still avoid the EBSLN rather than identifying and preserving it. OBJECTIVES: To describe the anatomic variations of the EBSLN, particularly at the junction of the inferior constrictor and cricothyroid muscles; to propose a systematic approach to identification and preservation of this nerve; and to define the identification rate of this nerve during thyroidectomy. MATERIALS AND METHODS: A retrospective review of thyroid lobectomies and total thyroidectomies performed between 1978 and 1997 was carried out. A total of 884 patients were included, with 1057 EBSLNs explored. Intraoperative findings of identification of the EBSLN were recorded and compared on an annual basis for both benign and malignant disease. Overall results were also compared with those found in previous series identified through a 50-year literature review. RESULTS: The 3 anatomic variations of the distal aspect of the EBSLN as it enters the cricothyroid were encountered and are described. The total identification rate over the 20-year period was 900 (85.1%) of 1057 nerves. Operations performed for benign disease were associated with higher identification rates (599 [86.1%] of 696) as opposed to those performed for malignant disease (301 [83.4%] of 361). Operations performed in recent years have a higher identification rate (over 90%). CONCLUSIONS: Understanding the 3 anatomic variations of the distal portion of the EBSLN and its relation to the inferior constrictor muscle allows for high rates of identification of this nerve. The EBSLN should be explored during thyroid surgery and identification is possible in most cases. Preservation of the EBSLN maintains optimal function of the larynx.

Humans↗
PubMed2003

Intraoperative parathyroid hormone assay: an accurate predictor of symptomatic hypocalcemia following thyroidectomy.

HYPOTHESIS: Intraoperative parathyroid hormone (IOPTH) assay is useful for predicting symptomatic hypocalcemia following total thyroidectomy. DESIGN: A prospective study of 30 patients undergoing total thyroidectomy with IOPTH levels obtained following skin closure and ionized calcium (Ca2+) levels obtained 6 hours postoperatively and on postoperative day 1. All patients were evaluated for symptoms of hypocalcemia. SETTING: University teaching hospital. MAIN OUTCOME MEASURES: Patients who developed symptomatic hypocalcemia were compared with asymptomatic patients in regard to age, diagnosis, thyroid weight, thyrotropin level, Ca2+ level, parathyroid status, and IOPTH level. RESULTS: The onset of symptomatic hypocalcemia ranged from 8 to 48 hours postoperatively (n = 10). One patient required readmission. Of 10 patients with symptoms, 5 developed tetany. There were no significant differences in age, diagnosis, thyroid weight, thyrotropin level, or the number of parathyroid glands preserved in patients with or without symptomatic hypocalcemia. All patients with an IOPTH level of less than 10 pg/mL (1.1 pmol/L) had symptoms (n = 8). The mean +/- SD IOPTH level (7.6 +/- 12.0 pg/mL [0.8 +/- 1.3 pmol/L]) in patients who developed symptomatic hypocalcemia was significantly lower than the mean IOPTH level (55.7 +/- 31.8 pg/mL [5.9 +/- 3.3 pmol/L]) in patients without symptoms (P =.001). The 6-hour and postoperative day 1 Ca2+ levels were significantly lower in patients with symptomatic hypocalcemia (P =.19 and P =.13, respectively). An IOPTH level of less than 10 pg/mL is 80% sensitive and 100% specific for the development of symptomatic hypocalcemia. CONCLUSION: The incorporation of the IOPTH assay in the management of thyroid disease is recommended to prevent and prospectively treat symptomatic hypocalcemia, thereby reducing readmissions following thyroidectomy.

Adult↗
PubMed1981

Limited subtotal thyroidectomy for Graves' disease.

Limited subtotal thyroidectomy was performed in 42 of 43 patients with Graves' disease. Twenty of 23 patients (87%) who were followed up for an average of 54 months after operation remained euthyroid. Only one patient (4.3%) had recurrent thyrotoxicosis. There were no deaths and no permanent complications. A coexisting, invasive papillary cancer necessitated total thyroidectomy in one patient, and occult papillary cancers were discovered histologically in three others. This study supports the thesis that postoperative thyroid function depends on the volume of remaining thyroid tissue. While preserving thyroid function, limited subtotal thyroidectomy lowers postoperative complications and induces no increase in recurrent thyrotoxicosis.

Adolescent↗
PubMed1997

Total thyroidectomy for Graves' disease.

BACKGROUND: Therapeutic options for treatment of hyperthyroidism caused by Graves' disease remain controversial. There are three main options: thiourea drugs, radioactive iodine ablation, and thyroidectomy. Each treatment has significant advantages and potential problems. METHODS: The present study is a retrospective analysis of our experience with total thyroidectomy in Graves' disease. Sixty-two patients underwent this procedure in 11 years' time and were followed for a minimum of 2 years after surgery. All had measurement of total thyroxine, T3 uptake, and radioactive iodine (RAI) uptake and scanning. Sixty-three percent of all patients had some element of hyperthyroid eye signs. All patients were rendered euthyroid with pharmacologic therapy prior to surgery. Postoperatively, the patients were evaluated for improvement in eye signs, incidence of recurrent laryngeal nerve injury, and hypoparathyroidism. RESULTS: None of the patients in this study have developed recurrent hyperthyroidism. All patients are maintained on levothyroxine. None of our patients incurred bilateral vocal cord paralysis. One patient (1.6%) demonstrated an immobile vocal cord more than 1 year following surgery. Ten patients (16%) demonstrated impaired mobility of one vocal cord in the immediate postoperative period. Nine of these patients recovered full vocal cord mobility within 6 months after surgery. Only one patient (1.6%) still required calcium and vitamin D therapy 1 year following surgery. However, in the immediate postoperative period, 23 patients (37%) required supplemental calcium and vitamin D. In 12 patients, calcium and vitamin D was discontinued within 1 month. In an additional 6 patients, calcium and vitamin D were discontinued within 4 months; 3 patients, within 6 months; and 1 patient, within 12 months after surgery. Incidental papillary carcinoma was found in 3 patients (5%). CONCLUSIONS: Total thyroidectomy for Graves' disease is an effective and safe therapy. When performed by an experienced head and neck surgeon, it carries a low morbidity rate. It should be presented to patients as a therapeutic option within the context of a comprehensive discussion of the risks and benefits of radioactive iodine, pharmacologic therapy, and surgery.

Adolescent↗
PubMed1993

Increased uptake of iodine-131 in metastases of differentiated thyroid carcinoma associated with less severe hypothyroidism following total thyroidectomy.

BACKGROUND: In an attempt to determine possible factors affecting the efficacy of iodine-131 (I-131) treatment for metastatic thyroid carcinoma, the authors focused their efforts on thyroid functions after total thyroidectomy. METHODS: Between 1980 and 1991, 47 patients with lung metastases of differentiated thyroid carcinoma were treated with I-131. Relationships of the images on post-therapy scans with various clinical features were studied. RESULTS: Among them, 28 (59.6%) showed I-131 uptake in the metastases on post-therapy scans. Younger patients had lesions that concentrated more radioactive iodine than did those of older patients. The amount of I-131 concentrated in the metastatic lesions correlated with serum triiodothyronine (T3), thyroxine (T4), and thyroglobulin levels and inversely with serum thyroid-stimulating hormone (TSH) levels determined at the time of therapy. Serum T3 and T4 levels were significantly higher in 28 patients with positive scans than in 19 patients with negative scans. Most patients who had metastases with markedly increased radioactivity were euthyroid or mildly hypothyroid, suggesting that thyroid hormones produced by tumor masses compensated for severe hypothyroidism after total thyroidectomy, and showed favorable responses to the treatment. In three patients successfully treated, decreases in serum thyroglobulin levels and the size of metastatic lesions were accompanied by the development of severe hypothyroidism. CONCLUSIONS: The presence of a large amount of metastatic functioning thyroid tissues responsive to I-131 treatment can be suspected in patients with less severe hypothyroidism after total thyroidectomy.

Adenocarcinoma↗
PubMed2006

Optimization of thyroxine replacement therapy after total or near-total thyroidectomy for benign thyroid disease.

BACKGROUND: Total or near-total thyroidectomy is increasingly used to treat benign thyroid conditions. Lifelong treatment with thyroxine (T4) is then required, but the optimal dose is difficult to predict. This study investigated factors that might predict the ideal T4 dose, with the aim of reducing delays in achieving normal thyroid function after surgery. METHODS: Data on 98 patients who underwent total or near-total thyroidectomy for benign disease were reviewed retrospectively. Patient and operative variables that might predict time to achieve normal thyroid function and optimal T4 replacement dose were examined. These data were then used to formulate an algorithm for T4 dosage, based on patient weight, that was subsequently applied prospectively to a comparable group of 27 patients. RESULTS: The median time to achieve normal thyroid function was 14.5 (range 2-120) weeks before introduction of the algorithm, and was greater in patients needing large changes in T4 dose. In multivariate analysis, the best predictors of optimal T4 dose were bodyweight (r = 0.46, P < 0.001) and age (r = -0.32, P = 0.002). Subsequent use of a weight-related algorithm improved time to achieve normal thyroid function. CONCLUSION: The T4 replacement dosage after total or near-total thyroidectomy is largely influenced by bodyweight. Use of a weight-related algorithm improves patient care compared with use of standard T4 dose-titration methods.

Adolescent↗
PubMed2006

Video-assisted subtotal or near-total thyroidectomy for Graves' disease.

BACKGROUND: Surgery remains the treatment of choice for patients with Graves' disease. The purpose of the present study was to assess the usefulness and efficacy of video-assisted subtotal or near-total thyroidectomy in patients with Graves' disease. METHODS: Between March 2000 and December 2004, 63 patients with Graves' disease underwent video-assisted subtotal, near-total or total thyroidectomy. Fifty-three patients (84 per cent) were considered for surgery after failure of antithyroid drug and radioiodine therapy, whereas the other ten patients were initially selected for surgical treatment based on their own preference. Treatment outcome was evaluated, including surgical complications, thyroid function, quality of life and patient satisfaction with the surgical result. RESULTS: All patients were operated on using a video-assisted technique, with some modifications depending on time and experience. There were no conversions to open surgery. Three patients (5 per cent) had temporary recurrent laryngeal nerve palsy that recovered spontaneously. Most patients were satisfied with the surgical results, particularly regarding the placement of the surgical scars. CONCLUSION: Video-assisted subtotal or near-total thyroidectomy is a safe and effective procedure for treatment of Graves' disease.

Adolescent↗
PubMed2006

Serum levels of the interferon-gamma-inducible alpha chemokine CXCL10 in patients with active Graves' disease, and modulation by methimazole therapy and thyroidectomy.

BACKGROUND: The interferon-gamma-inducible chemokine CXCL10 is highly expressed in infiltrating inflammatory cells, and in thyrocytes in patients with Graves' disease. The aim of this study was to measure serum levels of CXCL10 in relation to thyroid function and treatment. METHODS: Serum levels of CXCL10 were measured in 22 patients with Graves' disease when hyperthyroid, when euthyroid under methimazole therapy, and 3 days after near-total thyroidectomy. They were compared with levels in three groups of age- and sex-matched controls: 44 subjects with no thyroid disorder, 44 patients with euthyroid autoimmune thyroiditis and 20 with toxic nodular goitre. RESULTS: Basal serum levels of CXCL10 in patients with Graves' disease were higher than levels in patients with toxic nodular goitre or no thyroid disorder, and similar to levels in patients with autoimmune thyroiditis (mean(s.d.) 167(121), 100(24), 78(46) and 142(107) pg/ml respectively; P < 0.010). Among patients with Graves' disease, serum levels of CXCL10 were significantly higher in those aged over 50 years (P = 0.010), with a hypoechoic pattern at thyroid ultrasonography (P < 0.001) or with hypervascularity (P = 0.001). CXCL10 levels in patients with Graves' disease decreased significantly when euthyroidism was achieved by methimazole therapy (P < 0.010), and a further decrease was observed after thyroidectomy (P < 0.010). CONCLUSION: Serum levels of CXCL10 are higher in newly diagnosed hyperthyroid patients with Graves' disease than in those with toxic nodular goitre, and decrease when euthyroidism is achieved with antithyroid therapy. This high level may be related to the active inflammatory phase of Graves' disease. A further reduction of CXCL10 levels after thyroidectomy indicates that it is produced mainly in the thyroid in patients with autoimmune thyroid disease.

Antithyroid Agents↗
PubMed2006

Voice and vocal self-assessment after thyroidectomy.

BACKGROUND: Voice alterations after thyroidectomy can be found even with preserved function of laryngeal nerves. The purpose of this study was to evaluate voice before and after thyroid surgery and the role of orotracheal intubation on voice changes. METHODS: We conducted a prospective nonrandomized study of patients who underwent thyroid surgery and compared the results with a control group of patients who underwent breast surgery. Subjects underwent a videolaryngoscopic exam, a subjective and an objective voice analysis and a Voice Handicap Index (VHI) questionnaire before and after surgery. RESULTS: A total of 100 patients who underwent thyroidectomy and 30 who underwent breast surgery were studied. Both groups were similar in demographic, clinical, and surgical variables. Postoperative videolaryngoscopy showed larynx alterations in 28% of the thyroidectomized patients, without significant alterations in the control group. There were subjective voice changes in 29.7% of the patients without vocal fold immobility after thyroid surgery and no statistically significant changes after breast surgery. Acoustic analysis showed significant increased values in the voice turbulence index (VTI) parameter in both groups, although higher in the thyroid one. In the VHI assessment, voice complaints were more frequently registered in the thyroid group rather than in the control group. CONCLUSIONS: Voice alterations are frequent after thyroidectomy even with preserved vocal fold mobility. Such alterations were more frequently detected in that group than in patients who underwent breast surgery. Orotracheal intubation is just one of the multiple factors involved.

Adolescent↗
PubMed1992

Mirex-induced adaptive liver growth in rats subjected to thyroidectomy.

The organochlorine compound mirex (dodecachloro-octahydro-1,3,4-metheno-2H-cyclobuta-CD- pentalene) induces an adaptive liver growth dependent on the hormonal status of the experimental animal. In the intact laboratory rat, mirex induces liver growth that is an expression of both cellular hyperplasia and hypertrophy. However, in rats subjected to adrenalectomy, mirex induces liver growth that is essentially hyperplastic. Corticosterone supplements given to rats subjected to adrenalectomy and treated with mirex restore the hypertrophic component of liver growth. Therefore it appears that the expression of the hypertrophic component of mirex-induced liver growth is corticosterone dependent. To further explore the hormonal modulation of the expression of mirex-induced adaptive liver growth, rats subjected to thyroidectomy were studied. In male rats subjected to thyroidectomy, a single oral dose of mirex (100 mg/kg body wt) increased relative liver weight (liver wt/body wt x 100) by 62% within 72-hr after mirex administration. Liver growth occurred in the absence of [3H]thymidine incorporation into liver DNA. Thus the observed liver growth was totally hypertrophic. However, in mirex-dosed rats subjected to thyroidectomy given twice-daily subcutaneous injections of thyroxine (5 mg/kg body wt), relative liver weight was increased by 204% of the control value within 72-hr after mirex administration, and there was a peak of [3H]thymidine incorporation into liver DNA 54 hr after mirex administration. These studies suggest that the expression of hyperplasia in mirex-induced adaptive liver growth is thyroxine dependent.

Animals↗
PubMed2000

The efficacy of thyroidectomy for Graves' disease: A meta-analysis.

BACKGROUND: Surgery for Graves' disease was largely replaced in the mid-1900s by radioiodine and antithyroid drugs, due to the belief that they were more safe and effective. Since then, thyroid surgery has improved with preoperative drug therapy and modern operative techniques. Recent clinical studies of thyroidectomy for Graves' disease may not reflect outcomes accurately because of small sample size, especially when estimating ideal thyroid remnant size. The purpose of this study was to combine modern clinical trials and use meta-analysis to determine the overall efficacy of both total (TT) and subtotal thyroidectomy (ST) for Graves' disease, compare thyroid function and complications rates of TT and ST, and determine ideal thyroid remnant size. METHODS: Meta-analysis was performed on published studies in which patients underwent either TT or ST for Graves' disease. Meta-analysis was performed by weighted least-squares linear regression. P < 0.05 was considered significant. RESULTS: There were 35 studies comprising 7241 patients. Mean follow-up was 5.6 years. Overall, persistent or recurrent hyperthyroidism occurred in 7.2% of patients. TT was performed on 538 patients and hypothyroidism occurred in all cases. ST was performed in 6703 patients, 59.7% of whom achieved euthyroidism, 25. 6% became hypothyroid, and 7.9% had either persistent or recurrent hyperthyroidism. Permanent recurrent laryngeal nerve injury occurred in 0.9% of TT patients and 0.7% of ST patients (P = NS). Permanent hypoparathyroidism occurred in 1.6% of TT patients and 1.0% of ST patients (P = NS). There was an 8.9% decrease in hypothyroidism and 6.9% increase in euthyroidism for each gram of thyroid remnant (P < 0.0001 each). CONCLUSIONS: Overall, thyroidectomy successfully treated hyperthyroidism in 92% of patients with Graves' disease. There were no cases of hyperthyroidism following TT. ST achieved a euthyroid state in almost 60% of patients with an 8% rate of persistent or recurrent hyperthyroidism. There was no significant difference in complication rates between TT and ST.

Adolescent↗
PubMed1995

[Need for thyroidectomy in differentiated thyroid cancers].

In a retrospective case series study we compared data collected from 142 unselected patients with cancer of the thyroid gland treated in 1985-1994 with results from corresponding studies with reference to the necessity for radical thyroidectomy in cases of differentiated thyroid carcinoma. We standardly treated our patients by either primary or subsequent complete total thyroidectomy within 48 h after initial surgery followed by 131I ablation, achieving an overall R0 tumor clearance in 94.1% of cases. Recurrent laryngeal nerve palsy was diagnosed postoperatively in 7.7% of cases. Local tumor recurrence or nodal or distant spread occurred in 16.9% of patients with papillary, 9.1% of patients with follicular and 10% of patients with medullary carcinoma. Only one patient with papillary thyroid carcinoma died after 5 years at the age of 82, whereas 83% of anaplastic cancer patients died within 3 years. We conclude from our data that radical surgery ought to be performed for both differentiated thyroid cancer and undifferentiated cancer to reduce the rate of recurrence. When surgical management is careful radical thyroidectomy as standard treatment is associated with a reasonable rate of perioperative morbidity.

Adenocarcinoma, Follicular↗
PubMed1993

Branch retinal artery occlusion following thyroidectomy for papillary carcinoma of the thyroid: report of a case.

A rare case of branch retinal artery occlusion (BRAO) following a subtotal thyroidectomy for thyroid cancer in a 58-year-old woman is reported herein. Five days after her thyroidectomy, the patient complained of having had a reduction in visual acuity and visual field loss of the superior nasal side in her right eye since the operation. BRAO was diagnosed following the discovery by funduscopy of inferotemporal branch artery occlusion with retinal edema, hemorrhage, and periarterial sheathing in the right eye. Despite immediately puncturing the anterior camera and massaging the eyeball while administering intravenous anticoagulant therapy, the visual field disturbance remained unchanged. The most common causative factor of postoperative sudden BRAO is reported to be emboli. However, in our case, the most likely cause was the stretching and pressure exerted on the carotid artery with consequent atheromatous plaque formation at the time of thyroidectomy.

Carcinoma, Papillary↗
PubMedDate not supplied

Retrospective analysis of prognostic factors affecting the thyroid functional status after subtotal thyroidectomy for Graves' disease.

To determine the factors causing thyroid dysfunction after surgery for Graves' disease, we studied 321 patients who underwent subtotal thyroidectomy during the 7-year period from 1981 to 1987. Thyroid functional status was evaluated biochemically and the patients were divided into four categories: recurrent hyperthyroidism, euthyroidism, latent hypothyroidism, and hypothyroidism. The following factors were analyzed: sex, age at onset of the disease, indication for surgery, serum titer of antimicrosomal hemagglutination antibody (MCHA), weight of resected thyroid tissue, size of remnant thyroid relative to body surface area, pathological findings of lymphoid follicles, and lymphocytic infiltration in the thyroid tissue. Probabilities of failure (recurrent hyperthyroidism and hypothyroidism) were estimated by the Kaplan-Meier method. Prognostic factors for failure were identified by using Cox's proportional hazards model. The incidence of hyperthyroidism and hypothyroidism 5 years after subtotal thyroidectomy was 16.2% and 9.6%, respectively. Significant factors for hyperthyroidism were relatively large thyroid remnant, high serum titer of MCHA (greater than or equal to 1:3200), and age at onset of the disease less than 20 years. The significant factor for hypothyroidism was severe lymphocytic infiltration. The level of postoperative thyroid stimulating hormone (TSH)-binding inhibition immunoglobulins (TBII) in patients with recurrence was significantly higher than in patients in remission. It is reasonable to determine the amount of remnant thyroid tissue in relation to patient body surface area. Although subtotal thyroidectomy can induce immunological remission by reduction of antigen, if the remission disappears, that is if TBII increases, recurrence of hyperthyroidism may develop even in patients without the unfavorable factors.

Adolescent↗
PubMed2002

Palliative thyroidectomy for malignant lymphoma of the thyroid.

BACKGROUND: Current treatment of malignant lymphoma of the thyroid consists of chemotherapy and external beam radiation. The diagnosis can routinely be made by fine-needle aspiration, obviating the need for surgery. However, a significant number of patients present with symptoms of obstruction, necessitating thyroidectomy for palliation. METHODS: To determine the outcomes of patients with malignant thyroid lymphoma after palliative thyroidectomy, we reviewed our experience. Between 1980 and 2001, 27 patients with thyroid lymphoma and symptoms or signs of airway and/or esophageal obstruction were evaluated at 1 of 3 academic institutions. RESULTS: The mean age of the patients was 66 +/- 3 years, and the majority was female. Patients presented with symptoms of dyspnea/stridor (30%), dysphagia/pain (30%), or impending airway obstruction (40%). All underwent palliative surgery. In addition to surgery, 10 patients had combined chemo- and radiotherapy, 10 had radiotherapy alone, and 4 had only chemotherapy. Symptom-free survival after palliative surgery was determined by Kaplan-Meier analysis. The mean actuarial symptom-free survival of patients with symptomatic, malignant thyroid lymphoma was 10 years (95% confidence interval, 7.67 to 12.33 years). CONCLUSIONS: Patients with malignant lymphoma of the thyroid can present with obstructive symptoms requiring palliative intervention. In this group of patients, thyroidectomy can be associated with good long-term palliation and low morbidity.

Aged↗