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PubMed2004

Completion thyroidectomy in patients with thyroid cancer who initially underwent unilateral operation.

BACKGROUND: In some instances, thyroid cancer may be diagnosed with histological examination after resection of putative or suspected benign nodule. In these cases, completion thyroidectomy followed by radioiodine ablation is usually recommended to prevent recurrence. If small intrathyroidal cancer is found, completion thyroidectomy may not be performed. Many patients have separate cancers in the contralateral lobe and in these cases completion thyroidectomy is essential even though primary tumour is small and limited within thyroid. OBJECTIVE: We analysed the frequency of malignant lesions in the contralateral lobe after completion thyroidectomy and assessed the predictive factors that may anticipate the presence of malignant lesion that may necessitate completion thyroidectomy. PATIENTS: Between 1995 and 2001, 243 patients were operated under the cytological diagnosis of follicular neoplasm. A total of 214 of them underwent lobectomy and isthmectomy and 81 turned out to have malignant disease in the resected lobe and they underwent completion thyroidectomy within a week to 6 months after the permanent section diagnosis of cancer. Their mean age was 40.7 +/- 12.1 years (range 14-71 years). RESULTS: After initial surgery, 53 patients had follicular carcinoma, 24 papillary carcinoma, one Hürthle cell carcinoma, one medullary, one insular and one anaplastic carcinoma. Mean tumour size was 4.1 +/- 2.6 cm (range 0.9-11 cm). After completion thyroidectomy, factors predicting the presence of cancer in the contralateral lobe were assessed according to clinical parameters and pathologic findings in ipsilateral lobe. First surgery revealed cancer multifocality in 34 cases, perithyroidal tumour extension in six and regional lymph node metastases in three. After completion thyroidectomy, 29 of the 81 patients revealed additional cancer in the contralateral lobe. Age, sex, size or pathologic type of the primary tumour was not associated with the presence of additional tumour in the contralateral lobe. Cancer multifocality in the ipsilateral lobe was the only significant variable to predict the presence of additional cancer in the contralateral lobe (relative risk = 6.03, confidence interval 2.23-16.35). Coexistence of benign nodule in ipsilateral lobe was not associated with increased cancer risk in the contralateral lobe. CONCLUSIONS: When diagnosed as thyroid cancer after unilateral surgery, the only predictive factor for the presence of additional contralateral cancer was multifocality of cancer in the ipsilateral lobe. We suggest that completion thyroidectomy is mandatory if multifocal cancers are found in the resected lobe, even though the cancers are very small and limited within the thyroid.

Adolescent↗
PubMedDate not supplied

[Short- and long-term monitoring with high-resolution ultrasonography of postoperative thyroid residue. Personal experience with 200 thyroidectomies].

BACKGROUND: After having abandoned conservative operations of the thyroid (partial resection, enucleal resection) today total thyroidectomy and sub-total thyroidectomy and near total thyroidectomy are the operations of choice. Cause the frequent post-operative scintigraphic signs, on the 3rd month, of thyroidal residue of significative size, founded in our patients operated for sub-total thyroidectomy, we begun to study the echografical monitoring of the thyroidal recess. METHODS: From January 1995 to December 1997 we operated 200 patients for Thyroidectomy. The kinds of operations were: total thyroidectomy for 96 patients (48%), sub-total thyroidectomy for 64 patients (32%), and near total thyroidectomy for 40 patients (20%). We controlled all the patients by ecografical monitoring of the thyroidal recess to detect and to determinate the possible thyroidal residue, that it will be monitorized on the 7th day, on the 1st month, on the 6th month and on the 12th month. We measured the thyroidal residual dimensions and volume. We recorded all the examinations by VCR or film and after we elaborated the results by exponential graphics. The patients that showed the thyroidal residues underwent to a scintigraphy. RESULTS: The thyroidal residuals were measured within the 7Th post-operative day. In the following controls we have noted a thyroidal residue hypertrophy. Multinodular goither was the disease with the highest degree of growth (until the 200% of the first measure of the residue). After an initial phase of growth almost all the patients showed a trend to the stabilization, with the exception only of the patient that suffered from multinodular goither. The scintigraphic examination was not realiable, in our experience, about the mathematic measurement of the thyroidal tissue, showing always an overvaluation of the residue. The best specificity was showed by US-HR. CONCLUSIONS: The patient that undergoes to total thyroidectomy needs an adequate suppressive and substitutive therapy. We identify the presence of several stimulating factors the growth of the residual thyroidal tissue that could arise to promote the hyperplasia and the hypertrophy of the parenchyma (EGF, TSG, TSI, PG). There are factors that are unidentified and are not subject to the suppression caused by substitutive therapy.

Adolescent↗
PubMedDate not supplied

[Benign diseases of the thyroid: indications for surgical treatment and the current role of total thyroidectomy].

Total thyroidectomy is the most popular surgical option in a wide range of indications for the treatment of benign disease of the thyroid. The preference for the procedure derives from a long period of observation and clinical experience dating as far back as the early 'seventies and confirms its safety and efficiency. Nevertheless, many doubts still exist as to the indications in the context of benign thyroid disease, as well as the incidence and seriousness of the complications which, though not frequent, are often invalidating. On the basis of the experience gained over the period from January 1994 to November 2002 in 697 patients undergoing surgery for benign disease of the thyroid, the authors analyse the indications for the various different therapeutic options and evaluate the results of total thyroidectomy in terms of therapeutic efficiency, relapse rates and complications. The latter are analysed on the basis of dividing the patients into 2 groups, one comprising 545 patients treated with total thyroidectomy as first-line treatment and the second consisting of 34 patients treated with total thyroidectomy for relapsing goitre after subtotal thyroidectomy. Comparison of the respective incidences of complications reveals a significant difference between the two groups of patients. Total thyroidectomy after subtotal thyroidectomy presented a significantly higher percentage of complications than initial total thyroidectomy. The authors come out in favour of total thyroidectomy with its low incidence of complications and the radical control of the disease it affords, reserving lobectomy-isthmectomy for selected cases of patients with monolateral disease which does not expose the patient to any risk of relapse.

Adult↗
PubMed2005

Recurrent laryngeal nerve injury and preservation in thyroidectomy.

OBJECTIVE: We aim to evaluate the rates of recurrent laryngeal nerve (RLN) injury after thyroidectomy and to put forward the factors influencing the risk of RLN injury during thyroid surgery. METHODS: We retrospectively analyzed the records of 418 patients who underwent thyroid surgery for thyroid disease at the Turkish State Railway Hospital, Ankara and Gazi University Hospital between 1989-2003 for RLN injury and factors affecting this complication. Moreover, we evaluated 6 different types of operations used during surgical practice. Indirect laryngoscopy was performed preoperatively and was repeated postoperatively for all patients. RESULTS: Three hundred and thirty-nine (81.1%) were females and 79 (18.9%) were male. Indications for surgery were multinodular goiter in 253 cases, solitary nodule in 69, hyperthyroidism in 68, thyroid carcinoma in 5 and recurrent goiter in 23 cases. Bilateral subtotal thyroidectomy was performed in 286 cases (68.4%), unilateral subtotal thyroidectomy in 52 (12.4%), unilateral total thyroidectomy in 25 (5.9%), bilateral total thyroidectomy in 22 (5.3%), nodule excision in 10 (2.4%) and completion thyroidectomy for recurrent goiter in 23 (5.5%) cases. Unilateral vocal cord problems occurred, 16 (3.8%) cases and in 6 (1.2%) cases it became permanent. The distribution of permanent RLN paralysis over the cases was 0.04% multinodular goiter, 2.9% hyperthyroidism and 8.7% recurrent goiter (p<0.05). Transient RLN paralysis rate was 2%, while permanent RLN paralysis rate was 0.03% for bilateral subtotal thyroidectomies. In addition, in unilateral total thyroidectomies, transient RLN paralysis was 12% while permanent paralysis was 4%. For bilateral total thyroidectomies, 13.6% was transient and 9% was permanent RLN paralysis and 13% was transient and 8.7% was permanent paralysis for completion cases (p<0.05). CONCLUSION: We can avoid RLN injury during thyroid surgery by identifying the nerve and following its course carefully. Intraparenchymal dissection or subtotal excision can be performed if failure to identify RLN occur, and new operative techniques and medical management of benign thyroid diseases should be considered.

Adolescent↗
PubMed2004

The advantage of total thyroidectomy to avoid reoperation for incidental thyroid cancer in multinodular goiter.

HYPOTHESIS: To investigate the impact of total thyroidectomy on the rate of completion thyroidectomy for incidentally found thyroid cancer in euthyroid multinodular goiter. DESIGN: A randomized, prospective clinical trial. SETTING: A tertiary referral center. PATIENTS: Patients with euthyroid multinodular goiter without any preoperative suspicion of malignancy, history of familial thyroid cancer, or previous exposure to radiation were randomized (according to a random table) to total or near-total thyroidectomy leaving no remnant tissue or less than 1 g (group 1; n = 109) or bilateral subtotal thyroidectomy leaving 5 g or more of remnant tissue (group 2; n = 109). Patients with preoperative or perioperative suspicion of malignancy were excluded. MAIN OUTCOME MEASURES: We compared the complication rates and the incidence of thyroid cancer requiring radioactive iodine ablation and completion thyroidectomy between groups. RESULTS: There were no permanent complications. The rates of temporary unilateral vocal cord dysfunction and hypoparathyroidism showed no significant difference between groups 1 and 2 (0.9% vs 0.9% and 1.8% vs 0.9%, respectively; P>.05). Papillary cancer was found in 10 group 1 patients (9.2%) and 8 group 2 patients (7.3%) (P =.80). Of the 9 patients requiring radioactive iodine ablation, reoperation was avoided in 5 group 1 patients; the remaining 4 group 2 patients underwent completion thyroidectomy (P =.007). CONCLUSION: We recommend total or near-total thyroidectomy in multinodular goiter to eliminate the necessity for early completion thyroidectomy in case of a final diagnosis of thyroid cancer.

Adult↗
PubMed1998

Completion thyroidectomy for differentiated thyroid carcinoma.

Completion thyroidectomy is performed because of a deferred diagnosis of differentiated carcinoma of the thyroid or a significant thyroid remnant after initial operation. During a period of 6 years, data from 40 patients with differentiated thyroid carcinoma undergoing completion thyroidectomy were retrospectively reviewed. There were 4 men and 36 women (1:9), and the average age was 39.6+/-1.9 years (range, 20 to 62 years). The indications for the initial surgery were a solitary thyroid nodule in 36 (90%) patients, multinodular goiter in 3 (7.5%) patients, and Graves' disease in 1 (2.5%) patient. Three patients underwent completion thyroidectomy during the same hospital stay. In the remaining 37 patients, completion thyroidectomy was performed 4 to 252 days (44.1+/-7.8 days) after the initial operation. The length of hospital stay for the initial operation was not different from that for completion thyroidectomy (5.1+/-0.3 days vs. 5.2+/-0.3 days). The length of time needed to accomplish the initial operation was not different from that required for the completion thyroidectomy (122+/-7.5 minutes vs. 110.8+/-5.9 minutes). There was no 30-day perioperative mortality. The postoperative morbidity in completion thyroidectomy consisted of transient hypoparathyroidism in 3 (7.5%) patients, permanent hypoparathyroidism in 1 (2.5%) patient, transient recurrent laryngeal nerve palsy in 1 (2.5%) patient, and permanent recurrent laryngeal nerve palsy in 1 (2.5%) patient. On the other hand, one transient recurrent laryngeal nerve palsy and one transient hypoparathyroidism occurred at the initial operation. Completion thyroidectomy is a safe procedure to remove the thyroid remnant.

Adenocarcinoma, Follicular↗
PubMed1998

Risks of complication following thyroidectomy.

OBJECTIVE: Because hypoparathyroidism is a serious complication of thyroidectomy, we attempted to elucidate factors determining the risk of this postoperative outcome. SETTING: Four tertiary care hospitals in Albuquerque, New Mexico. PATIENTS: A retrospective study of 142 patients who underwent total or subtotal thyroidectomy between 1988 and 1995. MEASUREMENTS AND MAIN RESULTS: Permanent hypoparathyroidism was defined as hypocalcemic symptoms plus a requirement for oral vitamin D or calcium 6 months after thyroidectomy. Factors analyzed to determine their contribution to the risk of persistent postoperative hypoparathyroidism were the indication for thyroidectomy, performance of a preoperative thyroid needle biopsy, type of surgery, postoperative pathology, presence and stage of thyroid carcinoma, resident surgeon involvement, and specialty of the surgeon performing the procedure. Surgical specialty and stage of thyroid carcinoma were independent risk factors for persistent postoperative hypoparathyroidism by multivariate analysis. Nine (29%) of 31 patients who had thyroidectomy by otolaryngologists met criteria for permanent hypoparathyroidism, and 6 (5%) of 111 patients who had thyroidectomy by general surgeons met the same criteria (p < .001). Adjustment for the effect of stage did not eliminate the effect of specialty (p = .006), and adjustment for the effect of specialty did not eliminate the effect of stage (p = .02), on the occurrence of postoperative hypoparathyroidism. CONCLUSIONS: We conclude from our data that patients undergoing thyroidectomy by an otolaryngologist may be at a higher risk of permanent postoperative hypoparathyroidism than patients who undergo thyroidectomy by a general surgeon. This may reflect differences in case selection or surgical approach or both.

Administration, Oral↗
PubMed2002

Thyroidectomy using the harmonic scalpel: analysis of 105 consecutive cases.

OBJECTIVE: The purpose of this report was to evaluate the technical benefits, if any, of thyroidectomy using the harmonic scalpel versus conventional thyroidectomy. STUDY DESIGN: One hundred five consecutive patients underwent thyroidectomy over 1 year with use of the harmonic scalpel. They were compared with a group of 20 patients who underwent thyroidectomy 1 year earlier using conventional techniques. RESULTS: The incision length for those undergoing thyroidectomy with the harmonic knife averaged 4.5 cm compared with 5.5 cm for the conventional thyroidectomy group. The operating time for a hemithyroidectomy averaged 50 minutes for the harmonic scalpel group versus 80 minutes for the conventional technique. The operating time for a total thyroidectomy averaged 80 minutes for the harmonic scalpel group versus 120 minutes for the conventional thyroidectomy group. CONCLUSION: The use of the harmonic scalpel in thyroid surgery offers several advantages over the conventional technique. The incision length is shorter and the operating time is reduced. Bleeding is negligible and complications are few. SIGNIFICANCE: The harmonic scalpel, whose use was pioneered in laparoscopic surgery, offers the thyroid surgeon the ability to safely and expeditiously control the feeding vessels through a limited field.

Adult↗
PubMed1998

Total compared with subtotal thyroidectomy in benign nodular disease: personal series and review of published reports.

OBJECTIVE: To evaluate the outcome after total and subtotal thyroidectomy for the treatment of single and multinodular goitres in two comparable groups of patients. DESIGN: Prospective randomised study. SETTING: University hospital, Italy. SUBJECTS: 141 Patients operated on for benign goitre from 1975-85. INTERVENTIONS: 69 Patients were randomised to have total thyroidectomy and 72 subtotal thyroidectomy by standard techniques. MAIN OUTCOME MEASURES: Temporary or permanent palsy of the recurrent laryngeal nerve, temporary or permanent hypoparathyroidism, recurrence of the goitre, and the incidence of iatrogenic injuries after completion thyroidectomy. RESULTS: Patients were followed up for a median of 14.5 years (range 10-21). After total thyroidectomy 2 patients (3%) developed temporary palsy of the recurrent laryngeal nerve but there were no permanent lesions; and 24 (35%) developed temporary and 2 (3%) permanent hypoparathyroidism. After subtotal thyroidectomy 2 (3%) developed temporary and 1 (1%) permanent palsy of the recurrent laryngeal nerve; and 13 (18%) developed temporary and 1 (1%) permanent hypoparathyroidism. In addition, there were 10 recurrent goitres (14%). After completion thyroidectomy (n = 9) there were 2 cases of temporary and 1 of permanent palsy of the recurrent laryngeal nerve, and 2 cases of temporary and 2 of permanent hypoparathyroidism. CONCLUSION: Total thyroidectomy is the procedure of choice for the treatment of benign nodular goitre.

Adult↗
PubMed2001

Endoscopic thyroidectomy for solitary thyroid nodules.

Conventional thyroidectomy often leaves an undesirable scar on the anterior neck. The aim of this study was to assess the feasibility and efficacy of endoscopic thyroidectomy, a new minimally invasive technique for thyroid surgery. Between September 1998 and February 2000, 18 patients with a solitary thyroid nodule underwent endoscopic thyroidectomy utilizing CO2 insufflation. There were 16 females and 2 males with a mean age of 43 years (range 17-66 years). Indications for surgery included indeterminate cytology (n = 8), follicular neoplasm (n = 8), Hürthle cell neoplasm (n = 1), and toxic thyroid nodule (n = 1). The mean nodule diameter was 2.7 cm (0.6-7 cm). Analgesic requirement, return to normal activity, and cosmetic results were compared to 18 consecutive patients who had conventional thyroidectomy. Sixteen of 18 cases were successfully completed endoscopically with a mean operating time of 220 minutes (range, 120-330 minutes). There were no major complications, but 3 patients developed mild hypercarbia and 1 patient had an incidental parathyroidectomy. When compared to conventional thyroidectomy, patients undergoing endoscopic thyroidectomy had a significantly superior cosmetic result (p < 0.005) and a quicker return to normal activity (p < 0.05), but there was no difference in analgesic requirement. Endoscopic thyroidectomy is a technically feasible and safe procedure that leads to an improved cosmetic result and a quicker recovery. Open completion thyroidectomy is recommended for thyroid carcinoma until more data are available.

Adolescent↗
PubMed2002

Total thyroidectomy for the treatment of hyperthyroidism in patients with ophthalmopathy.

Total thyroidectomy was performed in 54 cases of Graves' ophthalmopathy from 1971 to August 2000. There were no surgical complications except for one case of mild hypocalcemia. The patients' postoperative lives were not disturbed. Ocular symptoms and signs were much improved after total thyroidectomy in most cases, but the ocular protrusion was reduced 0.9 mm on average (from 20.6 to 19.7 mm), and this improvement was not statistically significant. However, removal of the thyroid tissue was not complete in some cases in this series and the residual thyroid tissue may continuously support the progress of ophthalmopathy. Surgical influences on Graves' ophthalmopathy were compared between total and subtotal thyroidectomy in each of 50 gender- and age-matched cases from the same period. Average protrusion was reduced 0.9 mm after total thyroidectomy, but was increased 0.5 mm after subtotal thyroidectomy. In conclusion, total thyroidectomy can be performed as safely as subtotal thyroidectomy and is more effective for Graves' ophthalmopathy than subtotal thyroidectomy. However, this procedure would not be expected to completely inactivate aggressive ophthalmopathy, even if all thyroid tissue was removed. In severe cases, orbital decompression, corrective eye muscle, and lid surgery are necessary.

Adolescent↗
PubMed2003

Is there a place for thyroidectomy in older patients with thyrotoxic storm and cardiorespiratory failure?

Early thyroidectomy is the treatment of choice for thyrotoxic storm in patients with thyroid autonomy often induced by iodine. However, older patients who are mostly affected by this condition often have underlying chronic cardiopulmonary diseases, apparently contradicting surgical intervention. The published evidence for suitable treatment strategies in these patients is limited. We report the outcome of a series of older critically ill patients who were treated by thyroidectomy because of thyrotoxic storm. We retrospectively analyzed the outcome of 10 patients (4 males, 6 females; 70 years of age, range, 54-79, Burch-Wartofsky point scale, 61; range, 40-85) with thyrotoxic storm, thyroid autonomy, and severe cardiorespiratory and renal failure with cardiac arrhythmia, coronary artery or chronic obstructive pulmonary disease, or acute inflammation. Thyroidectomy was performed for the following reasons: symptoms of thyrotoxic storm deteriorated or did not improve within 24-48 hours despite intensive medical treatment, or patients developed thionamide-induced agranulocytosis or severe thrombocytopenia. All patients with severe accompanying diseases survived thyroidectomy (early post-operative mortality, 0%). The two oldest patients died 2-3 weeks after thyroidectomy because of myocardial infarction or respiratory failure (late postoperative mortality, 20%). In contrast, in the few previous reports of patients who underwent thyroidectomy for thyrotoxic storm and severe accompanying diseases (n = 7), late postoperative mortality was 43%. The overall mortality for all reported patients including our own, who underwent thyroidectomy for thyrotoxic storm with and without severe accompanying disease (n = 49) was 10%. Our results suggest that early total thyroidectomy should be considered as the method of choice for older, chronically ill patients with thyrotoxic storm complicated by cardiorespiratory and renal failure, especially if high-dose thionamide treatment, iopanoic acid, glucocorticoids, and intensive care fail to improve the patient's conditions within 12-24 hours.

Aged↗
PubMed1983

Total thyroidectomy. A review of 213 patients.

During a 10.5-year period ending in June 1982, total thyroidectomy was performed on 213 patients at the Vanderbilt University Medical Center. A nonfunctioning nodule on technetium scan was the primary indication for operation. Twenty-one of 213 patients had undergone previous partial thyroidectomy. The pathologic changes in the excised thyroids were carcinoma (81 patients), thyroiditis (27 patients), multiple benign adenoma (16 patients), thyrotoxicosis (27 patients), multinodular goiter (56 patients), and C-cell hyperplasia (three patients). Three total thyroidectomies were performed in search of a parathyroid adenoma. Fourteen patients had coexistent primary hyperparathyroidism. Excluding 12 patients with medullary carcinoma, 25% of all other patients with carcinoma would have had unrecognized tumor left in the remaining lobe had a total thyroidectomy not been performed. Calcium supplements were required in 59 patients during hospitalization, but only 2.8% of the patients developed permanent hypoparathyroidism. Since the adoption of Thompson's technique of total thyroidectomy, only one of the 128 patients (0.8%) has sustained permanent hypoparathyroidism. Two patients exhibited transient recurrent laryngeal nerve palsies without permanent nerve damage. There were no operative deaths. The low morbidity of total thyroidectomy appears to justify its use in all patients with differentiated thyroid malignancy. With surgeons experienced in this technique, total thyroidectomy should also be considered as the primary treatment for many other patients requiring thyroidectomy.

Adolescent↗
PubMed2005

Minimally invasive thyroidectomy using the Sofferman technique.

OBJECTIVES: Access to the thyroid compartment has traditionally been achieved by a Kocher incision followed by subplatysmal flap elevation and strap muscle retraction. A combination of novel access techniques was used to allow for minimally invasive thyroidectomy (MITh). METHODS AND MATERIALS: A prospective, nonrandomized evaluation of consecutive patients undergoing thyroidectomy was performed. A minimally invasive incision (< or =6 cm) was used in conjunction with the Sofferman technique (transection of the strap muscles) and videoendoscopic assistance to perform hemithyroidectomy or total thyroidectomy in eligible patients. Prospectively collected data include age, sex, pathology, incision length, duration of surgery, and blood loss and complications were considered. RESULTS: Forty-four patients underwent 48 thyroid surgeries between September 2003 and May 2004. There were 13 men and 31 women, with a mean age of 41.9 (range 19-73) years. Thirty-one (64.6%) of these were eligible to be performed by MITh; the remainder (n = 17, 35.4%) underwent conventional thyroidectomy. The mean incision length in the MITh cohort was 4.9 +/- 1.0 cm compared with 9.1 +/- 1.5 cm for conventional thyroidectomy. The mean surgical time for minimally invasive hemithyroidectomy was 115.7 minutes (n = 23), and for total thyroidectomy was 147.4 minutes (n = 8). There were no cases of permanent hypocalcemia or recurrent laryngeal nerve paralysis in either group. No patients in the MITh group had to be converted to a conventional thyroidectomy. The cosmetic results were excellent, although one patient in the MITh group developed a mildly hypertrophic scar that responded to triamcinolone injection. CONCLUSIONS: MITh is safe in carefully selected patients and probably results in more rapid wound healing. The cosmetic result is superior to that achieved with conventional thyroidectomy.

Adult↗
PubMed2006

A safe and cost-effective short hospital stay protocol to identify patients at low risk for the development of significant hypocalcemia after total thyroidectomy.

OBJECTIVE: The objective of this retrospective chart review was to determine if serial postoperative serum calcium levels early after total thyroidectomy can be used to develop an algorithm that identifies patients who are unlikely to develop significant hypocalcemia and can be safely discharged within 24 hours after surgery. METHODS: Records of 135 consecutive patients who underwent total/completion thyroidectomy and were operated on by the senior author from 2001 to 2005 have been reviewed. For the entire study group, reports of the early postoperative serum calcium levels (6 hours and 12 hours postoperatively), final thyroid pathology, preoperative examination, inpatient course, and postoperative follow up were reviewed. An endocrine medicine consultation was obtained for all patients while in the hospital after surgery. For patients who developed significant hypocalcemia, reports of their management and the need for readmission or permanent medications for hypoparathyroidism were reviewed. According to the change in serum calcium levels between 6 hours and 12 hours postoperatively, patients were divided into two groups: 1) positive slope (increasing) and 2) nonpositive (nonchanging/decreasing). RESULTS: All patients with a positive slope (50/50) did not develop significant hypocalcemia in contrast to only 59 of 85 patients (69.4%) with a nonpositive slope (P < .001, positive predictive value of positive slope in predicting freedom from significant hypocalcemia = 100%, 95% confidence interval = 92.9-100). In the nonpositive slope group, 61 patients had a serum calcium level > or =8 mg/dL at 12 hours postoperatively (< or =0.5 mg/dL below the low end of normal), and 53 (87%) of these patients remained free of significant hypocalcemia in contrast to only 6 (25%) of 24 patients with serum calcium level <8 mg/dL at 12 hours postoperatively (sensitivity = 90%, positive predictive value = 87%). In addition, of the eight patients who developed significant hypocalcemia in the nonpositive slope group with a serum calcium level > or =8 mg/dL at 12 hours postoperatively, 7 (88%) patients developed the signs and symptoms during the first 24 hours after total thyroidectomy. Readmission and permanent need for calcium supplementation happened in two patients, respectively, all with serum calcium levels <8 mg/dL at 12 hours after total thyroidectomy. The compressive and/or symptomatic large multinodular goiter as an indication for thyroidectomy was associated with developing significant hypocalcemia (P < .05). There was no statistically significant correlation between the development of significant hypocalcemia and gender, age, thyroid pathology other than goiter, or neck dissection. CONCLUSION: Patients with a positive serum calcium slope (t = 6 and 12 hours) after total thyroidectomy are safe to discharge within 24 hours after surgery with patient education with or without calcium supplementation. In addition, patients with a nonpositive slope and a serum calcium level > or =8 mg/dL at 12 hours postoperatively (< or =0.5 mg/dL below the low end of normal) are unlikely to develop significant hypocalcemia, especially beyond 24 hours postoperatively, and therefore can be safely discharged within 24 hours after total thyroidectomy with patient education and oral calcium supplementation. Our management algorithm identifies those patients at low risk of developing significant hypocalcemia early in the postoperative course after total thyroidectomy to allow for a short hospital stay and safe discharge.

Algorithms↗
PubMed1987

Thyroidectomy and central catecholamine neurons of the male rat. Evidence for the existence of an inhibitory dopaminergic mechanism in the external layer of the median eminence and for a facilitatory noradrenergic mechanism in the paraventricular hypothalamic nucleus regulating TSH secretion.

Using the Falck-Hillarp methodology in combination with quantitative microfluorimetry, catecholamine (CA) levels and utilization in discrete hypothalamic CA nerve terminal systems in the male rat have been analyzed 24 h, 1, 2 and 4 weeks following thyroidectomy as well as after T3 or T4 restitution therapy 4 weeks after thyroidectomy. By means of high pressure liquid chromatography (HPLC), dopamine (DA) and noradrenaline (NA) levels and utilization 4 weeks after thyroidectomy have been analyzed in various brain regions. Triiodothyronine treatment (10 micrograms/kg, s.c., twice daily during 10 days) of 4-week athyroidic rats increased serum T3 levels, but not T4 serum levels. Thyroxine treatment (36 micrograms/kg, s.c., twice daily during 10 days) of 4-week athyroidic rats increased serum T4 levels and the T3 levels were found to be even slightly higher than those found in normal animals. Triiodothyronine or T4 restitution therapy reversed the changes induced by thyroidectomy on the anterior pituitary hormones (TSH, prolactin and growth hormone) and corticosterone secretion. It is suggested that removal of thyroid hormones may be responsible for the changes in the anterior pituitary hormones and corticosterone secretions. In the quantitative microfluorimetrical analysis 24 h, 1, 2 and 4 weeks after thyroidectomy, decreases in DA levels and utilization and increases in NA levels and utilization were found in the lateral palisade zone (LPZ) of the median eminence and in the parvocellular and magnocellular parts of the paraventricular hypothalamic nucleus (PA), respectively. In addition, 1-,2- and 4-week decreases were found in DA levels and turnover in the medial palisade zone (MPZ) as well as in NA turnover in the dorsomedial hypothalamic nucleus (DM) and in the 'border zone' (BZ) between the medial and lateral hypothalamus ventral to the fornix. In the HPLC analysis it could be demonstrated that 4 weeks after thyroidectomy decreases in DA levels and utilization in the mediobasal hypothalamus and increases in DA levels as well as NA levels and utilization in the hypothalamus had developed. The T3 or T4 restitution therapies after 4 weeks of thyroidectomy counteracted the effects on CA levels and utilization in all hypothalamic CA nerve terminal systems except for the reduced NA utilization found in the DM following 4 weeks after thyroidectomy.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1991

Thyroidectomy induces Fos-like immunoreactivity within thyrotropin-releasing hormone-expressing neurons located in the paraventricular nucleus of the adult rat hypothalamus.

Effects of thyroidectomy on Fos-like immunoreactivity (IR) in the rat brain were examined using single and double-label immunocytochemical techniques. In particular, the possibility that Fos might be involved in thyroid hormone regulation of thyrotropin releasing hormone (TRH)-containing neurons located in the parvocellular region of the paraventricular nucleus of the hypothalamus (pPVN) was examined. Adult, male, Sprague-Dawley rats were used and all animals received either surgical removal of the thyroid gland or sham surgery. Two experiments were performed. In the first experiment, animals were killed 1, 3, or 6 days after surgery and numbers of Fos-like IR cells in the parvocellular (pPVN) and magnocellular (mPVN) regions of the PVN, the anterior hypothalamic nucleus (AH), the lateral hypothalamic nucleus (LH), and the pyriform cortex were determined. In the second experiment, animals received an intracerebroventricular injection of colchicine 5 days after surgery. The next day, animals were killed and numbers of Fos-like IR cells double-labeled for either TRH, corticotropin releasing factor (CRF), or methionine-enkephalin (met-Enk) were determined. Six days after thyroidectomy there was a significant increase in the number of Fos-like IR cells detected in the pPVN. No induction in the pPVN was observed 1 and 3 days after thyroidectomy, and no effects attributable specifically to thyroidectomy (as opposed to stress) on Fos expression in the mPVN, AH, LH, or pyriform cortex were observed. In addition, a rapid, stress-related, induction of Fos-like IR was detected in the mPVN, AH, and LH and was easily distinguished from Fos expression induced in the pPVN as a function of thyroidectomy. The time course for the effect of thyroidectomy on Fos expression in the pPVN paralleled increased plasma TSH concentration. A significant correlation between numbers of Fos-like IR cells in the pPVN and plasma TSH concentration following thyroidectomy was also observed, suggesting that plasma levels of TSH correlate directly with the number of activated TRH-containing neurons located in the pPVN. Double staining for Fos and TRH, CRF, or met-Enk revealed that thyroidectomy induced Fos-like IR specifically within TRH-, but not within CRF-, or met-Enk, expressing neurons in the pPVN. Taken together, the data suggest that Fos-like IR is induced within TRH-expressing neurons in the pPVN as a consequence of decreasing levels of circulating thyroid hormone (TH). Whether this reflects a direct effect of decreasing TH on Fos expression is not yet known; however, the data are consistent with the hypothesis that Fos is involved in TH-associated regulation of TRH production and release.

Animals↗
PubMed2003

[Thyroidectomy. A prospective assessment of hemithyroidectomy].

AIM: The results of hemithyroidectomy and total thyroidectomy were assessed in a prospective study. Total thyroidectomy was compared to hemithyroidectomy and contralateral resection. The rate of vocal cord palsy, hypocalcaemia, changes in PTH, and the frequency of sequelae were used to monitor the results. MATERIAL AND METHODS: One hundred and twenty patients underwent hemithyroidectomy for unilateral thyroid lesions and 80 hemithyroidectomy contralateral resection (35 patients) or total thyroidectomy (45 patients) for bilateral disease. Plasma calcium and PTH were measured pre- and post-operatively, and the need for calcium and vitamin D supplementation was registered. RESULTS: No permanent vocal cord palsy was encountered. Calcium substitution was not needed after hemithyroidectomy but for more than one year in 9% after hemithyroidectomy and contralateral resection, and in 7% after total thyroidectomy (NS). One needed substitution 2 years after total thyroidectomy. Pre- and postoperative plasma-PTH was found unchanged after hemithyroidectomy and after total thyroidectomy. DISCUSSION: Hemithyroidectomy and total thyroidectomy are safe procedures with few side effects, if a meticulous dissection is performed. Hypocalcaemia following bilateral operations is usually transient and the need for calcium and vitamin D supplementation is low and usually related to the underlying disease rather than to the operation. Total thyroidectomy will remove the target organ for the immune response in patients with hyperthyroidism and the risk of toxic ophthalmopathy is minimised. Lastly, the risk of recurrent disease is eliminated. Six per cent had minor and probably transient local complaints at control three months after the operation.

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