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PubMed2005

Recurrent laryngeal nerve palsy after thyroidectomy with routine identification of the recurrent laryngeal nerve.

BACKGROUND: The aim of this study was to assess the risk of recurrent laryngeal nerve palsy (RLNP) after thyroidectomy with routine identification of the recurrent laryngeal nerve (RLN) during the operation. METHODS: The present study was confined to 521 patients, 348 total lobectomies and 178 total thyroidectomies, treated by the same surgeon. Temporary and permanent RLNP rates were analyzed for patient groups with stratification of primary operation for benign thyroid disease, thyroid cancer, Graves' disease, and reoperation. Measurement of the RLNP rate was based on the number of nerves at risk. Twenty-six RLNs in 20 thyroid cancer patients with intentional sacrifice were excluded from analysis. RESULTS: Forty RLNs (40 patients) developed postoperative RLNP. Complete recovery of RLN function was documented for 35 of the 37 patients (94.6%) whose RLN integrity had been ensured intraoperatively. Recovery from temporary RLNP ranged from 3 days to 4 months (mean, 30.7 days). Overall incidence of temporary and permanent RLNP was 5.1% and 0.9%, respectively. The rates of temporary/permanent RLNP were 4.0/0.2%, 2.0/0.7%, 12.0/1.1%, and 10.8/8.1% for groups classified according to benign thyroid disease, thyroid cancer, Graves' disease, and reoperation, respectively. CONCLUSIONS: Operations for thyroid cancer, Graves' disease, and recurrent goiter demonstrated significantly higher RLNP rates. Invasion of RLN was identified in 19.4% of patients with thyroid cancer. Postoperatively, the RLN recovered in most of the patients without documented nerve damage during the operation. Total lobectomy with routine RLN identification is recommended as a basic procedure in thyroid operations.

Adolescent↗
PubMed2006

Voice and swallowing changes after thyroidectomy in patients without inferior laryngeal nerve injuries.

BACKGROUND: We performed a prospective analysis on voice and swallowing alterations following total thyroidectomy (TT), in the absence of recurrent nerve injury. METHODS: Patients aged 21 to 65 years undergoing TT, in the absence of laryngeal/pulmonary disease, previous neck surgery, or malignant diseases, were subjected to videostrobolaryngoscopy (VSL), acoustic voice analysis (AVA), and maximum phonation time (MPT) tests preoperatively and 3 months postoperatively. Voice impairment scores (VIS) and swallowing impairment scores (SIS) were obtained preoperatively, and at 1 week, 1 month, and 3 months postoperatively. RESULTS: Among the 127 selected patients, 39 completed the postoperative evaluation. No recurrent nerve injury was observed during the postoperative VSL in any of the patients. Preoperative and postoperative AVA and MPT scores did not differ significantly. The mean postoperative VIS was significantly higher than the preoperative VIS at 1 week and 1 month after TT (13.7 and 9.6 vs 4.4, respectively; P < .05) but not 3 months after TT (6.7). The mean SIS was higher than the preoperative SIS at 1 week, 1 month, and 3 months after TT (10.3, 6.0, and 2.8 vs 0.5, respectively; P < .05). CONCLUSIONS: Physicians should inform patients that transient voice and swallowing symptoms may occur following total thyroidectomy, and our data suggest mild symptoms may occur in the majority of operated patients.

Adult↗
PubMed2006

Incidental diagnosis of struma ovarii after thyroidectomy for thyroid cancer: functional imaging studies and follow-up.

BACKGROUND: Struma ovarii is a rare ovarian germ-cell tumor containing thyroid tissue. We report an unusual case of incidental diagnosis of struma ovarii after thyroidectomy for thyroid cancer. CASE: A 24-year-old woman presented with a papillary thyroid carcinoma (pT3N1). After (131)I administration for thyroid remnant ablation, whole-body scan showed a thyroid bed uptake and a right pelvic uptake corresponding to an ovarian cyst on ultrasonography. Preablation thyroglobulin was more elevated than usually found after total thyroidectomy. (18)F-FDG PET was normal. Histopathological analysis revealed a benign struma ovarii. At 6 months, after oophorectomy, serum-stimulated Tg returned to undetectable value and diagnostic WBS was negative. CONCLUSION: Only few cases of incidental scintigraphic diagnosis of struma ovarii have been described. To our knowledge, it is the first case revealed after remnant ablation for thyroid carcinoma. The distinction with ovarian metastasis is discussed.

Adult↗
PubMed1997

Regional changes in beta1 thyroid hormone receptor immunoreactivity in rat brain after thyroidectomy.

Quantitative [125I]protein G-based immunohistochemistry was used to map the distribution of beta1 thyroid hormone receptor (TRbeta1) in normal and thyroidectomized adult rat brain, using a previously characterized polyclonal antibody. The distribution of TRbeta1-like immunoreactivity in normal brain was largely but not perfectly concordant with previous accounts of TRbeta1 mRNA distribution in rat brain. Thyroidectomy resulted in increased immunolabeling in most brain regions (mean increase: 14%, range: -4% to +25%), with statistically significant effects being observed in 9 of the 36 brain regions examined. Brain regions showing the most pronounced effects included the habenular nucleus (+22%), the oriens layer of the hippocampal CA3 region (+24%), and the lateral geniculate nucleus of the thalamus (+23%). These results demonstrate that the TRbeta1 protein in brain is capable of plastic changes in response to adult-onset alterations in TH levels. The observed pattern of brain regional receptor changes following thyroidectomy may provide clues for functional effects of thyroid function alterations in adults.

Age Factors↗
PubMed1986

Cadmium-induced acute lung injury: compromised repair response following thyroidectomy.

The role of thyroid hormone in the pulmonary repair process following chloride-induced acute injury, was assessed in the present study. Thyroidectomized (Thyx), male Sprague-Dawley rats were exposed by inhalation to cadmium chloride aerosol (CdCl2, 10 mg/m3). Rats were sacrificed 1 hr after [3H]thymidine (3H-T) injection at intervals up to 10 days after exposure. Thyroidectomy, followed by CdCl2, produced earlier and more severe acute injury in the form of alveolar hemorrhage edema and hyaline membrane formation, than CdCl2 alone. However, Type 2 cell hyperplasia was markedly reduced in this group of rats compared with CdCl2 controls. Uptake of 3H-T by Thyx-CdCl2 lung tissue was only 40% of that measured in CdCl2 controls. Autoradiographic studies indicated that Type 2 cell labeling was less than 66% of controls up to 3 days after exposure. Cells obtained by lung lavage of Thyx-CdCl2 rats were reduced in number up to 60% with respect to controls, during the first week after exposure. Additionally, the activities of lung antioxidant enzymes (glucose-6-phosphate dehydrogenase, superoxide dismutase, and glutathione peroxidase were significantly inhibited (45-55%) throughout the experiment in Thyx-CdCl2 animals compared with normal rats. In summary, thyroidectomy impairs the repair response in CdCl2 lung damage by enhancing Type 2 cell damage, reducing Type 2 cell proliferation, altering alveolar macrophage populations, and depressing antioxidant defense systems.

Animals↗
PubMed1994

Retarded and excessive development of skin appendages in fetal lambs in response to thyroidectomy before wool follicle appearance.

The impact on wool follicles of development in an athyroid environment was studied in a series of twin fetal lambs by surgically thyroidectomizing one of each pair before the appearance of follicle buds and comparing development of epidermal appendages in it with their development in the normal co-twin. Thyroidectomy was undertaken at 51 to 54 days' gestation, i.e. after approximately one-third of the gestation period. Each treated fetus was then replaced in the uterus, allowing pregnancy to continue. Eight pairs of twins were removed at intervals from 67 to 122 days' gestation and skin samples from the thyroidectomized and the intact twins were compared. Micromorphometric examination of the samples was used to assess quantitatively the effects of thyroid deprivation on wool follicle development. In thyroidectomized fetuses there was a failure of keratinization in primary wool follicles, an absence of secondary follicles, a tendency to excessive follicular branching and sweat gland development, and a paucity of sebaceous gland formation. The density of wool follicles was substantially increased, but the mean cross-sectional area of these follicles was reduced. The effects of very early thyroidectomy imply that the thyroid plays a role in the stimulation and regulation of wool follicle differentiation. To test the reversibility of the effects observed in the skin of thyroidectomized fetuses, grafts from these animals were transplanted to normal, young fetal lambs. Subsequent examination of grafted skin revealed that complete keratinization had occurred but that none of the other abnormal features had been reversed.

Animals↗
PubMed1997

Heterotopic autotransplantation of parathyroid tissue in children undergoing total thyroidectomy.

AIM: The purpose of this study was to examine the efficacy of parathyroid autotransplantation in children undergoing total thyroidectomy. METHODS: We have prospectively evaluated 32 cases of total thyroidectomy in children. The ages ranged from 1 year to 15.7 years, and the mean was 8.9 years. In 31 cases, the indication for surgery was a diagnosis of MEN2A or 2B based on direct DNA testing. One child had suspected sporadic medullary thyroid carcinoma. All of the patients underwent heterotopic autotransplantation of parathyroid gland tissue. In 26 cases, the parathyroid tissue was placed in the nondominant forearm, while in 6 children it was autotransplanted into the sternocleidomastoid muscle. RESULTS: In 31 of 32 children (97%), the serum calcium level transiently decreased in the immediate postoperative period. All of the patients were placed on oral calcium carbonate and vitamin D supplementation, and the serum calcium levels became normal within several days. The supplemental medications were then weaned as tolerated. Within 3 months of their procedure, 30 patients (94%) had adequate parathyroid tissue engraftment, and the calcium and vitamin D medications were discontinued. One child required 9 months of calcium and vitamin D medications before she could be weaned from the medications. One child has been treated more recently, and is currently being weaned from supplemental calcium and vitamin D. Serum PTH levels in 22 patients who had placement of the tissue into their forearms were measured, and in each there was increased PTH in the grafted arm compared with the nongrafted arm. In five children who had parathyroid tissue grafted into the sternocleidomastoid muscle, the peripheral serum PTH levels were in the normal range. CONCLUSION: The heterotopic autotransplantation of resected parathyroid tissue is safe and effective in preventing permanent hypoparathyroidism.

Adolescent↗
PubMed1997

Phonatory characteristics of patients undergoing thyroidectomy without laryngeal nerve injury.

Complications that arise after thyroid surgery may be associated with infection, hemorrhage, hormonal problems, and laryngeal nerve injury. Voice alteration after thyroidectomy is usually caused by recurrent or superior laryngeal nerve injury. This voice dysfunction may also be associated with laryngotracheal fixation with impairment of vertical movement or by temporary malfunction of the strap muscles after surgery. In this study, we evaluated the voice function phonetically before and after thyroidectomy in 54 patients, although function of the recurrent and superior laryngeal nerves was normal. During surgery, the superior and recurrent laryngeal nerves were identified and protected, and after surgery electromyographic testing of the cricothyroid muscle was performed. Typical voice symptoms after surgery were easy fatigue during phonation and difficulty with high pitch and singing voice. Acoustic analysis revealed that the phonation time and fundamental frequency were not changed after surgery, but the speaking fundamental frequency, range of speaking fundamental frequency, and vocal range were significantly diminished after surgery. These data allowed us to suggest that the cause of voice dysfunction is not seen in neural lesions, but in a disturbance of the extralaryngeal skeleton. These voice changes emphasize the importance of the extralaryngeal mechanism for pitch control.

Adolescent↗
PubMed1996

[Amiodarone-induced thyrotoxicosis cured by thyroidectomy].

We report a case of amiodarone-induced thyrotoxicosis, diagnosed with a systematic laboratory investigation in a 64-year-old patient, for haematuria. Despite the interruption of amiodarone, hyperthyroidism and a goiter occurred. Conventional therapy betablockers, antithyroid agents, prednisone, potassium perchlorate) did not result in any clinical improvement. The development of a malignant thyrotoxicosis with neurologic disturbances and acute respiratory insufficiency required mechanical ventilation and a subtotal thyroidectomy. The patient's status improved progressively and he was discharged without sequelae. The respective roles of medical therapy and thyroidectomy in amiodarone-induced thyrotoxicosis are discussed.

Amiodarone↗
PubMed2002

Total video endoscopic thyroidectomy via the anterior chest approach using the cervical region-lifting method.

Endoscopic surgery offers superior cosmetic results compared to open procedures and is strongly preferred by many patients, especially women. We performed total endoscopic thyroidectomy via the anterior chest approach using a neck skin-lifting technique in which the skin is lifted by a large number of hooks to create the working space. This method is quite flexible and can be modified based on the size of the space needed. The fine hooks leave no scar on the anterior neck, the skin incisions are small, and the scars are completely covered by patients' undergarments. Endoscopic thyroidectomy is suitable for benign thyroid nodules, but some malignant foci diagnosed by frozen section usually can be managed without conversion to an open procedure. Women under 45 years of age with nodules <2 cm who have no evidence of lymphatic spread or local invasion are ideal candidates for this procedure.

Adolescent↗
PubMed1997

Acoustic analysis of the speaking voice after thyroidectomy.

Voices of 47 female patients were analyzed before and after thyroidectomy, with preservation of the recurrent and superior laryngeal nerves and normal vocal fold motility during the observation period. A mean decrease of the speaking fundamental frequency (SFF) of 12 Hz was found on day 4; in 8 patients the postoperative vocal pitch was more than 2 semitones lower. The distance between the highest and lowest F0 during speaking was diminished (speech was more monotone) and the vocal jitter was elevated. In the frequency spectrum, there was a diminished prominence of the harmonics. The other spectral parameters (as the slope of the spectrum and the H1/H2 ratio) were unchanged. All changes had disappeared the fifteenth day, except for a lower SFF (> 2 semitones) in 2 cases. It is concluded that after normal dissection of the laryngeal nerves, and in the absence of vocal fold paresis, other reasons for voice changes immediately after thyroidectomy remain: alterations in the neck muscles, in the laryngeal mucosa, and in the patient's general condition. Although the effects seem limited and of short duration, knowledge of them is helpful when informing the patient before thyroid surgery.

Female↗
PubMed2003

Total endoscopic thyroidectomy.

We have developed endoscopic thyroidectomy procedures using anterior chest and axillary approaches. Both of our procedures differ significantly from the usual thyroidectomy, which involves lifting both the platysma and the sternohyoid muscle. Because only the platysma is lifted during our procedures, a CO(2) insufflation pressure of less than 4 mmHg is sufficient. While the sternohyoid muscle is transected to obtain greater exposure of the thyroid gland in minimally invasive procedures in the neck, we do not divide it so as to prevent adhesions to the platysma, unless the nodule is large. As we accumulated experience with these procedures in 58 patients, typical operation time decreased to less than 120 minutes for the anterior approach and to less than 150 minutes for the axillary approach. Large follicular tumours can be extracted using the axillary approach, with all of its cosmetic advantages, whereas the anterior chest approach is advocated for removal of bilateral multinodular goitres and parathyroid lesions. Both approaches result in minimal postoperative hypoaesthesia, paraesthesia, and discomfort during swallowing. We conclude that endoscopic neck surgery is the procedure of choice in carefully selected patients with thyroid disease.

Adenocarcinoma, Follicular↗
PubMed2006

Parathyroid risk in total thyroidectomy for bilateral, benign, multinodular goitre: report of 351 surgical cases.

AIMS: To evaluate the risk of hypocalcaemia (transient or permanent) after total thyroidectomy for bilateral, benign, multinodular goitre, the frequency and impact of unintentional parathyroidectomy, and the value of parathyroid gland autotransplantation during thyroid surgery. MATERIALS AND METHODS: This was a retrospective study of 351 surgical patients who had undergone total thyroidectomy for bilateral, benign, multinodular goitre over a seven-year period. The primary endpoint was serum calcium concentration immediately post-operatively and during follow up. Normal serum calcium concentration was defined as 2 mmol/l. Parathyroid data were collected during surgery and histological examination. RESULTS: In 62 per cent of cases, no hypocalcaemia had been observed after surgery. In 35 per cent of cases, transient hypocalcaemia had been observed after surgery. In 3 per cent of cases, chronic hypocalcaemia had been present six months after surgery. Permanent hypoparathyroidism had been diagnosed two years after surgery in 1.4 per cent of cases. Unintentional parathyroidectomy had been detected in 5.2 per cent of cases. Parathyroid gland autotransplantation had been performed in 7 per cent of cases during surgery. CONCLUSION: Permanent hypoparathyroidism is rare, although transient hypoparathyroidism occurs relatively frequently. Unintentional parathyroidectomy and parathyroid gland autotransplantation do not affect serum calcium levels.

Calcium↗
PubMed1967

The effect of thyroidectomy on the pattern of fatty acids synthesized by mammary gland from lactating rats.

Thyroidectomy decreased the content of short-chain fatty acids and increased the content of long-chain fatty acids in the mammary glands of lactating rats. This effect was replicated in the glands of untreated rats limited to the same food intake as the thyroidectomized animals. Thyroidectomy decreased the incorporation of [6-(14)C]glucose into short-chain fatty acids and increased the incorporation into longer-chain acids. Restriction of the food intake of untreated animals did not cause a similar shift of the incorporation pattern. The possibility that the thyroxine effect on lipogenesis is secondary to its effect on carbohydrate metabolism is discussed.

Animals↗
PubMed1999

Prevention of post-operative nausea and vomiting with combined granisetron and droperidol in women undergoing thyroidectomy.

We have compared the efficacy and safety of combined granisetron and droperidol with each anti-emetic alone for preventing post-operative nausea and vomiting after thyroidectomy. In a prospective, randomized, double-blind study, 180 women received granisetron 40 micrograms kg-1, droperidol 20 micrograms kg-1, or granisetron 40 micrograms kg-1 plus droperidol 20 micrograms kg-1 (n = 60 of each) intravenously immediately before induction of anaesthesia. A standard general anaesthetic technique and post-operative analgesia were used. A complete response, defined as no post-operative nausea and vomiting and no need for another rescue anti-emetic, during the first 24 h after anaesthesia occurred in 88%, 60% and 98% of patients who had received granisetron, droperidol and granisetron plus droperidol (P < 0.05; overall Fisher's exact probability test). No clinically important adverse events due to the drugs were observed in any of the groups. In summary, prophylactic use of combined granisetron and droperidol is more effective than each drug alone for the prevention of post-operative nausea and vomiting in female patients undergoing thyroidectomy.

Adult↗
PubMed2000

Thyroidectomy modulates rat prostatic monosaccharides.

Earlier studies have shown that thyroid hormones play an important role in glycoprotein metabolism in the prostate. In this paper, hypothyroidism induced changes in prostatic glycoprotein-associated monosaccharides and fructose concentrations were studied in 30-day-old peripubertal rats. Hypothyroidism was induced by total surgical thyroidectomy and confirmed by radioimmunoassay (RIA) of thyroid hormones and thyroid stimulating hormone (TSH). Animals were killed after 30 and 60 days post-thyroidectomy. To test the direct effect of thyroid hormones on prostatic monosaccharides, prostatic tissue was incubated for 24 h at 37 degrees C with 25, 50 or 100 ng/mL T3. Ventral prostatic hexosamines and sialic acid concentrations were significantly decreased in hypothyroid rats aged 30 and 60 days, whereas fucose concentration was increased at 30 days but decreased at 60 days in hypothyroid rats. In the case of the dorsolateral prostate, hypothyroidism enhanced the concentration of hexosamines but caused a decrease in levels of fucose, sialic acid and fructose, irrespective of the duration of hypothyroidism. Concentrations of fucose, fructose and hexosamines in the anterior prostate were decreased and sialic acid concentration was increased in 60-day hypothyroid rats. In in vitro studies, the concentrations of fucose, sialic acid and hexosamines were significantly increased in all three prostatic lobes irrespective of the T3 dose with which they had been incubated. A consistent increase in fructose concentration was observed in anterior and dorsolateral prostates when incubated with different doses of T3 stimulation. It is concluded that the influence of hypothyroidism on prostatic monosaccharides seems to be specific for each sugar in different lobes of the prostate. These results clearly show that thyroid hormones differentially regulate prostatic glycoprotein metabolism.

Animals↗
PubMed2002

Short-term resolution of psoriasis after total thyroidectomy for euthyroid multinodular goitre.

A 36-year-old Chinese female with an 8-year history of chronic, generalized plaque psoriasis demonstrated a marked improvement of the disease after removal of an intercurrent euthyroid multinodular goitre. Thyroxine was commenced immediately postoperatively. No thyroid antibodies were detected and thyroid function and calcium levels remained within normal limits both pre- and postoperatively. Four weeks following surgery, narrow-band ultraviolet B (nbUVB) therapy was recommenced for recurrent psoriasis. The manifestations of psoriasis at this stage were less severe than before thyroidectomy and responded well to treatment, whereas before surgery the response to therapy had been poor. One year following total thyroidectomy, the patient received very effective psoriasis control with nbUVB therapy. The possible role of surgery and thyroid hormones in altering the pathogenesis of psoriasis in the acute setting is clearly of interest and warrants further research consideration.

Adult↗
PubMed2002

Parathyroid autotransplantation during thyroidectomy.

Permanent hypoparathyroidism is a debilitating morbidity following thyroidectomy, with a reported incidence of up to 43%. Apart from meticulous dissection to preserve parathyroid glands and their blood supply, parathyroid autotransplantation (PA) has been increasingly employed to preserve parathyroid function. The adoption of PA during thyroidectomy has been reported to be associated with a low incidence of permanent hypoparathyroidism. Biochemical function of parathyroid autografts can be demonstrated objectively by forearm reimplantation or during long-term follow up. The clearest indication for PA is for inadvertently removed or devascularized parathyroid glands during thyroid surgery. Other strategies, including routine autotransplantation of at least one parathyroid gland, can be considered, but is associated with a high incidence of transient hypocalcaemia. Apart from refinement in technique to facilitate graft success, a reliable way to assess overall parathyroid function or viability of individual parathyroid gland may assist in monitoring parathyroid function and selecting patients requiring this procedure to prevent permanent hypoparathyroidism.

Calcium↗