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PubMed1997

Hypocalcaemia following thyroidectomy for thyrotoxicosis.

BACKGROUND: Temporary postoperative hypocalcaemia is a relatively common complication following thyroidectomy for thyrotoxicosis. Damage, devascularization or inadvertent removal of the parathyroid glands is the most widely accepted reason, but other causes have been postulated including release of calcitonin during operative manipulation and "hungry bone syndrome' due to postoperative reversal of thyrotoxic osteodystrophy. METHODS: The study included 63 patients who had subtotal thyroidectomy, 51 for thyrotoxicosis and 12 for non-toxic goitre. Ninety-two per cent had at least three parathyroid glands preserved. All had postoperative levels of parathyroid hormone measured. RESULTS: The incidence of biochemical hypocalcaemia was 46 per cent and that of symptomatic hypocalcaemia was 21 per cent. No patient was hypoparathyroid. The incidence of hypocalcaemia was 27 of 51 in thyrotoxic patients compared with two of 12 in the non-toxic goitre group (P < 0.05). CONCLUSION: Hypoparathyroidism does not appear to be the main reason for hypocalcaemia after thyroidectomy, and other causes such as "hungry bone syndrome' may be important contributory factors.

Adolescent↗
PubMed1977

[Platelet retention and hypothyroidism: an investigation in patients with thyroid carcinoma treated by total thyroidectomy (author's transl)].

Platelet retention was investigated using a standardized technique with a glass pearl column in 18 patients with malignant thyroid disease treated by thyroidectomy before and after high-dose radioiodine treatment (80 or 150 mCi). As compared with the normal controls platelet retention was significantly lower in 13 hypothyroid patients in whom thyroidectomy had been undertaken at least 6 months previously and hormone substitution therapy had been interrupted 3 weeks before the period of investigation. The remaining 5 patients, studied about 18 days following thyroidectomy, were euthyroid and displayed platelet retention values within the lower limits of the normal range except for one patient with markedly reduced values. Thyroid substitution therapy with synthetic preparations induced recovery of platelet retention in both groups examined over a 4 week period, the increase being highly significant in the group of hypothyroid patients. A transient increase in platelet retention was observed 24 hours after a therapeutic dose of radioiodine, and initial values being regained after a further 24-hour period. This phenomenon was found in both, the euthyroid and hypothyroid group, however, it was more pronounced in the latter patients. Our results indicate a dependence of platelet retention on thyroid hormone concentration. The observed transient increase after radioiodine may be due to a radiation effect.

Adolescent↗
PubMed1996

[The results after an organ-preserving operation and total thyroidectomy in differentiated thyroid carcinoma].

A total of 196 patients with differentiated thyroid gland carcinoma are operated over the period 1980 through 1994, and followed up over periods ranging from 1 to 14 years after the operation. Surgical treatment consists in total thyroidectomy in 39.8 per cent of the cases, and organ salvaging operation--in 60.2 per cent. In 124 instances the histological diagnosis is papillary carcinoma, and in 72--follicular carcinoma. Local relapses and lethality are higher in patients with total thyroidectomy--6.4 per cent local recurrences and 3.8 per cent lethality, whereas in the group of organ-salvaging operations--1.6 and 0.9 per cent, respectively. Analysis of the operative interventions according to risk group, stage of disease and histopathological findings shows that there is no significant difference in lethality, but there is a higher rate of relapses among patients treated with total thyroidectomy.

Adenocarcinoma, Follicular↗
PubMed1997

[Evaluation of the efficacy of treatment with exogenous thyroxin in patients after thyroidectomy].

The study was performed in 228 patients after thyroidectomy, including 101 individuals permanently treated with thyroxin and 127 ones in whom treatment with thyroxin was started on the average 5 years after surgery. Control group consisted of 35 patients after thyroidectomy, average 2 years after surgery, not treated with thyroxin. Stump volumes and serum TSH concentrations were significantly higher in the patients who began treatment a long time after surgery (mean after 5 years) when compared with the control group (mean after 2 years). It was proven that treatment with thyroxin led to significant decrease of the stump volume and to serum TSH normalisation. Treatment with thyroxin was successive in not all patients with nodular regrowth; in some of them despite using suppressive doses of thyroxin, progression of the lesions occurred, what claimed for different regrowth etiology. In spite of high serum TSH concentrations in 132 patients, only in 60 of them clinical manifestation of hyperthyroidism was observed. Treatment with thyroxin should be recognised as reasonable in prophylaxis and therapy of patients after thyroidectomy.

Humans↗
PubMed1996

Post-thyroidectomy hypocalcemia: the role of calcitonin, parathormone and serum albumin.

To investigate the pathogenesis of post-thyroidectomy hypocalcemia calcium, phosphate, calcitonin, parathormone, albumin, triiodothyronine and thyroxine levels were monitored during operation and postoperatively in 25 female patients undergoing bilateral subtotal thyroidectomy for non-toxic nodular goiter. A highly significant fall in uncorrected serum calcium and albumin levels started with the completion of lobectomies and a significant correlation between the course of serum calcium and albumin levels were seen, an early peak in calcitonin corresponded well with the a drop in corrected calcium and inorganic phosphate levels. An overt parathyroid response to hypocalcemia was not observed. We conclude, on the basis of the postoperative hypoalbuminemia, that a calcitonin leak triggered the early onset of hypocalcemia while an insufficient parathyroid response contributed to the post-thyroidectomy hypocalcemia.

Calcitonin↗
PubMed1998

Safety of completion thyroidectomy for multicentric carcinoma.

The role of completion thyroidectomy after lobectomy for well-differentiated thyroid carcinoma remains controversial. The purpose of the present study is to compare the relative safety of a one-stage versus a two-stage approach in the management of thyroid cancer. Thirty consecutive patients with thyroid carcinoma were studied. In 14 patients, frozen-section diagnosis of carcinoma allowed total thyroidectomy at the initial operation. In 16 patients, carcinoma was found only on permanent section; thus, completion thyroidectomy was undertaken as a second stage. Transient hypocalcemia occurred in one patient in each group (one-stage, 7%; two-stage, 6%). There was one unilateral recurrent nerve paresis in the one-stage group and none in the two-stage group. We conclude that a two-stage procedure is a safe and effective approach for the treatment of thyroid cancer and can be employed in those instances in which the diagnosis of malignancy is insecure at the initial operation.

Adenocarcinoma, Follicular↗
PubMedDate not supplied

[Clinical study of residual function and recurrence in patients undergoing partial thyroidectomy for euthyroid nodular goiter].

The different surgical options for the treatment of non toxic nodular goiter led the Authors to study the residual thyroid function following conservative surgery (subtotal thyroidectomy, lobectomy and enucleation). Follow-up showed an overall recurrence rate of 49%, with a higher rate after lobectomy and enucleation than after subtotal thyroidectomy. On the other hand, subclinical hypothyroidism was higher in patients who underwent subtotal thyroidectomy. No significative correlation was found between high plasmatic levels of TSH and recurrences.

Adult↗
PubMed1998

[Thyroid carcinoma in a thyroglossal duct cyst: tumor resection alone or a total thyroidectomy?].

Tumours arising in a thyroglossal duct cyst are very rare. Most of them develop from ectopic thyroid remnants. Controversies persist concerning th treatment of these neoplasms, some authors preferring local excision (Sistrunk procedure), while others prefer a more radical approach (associated total thyroidectomy). From 1977 to 1996 we observed and treated 10 patients with by a thyroglossal duct tumour: 8 females and 2 males. A mass in the midline of the neck was the presenting complaint in all cases. Each patient was treated by a Sistrunk procedure associated with total thyroidectomy. Histopathology reports showed 7 papillary carcinomas, 1 Hürthle cell carcinoma, 1 follicular carcinoma and 1 insular carcinoma. Systematic examination of the thyroid gland revealed foci of papillary cancer in 4 cases (40%), with only 1 tumour being larger than 1 centimetre. Cervical metastases were found at operation in 1 case. This series suggests that total thyroidectomy for tumours of thyroglossal cysts could be justified by the high incidence of associated papillary carcinomas of the thyroid and by the relatively aggressive nature that some tumors. In these cases, a radical therapeutic attitude allows, better patients management (total scintigraphy, serum thyroglobulin measurement) and allows the possibility of a complementary radioiodine treatment.

Adult↗
PubMed1998

[Complications of thyroid surgery, apropos of 104 thyroidectomies at the Ougadougou University Hospital Center].

We report a series of 104 thyroidectomies collected in Surgery and ENT departments of the University Hospital Center (UHC) of Ouagadougou. This study was composed of 85 women (81.73%) and 19 men (18.27%) 8 to 73 years old. 49 unilateral resection and 85 bilateral one were realized. Histopathologic examination has been done for 54 specimen only: 49 benign lesions (95.20%) and 5 malignant lesions (4.80%) were noted. We have observed: 7 cases of hemorrhagic complications (6.73%) with 1 death, 10 cases of unilateral laryngeal recurrent nerve palsy, permanent in 4 cases (3.85%), 2 cases of upper laryngeal nerve palsy (1.92%), 2 cases of permanent hypoparathyroidism (1.92%), 5 cases of post operative infection (4.80%). There were 2 deaths (1.92%). These results are similar with other authors results but the frequency of thyroidectomy complications is still important. Improvements in clinical practice, more specialists and great experience would improve post operative results of thyroidectomy.

Adolescent↗
PubMed1998

[Results of two-stage thyroidectomy in differentiated thyroid gland carcinoma].

This retrospective study (1986-1996) investigated 60 patients after total thyroidectomy indicated by a differentiated thyroid carcinoma. Analyzing the rate of paralysis of the recurrent nerve after secondary thyroidectomy due to the timing of the second operation, we found that only patients with secondary thyroidectomy having their second operation at an interval > 7 days suffered from permanent paralysis of the recurrent nerve. In conclusion, a second radical surgical procedure must be performed as early as possible to minimize complications.

Humans↗
PubMed1991

Thyroidectomy under local anesthesia.

Thyroidectomy for benign and malignant disease is most commonly performed with the patient under general anesthesia, although the literature is sprinkled with reports of series of operations performed using local anesthetic techniques. A retrospective review of 43 sequential thyroidectomies compares 21 performed using local anesthesia with 22 performed using general anesthesia. No significant difference was demonstrated in the incidence of major complications. All patients who required a second operation to remove the remaining hemithyroid after the final pathology reports were reviewed elected local anesthesia for their second procedure, attesting to patient satisfaction. Some hemithyroidectomies performed using local anesthesia were outpatient procedures. The indications, guidelines for patient selection, and operative technique of this effective alternative approach to thyroid surgery are presented.

Ambulatory Surgical Procedures↗
PubMed1999

Parathyroid autotransplantation during thyroidectomy: is frozen section necessary?

OBJECTIVE: To evaluate the accuracy of parathyroid gland identification and the need for routine frozen section examination before parathyroid autotransplantation during thyroidectomy. DESIGN: A prospective case series. SETTING: An endocrine surgical unit. PATIENTS: From January 1, 1995, to December 31, 1997, parathyroid autotransplantation was attempted for devascularized or inadvertently removed glands in 152 (33.7%) of 450 patients during thyroidectomy. Before autotransplantation, a biopsy specimen of the transplanted tissue was sent for histological examination without frozen section confirmation. MAIN OUTCOME MEASURES: Positive identification of parathyroid tissue in microscopic examination. RESULTS: Of 179 attempted autotransplantations of parathyroid glands, parathyroid tissue was confirmed in 167 biopsy specimens (93.3%). Incorrect identification of parathyroid gland occurred in 12 instances. The tissue mistaken as parathyroid gland included fat in 6 cases, thyroid tissue in 4 cases, lymph node in 1 case, and thymus in 1 case. Transplantation of at least 1 parathyroid gland (range, 1-3) was confirmed in 144 patients. For patients with confirmed parathyroid autotransplantation at risk of hypoparathyroidism (n = 112), postoperative transient hypocalcemia occurred in 22 (19.6%), while no patient developed any permanent hypocalcemia during a median follow-up of 6 months. CONCLUSIONS: Devascularized or inadvertently removed parathyroid glands can be identified expeditiously without routine frozen section during thyroid surgery. Immediate autotransplantation should be performed and permanent hypoparathyroidism can be avoided with this measure.

Adolescent↗
PubMed2004

Predictors of airway complications after thyroidectomy for substernal goiter.

HYPOTHESIS: Airway complications after thyroidectomy for substernal goiter can be predicted by preoperative symptom profiles, radiologic findings, or other factors. DESIGN: Retrospective review. Settings A university tertiary care center and a veterans' hospital. PATIENTS: Sixty patients with substernal goiter who underwent thyroidectomy between 1993 and 2002. MAIN OUTCOME MEASURES: Symptoms, preoperative radiologic findings, extent of thyroid resection, tumor size, and postoperative complications. RESULTS: Dysphagia was the most common preoperative symptom (n = 26), followed by dyspnea (n = 21), orthopnea (n = 13), and hoarseness (n = 6); 18 patients (30%) had superior vena caval obstruction. Thirteen patients (22%) were asymptomatic. Preoperative imaging identified tracheal deviation or compression in 45 patients (75%). Substernal goiter was resected via a cervical approach in 59 patients (98%). Of 47 patients with preoperative symptoms, 41 (87%) reported improvement postoperatively. Seven patients (12%) had postoperative airway complications: 1 developed a neck hematoma requiring reoperation, and 6 could not be immediately extubated; all 6 were successfully extubated after 1 to 10 days. Patients with airway complications were older (mean +/- SEM, 70.3 +/- 3.6 years vs 61.5 +/- 2.2 years), had larger goiters (mean +/- SEM, 210.7 +/- 37.0 g vs 112.2 +/- 7.7 g), and were more likely to have tracheal compression on preoperative imaging than those who did not have complications (P<.05). CONCLUSIONS: Most patients with substernal goiters underwent thyroid resection via a cervical approach with an improvement in symptoms. The few patients who developed postoperative airway complications were older, had larger goiters, and were more likely to have tracheal compression on preoperative imaging than those without airway complications.

Age Factors↗
PubMed2006

Increased mortality and morbidity associated with thyroidectomy for intrathoracic goiters reaching the carina tracheae.

HYPOTHESIS: Complications associated with thyroidectomy for intrathoracic goiters have been underestimated because of the lack of a precise definition of high-risk patients. DESIGN: Retrospective multicenter multinational review of medical records and radiographic images of patients who underwent thyroidectomy for intrathoracic goiters reaching the carina tracheae. Demographic, clinical, operative, anatomical, and pathological data were recorded. RESULTS: There were 35 patients (mean +/- SE age, 63 +/- 11 years) included in the study. In 4 patients, the goiter was asymptomatic; 10 patients had dysphagia, 24 patients had dyspnea, and 3 patients had superior vena cava syndrome. A median sternotomy was required in 12 patients and a right-sided thoracotomy in 1 patient. The mean +/- SE operative time was 145 +/- 72 minutes (range, 50-360 minutes). Transient hypoparathyroidism developed in 13 patients. Four patients experienced transient hoarseness, and 1 patient had permanent vocal cord paralysis. There were no significant differences between the proportion of patients who underwent or did not undergo sternotomy or thoracotomy regarding vocal cord dysfunction (2 [15%] of 13 patients vs 3 [13%] of 22 patients) or hypoparathyroidism (5 [38%] of 13 vs 6 [28%] of 22 patients). The mean postoperative hospital stay was 10 days (range, 2-84 days). Four patients required reoperation. Two patients died. Nine of 14 patients with thyroid glands weighing at least 260 g required sternotomy vs 3 of 14 patients with thyroid glands weighing less than 260 g (P = .02). Overall, 18 [52%] of 35 patients were discharged without any complication. CONCLUSION: Intrathoracic goiters reaching the carina tracheae carry a high unreported risk of sternotomy, postoperative complications, reoperation, and death.

Adult↗
PubMed1981

The morbidity of total thyroidectomy.

Of 245 total thyroidectomies done over a ten-year period, most were in patients who had previously received irradiation about the head and neck for benign conditions in infancy and childhood. There was no operative mortality, and only one patient had postoperative bleeding requiring reoperation. Of six patients with paralyzed recurrent laryngeal nerves in the immediate postoperative period, vocal cord function returned in all but one over one year. Forty-nine patients required at least one dose of calcium postoperatively, and 41 were taking calcium when discharged from the hospital. After one year, only two patients took calcium regularly; in both, lymph nodes were removed from both paratracheal grooves. In evaluating comparative statistics, increased morbidity of total thyroidectomy needs to be considered on a long-term basis rather than in the immediate postoperative period.

Adult↗
PubMed1983

Total thyroidectomy for Hürthle cell neoplasm of the thyroid.

The treatment of Hürthle cell neoplasms of the thyroid is controversial because of a lack of information about their clinical behavior and long-term follow-up. We reevaluated our experience of the past 33 years and compared our early experience with the more aggressive surgical approach used during the past ten years. We treated 62 patients with Hürthle cell neoplasm from 1949 through 1982. Twenty-six patients had benign neoplasms and 35 had malignant neoplasms proven by capsular or vascular invasion or nodal metastasis. Fourteen deaths were directly attributable to recurrent or metastatic disease, three among those with benign lesions. An aggressive surgical approach, involving total thyroidectomy or early-completion total thyroidectomy following lobectomy for all tumors histologically malignant or larger than 2 cm, resulted in a lower recurrence rate (21% v 59%) and fewer operations per patient (1.7 v 2.9) than in patients having other operations.

Adolescent↗
PubMed1983

Cervical distribution of iodine 131 following total thyroidectomy for thyroid cancer.

The use of postoperative radioiodine thyroid scanning has questioned whether total thyroidectomy is surgically possible. Similar to earlier studies, we have found functioning iodine 131 (131I)-avid thyroid tissue in our patients following total thyroidectomy for thyroid cancer. Preoperative and postoperative thyroid scans were compared in 24 patients to study the cervical location of postthyroidectomy residual thyroid tissue. Thyroid scanning detected 44 distinct sites of uptake. Thirty-eight of these foci were located either at the extremes of the upper poles of the thyroid gland (24) or along the embryonic thyroid descent tract (14). We conclude that these foci of 131I uptake represent incomplete resection of normal thyroid tissue, and that surgical attention to these areas should result more frequently in extirpation of the entire thyroid gland.

Adolescent↗
PubMed1989

Medullary thyroid carcinoma. The need for early diagnosis and total thyroidectomy.

Forty patients with medullary thyroid carcinoma and 3 patients with C-cell hyperplasia were studied. Seventeen (40%) cases were sporadic and 26 (60%) were hereditary. Eight patients had type lla multiple endocrine neoplasia, 7 patients had type llb multiple endocrine neoplasia, and 11 patients had familial nonmultiple endocrine neoplasia medullary thyroid carcinoma. Mean follow-up was 6.3 years, with actuarial survival of 88% and 78% at 5 and 10 years (22 and 13 patients), respectively. Seven patients died 1.5 to 10 years after the initial operation; all had advanced disease at presentation (6 with distant, 1 with lymph node metastasis). No deaths occurred in patients with familial nonmultiple endocrine neoplasia medullary thyroid carcinoma, C-cell hyperplasia, or medullary thyroid carcinoma limited to the thyroid gland. Nineteen (68%) of 28 patients diagnosed without screening had regional or distant metastases, whereas only 6 (40%) of 15 patients diagnosed by screening had metastases. Twenty-six patients treated initially with total thyroidectomy and central neck clearance required an average of one reoperation, whereas those with lesser initial procedures required an average of two reoperations. We concluded that (1) familial nonmultiple endocrine neoplasia medullary thyroid carcinoma, early medullary thyroid carcinoma or C-cell hyperplasia, and asymptomatic patients have a good prognosis; (2) screening for medullary thyroid carcinoma by measuring serum calcitonin levels results in earlier diagnosis; and (3) total thyroidectomy and central neck clearance is the procedure of choice for medullary thyroid carcinoma.

Adult↗