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PubMed2002

[Management of recurrent post thyroidectomy abductor vocal cord paralysis at the Ear, Nose and Throat (ENT) department of the Dakar University Teaching Hospital: report of 14 cases].

Latrogenic injury of the recurrent laryngeal nerve is a serious accident in the thyroid gland surgery. Bilateral losses of the abduction of the larynx, occurring during thyroidectomy, determine several dyspneas which often necessitate emergency tracheostomy. In second hand, 14 patients, who had undergone thyroidectomy, were admitted in the Ear, Nose and throat departement of Dakar university hospital with bilateral abductor vocal cord paralysis. Material consits of 12 women and 2 men. They were aged between 15 and 58 years old. Clinically, laryngeal dyspnea was noticed for all the patients and, emergency tracheostomy was performed for 10 patients (71,42%). Bilateral abductor vocal cord paralysis occurred after total or subtotal thyroidectomy in 12 cases. In the most cases (71,42%), the treatment was carried out, with arytenoidopexy, by extralaryngeal route. Successful results were noticed for 11 cases (78,6%) and decanulation was realised between 2 to 26 days after procedure operative. If results were satisfied for respiration, voice quality was bad.

Adolescent↗
PubMedDate not supplied

[Post-thyroidectomy hypocalcemia].

INTRODUCTION: The correlation between hypocalcemia and total thyroidectomy could be correlated to the influence practice from the TSH hormone on the thyroid C cells, in fact in conditions of hyperthyroidism the low values of the thyrotropin is correlated to a reduction of the plasmatic concentration of calcitonin and consequently of calcemia. of our study is verify the incidence of the hypocalcemia post-tyroidectomy and appraise the effectiveness of the pharmacological treatment with calcium salts and possibly D vitamin. MATERIALS AND METHODS: Of the 432 operated patients, 348 has stayed subjected to total thyroidectomy and 84 to loboistmusectomy. In none case subjected to emityroidectomy has been verified a hypocalcemia in the post-operative and in 67 cases in which we have administered pre-operative calcium salts orally, calcemia has sustained within acceptable values. RESULTS: Our experience only 1'11.2% of the patients subjected to total thyroidectomy they have presented a reduction of the calcemia to the of under of the 7.10 mg/dl and they have stayed subjected medical therapy with calcium salts in ev in the symptomatic forms, and to oral therapy in patients absent symptoms, while in two cases is not been practiced any therapy because the symptomatology has disappeared spontaneously DISCUSSION: Syndrome hypocalcemica has determined from the deficit-also transitory-parathyroid glands, from the action of the calcitonin (it favors the amassing of the calcium in to bon), and from a reduced bony reserve of calcium. In fact in those patients operated for a euthyroid goitre or for thyroid tumor the saving of the parathyroid glands avoids the outbreak of hypocalcemia (7, 8). Therefore the physio-pathological mechanism responsible of symptoms (excluded the medical causes: pharmacological treatments with steroid, oral conraceptives, diuretics, salts of lithium, oral antacid and diazepam) (9) also not being still of the all known, it would have his primum movens in the parathyroid glands ischemia. CONCLUSIONS: The precocious evaluation of the calcemia in the period post-operative is useful to discern the patients that will require of a pharmacological treatment of support, so that avoid of the serious and permanent damages to the varied organs.

Adolescent↗
PubMed2005

High risk for microcarcinoma in thyroid benign diseases. Incidence in a one year period of total thyroidectomies.

Over the last few years, incidental thyroid microcarcinoma (TMC) has become a frequent disease and its incidence in some reports is considerable. The discovery of new cases depends on the progress of the diagnostics (US scan, fine needle biopsy and cytology, CT, MRI), on the extended indications to thyroidectomy for benign disease and on the attention in pathologic examination of the specimen. The clinical evolution of this disease is not well known: in spite of a high incidence reported in some autoptic series, suggesting that this tumour could have a good prognosis, some authors report an overall incidence of up to 11% of local recurrence, metastasis and mortality. For these reasons the treatment of TMC is still controversial today. Aim of this study was to estimate the incidence and the clinico-pathological findings of TMC over a one year period of total thyroidectomies for diffuse benign thyroid diseases, and to evaluate, on the basis of the frequency of incidental microcarcinoma, if the surgical procedure of complete removal of the gland should be adopted in any case. In this series no patient had pre-operative diagnosis or tentative diagnosis of carcinoma and the incidence of TMC at the final histologic examination was 27.4%. Total thyroidectomy confirmed to be the treatment of choice for diffuse benign diseases and appeared necessary to obtain both, diagnosis and treatment of incidental TMC.

Adult↗
PubMed2005

Which therapy to prevent post-thyroidectomy hypocalcemia?

Hypocalcemia is one of the most frequent complications after total extracapsular thyroidectomy (TET). In most of cases it is a transient phenomenon. The aim of this study is to evaluate if and how the oral administration of calcium or calcium combined with D-vitamin could effectively prevent post-thyroidectomy hypocalcemia. A randomized prospective study was performed, recruiting 120 patients who underwent total thyroidectomy. The patients in our series were randomly assigned to one of two groups: group A--patients who received calcium lactogluconate/calcium carbonate (mg 300 per day); group B--patients who received calcium carbonate/cholecalciferol therapy (calcium carbonate: 1500 mg per day; cholecalciferol 400 UI per day). The groups were well matched for age, sex and pathologies. Patients of both A and B groups were divided in two subgroups: those operated on for benign thyroid diseases (A1 and B1) and those operated on for malignancy (A2, B2). Serum calcium assays, performed 24, 48 and 72 hours after surgery, showed mean values of calcemia higher in patients of the B1 and B2 group. Statistical analysis was performed using a Student's t test. Mean serum calcium concentrations on post-operative day one, two and three were higher in patients of the group B (p<<0.01). Early and combined oral administration of both calcium and vitamin D seemed to prove major efficacy in preventing and treating post-operative hypocalcemia, showing mean serum calcium levels higher than those of patients who received only oral calcium administration. Nevertheless, further studies are necessary to validate these data.

Adult↗
PubMedDate not supplied

Total thyroidectomy: the treatment of choice in differentiated thyroid carcinoma.

INTRODUCTION: Clinically detectable thyroid carcinoma constitutes less than 1% of human cancers. Ninety percent of all thyroid malignancies are differentiated papillary and follicular carcinoma. Surgery plays a key role in differentiated thyroid carcinoma as it carries excellent prognosis, lower recurrence rate and low mortality rate but controversy persists for extent of surgery and optimal surgical management of lymph node metastasis. PATIENT AND METHOD: A retrospective analysis was done for the cases that underwent total thyroidectomy with lymph node dissection for differentiated carcinoma of thyroid in Kathmandu Medical College during two year periods (Oct 2001 to Oct 2003). RESULT: In our experience with 18 cases of Differentiated Thyroid Carcinoma (DTC) treated with total thyroidectomies and lymph node dissection, papillary carcinoma was predominant with 83% incidence. Disease was prevalent in 50 to 60 year age group. Except two cases of transient hypocalcaemia and few wound related complications, there have been no other complications. CONCLUSION: Total thyroidectomy with lymph node dissection is safe and effective, so, the treatment of choice in cases of differentiated thyroid carcinoma.

Adult↗
PubMed2005

Early hypothyroidism after subtotal thyroidectomy in patients with Graves' disease--the role of the preoperative conservative treatment and hormonal status.

AIM: The aim of the present study was to evaluate the role of the preoperative antithyroid drug treatment and hormonal status in the development of early postoperative hypothyroidism after subtotal thyroidectomy in patients with Graves' disease. MATERIAL AND METHODS: Eighty-five patients with Graves' disease (males : females ratio 1:5.54, age range 19 to 64, 37.52 +/- 1.09 yrs) who had previously undergone surgical treatment were enrolled in the study. All patients underwent bilateral subtotal thyroidectomy with the amount of remnant tissue of 2-3 g for each lobe (total 4-6 g). Development of early (within one year after the operation) postoperative hypothyroidism was analyzed regarding the type of the antithyroid drug, preoperative dose, duration of the preoperative medical treatment, FT3, FT4, FT3/FT4 and hTSH. RESULTS: Forty six percent of all examined patients (54.12%) were euthyroid and 39 (45.88%/)--hypothyroid. Postoperative hypothyroidism was developed by 33.33% of the patients that had received preoperatively propylthiouracil compared with 50.82% of those treated with methymazol (p > 0.05). The duration of the preoperative treatment was 38.36 +/- 3.53 months for the hypothyroid patients and 30.11 +/- 2.34 months for the euthyroid patients (p < 0.05). Postoperative hypothyroidism developed in 58.70% of the patients with preoperatively suppressed thyroid-stimulating hormone (hTSH) and in 33.33% of those with normalized values of hTSH (p < 0.05). No statistically significant between-group difference was found in the preoperative dose of antithyroid agent, mean values of free triiodothyronine (FT3), free thyroxine (FT4), FT3/FT4, thyrotropic hormone (TSH). CONCLUSIONS: Longer preoperative antithyroid drug treatment and suppression of hTSH in the preoperative period correlated with higher risk of hypothyroidism after subtotal thyroidectomy. The type and the preoperative dose of the antithyroid agent, as well as the mean values of thyroid hormones before the operation have no prognostic significance for postoperative thyroid hypofunction.

Adult↗
PubMed1991

Early thyroidectomy for medullary thyroid carcinoma in children and young adults with the multiple endocrine neoplasia type 2A (MEN 2A) syndrome.

A South African family, at risk for the multiple endocrine neoplasia type 2A (MEN 2A) syndrome, was identified. The Bloemfontein MEN Study Group was founded, inter alia, to study the effects of early detection of medullary carcinoma of the thyroid (MTC) and treatment by total thyroidectomy in children and young adults with MEN 2A. Genotypes were identified by DNA probe and MTC diagnosed by basal and stimulated calcitonin levels. Between 1986 and 1989, 10 members of the family underwent total thyroidectomy and central lymph node dissection for MTC. There were 6 female and 4 male patients (mean age 22,0 years; range 10 - 35 years). Histological examination of the resected thyroid revealed MTC in all patients; 8 had bilateral disease and 2 unilateral. Lymph nodes were negative for MTC in all patients. None of the patients suffered injury to the recurrent nerve, while 1 experienced transient hypoparathyroidism postoperatively. Replacement therapy is maintaining thyroid hormone levels in all patients. Screening should probably begin at the age of 1 year, and total thyroidectomy should be performed when an elevated calcitonin level is observed.

Adolescent↗
PubMed2006

Preliminary experience in minimally invasive videoassisted thyroidectomy (MIVAT).

BACKGROUND: We report our initial experience in the treatment of thyroid disease with Minimally Invasive Videoassisted Technique (MIVAT) introduced by Miccoli. METHODS: We have treated from July to September 2005, 5 patients, with MIVAT. The procedure is carried out through an incision of 15-20 mm 2 cm on sternal notch and the thyroidectomy is performed by dedicated instruments. RESULTS: We have surgically treated 3 follicular hyperplasias, one Hurthle adenoma and one papillary carcinoma. The mean time of thyroidectomy was 98 +/- 14 minutes; four cases were discharged after 24 hours and one case after 48 hours for a postoperative hypertension. No hypocalcemia, no nerve palsy. Cosmetic result and postoperative pain were excellent. CONCLUSION: MIVAT is a safe, reproducible technique with an indication in a minority of patients candidates to thyroidectomy and is characterized by a better postoperative discomfort.

Adult↗
PubMedDate not supplied

[Incidental thyroid microcarcinoma in benign thyroid disease. Incidence in a total of 100 consecutive thyroidectomies].

Over the past few years, incidental thyroid microcarcinoma has become a frequent disease and its incidence in some reports is considerable. Discovering new cases depends on the extended indications for total thyroidectomy for benign disease, on progress in the field of diagnostic instruments (ultrasound, scintigram, fine needle biopsy for cytology, CT scan, MRI), and on the pathology examination of very thin slices of specimens. In spite of the high incidence reported in some autopsy series, suggesting that this tumour may have a good prognosis, some Authors report an overall incidence of up to 11% of local recurrence, metastasis or mortality. For all these reasons the surgical treatment of incidental thyroid microcarcinoma is still controversial. The aim of this study was to estimate the incidence and examine the clinical-pathological findings of incidental thyroid microcarcinoma in a series of 100 consecutive thyroidectomies and to evaluate whether complete removal of the gland should be adopted in all cases. In the present series the incidence of incidental thyroid microcarcinoma was 21.6% (19/88). Total thyroidectomy was considered the treatment of choice for diffuse benign disease and appeared to be necessary for both the diagnosis and treatment of incidental thyroid microcarcinoma.

Adult↗
PubMed1991

Second operations for "completion" of thyroidectomy in treatment of differentiated thyroid cancer.

The role of elective completion thyroidectomy after lobectomy for differentiated thyroid cancers remains controversial. The potential benefit of tumor removal by the second procedure is considered by some to be overbalanced by a prohibitive operative morbidity rate. During a 20-year period at the University of Chicago Medical Center, 26 patients underwent completion thyroidectomy within a 6-month period of the original thyroid operation. This group represents 8% of the 326 patients who underwent surgery during that time for differentiated thyroid cancer (269 papillary and 57 follicular). Of the 26 patients, 18 had papillary and eight had follicular cancers. The average size was 2.5 cm, with 24 of 26 being greater than 1 cm in diameter. At the first operation, 81% of tumors were intrathyroidal. Eight percent had lymph node metastases and 12% manifested local invasion. Tumor was found in eight (31%) of 26 of the reoperative specimens. The incidence of tumor did not vary by histologic type but did differ according to the extent of the original operation. Cancer was found in 50% (three of six) of those who had undergone previous partial lobectomy, in 33% (five of 15) of those after a total lobectomy, and in none of five who had undergone a prior bilateral (although incomplete) thyroid resection. One permanent recurrent nerve injury occurred at the first operation. No additional recurrent nerve injuries or hypoparathyroidism occurred as a result of the second operation. Finally, no disease characteristic of the initial tumor (e.g., size, clinical class, tumor capsular invasion, multifocality, thyroiditis, or extrathyroidal tumor invasiveness) predicted the presence or absence of tumor on the second side. We conclude that completion thyroidectomy is appropriate for patients with lesions 1 cm or greater who have undergone lobectomy or less at the original operation, because 40% of such patients would be expected to have residual cancer. With care, this operation can be performed with minimal morbidity.

Adenocarcinoma↗
PubMed1991

[Role of total thyroidectomy in the treatment of multinodular goiter].

Although it may seem to be excessive, total thyroidectomy has recently been advocated by several authors for the treatment of diffuse multiheteronodular goiters. As a complement to a recent study on the thyroid function following thyroidectomy for benign goiters, the authors specify the role of this surgical technique, which had been reserved for the sole thyroid neoplasms for a long time. On the occasion of the presentation of a series of 75 cases gathered from 1989 to 1990, the justification of glandular resection is based on the publication of new pathogenetic data and on the absence of any increase in morbidity, subject to precise indications and to a strict technique aimed at preserving recurrents and locating the parathyroid glands while maintaining their vasculature. When aimed at reducing the frequency of recurrence of euthyroid and toxic diffuse multinodular goiters, total thyroidectomy might also contribute in reducing the morbidity of second surgery, at the expense of a permanent substitution therapy. While the choice of its indications must remain eclecty, thelong-term consequences of initial surgery with too restricted glandular exeresis must be recognized.

Adult↗
PubMed1990

Effect of thyroidectomy on hypothalamic concentration and in vitro release of thyrotropin-releasing hormone in ovariectomized rats.

This investigation was designed to study the effect of thyroidectomy on the release of thyrotropin-releasing hormone (TRH) from the mediobasal hypothalamus (MBH) of ovariectomized (Ovx) rats in vitro. Immediately after ovariectomy, rats were thyroidectomized (Tx) or sham Tx, and decapitated 10 weeks later. The blood samples were collected, mixed with or without 2,3-dimercaptopropanol (BAL). The serum samples with BAL were assayed for immunoreactive (IR) TRH and those without BAL were assayed for thyroid-stimulating hormone (TSH) by radioimmunoassay (RIA). The mediobasal hypothalamus was extracted by 0.1 N HC1, or superfused with Krebs-Ringer phosphate buffer at 37 degrees C in a superfusion chamber, and stimulated by potassium ion (30 mM). The superfusate flowing from the superfusion chamber was collected during successive 10-min intervals at a rate of 0.5 ml/10 min and acidified with 5 N HC1. Concentrations of TRH in medium and tissue samples were determined by RIA. Thyroidectomy increased TSH concentration in the serum, but decreased TRH concentration in the serum and MBH. Both the spontaneous release and the K(+)-stimulated release of TRH from MBHs in vitro were lower in Ovx-Tx than in Ovx rats. These results suggest that the increased secretion of TSH in ovariectomized rats following thyroidectomy can not be attributed to changes of TRH secretion from mediobasal hypothalamus.

Animals↗
PubMed1990

[Hypocalcemia after total thyroidectomy. Therapeutic considerations].

One of the post-operative complications of total thyroidectomy is the onset of a transitory or permanent hypocalcemic syndrome. Hypocalcemia is caused by different physiopathological mechanisms that operate either individually or in association (parathyroidal deficit, deficiency of bone calcium subsequent to parathyroid osteodystrophy, acute emission of calcitonin into the circulation). Calcemia levels were studied p.o. in a selected group of 25 patients who had undergone total extracapsular thyroidectomy with the apparent preservation of the parathyroid glands. Totals thyroidectomy has been performed in 15 patients with euthyroid goitre, in 4 with papillary carcinoma, in 3 with diffuse toxic goitre and in 3 with multinodular toxic goitre. Eight patients received drug and diet therapy since calcemia levels were lower than 7.5 mg/ml. Fifteen days after the operation, calcemia levels in 21 patients were subliminal and dihydrotachysterol therapy was commenced. Hypocalcemia was permanent in only one case.

Calcium↗
PubMed1986

[Effect of thyroidectomy on phosphorylative oxidation and RNA synthesis in various regions of the brain in the adult monkey].

The subcellular effects of thyroidectomy in selected brain regions of Cynomolgus monkey were analyzed. 20 days after operation the respiratory rates, the activities of succinate cytochrome c reductase, glycerol-3-phosphate dehydrogenase and of oligomycin-sensitive ATPase were decreased in mitochondria isolated from all brain structures. The highest reduction (30%) was found in cerebral cortex and hippocampus. Cerebellar and striatal activities were reduced by about 20%. A smaller decrease (15%) was observed in thalamus. The effects of thyroidectomy on in vitro RNA synthesis were followed in cerebral cortex, cerebellum and thalamus. In the three analyzed regions, the activities of nucleolar and nucleoplasmic RNA polymerases dropped by 40%. Replacement therapy with T4 (2.5 micrograms/kg/day) or T3 (1 microgram/kg/day) administered immediately after thyroidectomy for 20 days, maintained mitochondrial and nuclear activities at normal level.

Adenosine Triphosphatases↗
PubMed1989

Does fine-needle aspiration biopsy really spare patients thyroidectomy?

Fine-needle aspiration (FNA) biopsy is widely used in the evaluation of nodular thyroid disease. From January 1979 to May 1983, 100 patients underwent FNA biopsy at Wake Forest University Medical Center for evaluation of nodular thyroid disease. Forty-six underwent immediate thyroidectomy based upon clinical and cytologic criteria. Fifty-three patients identified as having benign atypical or normal cells initially were managed nonoperatively. An additional patient with Hürthle cell neoplasm diagnosed by cytologic evaluation refused surgery and is included in the group treated nonsurgically. This report concentrates on the characteristics and subsequent course of these 54 patients. Emphasis was placed on whether surgery was actually avoided or merely delayed by the results of FNA biopsy. Follow-up evaluation ranged from 16 to 92 months (mean, 57 months). Fifty-two (96%) patients had not been operated upon for thyroid disease during the follow-up period, and in none of the 52 had there developed new indications for surgery. The two (4%) patients who had undergone thyroidectomy proved to have benign disease. The authors conclude that with adequate clinical follow-up, FNA biopsy can accurately and appropriately guide the nonoperative management of nodular thyroid disease, and that the technique does spare patients the cost and risk of thyroidectomy, both initially and during subsequent follow-up evaluation.

Adenoma↗
PubMed1989

Total thyroidectomy for benign thyroid disease: when and why.

Surgical complications after total thyroidectomy (TT) and subtotal thyroidectomy (STT) are analysed in a series of 364 patients operated on over a 36-month period. All operations were carried out because of the following 3 groups of disease: malignant tumors, multinodular goiter and Graves' disease. The difference among the incidence of surgical complications resulted to be not statistically significant when as discriminating factors the type of surgery or disease were used, while the difference was statistically significant when the results obtained in the 2 groups of patients operated only once or undergoing reoperative surgery for recurrence, were compared. Based on these observations, the surgical approach consistent with the above mentioned types of thyroid disease is reported, and the preference for total thyroidectomy is justified to a larger extent by what has been done to-date also in case of benign thyroid disease. The choice of the type of surgery should always be made, based on a careful clinical and intraoperative assessment of each case.

Adult↗
PubMed1988

Thyroid and parathyroid response to subtotal thyroidectomy.

Hypocalcemia occurring a few days after total subtotal thyroidectomy has been attributed either to parathyroid insufficiency or to calcitonin release. To investigate this matter further, we measured serum calcium, phosphate, T3, T4, TSH, parathormone (PTH), calcitonin (CT) and cAMP, in 27 women aged 23 to 63 years, before and also 3 and 7 days after subtotal thyroidectomy for multinodular nontoxic goiter. Ca, T3 and T4 decreased, whereas TSH increased appropriately to the decrease in T4 and T3. There was no increase in PTH appropriate to the Ca decrease. In contrast, PTH, cAMP and CT showed statistically unsignificant tendency to decrease. It was concluded that hypocalcemia after thyroidectomy is not due to CT release, but rather to a relative PTH insufficiency.

Adult↗
PubMed1986

[Effect of thyroidectomy on variations during the spring and summer of the testicular activity and blood prolactin in the mink].

The possible role of thyroid hormones in the setting of sexual quiescence was investigated in the mink, since levels of thyroid hormones were earlier shown to rise while testicular activity decreased. When performed at the beginning of the sexual period, thyroidectomy transiently stimulated testosterone production, and significantly prolonged the duration of maximal testicular development. These results indicate that mink conforms to a pattern of inhibitory thyroid-testis interactions similar to that previously described in several species of birds and mammals. Thyroidectomy was unable, however, to prevent ultimately the installation of sexual quiescence which also appears independent of the photoperiod. On the other hand, thyroidectomy did not modify, from February to October, the general pattern of prolactin secretion, even though the vernal stimulation of prolactin secretion, induced by increasing daylength, was significantly enhanced in the absence of thyroid hormones.

Animals↗