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PubMed2000

Refractory amiodarone-associated thyrotoxicosis: an indication for thyroidectomy.

BACKGROUND: Tasmania is an area of endemic iodine deficiency. Amiodarone is a class III anti-arrhythmic drug that is widely used for the management of ventricular and supraventricular tachydysrhythmias. Individuals from areas of endemic iodine deficiency appear more likely to manifest hyperthyroidism following amiodarone therapy, whereas hypothyroidism is a more frequent complication in iodine-replete communities. METHODS: Cases series. The clinical and biochemical response to medical and surgical management of five consecutive Tasmanian patients presenting with severe type-II amiodarone-associated thyrotoxicosis was reviewed. RESULTS: Five patients were identified. Combinations of antithyroid therapy including propylthiouracil, lithium carbonate, dexamethasone and cholestyramine were used. Thyroidectomy was required in two cases (40%) due to severe unremitting thyrotoxicosis despite combined drug regimens. Anaesthesia and total thyroidectomy were undertaken without complication despite the presence of severe hyperthyroidism at the time of surgery. In both cases thyroid histopathology demonstrated degenerative and destructive follicular lesions with multinuclear cell infiltrate and focal fibrosis. CONCLUSION: Amiodarone-associated thyrotoxicosis may be severe and refractory to medical therapy. Despite the potential risks of anaesthesia associated with uncontrolled thyrotoxicosis, thyroidectomy should be considered in the setting of life-threatening thyrotoxicosis.

Acute Disease↗
PubMed1988

Possible homologies between photorefractoriness in sheep and birds: the effect of thyroidectomy on the length of the ewe's breeding season.

Comparisons are drawn between the photoperiodically driven breeding cycles in "long-day" birds and "short-day" mammals, emphasizing the importance of photorefractoriness as a key regulator in the timing processes. It is argued that the two types of breeding cycle may not be so radically different as previously thought and, indeed the cycles may be strictly homologous. Evidence in support of this comes from the role of the thyroid glands in seasonality. In starlings and quail, thyroidectomy prevents refractoriness developing and the birds remain in breeding indefinitely under long days. If the processes underlying refractoriness are similar across species then thyroidectomy should greatly alter the ewe's breeding cycle. In two experiments, Welsh Mountain ewes were thyroidectomized in the summer during anoestrus and their subsequent periods of oestrus monitored under various daylengths. There was no effect of thyroidectomy on the time when oestrous cyclicity began in the Autumn but the onset of anoestrus was profoundly disrupted. All the ewes continued to cycle well beyond the end of the normal breeding season and a number have continued throughout the entire period of anoestrus.

Animals↗
PubMed1977

[Radical thyroidectomy for malignant thyroid tumour: prognosis and complications (author's transl)].

270 patients were operated on for malignant thyroid tumour between 1955 and 1974. Before 1967, less radical methods of operation had been preferred, but since 1968, radical thyroidectomy - if necessary supplemented by selective or radical neck dissection - has become the procedure of choice if a curative operation was still feasible. This has brought about a significant fall in the incidence of recurrences and increased the survival rate in patients with well-differentiated carcinoma. The proportion of postoperative complications has been within reasonable bounds. The incidence of postoperative recurrent-nerve paralysis, at 9.4%, has not been raised by radical procedures, while the proportion of permanent tetany (11%) after radical thyroidectomy is much higher than after sub-total resection (2%). But the advantages of radical thyroidectomy outweigh the increased incidence of postoperative hypoparathyroidism.

Adolescent↗
PubMed1997

Results and follow-up in eleven MEN 2A gene carriers after prophylactic thyroidectomy.

In 11 MEN 2A gene carriers prophylactic thyroidectomy was carried out between the age of 4 to 17 years. All gene carriers had pathological basal and/or pentagastrin stimulated serum calcitonin levels. On histological examination in five patients C-cell hyperplasia (CCH) and in 6 patients medullary microcarcinoma (< 1 cm, mostly multifocally) was shown. No patient had lymph node involvement. There was no recurrent laryngeal nerve damage in these 11 patients and no permanent hypoparathyroidism. After prophylactic thyroidectomy all 11 patients were cured, they showed normal basal and pentagastrin stimulated calcitonin levels. In the follow-up (mean 19 months) under thyroxine substitution therapy in 9 of these 11 patients TSH was at least at one examination out of the normal range. In 2 patients TSH was suppressed, in 1 of these FT3 was slightly elevated. In 7 patients TSH was elevated between 4.9 to 147 microU/ml. The application of genetic testing is save concerning diagnostic accuracy. If prophylactic thyroidectomy is done at early ages cure rate is 100%. Despite this encouraging results thyroxine substitution therapy in the follow-up carries some problems concerning optimal dosage and non-compliance. Therefore TSH has to be estimated in the follow-up every 3 months.

Adolescent↗
PubMed1998

Prophylactic thyroidectomy, based on direct genetic testing, in patients at risk for the multiple endocrine neoplasia type 2 syndromes.

Since the discovery that germ-line mutations in the RET protooncogene are responsible for the multiple endocrine neoplasia (MEN) syndromes types 2A and 2B, prophylactic thyroidectomy has been recommended for MEN patients to prevent medullary thyroid carcinoma (MTC). In this report, we present the medium-term follow up results on the earliest group of 18 patients having prophylactic thyroidectomy for MEN 2A. There were no operative complications. Microscopic or grossly evident MTC was present in 14 (78%) of the resected patients. None of the patients had metastasis of their MTC to regional lymph nodes. At three years' follow up, there is no evidence of residual or recurrent MTC, based on biochemical testing. We conclude that prophylactic thyroidectomy, based on direct DNA testing for RET gene mutations, is an effective and safe way to manage MTC in patients with MEN 2A.

Adolescent↗
PubMed2005

[Is the thyroidectomy a surgical standard procedure for therapy of Graves' disease?].

Surgery is an important therapeutic option in the treatment of Graves' disease. Nevertheless it is still controversial discussed wether the extent of resection correlates with the rate of surgical complications and the therapeutic success. Therefore we performed a retrospective analysis on 75 surgically treated patients. 58 of these 75 patients were examined after a median interval of 34.2 months. The examination focussed on the appearance of temporary and permanent palsy of the recurrent laryngeal nerve, hypoparathyroidism, recurrences, and on the postoperative course of thyroid-stimulating-hormone-receptor antibody (TSH-ab) titers. Total thyroidectomy has been performed in 51 and bilateral resection with a remnant thyroid volume less than 2 ml each side in 24 patients. We could not confirm a significant difference concerning the postoperative complication rates between both groups. In the bilateral resection group we saw 3 cases of recurrent goitre and a more unfavourable course of TSH-ab titers than in the thyroidectomy group. For these reasons we propose the total thyroidectomy as surgical standard procedure for therapy of Graves' disease.

Autoantibodies↗
PubMed2001

Routine parathyroid autotransplantation during thyroidectomy.

BACKGROUND: Parathyroid autotransplantation (PTHAT) during thyroidectomy has been shown to reduce the incidence of permanent hypoparathyroidism. Although selective PTHAT is most commonly adopted, the value of routine PTHAT has not been well documented. METHODS: From January, 1998 to March, 1999, an operative strategy incorporating routine autotransplantation of at least 1 parathyroid gland was used during thyroidectomy. The postoperative outcome of patients (n = 118) was evaluated and compared with patients (n = 271) operated during a policy of selective PTHAT (January, 1995 to October, 1997). RESULTS: Two or more parathyroid glands were autotransplanted in 26 patients (22%) while 92 patients (78%) received autotransplantation of 1 parathyroid gland. Postoperative hypocalcemia occurred in 29 patients (25%) and 2 patients (1.7%) had permanent hypocalcemia develop. When a policy of selective PTHAT was adopted, 98 patients (36%) underwent PTHAT, and 5 patients developed permanent hypocalcemia (1.8%). The incidence of postoperative hypocalcemia was higher in patients who underwent routine PTHAT (25%) compared with that in patients who underwent selective PTHAT (15%) (P =.014). In addition, the operating time was significantly longer when routine PTHAT was adopted (153 minutes vs 130 minutes; P <.001). CONCLUSIONS: A low incidence of permanent hypoparathyroidism can be achieved by either routine or selective PTHAT during thyroidectomy but routine PTHAT is associated with a high incidence of postoperative hypocalcemia.

Adult↗
PubMed2002

Preparation with iopanoic acid rapidly controls thyrotoxicosis in patients with amiodarone-induced thyrotoxicosis before thyroidectomy.

BACKGROUND: Amiodarone-induced thyrotoxicosis (AIT) may develop either in apparently normal glands (type II AIT) or in the presence of thyroid abnormalities (type I AIT). Sometimes AIT is resistant to conventional treatment. Thyroidectomy was used in patients with AIT, but in patients who are thyrotoxic it may be hazardous. METHODS; Seven patients with AIT (6 type I and 1 type II, 5 men, 2 women, mean age 70 years [range, 60-82 years]) were prepared for total thyroidectomy with a short course of iopanoic acid (1 g/day orally for a mean of 13 days), an oral iodinated cholecystographic agent inhibiting 5'-deiodinase and causing a reduction in the peripheral conversion of thyroxine to triiodothyronine. Mean thyroid volume was 64 mL (range, 10-145 mL). RESULTS: Mean serum-free triiodothyronine levels decreased from 20 +/- 16.7 pmol/L to 6 +/- 2 pmol/L (P =.0004), whereas serum-free thyroxine values remained unchanged. Euthyroidism was rapidly (7-20 days) restored, allowing an uncomplicated total thyroidectomy in all patients and the ability to continue amiodarone therapy in 6 patients. None had increased surgical bleeding, recurrent nerve palsy, or hypoparathyroidism. No cardiovascular complications occurred. CONCLUSIONS: Iopanoic acid is an effective drug allowing rapid control of hyperthyroidism in AIT.

Aged↗
PubMed2002

Is routine supplementation therapy (calcium and vitamin D) useful after total thyroidectomy?

BACKGROUND: Our goal was to determine whether routine oral calcium (OC) and vitamin D (VD) administration can effectively prevent symptoms of hypocalcemia after total thyroidectomy. METHODS: Seventy-nine patients who underwent total thyroidectomy were randomly allotted to one of the following groups: (1) group A, no treatment; (2) group B, OC 3 g per day; (3) group C, OC 3 g + VD 1 mg per day. Treatment was started on postoperative (PO) day 1 in groups B and C. RESULTS: Fewer patients in groups B and C experienced symptoms when compared with group A (P =.005). Patients in groups B and C had only minor symptoms, whereas 2 patients in group A experienced major symptoms and 6 required intravenous calcium (P <.01). The rate of hypocalcemia was slightly lower in group C (P = not significant). Treatment was discontinued by PO day 7 in all but 8 patients. Two patients still required treatment 6 months after operation (2.5%). PO parathyroid hormone levels did not differ in the 3 groups (P = not significant). CONCLUSIONS: Routine supplementation therapy with OC or VD effectively prevents symptomatic hypocalcemia after total thyroidectomy and may allow for a safe early discharge. Further studies are necessary to determine the best treatment. The combination of OC and VD may further reduce the rate of PO hypocalcemia, without inhibiting parathyroid hormone secretion.

Adult↗
PubMed1998

Changes in thyroid function and immunological parameters long after subtotal thyroidectomy for Graves' disease.

OBJECTIVE: To find out whether subtotal thyroidectomy results in long term stable functional and immunological remission in patients with Graves' disease. DESIGN: Retrospective study. SETTING: Teaching hospital, Japan. SUBJECTS: 176 patients who underwent subtotal thyroidectomy for Graves' disease, 1970-79. INTERVENTION: Follow up surveys in 1984 and 1992. MAIN OUTCOME MEASURES: Changes in thyroid function, antibody titres, and lymphocyte subsets. RESULTS: 29/79 patients (39%) who were euthyroid in 1984 had evidence of thyroid dysfunction in 1992. Of the 8 patients with latent hypothyroidism in 1984, 3 (38%) had become euthyroid by 1992, and none required treatment. Of the 29 patients who were hypothyroid in 1984, 5 had latent hypothyroidism and 1 was euthyroid in 1992, and of the 18 patients with recurrent hyperthyroidism in 1984, 1 had become euthyroid by 1992. The number of positive titres to TSH-binding inhibitory immunoglobulin was significantly higher in the recurrence group (31/36, 86%) compared with the hypothyroid (7/26, 27%), latent hypothyroidism (8/37, 22%), and euthyroid (22/77, 29%) groups (p < 0.01). There were also significant differences in the mean (SD) number of Leu HLA DR subsets between the control (17 (3), n = 18) and recurrence (21 (6), n = 38), hypothyroid (22 (6), n = 35), latent hypothyroidism (22 (6), n = 22), and euthyroid (22 (9), n = 64) groups (p < 0.002). There were no differences in the number of T cell subsets among the groups. CONCLUSION: Treatment of Graves' disease by subtotal thyroidectomy does not necessarily result in stable late functional or immunological remission. Long term follow up of such patients may be necessary.

Antigens, CD↗
PubMed2002

Thyroidectomy using local anesthesia in critically ill patients with amiodarone-induced thyrotoxicosis: a review and description of the technique.

Hyperthyroidism caused by amiodarone is a well-known and accepted side effect of therapy. This problem can frequently be treated by medical means if patients are stable. In some patients, particularly those who are critically ill with cardiac disease the addition of hyperthyroidism can be particularly detrimental. These patients present with an interesting paradox because they are frequently on amiodarone because of life-threatening arrhythmias not responsive to other regimens, yet the amiodarone can precipitate hyperthyroidism that can acutely worsen the progression of their disease and prevalence of arrhythmias. In these patients, prompt treatment of their hyperthyroidism by total thyroidectomy may be the best option. Unfortunately, this also raises another treatment paradox in that these patients are at particularly high risk for complications from general anesthesia. In this subset of patients, total thyroidectomy under local anesthesia may be the best treatment option. Herein, we present a review of amiodarone-induced hyperthyroidism and our technique and review of our experience in its management with total thyroidectomy performed under local anesthesia.

Adult↗
PubMed2003

Total video endoscopic thyroidectomy by an axillary approach.

BACKGROUND: A permanent transverse surgical scar is an unavoidable problem after conventional thyroidectomy. Endoscopic thyroidectomy performed via an axillary approach leaves no scarring at the neck and anterior chest wall and so provides an excellent cosmetic result. The axillary scars are usually not seen when the arm is in a normal position. MATERIALS AND METHODS: From April 2001 to February 2003, we used a four-port technique to perform 45 lobectomy and isthmectomy procedures. One 12-mm port for the flexible laparoscope (EL2-TF410, Fuji Photo Optical, Tokyo, Japan) and three additional 5-mm ports for instruments and suction were inserted through the axilla on the side of the nodule. The CO(2 )insufflation pressure was set at 4 mm Hg, and in most cases, a 5-mm Johnson & Johnson Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, Ohio, U.S.A.) was used for the dissection. RESULTS: Of 45 procedures, 44 were performed successfully. In one case, conversion to a conventional technique was required. The mean operating time was 131.2 minutes, and the mean blood loss was 51.6 mL. The recurrent laryngeal nerves were clearly identified in every case, and no case of permanent voice change occurred after surgery. In one patient, a 20-mL seroma developed on the 10th postoperative day, which was treated by simple aspiration. One patient experienced a transient voice change. The patients were discharged on average at 2.9 days after the operation. CONCLUSIONS: Endoscopic thyroidectomy by an axillary approach to manage benign thyroid disease is feasible and safe and provides promising cosmetic results. We think that this approach may play an important role in the near future.

Adenocarcinoma, Follicular↗
PubMed1998

Body mass and body composition after total thyroidectomy for benign goiters.

To date there are no data available as to whether postmenopausal women who undergo total thyroidectomy for benign euthyroid goiter demonstrate changes in body mass or body composition. We prospectively evaluated 8 postmenopausal women (mean age 57 +/- 7; range 48 to 70 years) who underwent total thyroidectomy for benign goiter. All patients were euthyroid preoperatively (serum free thyroxine [FT4] 12.7 +/- 0.6 pmol/L and serum thyrotropin [TSH] 0.98 +/- 0.2 mU/L) and were commenced on adequate thyroxine replacement immediately postoperatively in order to maintain a serum TSH within the normal range (0.5-4 mU/L). Body mass, body composition, and thyroid function were assessed preoperatively, and at 4 and 12 months postoperatively. Body composition was assessed by anthropometry and dual energy x-ray absorptiometry (Lunar DPX-L scanner). Eight healthy postmenopausal women without evidence of thyroid disease matched for age, weight, and estrogen therapy who were followed over the same period were used as controls. All patients were maintained in a euthyroid status throughout the study. No significant changes in body mass or any parameter of body composition were demonstrated at 4 and 12 months postoperatively. Similar findings were recorded in our control group. We conclude that total thyroidectomy in euthyroid postmenopausal women with benign goiter does not result in a significant change in either body mass or body composition if adequate thyroxine replacement is maintained.

Aged↗
PubMed2005

Successful treatment for recurrent painful Hashimoto's thyroiditis by total thyroidectomy.

Painful Hashimoto's thyroiditis is an atypical variant of Hashimoto's thyroiditis characterized by thyroid pain and fever. In patients with this condition, anti-inflammatory agents are not always effective as in those with subacute thyroiditis. Therefore, long-term pain management is an important issue. We report herein four cases of painful Hashimoto's thyroiditis requiring total thyroidectomy to relieve thyroid pain and histologic findings of the thyroid gland. All patients had high titers of anti-thyroperoxidase (TPO) and thyroglobulin antibodies. Three were hypothyroid, and the other was euthyroid. During the first visit, four patients had fever and/or thyroid pain with elevated C-reactive protein or erythrocyte sedimentation rate, and they were treated with oral corticosteroids given continuously or intermittently for 9 to 48 months. Because a reduction or discontinuation of corticosteroids caused recurrent painful attacks, the decision was made to perform surgery. After total thyroidectomy, their symptoms disappeared. The histopathologic characteristics of these hypothyroid cases were advanced fibrosis and destructive thyroid architecture. One euthyroid case showed a mild fibrous change and the presence of foreign body type giant cells. In conclusion, total thyroidectomy is the effective and reliable treatment for patients with recurrent painful Hashimoto's thyroiditis. Pathologic characteristics include advanced fibrosis and destructive thyroid architecture.

Adult↗
PubMed2006

Preoperative greater occipital nerve block in total thyroidectomy patients can reduce postoperative occipital headache and posterior neck pain.

Patients undergoing thyroidectomy with neck fully extended usually experience occipital headache and posterior neck pain. We have attempted to evaluate the effect of preoperative greater occipital nerve (GON) block on occipital headache and posterior neck pain after thyroidectomy. Eighty-two patients undergoing elective total thyroidectomy were randomly allocated to two groups. In block group, bilateral GON blocks with 0.25% bupivacaine were performed. The control group did not have any prior block. Occipital headache and posterior neck stiffness were assessed using the visual analogue scale (VAS) and verbal rating scale. VAS of occipital headache and posterior neck pain in block group was significantly lower compared to that in the control group at postoperative 12 and 24 hours (p < 0.05). In addition, the proportion of patients reporting moderate or severe occipital headache and posterior neck pain at postoperative 12 and 24 hours in block group was significantly lower than that in control group (p < 0.001). No side effects were observed during and after GON block. We conclude that preoperative GON block with 0.25% bupivacaine is an effective technique to reduce occipital headache and posterior neck pain after thyroid surgery.

Adolescent↗
PubMed2003

Supplemental oxygen does not reduce postoperative nausea and vomiting after thyroidectomy.

BACKGROUND: Supplemental intra-operative oxygen 80% halves the incidence of nausea and vomiting after open and laparoscopic abdominal surgery, perhaps by ameliorating intestinal ischaemia associated with abdominal surgery. It is unlikely that thyroid surgery compromises intestinal perfusion. We therefore tested the hypothesis that supplemental perioperative oxygen does not reduce the risk of postoperative nausea and vomiting (PONV) after thyroidectomy. METHODS: One hundred and fifty patients undergoing thyroidectomy were given sevoflurane anaesthesia. After induction, patients were randomly assigned to the following treatments: (i). 30% oxygen, (ii). 80% oxygen, or (iii). 30% oxygen with droperidol 0.625 mg. RESULTS: The overall incidence of nausea during the first 24 h after surgery was 48% in the patients given oxygen 30%, 46% in those given oxygen 80%, and 22% in those given droperidol (P=0.004). There were no significant differences between the oxygen 30% and 80% groups in incidence or severity of PONV, the need for rescue antiemetics, or patient satisfaction. Droperidol significantly shortened the time to first meal. CONCLUSIONS: Supplemental oxygen was ineffective in preventing nausea and vomiting after thyroidectomy, but droperidol reduced the incidence.

Adult↗
PubMed1991

Natural course of Graves' disease after subtotal thyroidectomy and management of patients with postoperative thyroid dysfunction.

The Natural course of Graves' disease after subtotal thyroidectomy was studied in 67 patients who had subtotal thyroidectomy for Graves' disease and did not receive any medical treatment for 8 to 12 years after surgery. Postoperative thyroid status was determined by serum free thyroxine (T4), free triiodothyronine (T3), and thyrotropin (TSH) levels in the first period (1 year after surgery), second period (3.9 +/- 1.0 years), and third period (8.8 +/- 1.5 years). Serum thyroid stimulating antibody (TSAb) and TSH binding inhibitor immunoglobulin (TBII) activities were also measured. A total of 53 patients (79%) changed thyroid status during the observation period. One year after surgery, 50 percent of euthyroid subjects developed abnormal thyroid function in the next period. Reversible latent hypothyroidism was the most common type of thyroid dysfunction seen in up to 46% of patients. Interestingly, hyperthyroidism and hypothyroidism that developed in the postoperative period were temporary disorders in most cases. Serum TSAb and TBII activities did not help predict the postoperative changes of thyroid status. Our study indicates that the instability of the thyroid function is common after subtotal thyroidectomy.

Adult↗
PubMed2000

The use of dexamethasone for preventing postoperative nausea and vomiting in females undergoing thyroidectomy: a dose-ranging study.

We sought to determine the minimum effective dose of dexamethasone in preventing postoperative nausea and vomiting in women undergoing thyroidectomy. Two hundred twenty-five women (n = 45 in each of five groups) undergoing thyroidectomy under general anesthesia were enrolled in this randomized, double-blinded, placebo-controlled study. Immediately after the induction of anesthesia, patients received IV dexamethasone at doses of 10 mg (D10), 5 mg (D5), 2.5 mg (D2.5), 1.25 mg (D1.25), or saline (S). We found that Groups D10 and D5 were significantly different from Group S in the total incidences of nausea and vomiting, more than four vomiting episodes, the proportions of patients requiring rescue antiemetics, and the incidences of complete responses. The differences between Groups D10 and D5 were not significant. Dexamethasone 2.5 mg reduced the total incidence of nausea and vomiting. Dexamethasone 1.25 mg was not effective. Dexamethasone 5 mg IV is the minimum effective dose in preventing postoperative nausea and vomiting in women undergoing thyroidectomy.

Adult↗