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PubMed2006

Thyroidectomy in the cat.

Thyroidectomy in cats is most commonly indicated to treat hyperthyroidism because of adenomatous hyperplasia of the thyroid glands. Preoperative stabilization of the hyperthyroid cat with antithyroid drugs is preferred to minimize anesthetic and surgical complications. Multiple surgical techniques for thyroidectomy have been reported, and results of surgery and complications differ between techniques. The extracapsular technique offers the most complete removal of abnormal thyroid tissue, while still being associated with a low incidence of postoperative hypoparathyroidism. Important postoperative considerations are to carefully monitor serum calcium concentrations and treat hypocalcemia if necessary, and to monitor the cat for evidence of relapse of hyperthyroidism.

Animals↗

PubMed2001

Quantitative measurement of thyroglobulin mRNA in peripheral blood of patients after total thyroidectomy.

Previous studies have reported the clinical usefulness of reverse transcription-polymerase chain reaction (RT-PCR) detection of thyroglobulin (TG) mRNA in the peripheral blood of patients with differentiated thyroid carcinoma. To evaluate this usefulness, we measured TG mRNA in the peripheral blood of patients diagnosed with thyroid carcinoma after total thyroidectomy by real-time quantitative RT-PCR using glyceraldehyde-3-phosphate dehydrogenase (GAPDH) mRNA as an internal control. Surprisingly, we detected TG mRNA in all samples obtained after total thyroidectomy, including those from 4 medullary carcinomas. Further, there was no statistical difference in expression levels of TG mRNA in the patients with or without metastasis, and no significant correlation was found between serum TG concentrations and the expression levels of TG mRNA. These results give rise to a question regarding the clinical applications of not only RT-PCR detection but also quantitative measurement of TG mRNA in peripheral blood.

Adolescent↗

PubMed1983

Differential effects of propylthiouracil, methimazole and thyroidectomy on liver ferritin.

Different groups of rats were made hypothyroid by thyroidectomy (Tx) or treatment with propylthiouracil (PTU) or methimazole (MMI). Some of the hypothyroid rats from each group were simultaneously treated with thyroxine (T4). Liver ferritin concentration and 14C-glycine incorporation into liver ferritin in these rats were studied. Only in MMI-treated rats the ferritin concentration was elevated, which was reduced by simultaneous T4 treatment. PTU treatment resulted in 36-42% reduction in ferritin synthesis, which was not responsive to T4. Thyroidectomy induced 23% enhancement in ferritin synthesis, which was normal in T4-treated Tx rats. The possible causes for these differential effects in hypothyroid rats have been discussed.

Animals↗

PubMed1991

Total thyroidectomy in the treatment of Basedow's ophthalmopathy.

Four patients in the age 42-63 (3 females and 1 male) with Basedow's disease and hyperthyroidism were investigated. Visual changes were classified to the IV group of American Thyreologic Society's classification. A total thyroidectomy was performed when status of euthyreosis has been obtained. Check examinations were carried out 6, 12 and 18 months after surgery. It has been confirmed that total thyroidectomy performed in patients with thyroid ophthalmopathy leads to reduction of infiltrative changes in the orbit. However, this can be stated not earlier than 12 months after surgery.

Adult↗

PubMed1999

Thyroidectomy in iodine induced thyrotoxic storm.

Between January 1996 and September 1997 we treated 4 patients with iodine-induced thyrotoxic storm (2 females, 2 men; age 54-77 years). Iodine contamination was due to iodine-containing contrast media in 3 patients and iodine-containing disinfectant in 1 patient. Thyroid storm with tachycardia, hypertension, sweating, tremor, weight loss and coma occured 3-10 weeks after iodine contamination. These symptoms were accompanied by raised fT4- and fT3-values. All 4 patients were initially treated with antithyroid drugs for 7 days, whereas 2 patients with coronary artery disease, demonstrated by coronary angio-graphy, were treated with antithyroid drugs for 2 weeks. Because of unsuccessful antithyroid drug treatment, all 4 patients underwent subtotal thyroidectomy. There were no perioperative complications. We conclude that early thyroidectomy is the appropriate treatment for iodine-induced thyrotoxicosis even in patients with severe accompanying diseases.

Aged↗

PubMed1992

Thyroidectomy blocks stress-induced prolactin rise in rats: role of the central serotonergic system.

Thyroidectomized (TX) adult Wistar male rats and their sham-operated controls were submitted to immobilization stress during forty minutes. Thyroidectomy partially blocks stress-induced prolactin (PRL) secretion. Previous administration of MK 212, a serotonin agonist, reverts this picture. The effect of MK 212 is specifically due to its interaction with 5HT2 receptors, since the injection of LY 53857, a selective blocker of these receptors, 30 min before MK 212, prevents the effect of this serotonin agonist. LY 53857, injected alone, yields a partial blockade of PRL secretion during stress in sham-operated rats. TX rats receiving LY 53857 or saline have comparable low values of plasma PRL during stress. It is suggested that thyroidectomy disrupts the functional integrity of the central serotonergic pathways involved in the stress-induced PRL rise.

Animals↗

PubMed2000

Prophylactic thyroidectomy in the treatment of thyroid medullary carcinoma. Age for surgery?

Since the association of RET proto-oncogene mutations and medullary thyroid carcinoma in children there has been much discussion regarding timing of surgery. Our study group was formed from a brother and sister (8 and 5) and 3 brothers (9, 13, 16) selected on the basis of a positive family history for thyroid medullary carcinoma. Histological examinations of the thyroidectomy specimens showed that the 8- and 9-year old had microinvasive carcinoma and the remaining three had C-cell hyperplasia. Our recommendation is for prophylactic thyroidectomy for children with RET proto oncogene mutations at an early age, clearly before age 5.

Adolescent↗

PubMed2001

Small doses of propofol, droperidol, and metoclopramide for the prevention of postoperative nausea and vomiting after thyroidectomy.

OBJECTIVE: To evaluate the efficacy and safety of small doses of propofol, droperidol, and metoclopramide for the prevention of postoperative nausea and vomiting (PONV) after thyroidectomy. STUDY DESIGN: Prospective, randomized, double-blinded study. SETTING: University-affiliated teaching hospital. METHODS: In a randomized, double-blinded study, 90 patients (75 females) received propofol 0.5 mg/kg, droperidol 20 microg/kg, or metoclopramide 0.2 mg/kg intravenously (n = 30 in each group) at the end of surgery. A standardized general anesthetic technique was used. RESULTS: The incidence of PONV during the first 24 hours after anesthesia was recorded in 13%, 47%, and 50% of patients who had received propofol, droperidol, and metoclopramide, respectively (P < 0.05; overall Fisher exact probability test). No clinically important adverse events were observed in any of the groups. CONCLUSION: Small dose (0.5 mg/kg) of propofol is more effective than droperidol or metoclopramide for the prevention of PONV after thyroidectomy.

Antiemetics↗

PubMed1998

Postoperative hypocalcemia in patients who did or did not undergo parathyroid autotransplantation during thyroidectomy: a comparative study.

BACKGROUND: Permanent hypoparathyroidism is a recognized complication of thyroidectomy. Apart from preservation of parathyroid glands in situ by meticulous dissection, parathyroid autotransplantation (PTHAT) has been performed increasingly to avoid permanent hypoparathyroidism. METHODS: From January 1995 to October 1997, PTHAT was performed routinely for devascularized or inadvertently removed glands in 98 (36%) of 271 patients undergoing thyroidectomy. Potential risk factors and the impact of PTHAT on postoperative hypocalcemia were studied. RESULTS: Postoperative hypocalcemia occurred in 40 patients (14.8%), whereas 5 patients (1.8%) had permanent hypocalcemia during a median follow-up of 9 months. The incidence of transient hypocalcemia (n = 35) was higher in patients who underwent PTHAT (21.4%) than in patients who did not undergo PTHAT (8.1%) (P < .01). Permanent hypocalcemia occurred only in patients who did not undergo PTHAT. None of the 21 patients who had postoperative hypocalemia after PTHAT had permanent hypoparathyroidism compared with 26% (5/19) of patients who did not undergo PTHAT (P = .018). When the resected thyroid gland was examined for parathyroid tissue, the incidence of positive identification was higher in patients who did not undergo PTHAT (13%) than in patients who did undergo PTHAT (4%) (P = .015). CONCLUSIONS: Patients with postoperative hypocalcemia after PTHAT have virtually no risk of having permanent hypoparathyroidism. A more careful examination of the resected thyroid tissue can help to identify inadvertently removed parathyroid glands for autotransplantation.

Adolescent↗

PubMed1996

Effect of fetal thyroidectomy on brown adipose tissue and thermoregulation in newborn lambs.

The effect of fetal thyroidectomy on thermoregulation in newborn lambs was investigated. Seven of 14 lambs born normally at term were thyroidectomized at Day 127 of gestation. Colonic temperature and oxygen consumption were measured during non-rapid eye movement sleep 6-45 h after birth. All lambs were then killed and perirenal brown adipose tissue was sampled for measurement of thermogenic activity (guanosine diphosphate binding), uncoupling protein and lipid contents. Thyroidectomized lambs tended to have a mean colonic temperature 2.35 degrees C lower (P = 0.067) than controls and two became hypothermic (i.e. colonic temperature < 35 degrees C). Thyroidectomized lambs exhibited lower rates of oxygen consumption (P = 0.05) and an increased incidence of shivering thermogenesis. The perirenal adipose tissue of these lambs had a lower thermogenic activity (P < 0.01), less uncoupling protein (P < 0.01) and higher lipid content (P = 0.072) compared with intact controls. It is concluded that fetal thyroidectomy results in a decreased ability of newborn lambs to utilize nonshivering thermogenesis in brown adipose tissue as well as increasing the incidence of hypothermia. These changes are associated with decreased synthesis of uncoupling protein and functional development of brown adipose tissue in the late gestation fetus.

Adipose Tissue, Brown↗

PubMed1999

Extent of thyroidectomy in nodular thyroid disease.

OBJECTIVE: To find out which procedure was the safest for each indication for operation in diseases of the thyroid gland. DESIGN: Retrospective study. SETTING: Two teaching hospitals, The Netherlands. SUBJECTS: 599 consecutive patients who had 601 thyroid operations between 1 October 1985 and 1 June 1993. MAIN OUTCOME MEASURES: Incidence of complications, particularly postoperative hypocalcaemia and injuries to the recurrent laryngeal nerve. RESULTS: Accidental injuries to the recurrent laryngeal nerve occurred in 0.7% of the nerves at risk (7/948) and the incidence of permanent hypocalcaemia was 5.2% (31/599). In subtotal procedures (bilateral subtotal thyroidectomy with the remnant left dorsally or total hemithyroidectomy combined with subtotal hemithyroidectomy on the other side with a remnant left at the upper pole) the rate was 11/390 (2.8%) compared with 18/525 (3.4%) after total resections. The corresponding numbers of accidental injuries to the recurrent laryngeal nerve were 2 and 4. CONCLUSIONS: Total thyroidectomies are more likely to be done for malignant disease, so the slightly higher complication rates probably reflect the nature of the disease, which requires more radical resection. Both subtotal procedures can be done with comparable low morbidity.

Adult↗

PubMed2003

Effects of thyroidectomy alone or followed by radioiodine ablation of thyroid remnants on the outcome of graves' ophthalmopathy.

Fifty-five patients with Graves' disease (GD) and mild to moderate Graves' ophthalmopathy (GO) underwent near-total thyroidectomy (Tx). In 16 patients this was followed by a standard ablative dose of (131)I because of the hystologic evidence of differentiated thyroid carcinoma. We retrospectively evaluated whether or not GO activity could be affected by thyroid surgery alone or followed by complete ablation of thyroid tissue. Accordingly, on the basis of clinical activity score (CAS) values prior to thyroidectomy, we identified two groups: group A with active GO (CAS > or = 3; n = 31) and group B with inactive GO (CAS < or = 2; n = 24). CAS values were then recorded at 6, 12, and 24 months after surgery/(131)I ablation. Over the course of the follow-up period, GO became inactive in approximately 70% of group A patients (CAS 4.2 +/- 0.8 at baseline, 2.1 +/- 2.0 at 24 months, p < 0.0001) and became active in 37.5% patients from group B. When we examined GO activity according to the type of treatment used (Tx or Tx and (131)I), the prevalence of inactive GO both short- and long-term, was significantly higher in the group of patients who underwent Tx and (131)I ablation. Therefore, this seems to be a more effective means of inducing and maintaining inactive GO.

Adult↗

PubMed1997

Factors affecting thyroid function after subtotal thyroidectomy for Graves' disease: case control study by remnant-weight matched-pair analysis.

In order to determine whether there are any predictive factors, other than the amount of remnant thyroid tissue, for subsequent thyroid function after subtotal thyroidectomy for Graves' disease, thyroid function was assessed in 329 patients 3 years after surgery, and a case control study was carried out in euthyroid, hyperthyroid, and hypothyroid groups by remnant-weight matched-pair analysis. Factors that affected thyroid function 3 years after surgery were thyroid gland infiltration by lymphocytes and the thyrotropin binding inhibiting immunoglobulin (TBII) value in the hyperthyroid and euthyroid groups, and the free triiodothyronine (FT3) value at the time of surgery and lymph follicle formation in the thyroid gland in the hypothyroid and euthyroid groups. It is concluded that no single factor studied at surgery, other than the amount of remnant tissue, can predict thyroid function after subtotal thyroidectomy for Graves' disease.

Adult↗

PubMed1997

Development of Graves' disease nine years after total thyroidectomy due to follicular carcinoma of the thyroid.

We report a 49-year-old woman with Marfan syndrome who underwent total thyroidectomy for follicular carcinoma. The patient was given 100 mCi of radioactive iodine (131I) followed by levothyroxine (LT4) 0.2 mg/day after surgery. The subsequent five total body scans were negative and thyroglobulin (TG) measurements ranged between undetectable levels to 12 ng/mL. Nine years after thyroidectomy the patient developed bilateral exophthalmos with markedly positive thyroid-stimulating immunoglobulins (TSI), indicating the presence of Graves' disease. TG levels increased and concurrently pulmonary metastases that did not concentrate radioiodine at tracer doses, were diagnosed. Due to these metastatic lesions, the patient received a therapeutic dose of 150 mCi of 131I 1 month after LT4 withdrawal, and a total body scan was made 10 days later. Slight uptake of 131I was found in the right side of the neck, whereas predominant uptake occurred in the right lung base. We suggest that the elevated TSI played a role in the growth of metastases.

Adenocarcinoma, Follicular↗

PubMed2000

Unusual complication of total thyroidectomy: arteriovenous fistula.

We describe the case of a 29-year-old woman from the Chernobyl area, who moved to the Czech Republic 10 years after the Chernobyl nuclear disaster. She was evaluated for a large goiter. Fine-needle aspiration cytology indicated a diagnosis of a typical degenerated Hurthle cell adenoma. She underwent total thyroidectomy but a continual loud murmur was found 1 month after surgery. An arteriovenous (AV) fistula between the right thyrocervical trunk and the right jugular vein was proven angiographically. This fistula was successfully closed by artificial embolization performed by detachable Gianturco-Anderson-Wallace (GAW) coil. This is the first description of using such a procedure in order to close an AV fistula after thyroidectomy.

Adenoma, Oxyphilic↗

PubMed2005

Importance of the intraoperative identification of the external branch of the superior laryngeal nerve during thyroidectomy: electromyographic evaluation.

OBJECTIVE: To establish the frequency and degree of postthyroidectomy injury of the external branch of the superior laryngeal nerve (EBSLN) by means of electromyography and to assess whether intraoperative identification of the nerve and the presence of malignancy influence morbidity. PATIENTS AND METHODS: Prospective, randomized, blind study. Comparison of 100 superior thyroid poles subjected to surgery because of benign and malignant disease, divided in three groups: G1, thyroidectomies, without searching for the EBSLN; G2, thyroidectomies, searching for the EBSLN; G3, Control, lobes, contralateral to the lobectomy, not surgically manipulated. The electromyographic function of the EBSLN was assessed in all cases, classifying the degree of injury and clinically assessing its function. Central tendency measures were used, as well as X (2) and multiple variance analysis. RESULTS: In G1, with 50 dissections of the superior pole, 25 injuries were found in 15 patients (10 bilateral and 5 unilateral). In G2, EBSLN injury was found after 13 explorations of the superior pole in 8 patients (5 bilateral and 3 unilateral). G3 patients did not present EBSLN injury. X (2) among groups and degree of injury revealed that intraoperative identification of the EBSLN decreases its injury. No evidence were found that injury frequency is increased by the presence of thyroid malignancy, extracapsular infiltration, or size of tumor. Clinical manifestations of hoarseness were present in 14% of G1 patients and 8% of G2 patients. DISCUSSION: The rate of EBSLN injury increased when not exploring and/or identifying it expressly. The presence of cancer, extracapsular extension, or size of the thyroid tumor exerted no influence on the frequency of injury; localization of the nerve was the only factor affecting injury. Hoarseness correlated with the degree of injury. CONCLUSION: EBSLN must be localized expressly to decrease the risk of injury.

Adolescent↗

PubMed1996

Antiemetic effect of subhypnotic doses of propofol after thyroidectomy.

Postoperative nausea and vomiting (PONV) are unpleasant, often underestimated side effects of anaesthesia and surgery, not devoid of medical complications. Prevention with antiemetics is only partially effective. Propofol has been shown recently to possess antiemetic properties in several situations. In this prospective, randomized, controlled trial, we have compared the antiemetic efficacy of subhypnotic doses of propofol, with Intralipid as placebo, after thyroidectomy. We studied 64 patients of both sexes, aged 22-71 yr, ASA I or II, undergoing thyroidectomy. After premedication with a benzodiazepine, balanced anaesthesia was produced with isoflurane and nitrous oxide in oxygen, and supplementary analgesia with fentanyl i.v. as required. Postoperative analgesia was provided with non-opioids, and piritramide 0.25 mg kg-1 i.m. on demand. Patients were allocated randomly and blindly to receive a 20-h infusion of either propofol or 10% Intralipid 0.1 ml kg-1 h-1. Intralipid, the excipient of propofol, was chosen as placebo as it is devoid of antiemetic effects. Sedation scores, respiratory and cardiovascular variables, and incidence of PONV were assessed every 4 h for 24 h. Pulse oximetry and ECG were monitored continuously. Both groups were comparable in characteristics, surgical and anaesthesia procedures, amount of opioids given during and after operation, and total amount of the study drug infused after operation. Occurrence of PONV was similar before the start (propofol 41%, Intralipid 50%) and after completion (propofol 0.64%, Intralipid 1.6%) of infusion and decreased with time in both groups during the infusion. However, symptoms were reduced to nil with propofol but persisted and were more severe with Intralipid during infusion (P < or = 0.01). The overall incidence of PONV during infusion was 10% (three of 32 patients) in the propofol group and 65% (21 of 32 patients) in the Intralipid group. Cardiovascular and respiratory variables, and SpO2 were unaltered, and sedation decreased similarly with time in both groups. We conclude that propofol, given at subhypnotic doses, effectively reduced the incidence of PONV without untoward sedative or cardiovascular effects.

Adult↗

PubMed1998

Prophylactic antiemetic therapy with granisetron in women undergoing thyroidectomy.

We have evaluated the efficacy and safety of granisetron, a selective 5-hydroxytryptamine type-3 receptor antagonist, for the prevention of postoperative nausea and vomiting (PONV) in women undergoing thyroidectomy. In a prospective, randomized, placebo-controlled, double-blind study, 100 ASA I patients, aged 30-57 yr, received placebo or granisetron at three different doses (20, 40 or 100 micrograms kg-1) (n = 25 each), i.v., immediately before induction of anaesthesia. A standard general anaesthetic technique was used. A complete response, defined as no PONV and no need for another rescue antiemetic during the first 3 h after anaesthesia, was seen in 36%, 44%, 92% and 92% of patients who received placebo, granisetron 20 micrograms kg-1, 40 micrograms kg-1 and 100 micrograms kg-1, respectively; corresponding values during the next 21 h after anaesthesia were 40%, 44%, 88%, and 88% (P < 0.05; overall Fisher's exact probability test). There were no clinically important adverse events in any group. We conclude that granisetron 40 micrograms kg-1 was an effective antiemetic for the prevention of PONV after thyroidectomy. Increasing the dose to 100 micrograms kg-1 provided no further benefit.

Adult↗