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PubMed1978

Changes of LH, TSH, GH, FSH and PRL in pituitaries and sera of rats after thyroidectomy and thyroxine treatment as studied by radioimmunoassay and disc electrophoresis.

Rat pituitary hormones (LH, TSH, GH, FSH and PRL) were located in polyacrylamide gels after the separation of rat pituitary homogenate with the aid of electrophoresis. Furthermore, the incorporation of 3H-glucosamine and 14C-leucine into various protein fractions of incubation media and pituitaries incubated for 6 h in vitro, homogenized and then subjected to disc electrophoresis was measured in six groups of rats: 1. control; 2. two weeks after thyroidectomy (Tx); 3.--6. two weeks after thyroidectomy and injected 20 micrograms L-thyroxine (T4) i.p. per animal at 6, 12, 24 and 48 h before sacrifice, respectively. A decrease of 14C-leucine incorporation into GH and PRL after thyroidectomy was found which was improved by T4 treatment. Moreover, an increase of 3H-glucosamine and 14C-leucine incorporation into TSH zone and origin zone was observed, the former presumably representing the extracted TSH and the latter consisting of unextracted portion of TSH, other hormones and unidentified proteins. Such increase was significantly less after T4 treatment. Finally, changes of radioimmunoassayable LH, TSH, GH, FSH and PRL in pituitaries and sera of analogous groups of rats, but consisting of another animals were measured. The content of TSH in the pituitary slightly increased after Tx, but increased further after T4 treatment. In contrast, the content of all other hormones in the pituitary decreased after Tx, while T4 treatment resulted in a stepwise increase. In plasma, a significant decrease of GH and PRL after Tx was found with no remarkable changes after T4 treatment. The level of LH and FSH was unchanged, while that of TSH increased significantly after Tx and sharply decreased to the original level as early as at 6 h after the injection of T4.

Animals↗
PubMed1988

Tracheomalacia from compressing goiter: management after thyroidectomy.

Tracheomalacia may result from prolonged compression by expanding goiter, particularly within the confines of the thoracic inlet. Constriction of the upper airway by the growing goiter may be indication for operation, but the residual problem of tracheomalacia after thyroidectomy is a life-threatening postoperative complication. Examples of postoperative tracheomalacia in patients with neglected goiters endemic in the third world or recurrent goiter with airway compromise in a western medical center referral practice are described for development of management methods. Two patients with lethal postthyroidectomy tracheomalacia led me to anticipate this complication in certain identifiable high-risk patients in my own practice, and the cases of five patients are described for whom several techniques of tracheal support were attempted. One patient, for whom staged tracheoplasty was planned, opted for tracheostomy, whereas four patients have had adequate tracheal airways restored by extrinsic support. One was treated by subtotal thyroidectomy with tracheal suspension; one by staged thyroid reductions; two were treated by creation of extrinsic tracheal neo-rings constructed of surgical wire and vascular prostheses. The patient with the most dramatic airway impairment from the most extensive tracheomalacia experienced very satisfactory airway security. A second patient was also supported by the prosthetic rings but extruded one of them, possibly because of tracheostomy contamination. Until tracheal replacement or better tolerated prosthetic or biologic supports are devised, tracheomalacia will remain a vexing problem complicating thyroidectomy for long-standing or recurrent airway-compressing goiter.

Adult↗
PubMed1988

Local recurrence of papillary thyroid carcinoma after unilateral or bilateral thyroidectomy.

Because prospective, randomized studies on papillary carcinoma of the thyroid are lacking, the results of retrospective studies from the basis of our present knowledge. To assess differences in treatment modalities, the patient groups must be comparable. A prognostic score has been devised by the use of multivariate analysis which can accurately distinguish patients at various levels of risk for disease-related mortality. To obtain the score, the calculated contributions of four significant variables are added. These variables are Age, tumor Grade, Extent, and Size (AGES). Using this scoring system, locally recurrent papillary thyroid carcinoma was studied in 816 patients primarily treated at the Mayo Clinic between 1946 and 1970. Locally recurrent disease developed in 54 (6.6%) patients, with the highest risk of occurrence in the first five years following initial thyroidectomy. Both in low- and high-risk patients, patients who had undergone unilateral thyroid resection had significantly more local recurrences than those with bilateral resections. However, there was no such difference when comparing subtotal to total thyroidectomy. Even though local disease was the cause of death in over one-half of the patients who died of thyroid cancer, this represented less than two percent of the entire series. From analysis of these data, bilateral resection - but not necessarily total thyroidectomy - with specific care to preserve both recurrent laryngeal nerves and at least one parathyroid gland in situ, seems to provide optimal treatment. When recurrence does occur, it appears worthwhile to attempt further surgical resection.

Adolescent↗
PubMed1987

Preservation of the parathyroid glands in total thyroidectomy.

A series of 183 patients who underwent total thyroidectomy is presented. The operative method, which emphasizes visualization and preservation of the parathyroid glands and their blood supply, as well as exposure of the recurrent laryngeal nerves, is discussed in detail. Permanent hypoparathyroidism was a complication in six patients (3.3 per cent). Permanent nerve injury occurred in one patient (0.55 per cent). Postoperatively, 78 patients had radioactive iodine uptake studies to evaluate the amount of residual thyroid tissue in the neck. Sixty-four (82 per cent) had 24 hour uptake studies of less than 2 per cent and 52 had an uptake of less than 1 per cent. Although a careful and consistent technique of total thyroidectomy substantially reduces the danger of permanent hypocalcemia, we experienced this complication sporadically. Since no operative technique completely removes the danger of permanent hypoparathyroidism, it is our opinion that total thyroidectomy should not be the standard management for carcinoma of the thyroid gland. It is best reserved for those patients in whom the extent of disease or the aggressiveness of the histologic cell type warrants the increased risk.

Adult↗
PubMed1982

[Effect of thyroidectomy and hyperthyroidism on Ca2+/2H+-antiporter activity in rat liver mitochondria].

The manifestation of Ca2+/2H+ antiporter activity in rat liver mitochondria was shown to be inhibited in thyroidectomy and stimulated in hyperthyroidosis. Experiments with measuring the kinetics of the swelling of deenergized mitochondria in isoosmotic solutions Ca (NO3)2, pH 8.1 demonstrated inhibition of the swelling of liver mitochondria during thyroidectomy and stimulation because of administering thyroid hormones in vivo. During thyroidectomy, the phosphate-induced swelling of rat liver mitochondria was powerfully inhibited. Meanwhile administration of thyroxine to rats stimulated the swelling of mitochondria.

Animals↗
PubMed1983

The surgical complications of thyroidectomy.

The surgical complications of thyroidectomy are relatively few but still need to be carefully considered before an operation is recommended. The major problems that lead to continuing morbidity are those of permanent hypoparathyroidism and recurrent laryngeal nerve damage. The incidence of both rises dramatically whenever a total thyroidectomy is performed, particularly when this is for a malignancy, or when the patient has undergone previous surgery to the thyroid or parathyroid glands. Other complications of thyroidectomy are relatively uncommon.

Humans↗
PubMed1981

Effects of thyroidectomy and triiodothyronine administration on rat liver alcohol dehydrogenase.

The effect of thyroidectomy on the activity of liver alcohol dehydrogenase and on the rate of ethanol elimination was determined in the rat. Thyroidectomy resulted in a marked increase in liver alcohol dehydrogenase activity. Three isoenzymes of alcohol dehydrogenase activity were demonstrated in thyroidectomized animals by starch gel electrophoresis, as compared with two in sham-operated control animals. Triiodothyronine administration decreased the enzyme activity in control animals, and suppressed the enhanced activity in thyroidectomized animals. Inhibition of alcohol dehydrogenase by triiodothyronine in vitro was found to be competitive with respect to NAD+ and uncompetitive with respect to ethanol in both contrast and thyroidectomized animals. Thyroidectomy did not result in any changes in the rate of ethanol elimination. The cytosolic free NAD+/NADH ratio decreased after ethanol administration in both control and thyroidectomized animals, while the mitochondrial-free NAD+/NADH ratio decreased only in the control animals. These results indicate that the thyroid is a repressor of liver alcohol dehydrogenase activity. A defect in the transfer of reducing equivalents from the cytosol to the mitochondria appears to limit the rate of ethanol elimination in thyroidectomized animals with increased liver alcohol dehydrogenase activity.

Alcohol Oxidoreductases↗
PubMed1994

[Anatomic and surgical considerations regarding the recurrent laryngeal nerve in thyroidectomy].

The majority of surgeons view the preliminary identification of the recurrent laryngeal nerve (RLN) as an essential stage in thyroidectomy in order to preserve thyroid integrity. This conviction is based on the fact that the anatomical relations of the recurrent nerve during the cervical tract with adjacent structures are highly variable. The preparation of the RLN in a series of 42 thyroidectomies performed by the 1st Department of Pathological Surgery of the University of Florence confirmed this variability above all with regard to relations with the trachea, Berry's ligament and the branches of the lower thyroid artery. As a result, it is justified to consider the identification and preliminary preparation of the RLN on both sides as a fundamental and unavoidable stage in thyroidectomy.

Adult↗
PubMed1994

[Transient hypocalcemia after thyroidectomy].

In a patient submitted to thyroidectomy a transitory hypocalcemia can develop, the frequency of which is very variable in reference with on international literature. Several hypotheses have been enunciated to explain the phenomenon. This study would contribute to suggest its etiology and to quantify its entity. For this purpose we selected a series of patients among those operated from September, 1989 to May, 1991. 6 of them were affected by non toxic multinodular goiter (group 1), while 12 were affected by Graves' disease (group 2). We evaluated their serum levels of calcium, parathormone (iPTH), calcitonin (CT), osteocalcin and total proteins. In both groups we registered a temporary hypocalcemia that resulted statistically significant. In group 1 the hypocalcemia was associated with a decrease in iPTH levels, so that the cause of hypocalcemia in patients submitted to thyroidectomy for nontoxic multinodular goiter seems to be a transient parathyroid failure, while in group 2 the hypocalcemia was associated with a decrease in total protein levels, showing a different pathogenetic mechanism. We conclude that the transitory hypocalcemia post-thyroidectomy relies on a different etiology in the two thyropathies.

Adult↗
PubMed1993

Thyroidectomy and thyroxine administration alter serum calcium levels in rat.

The effects of thyroidectomy and thyroxine on serum calcium concentration were studied in adult albino Wistar strain rats using the technique described by Baginski et al. (1973) as used by Lorentz [10]. Thyroidectomy decreased serum calcium concentration from 2.28 +/- 0.02 mmol/l to 1.61 +/- 0.01 mmol/l. Chronic administration of thyroxine (6-8 micrograms/100 g body wt/day) for 35 days caused an increased serum calcium concentrations from 2.28 +/- 0.02 mmol/l to 2.98 +/- 0.05 mmol/l. These findings suggest that thyroidectomy and the dose of thyroxine used affected calcium metabolism in rats.

Administration, Oral↗
PubMed1993

Delayed recovery from post-thyroidectomy hypoparathyroidism: a case report.

Thirteen hours after a subtotal thyroidectomy was performed for hyperthyroidism, a patient developed carpopedal spasms, parathesias and hypocalcemia to 6.9 mg/dL. After initial stabilization with intravenous calcium administration, oral calcium carbonate and calcitriol were required. Ten months postoperatively serum calcium levels rose and supplementation was gradually discontinued. The serum parathyroid hormone (PTH) level was 1.0 pg/mL on the second postoperative day and levels were undetectable despite sensitive testing 3 months later (normal 10-65 pg/mL). Two years after surgery, the PTH level has increased to 36 pg/mL, but remains relatively low considering the patient's continued mild hypocalcemia. To our knowledge, there has been no previously reported case of long-term post-thyroidectomy hypocalcemia documenting undetectable parathyroid function and subsequent spontaneous improvement. This case suggests that delayed recovery of parathyroid function and discontinuation of vitamin D and calcium supplementation may be possible in some post-thyroidectomy patients with hypocalcemia due to severe hypoparathyroidism.

Adult↗
PubMed1995

A regional study of thyroidectomy: surgical pathology suggests scope to improve quality and reduce cost.

This study of thyroid histopathological data from hospitals in the South West Thames region was undertaken to assess current practice and the scope for improvement. Over a 6 month period, 186 thyroid operations were performed on 179 patients at eight hospitals serving almost 1.7 million people. The frequency of thyroidectomy in different hospitals varied from 13 to 35 per 100,000 per year and 6.4% of the operations were second thyroidectomies. Benign multinodular goitre was the most common histological finding (34%). A benign solitary nodule was found in 36% and malignancy in 8.4% of the specimens. Correlation of histological analysis and type of operation suggested that a variety of operations were performed for the same pathological condition and that some operations were diagnostic procedures only. Overall, 63 of the 186 operations (34%) might have been avoided by a firm preoperative diagnosis. Only 67 thyroid fine needle aspiration biopsies (FNAC) were performed at the eight hospitals during the study period. Only 15 (8%) of the patients who underwent thyroid operation had been investigated by FNAC. Reduction in thyroid surgery through more widespread use of FNAC could result in savings of 100,000 pounds per million population per year. Regional activity data show that more than 50 surgeons currently undertake a workload of less than 500 thyroidectomies each year. Increased subspecialisation may be required to reduce costs and raise standards.

Biopsy, Needle↗
PubMed1995

Thyroidectomy for large multinodular colloid goitre.

Between 1983 and 1993 a total of 474 patients underwent thyroidectomy in one surgical unit. In 64 (14%) of these, a multinodular colloid goitre weighing more than 100 g was resected. Preoperative symptoms in this group of patients with large goitres included respiratory difficulty (42%) and dysphagia (22%) whilst 22% demonstrated distension of the veins of the neck or anterior chest wall. Plain radiography revealed evidence of tracheal deviation in 70% of patients and tracheal compression in 42%. Total thyroidectomy was carried out in 47 patients and unilateral total lobectomy in 11; six patients underwent completion thyroidectomy for massive recurrent goitre following previous resection. There was no perioperative mortality. Complications included permanent unilateral vocal cord paralysis in two patients (1.7% of recurrent laryngeal nerves at risk), permanent hypoparathyroidism in two (3.1%) and temporary emergency tracheostomy in one individual. We advocate total resection for patients with large multinodular colloid goitre.

Goiter, Nodular↗
PubMedDate not supplied

[Total thyroidectomy in the treatment of multinodular toxic goiter].

The Authors report their experience in the management of 201 patients with multinodular toxic goiter (MTG): 122 (60.7%) underwent subtotal thyroidectomy (STT), while 79 (39.3%) underwent total thyroidectomy (TT). Through a retrospective study the patients were stratified into two groups according to the type of operation (TT or STT). Overall, neither operative mortality nor recurrent nerve damage were encountered. Permanent hypocalcemia was observed in 7 patients (5.7%) who underwent STT and in 6 patients (7.5%) who underwent TT (p=N.S.), while transitory hypocalcemia was observed in 12 cases (9.8%) in group I and 11 cases (13.9%) in group II (p=N.S.). All patients were followed every 4 months for the first year and every 6 months thereafter. Average and median follow-up period were, respectively, 72 and 74 months. The Authors conclude that total thyroidectomy is the surgical treatment of choice in multinodular toxic goiter (MTG). A thorough anatomical-surgical evaluation is essential in order to prevent the complications characteristic of this type of surgery (inferior laryngeal nerve injury and hypoparathyroidism).

Adolescent↗
PubMed1977

Successful autotransplantation of the parathyroid glands during total thyroidectomy for carcinoma.

In a consecutive series of 118 total thyroidectomies during a period of 11 years, autotransplantation of one or more parathyroid glands was used in 64 patients. During the first nine years of this series, autotransplantation was used in only 25 per cent of the total thyroidectomies, with a 3 per cent incidence of permanent hypoparathyroidism. During the last two years, autotransplantation of the parathyroid was used in 89 per cent of 54 total thyroidectomies, with a zero incidence of hypoparathyroidism.

Adolescent↗
PubMed1996

Same-day admission thyroidectomy programme: quality assurance study.

OBJECTIVE: This study was conducted to evaluate the effectiveness of a same-day admission thyroidectomy programme. DESIGN: Prospective patient surveys and a retrospective quality assurance study were conducted. METHOD: Management of the initial 58 patients having a thyroidectomy at St. Joseph's Hospital, London, Ontario, after May 1992 when a same-day admission thyroidectomy programme was initiated, was evaluated. Early in the process, staff evaluation of the programme was also surveyed. RESULTS: The average length of stay for these patients was reduced from 4.5 to 3.2 days. No operative delays, cancellations, readmissions, or increased complications resulted from the new protocol. Also, patient and staff acceptance of the new programme was high. CONCLUSION: Our success with this programme has encouraged us to apply these concepts to more complex surgical patients.

Adolescent↗
PubMed1996

[The calcium tolerance test in thyrotoxicosis, Hashimoto's thyroiditis and after total thyroidectomy].

Basic indicators of calcium and bone metabolism and the calcium tolerance test were investigated in patients with untreated hyperthyroidism, Hashimoto's thyroiditis, after total thyroidectomy and in controls. In florid hyperthyroidism elevated values of indicators of bone new formation (osteocalcin and bone fraction of alkaline phosphatases) and of bone resorption (urinary pyridinoline and deoxypyridinoline) were found and a protracted return of the serum calcium level to baseline values (during the 120th minute after completed infusion containing calcium). The calcitonin serum levels were significantly reduced after completion of the infusion up to the 120th minute. These results suggest a reduced calcitonin activity in hyperthyroidism, caused probably by exhaustion of C cells during the prolonged tendency of hypercalcaemia associated with untreated hyperthyroidism. In patients with autoimmune Hashimoto's thyroiditis no significant deviations in basal indicators of the calcium and bone metabolism were found nor deviations of the serum calcium and calcitonin levels during the calcium tolerance test. After total thyroidectomy the basal values of calcitoninaemia are significantly reduced and during the calcium tolerance test the elevated serum calcium level persists from the end of the calcium containing infusion up to the 120th minute. The calcitonin values are at all time intervals significantly low or cannot be detected (during the 120th and 240th minute). Changes of the serum calcium and calcitonin level are due to the surgical removal of the calcitonin source, thyroid C cells. The investigation confirmed the impaired calcium and bone metabolism and impaired calcium tolerance test in hyperthyroidism and in particular after total thyroidectomy. Reduced calcitonin values in these patients can act as a factor promoting the development of osteoporosis.

Adult↗
PubMedDate not supplied

[Total thyroidectomy technique: suggestions and proposals of surgical practice].

Total thyroidectomy at present depicts a diffuse surgical procedure in the management of benign and malignant disease of thyroid gland. It is followed by a low incidence of iatrogenic damages (nervous lesions or permanent hypoparathyroidism), just like subtotal thyroidectomy and lower than surgery for nodular recurrences. Authors present the surgical technique they follow to perform total thyroidectomy, used in over 400 cases of benign thyroid diseases operated since 1986. The most important points of this surgical procedures are represented by exposure and sparing of inferior laryngeal nerve and by preservation of parathyroid function. Parathyroid glands can be exposed to direct surgical trauma but, more often, they are injured by damage of their vascular supply. To avoid this complication, vascular ligations of inferior thyroid artery have to be done never on the trunk of the artery, but on its branches just near the glandular capsula. Sparing of inferior laryngeal nerves comports the exposure of this structure for all its cervical course especially in the terminal edge, when the nerve is nearest to the gland. Systematical application of illustrated procedure has produced no operative mortality, no inferior laryngeal nerve permanent palsy, transient hoarseness in 0.5%, and transient symptomatic hypocalcemia in 2.7%.

Goiter, Nodular↗