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PubMed1999

Parathyroid biopsy to facilitate the preservation of functional parathyroid tissue during thyroidectomy.

BACKGROUND: The preservation of viable parathyroid tissue, either by preserving parathyroid glands in situ with an intact blood supply or by autotransplantation, is an integral element of thyroid surgery. There is a general impression that nonviable parathyroid glands can be recognized on the basis of black or purple-black discoloration of the gland. We came to believe that this is not a reliable way to assess the viability of parathyroid glands because we observed that when we excised parathyroid glands (with the intention of reimplanting them) in situations where it was not feasible to preserve their blood supply, they did not become discolored. METHODS: To assess the status of the parathyroid blood supply, we performed incisional biopsies of suspected parathyroid glands during 14 consecutive thyroid operations (9 hemithyroidectomies, 1 completion thyroidectomy, 4 total thyroidectomies), and observed the biopsy site for evidence of active bleeding. RESULTS: Thirty-four of 36 possible parathyroid glands were histologically confirmed. Seventeen bled actively from the biopsy site and were preserved in situ. The other 17 were felt to be nonviable: 5 were severely discolored (black) and either no bleeding or minor venous oozing was seen when they were biopsied; 12 with normal coloration (3 were harvested prior to biopsy), did not bleed actively following an incisional biopsy. Parathyroid glands that were judged to be devascularized were autotransplanted into the sternocleidomastoid muscle. CONCLUSIONS: The absence of discoloration is not a reliable way to determine whether the parathyroid blood supply is intact. Biopsy of the parathyroid glands during thyroid surgery facilitates the identification of devascularized parathyroid glands that can be salvaged with autotransplantation.

Adult↗

PubMed1986

Ultrastructure and cytochemistry of thyroid lysosomes following subtotal thyroidectomy.

Following subtotal thyroidectomy, the amount of circulating thyroid hormone decreases and causes an increase in the secretion of thyrotropin (TSH) by the anterior pituitary gland. Serum levels of circulating TSH remain elevated until thyroid secretion returns to normal. In this study we have analyzed the effects of such chronic stimulation of thyroid cells by TSH, with particular emphasis on ultrastructural and cytochemical changes in the lysosomes. Weanling Sprague-Dawley rats underwent subtotal thyroidectomy and 6 weeks later the residual thyroid tissue was removed and processed for ultrastructural and cytochemical analysis. There were obvious ultrastructural signs of hyperactivity. The cells were hypertrophied and there were colloid droplets in the cells as well as extremely abundant oddly shaped lysosomes. The lysosomes reacted positively for acid phosphatase and for glycoproteins, suggesting that they are secondary lysosomes, ones which have complexed with thyroglobulin prior to release of thyroid hormones from the cells. This tremendous increase in the number of these structures in the cells is similar to that observed under normal conditions during the aging process and suggests a slowdown in the proteolytic degradation of thyroglobulin during long periods of chronic stimulation by TSH.

Acid Phosphatase↗

PubMed1976

Thyroidectomy for non-familial medullary carcinoma.

Two cases of non-familial medullary carcinoma of the thyroid which had thyroid tissue remaining after initial thyroidectomy were shown to contain residual, intra-glandular carcinoma at reoperation. This observation, the distribution of C cells in the normal thyroid gland and the lymph node spread of this carcinoma have led to the proposal of a bilateral 90 per cent upper pole thyroidectomy including the superior parathyroids for cases of non-familial medullary carcinoma. This operation removes all the C-cell-bearing area and leaves a small thyroid remnant at the lower pole for preservation of the inferior parathyroid glands. The operation is discussed with reference to these factors.

Adult↗

PubMed1983

Long term follow-up of hyperthyroid patients treated by subtotal thyroidectomy.

The early and long term complications of subtotal thyroidectomy in 306 hyperthyroid patients (multinodular goitre and diffuse hyperplasia) followed for up to 30 yr are reviewed. There were no perioperative deaths. Sixteen patients (5.2 per cent) had transient symptomatic hypocalcaemia, while 9 (2.9 per cent) had permanent hypocalcaemia. Permanent unilateral vocal cord paralysis occurred in 11 (3.6 per cent) patients (1.8 per cent of nerves at risk). Cumulative per cent (+/- s.e.m.) relapse and hypothyroid rates at 30 yr (life-table analysis) were 15.6 +/- 2.4 per cent and 20.5 +/- 2.1 per cent, respectively. Lifelong follow-up of post-thyroidectomy patients is mandatory because of the risk of relapse of hypothyroidism.

Adolescent↗

PubMed1983

Late onset hypothyroidism after subtotal thyroidectomy for hyperthyroidism: implications for long term follow-up.

A follow-up register has been used in Aberdeen and Dundee to record early and late onset hypothyroidism occurring in a large population of post-thyroidectomy patients treated for hyperthyroidism. In one centre, in a total of 1170 patients, the prevalence of postoperative hypothyroidism, at the time of entry to the register, was 41 per cent. Of these early cases of hypothyroidism 93 per cent occurred within 18 months of operation. Results are presented from a 12-year prospective study of patients treated in two centres, who were euthyroid when entered on the follow-up register. In one centre, based on 683 patients, the 10-year incidence of late onset hypothyroidism estimated by actuarial methods was 7.4 per cent (95 per cent confidence limits, 3.8-11.1); in the other centre with 156 patients the 5-year incidence was 10.8 per cent (95 per cent confidence limits, 3-18.6). The minimum predicted annual incidence is 1 per cent. Large thyroid remnants do not protect some patients against early or late postoperative hypothyroidism but do lead to an increased risk of recurrent hyperthyroidism. Hypothyroidism after subtotal thyroidectomy for hyperthyroidism shows a bimodal pattern and this study emphasizes the need to maintain life-long follow-up.

Follow-Up Studies↗

PubMed1993

Graves' ophthalmopathy after subtotal thyroidectomy and radioiodine therapy.

Forty-five patients with Graves' ophthalmopathy were studied prospectively. Twenty-one patients (42 orbits; group 1) were treated surgically by subtotal thyroidectomy and 24 (48 orbits; group 2) received radioiodine therapy. All patients underwent tests of thyroid function, ophthalmological examination, and axial and coronal computed tomography before and 12 months after treatment. Patients in group 1 showed significant improvement in the Feldon score (P < 0.001), in proptosis as estimated by Hertel exophthalmometry (P < 0.001) and in proptosis (P < 0.001), maximum diameter of the medial rectus (P < 0.01), lateral rectus (P < 0.05), superior group (P < 0.05) and inferior rectus (P < 0.001) muscles as estimated by computed tomography. Patients in group 2 showed significant improvement only in the Feldon score (P < 0.05). The ophthalmopathy of Graves' disease improves to a greater extent after subtotal thyroidectomy than after radioiodine therapy.

Adolescent↗

PubMed2003

Arteria lusoria identified on preoperative CT and nonrecurrent inferior laryngeal nerve during thyroidectomy: a retrospective study.

BACKGROUND: To evaluate surgical identification of nonrecurrence of the inferior laryngeal nerve (NRILN) during thyroidectomy in patients with an aberrant subclavian artery (a. lusoria) as seen on CT. MATERIAL AND METHODS: The medical files of patients treated by thyroidectomy between January 1998-December 2000 (n = 583) were retrospectively reviewed for preoperative and postoperative mobility of the vocal cords and perioperative identification of NRILN. The available preoperative CT studies (n = 163) were reviewed for presence of a. lusoria. RESULTS: In five patients, the CT study revealed an a. lusoria (3.16%). In one of five of these patients, an NRILN was surgically detected; the overall detection rate of NRILN was 0.21%. In one of four patients with nonidentification of this nerve during surgery, immediate unilateral and permanent vocal cord paralysis were present after surgery. No permanent vocal cord paralysis occurred in any of the other patients. CONCLUSION: The identification of a. lusoria should alert the radiologist and surgeon that a NRILN is present, allowing an anticipating surgical technique, reducing the risk of neural injury.

Humans↗

PubMedDate not supplied

Postoperative radioactive iodine evaluation of total thyroidectomy for thyroid carcinoma: reappraisal and therapeutic implications.

The records of 430 patients who underwent total thyroidectomy with radioactive iodine (RAI) uptake studies performed postoperatively were reviewed. Indications for the administration of an ablative dose of iodine 131 are given. The majority (85.4%) had no or low (less than 2%) evidence of focal uptake and therefore were not treated with ablative doses of iodine 131. RAI scanning is necessary postoperatively to determine the completeness of the surgical procedure and to detect residual or metastatic disease. Small foci of residual disease or occult distant metastases can be adequately treated with therapeutic doses of RAI. Nodal or distant metastases that become clinically evident following thyroidectomy are usually not successfully treated with RAI.

Adolescent↗

PubMedDate not supplied

Morbidity of completion thyroidectomy for initially misdiagnosed thyroid carcinoma.

We reviewed 757 cases of thyroid carcinoma treated between 1963 and 1986 to investigate the morbidity associated with completion thyroidectomy when a nodule initially reported to be benign by frozen section is subsequently found to be malignant; 66 patients underwent completion thyroidectomy as a second procedure for initially misdiagnosed thyroid carcinoma. Fifty-one patients had papillary carcinoma, 12 follicular carcinoma, and 3 Hürthle cell carcinoma. Final pathology revealed 28 cases of multicentricity of which 19 were bilateral. Complications included transient hypocalcemia (12.1%), recurrent laryngeal nerve palsy (1.5%), and wound hematomas or infections (9.1%). No cases of permanent hypoparathyroidism or vocal cord paralysis were encountered. Reoperation for initially misdiagnosed thyroid carcinoma appears to be warranted in light of the low morbidity and high incidence of bilateral and multicentric disease reported in this series.

Carcinoma↗

PubMed2004

Total thyroidectomy is improved by loupe magnification.

With this study, we verified if a microsurgical approach with magnification could improve the outcome of total thyroidectomy. Ninety-seven patients were consecutively randomized into group A (surgery with x 2.5 magnification and microsurgical instruments, n = 47) or group B (surgery with no magnification, n = 50). The mean operative time was 125 +/- 4.0 min in group A, and 150 +/- 4.0 min in group B (P = 0.00012). The recurrent laryngeal nerve was identified in all patients of group A, and in 96.8% of group B. The overall morbidity rate was 4.0% in group A and 25.5% in group B (P = 0.0038). This study indicates that a microsurgical approach with magnification is feasible, reduces surgical time, and improves the outcome in total thyroidectomy.

Adult↗

PubMed1998

Thyroidectomy of house sparrows (Passer domesticus) prevents photo-induced testicular growth but not the increased hypothalamic gonadotrophin-releasing hormone.

Thyroidectomy of starlings (Sturnus vulgaris) prevents the decrease in hypothalamic gonadotrophin-releasing hormone (GnRH) which normally occurs at the onset of photorefractoriness. To extend this observation to another species, changes in testicular mass, bill colour, moult, and hypothalamic GnRH content were monitored in photostimulated and nonphotostimulated intact and thyroidectomized house sparrows (Passer domesticus). Photostimulated intact birds rapidly increased testicular mass and GnRH. Later, testicular mass and GnRH decreased, and birds moulted, as they became photorefractory. Nonphotostimulated intact birds showed an increase in testicular mass and GnRH. Neither photostimulated nor nonphotostimulated thyroidectomized birds showed a marked increase in testicular mass, but both showed an increase in GnRH. Photostimulated thyroidectomized birds showed no subsequent decrease in GnRH and they did not moult. It is suggested that in this species, thyroidectomy inhibits the release of GnRH as well as preventing the downregulation of GnRH synthesis normally associated with the development of photorefractoriness.

Animals↗

PubMed1985

Thyroidectomy induces coated pit formation on cerebellar mossy fiber terminals.

The influence that thyroid hormones have on the development of the cerebellar cortex is well known. Their absence in adults leads to important functional changes probably related to abnormalities in nerve terminal activity, although no morphological alterations have hitherto been described. Using ultrastructural morphometric methods, we have studied the effects of thyroidectomy on the cerebellar cortex mossy fiber terminals of adult rats with different survival periods. No significant changes in the volume and surface area of these terminals were found. The numbers of synaptic vesicles in groups 7, 15 and 30 days after thyroidectomy were significantly greater than in controls. A significant increase in coated pit formation was found when thyroidectomized groups were compared with controls. This increase is due to the lack of thyroxin since it can be counteracted by thyroxin administration. Whether this increased coated pit formation is a membrane retrieval mechanism or is related to the uptake of extracellular molecules remains to be determined.

Animals↗

PubMed1994

The role of technetium-99m sestamibi whole-body scans in diagnosing metastatic Hürthle cell carcinoma of the thyroid gland after total thyroidectomy: a comparison with iodine-131 and thallium-201 whole-body scans.

Thirty-seven patients with Hürthle cell carcinoma of the thyroid gland underwent total thyroidectomy and then technetium-99m sestamibi (2-methoxy-isobutylisonitrile), iodine-131 and thallium-201 whole-body scans. Twenty-two of them had elevated human serum thyroglobulin (HTg) levels. Among these 22 patients, abnormal uptake of 131I was seen in four (18.1%), abnormal uptake of 201Tl chloride in 15 (68.1%), and abnormal 99mTc-sestamibi accumulation in 18 (81.8%). No patients with normal levels had a positive whole-body scan. In comparison with the 131I and 201Tl chloride images, the 99mTc-sestamibi images were of superior quality and detected significantly more (P < 0.05) metastatic lesions of Hürthle cell carcinoma of the thyroid gland in patients with elevated HTg after total thyroidectomy. A mechanism is proposed that may explain these findings.

Adenocarcinoma↗

PubMed1993

Morphofunctional study on prolactin-producing cells of the anterior pituitaries in adult male rats following thyroidectomy, thyroxine treatment and/or thyrotropin-releasing hormone treatment.

An immunoelectron-microscopic and morphometric study was carried out on the anterior pituitary prolactin (PRL) cells of adult male Wistar rats treated with a combination of thyroidectomy and administration of L-thyroxine (T4) and/or synthetic thyrotropin-releasing hormone (TRH) in order to clarify the effects of changes in the hypothalamus-pituitary-thyroid axis on the ultrastructure and function of PRL cells. After thyroidectomy, PRL cells underwent atrophy and hypofunction of their cell organelles, but these changes tended to be restored to their normal level by T4 treatment. On the other hand, the administration of TRH to intact rats produced hypertrophy and hyperfunction in the PRL cells, although this treatment had no effect on the PRL cells of thyroidectomized rats. However, treatment with a combination of T4 and TRH had a strong effect and led to hypertrophy and hyperfunction in the PRL cells of thyroidectomized rats. Serum and pituitary PRL levels were measured by radioimmunoassay (RIA) for a comparison with the morphological results. They correlated well with the morphological changes. These results indicate that TRH stimulates PRL secretion in the presence of thyroid hormone, and that the thyroid hormone plays an important role in the basic maintenance of PRL cell function and its reactivity to TRH.

Animals↗

PubMed1985

Iodine-induced thyrotoxicosis--a case for subtotal thyroidectomy in severely ill patients.

Iodine-induced thyrotoxicosis (IIT), due to iodine application in high amounts in patients with circumscript or disseminated thyroid autonomy, is complicated by a prolonged course, mainly due on the body's resistance to conservative therapy with thiourea derivates. Therefore, we decided to perform subtotal thyroidectomy in 16 thyrotoxic patients. This is in contrast to the common opinion that surgery should only be performed after normalization of thyroid hormones. In all 16 patients with severe IIT, including three patients with thyroid storm, hormone levels decreased within a few days after surgery to normal or subnormal values and the clinical picture of thyrotoxicosis disappeared. In the case of thyroid storm the signs of disorientation normalized within 1-3 days. One patient died 5 weeks after surgery due to severe concomitant diseases. One patient exhibited transitory respiration distress and another had postoperative hypocalcaemia. In nine patients L-thyroxine replacement became necessary because of subclinical or clinical hypothyroidism. Only by this procedure will the high intrathyroidal storage of iodine and performed hormone be extracted. Surgery as a treatment for thyrotoxicosis should be reserved for patients with severe IIT, where conservative treatment has been shown to be ineffective. Furthermore, in rare selected cases, when a rapid normalization is required, surgery without preoperative treatment seems to be justified. The effect of surgery was impressive in all our cases and there were only minor perioperative complications. Thus, it could be shown that subtotal thyroidectomy may be a rational and effective treatment in severe IIT which should be carefully considered and weighed against other types of therapy.

Adult↗

PubMed1986

Effects of thyroidectomy and thyroxine replacement on the responsiveness of the anterior pituitaries from male rats to thyrotropin-releasing hormone in vitro.

Thyroidectomy decreased prolactin concentrations in the anterior pituitary (AP) and serum of the male rat. The amount of basal and thyrotropin-releasing hormone (TRH)-stimulated release of prolactin by AP in vitro was lower in thyroidectomized (Tx) rats than in sham Tx rats. These results suggest that the inhibitory effects of thyroidectomy on pituitary and serum prolactin in male rats are mediated in part by the reduction of the production and spontaneous release of prolactin and the responsiveness of prolactin to TRH.

Animals↗

PubMed1979

Effects of thyroidectomy on monoamine oxidase activities toward tyramine and serotonin in the circumventricular nuclei of the rat.

Following thyroidectomy, monoamine oxidase (MAO) activities toward tyramine decreased significantly by 20% in the nucleus periventricularis and the nucleus arcuatus among the 3 hypothalamic nuclei of the rat, while MAO activity toward serotonin decreased significantly by 10% only in the nucleus periventricularis. It is suggested that thyroidectomy induced selective changes on the multiple forms of MAO in the discrete circumventricular nuclei.

Animals↗

PubMed1982

Anterior pituitary, thyroid, parathyroid and adrenal responses to subtotal thyroidectomy in patients with Graves' disease.

Changes in the serum levels of anterior pituitary, thyroid, parathyroid, and adrenal hormones following subtotal thyroidectomy in 31 patients with Graves' disease were investigated. In 14 patients, rapid ACTH tests were performed on the preoperative and the first, third, and seventh post-operative days. Remarkable differences were not seen with regard to the changes in anterior pituitary hormones or cortisol, compared to those seen during general surgery. As to the thyroid hormones, the serum level of triiodothyronine (T3) decreased markedly after surgery and fell to half that of the preoperative value on the first postoperative day. Thereafter, a low value of T3 was maintained during the early postoperative period. Unlike T3, the serum level of thyroxine (T4) decreased gradually until the 7th post-operative day. The levels of both epinephrine and norepinephrine increased transiently during surgery, but the serum level of norepinephrine increased again on the third postoperative day. In the postoperative period, almost half the number of patients showed an inadequate cortisol response to rapid ACTH tests. It is suggested that the unique responses, such as the rise in serum norepinephrine or an inadequate response of cortisol to ACTH, or hypocalcemia, after subtotal thyroidectomy in patients with Graves' disease is largely due to the rapid decrease of T3 in the hypothyroid state, as was noted during the postoperative period.

Adult↗