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PubMed1976

In utero fetal lamb thyroidectomy and thyroid autograft transplantation.

Our fetal surgical model was utilized to perform in utero fetal lamb thyroidectomy and autograft transplantation of thyroid tissue to fetal thigh at 82-93 days gestation. Successful in utero transplantation was possible in two of six experimental animals. In one twin pregnancy with an unoperated control lamb, observations were continued to age six months. The athyrotic lamb with a thigh autograft was larger at birth and had a transient weak sucking reflex and awkward gait. It then grew and developed normally with no stigmata of cretinism or delay in bone maturation. At age six months an increase in thyroid stimulating hormone (oTSH) was the single distinguishing observation in the twin with the transplant. Although oTSH levels were elevated to age six months, the pituitary continued to be responsive to thyrotropin releasing hormone (TRH) stimulation. These findings suggest that in utero transplantation of thyroid tissue is technically feasible and that the previously described development of in utero cretinism following fetal thyroidectomy can be prevented by a functioning autograft. This technique will be useful in attempting allograft transplantation in utero.

Animals↗
PubMed2005

[Total thyroidectomy with a modified Miccoli's approach for treatment of Graves' disease--feasibility and its applying techniques].

OBJECTIVE: To assess the feasibility and relevant applying techniques of total thyroidectomy for Graves' disease with a modified Miccoli's approach. METHODS: Forty-two patients with Graves' disease consecutively received the radical operation from June 2002 to December 2004.The modification includes: (1) Incision extending according to the degree of lobe enlargement (3-6 cm, average 4 cm); (2) A space maintain-regulating device was used to change dimensionally the volume of working space (mainly height) when specific manipulation needed; (3) A volume-reducing resection step was performed for the gland with degree III hyperplasia by cutting off the middle-inferior part of the lobe prior to endoscopic lobectomy. The approach was designed to mainly use ultrasonically-activated scalpels, with suction-dissector or others as supplementary instruments. During the operations, a method of "sequenced dissect-coagulate-cut" was employed to directly divide all branches of thyroid vessels without ligation or application of hemoclips. RESULTS: All procedures were completed successfully. None of them were converted to open surgery due to uncontrolled bleeding or severe postoperative hematoma. No severe complications occurred, except 2 cases who suffered from temporary hoarseness. CONCLUSION: Total thyroidectomy for Graves' disease can be safely performed with the modified Miccoli's approach by using ultrasonic scalpel and the space maintain-regulating device. Application of these adaptive reforms can obviously reduce the difficulties in manipulation, and thus, make the usage of this minimally invasive design also clinically possible for even radical treatment of the gland.

Adolescent↗
PubMed1999

Parathyroid autotransplantation with total thyroidectomy for thyroid carcinoma: long-term follow-up of grafted parathyroid function.

BACKGROUND: Permanent hypoparathyroidism is a major complication of thyroidectomy. Autotransplantation of parathyroid glands has been attempted to prevent this complication. However, no direct data have been available to assess grafted parathyroid function after long-term follow-up in terms of the serum intact parathyroid hormone (PTH) concentration. METHODS: Eighty-four consecutive patients with differentiated thyroid carcinoma who underwent total thyroidectomy and bilateral modified neck dissection from 1992 to 1996 were enrolled. They concomitantly underwent total parathyroidectomy and autotransplantation of all parathyroid glands to the pectoralis major muscle. The serum intact PTH concentration was periodically measured as an index of grafted parathyroid function. RESULTS: The mean follow-up was 34 months. In all autotransplanted patients serum intact PTH concentrations fell below detectable limits immediately after surgery. They were restored to the normal range within 1 month postoperatively and were maintained during observation in 80 (95%) of 84 patients. Seventy-eight of 80 patients with normal intact PTH values were normocalcemic without any treatment and the remainder were normocalcemic with 1 microgram of 1 alpha-vitamin D3. Four hypoparathyroid patients were normocalcemic with 2 micrograms of 1 alpha-vitamin D3. The postoperative average serum intact PTH concentration of patients having more than 2 autotransplanted parathyroid glands was almost equal to that of patients with preservation of the parathyroid glands in situ. The incidence of permanent hypoparathyroidism was inversely correlated with the number of autotransplanted parathyroid glands. CONCLUSIONS: The recovery patterns of the intact PTH concentration indicate that the glands were grafted successfully and functioned for a long period. This feasible method of parathyroid autotransplantation bears comparison with the previous reports in terms of the incidence of permanent postoperative hypoparathyroidism, and it can be performed simply and is reproducible.

Adolescent↗
PubMed1999

Reoperation as treatment of relapse after subtotal thyroidectomy in Graves' disease.

BACKGROUND AND METHODS: In Graves' disease radioiodine is the recommended treatment for relapses after subtotal thyroidectomy. If patients reject radioiodine, hyperthyroidism is managed with antithyroid drugs; surgery is generally not considered as an alternative. Here we retrospectively analyzed 30 consecutive patients with Graves' disease who had recurrent hyperthyroidism after subtotal thyroidectomy. RESULTS: On relapse after the first operation, the patients were initially treated by medication; 25 opted for definitive treatment (19 for reoperation and 6 for radioiodine). Operations consisted of 10 unilateral and 8 bilateral resections (total or near-total with capsular remnants of < 1 g) and 1 transsternal approach (because of dystopic intrathoracic thyroid tissue). The decision between a unilateral and a bilateral reintervention was based on the ultrasonographic determination of remnant volumes. These size estimates were valid because they were significantly correlated to the weight of the resected remnants (r = 0.92, slope = 0.95). Eighteen of the 19 patients were adequately treated by this approach. Unilateral resection was performed in 1 patient with a remaining contralateral remnant of 5.4 mL; this patient had a second relapse. The complication rate was low (2 cases of transient recurrent nerve injury and 1 of transient hypocalcemia). CONCLUSION: Provided that no contraindication is present, reoperation is safe, effective, and expeditious in recurrent hyperthyroidism. Because the likelihood of a recurrence depends on the total remnant size, the goal is to keep it below 2 g. Preoperative ultrasonography can effectively guide the decision between a unilateral and a bilateral resection.

Adult↗
PubMedDate not supplied

[Transcutaneous radiotherapy after thyroidectomy for differentiated thyroid carcinoma].

PURPOSE: To compare the results, in terms of 10-year actuarial survival, between I-131-therapy and I-131-therapy + external beam radiotherapy (RT) in patients operated on for differentiated thyroid carcinoma. PATIENTS AND METHODS: Over a period of 13 years (1982-1995) 408 patients underwent thyroidectomy with or without linphoadenectomy for pT0/T4 Nx or pN0, pN1a, pN1b thyroid carcinoma. In all cases, thyroidectomy was radical. Patients were divided into two groups, which were comparable according to several prognostic factors: group A composed of 165 patients (surgery + I-131) and group B, 243 patients (surgery + I-131 + RT). RESULTS: The percentage of deaths related to relapsed or metastatic thyroid carcinoma was 6.25%. In the group treated with adjuvant radiotherapy, 14.8% of the patients experienced acute tracheal or esophageal side effects. Late toxicity (mouth dryness, skin and/or muscle fibrosis) was recorded only in a small percentage of the patients (2.4%). CONCLUSIONS: Adjuvant RT resulted in a statistically significant improvement (p < 0.01) in survival of patients with extracapsular diffusion of the cancer, especially those with pT4 N1b tumors or tumors involving the trachea.

Carcinoma↗
PubMedDate not supplied

Blastocyst implantation: effect of thyroidectomy and thyroxine replacement in the rat.

The long term effects of thyroidectomy and chronic thyroxine treatment on blastocyst implantations in female albino rats were studies. Implantation was delayed in both thyroidectomized and hyperthyroid rats, as there was no evidence of blastocyst implantation on day 6 of pregnancy. By day 9, when signs of implantation were observed, the number and weights of the implantation sites were significantly reduced in the athyroid and hyperthyroid rats. Both thyroidectomy and chronic thyroxine treatment significantly reduced the fetal sites and increased the incidence of resorptions when compared with the control. It is concluded that a functional thyroid gland is required for normal implantation to occur.

Animals↗
PubMed1999

Secondary thyroidectomy in patients with prior thyroid surgery for benign disease: a study of 203 cases.

BACKGROUND: The goal of this study was to evaluate the complication rate of secondary thyroidectomy in patients with prior thyroid surgery for benign disease. METHODS: Over an 8-year period, 203 thyroid reoperations were performed on 202 patients. All information relating to operative procedures, pathology, and complications was recorded prospectively. RESULTS: There were 24 men and 178 women with a mean age of 52 years. Prior surgery was unilateral in 136 cases (67%) and bilateral in 67 cases (33%), and 14 patients (6.9%) had more than 1 previous thyroid operation. For euthyroid or pretoxic recurrent nodular goiter, 190 reoperations were performed and 13 reoperations were performed for recurrent thyrotoxicosis. Twenty-three cancers were found in a specimen (11.4%). Completion thyroidectomy was done in 143 patients. Postoperative complications occurred in 21 patients (10.4%): recurrent laryngeal nerve palsy (7 patients), hypocalcemia (8 patients), hematoma requiring surgical evacuation (5 patients), and wound infection (1 patient). Complications remained permanent in 4 patients (2%). CONCLUSIONS: The permanent complication rate is higher in thyroid reoperations than in primary thyroid operations. However, we believe that this 2% rate is low enough to allow reoperation whenever it is necessary, provided precise operative rules are respected.

Adult↗
PubMed1999

Videoendoscopic thyroidectomy: experimental development of a new technique.

Applications of minimally invasive surgery have evolved from laparoscopic cholecystectomy and spread beyond conventional body cavities to new applications and disease processes. The purpose of the present study was to evaluate the feasibility of performing videoendoscopic thyroidectomy in a canine model. Adult mongrel dogs served as the experimental model for this study. The pretracheal space was entered via a 2.5-cm midline neck incision superior to the sternal notch and then expanded with a balloon spacemaker. A mechanical lift device was used to maintain exposure, and a 12-mm midline cervical port and two lateral 5-mm cervical ports were placed. Dissection was carried out with pediatric endoscopic instruments, and hemostasis was obtained with endoscopic clips and an ultrasonic coagulator. Histologic analysis of the excised tissue was performed in all cases. Mean operative time for thyroid lobectomy was 69 minutes (range 58 to 99). The laryngeal nerves and external parathyroid glands were identified endoscopically in all cases. Blood loss was minimal. No complications were observed intraoperatively or during 1 week of postoperative follow-up. Serum calcium levels were stable. No wound hematomas, laryngeal nerve injuries, or other complications occurred. On average 16 mL (range 2 to 65) of seroma fluid was present in the pretracheal space at autopsy. In conclusion, a videoendoscopic approach to thyroid lobectomy is feasible in an animal model and provides adequate visualization of the important anatomy relevant to this procedure. These techniques may be applicable to thyroidectomy in humans and may impact on minimally invasive surgery in other nontraditional locations.

Animals↗
PubMed2000

[The results of total thyroidectomy in Basedow's disease. The authors' personal experience of 180 cases].

The therapeutic guidelines of Basedow (Graves') disease are based on three different approaches: medical treatment with anti-thyroid drugs, radio-iodine therapy and surgery. This choice has increasing consensus for the great improvement of the techniques, which at the moment are practically free of mortality risks, and have very low morbidity incidence, as well as for its positive influence on the course of the Graves' ophthalmopathy. For authors' study 180 patients affected with Graves disease, who have undergone total thyroidectomy, were retrospectively enrolled. The results show that hyperthyroidism symptoms are almost completely cured in most of the subjects, with a very low rate of complications as related to nervous (ricorrential) and parathyroid gland function. Furthermore, total thyroidectomy has resulted to have a positive impact in the clinical course of Graves' ophthalmopathy, particularly regarding some aspects of the eyes involvement, which have a dramatic effect in the "quo ad valitudinem" prognosis of these patients.

Adolescent↗
PubMed1976

Investigation of luteinizing-inducing effect of pinealectomy or thyroidectomy in different types of anovulatory syndromes in rats.

The luteinizing-inducing effect of pinealectomy and of thyroidectomy was investigated in the constant estrous anovulatory (CEA) syndrome caused either by frontal hypothalamic deafferentation (FHD) or by neonatal androgen treatment (NA). Thyroidectomy failed to induce luteinization in both types of CEA syndrome. However, pinealectomy provoked the formation of corpora lutea in FHD, but not in NA induced CEA syndrome. It was concluded that the luteinizing-inducing effect of pinealectomy is a specific consequence of the removal of the pineal hormone-like principles. The differences in the mechanism of development of the CEA syndrome following FHD or NA might account for the failure of pinealectomy to elicite luteinization in the NA induced CEA rat.

Animals↗
PubMed2000

Granisetron/dexamethasone combination for the prevention of postoperative nausea and vomiting after thyroidectomy.

This study was undertaken to evaluate the efficacy of granisetron plus dexamethasone for preventing postoperative nausea and vomiting (PONV) after thyroidectomy. In a prospective, randomized, double-blind study, 130 female patients received either granisetron 40 micrograms/kg or granisetron 40 micrograms/kg plus dexamethasone 8 mg intravenously immediately before the induction of anaesthesia (n = 65 in each group). A standard general anaesthetic technique was used. A complete response (no PONV, no rescue) during the first three hours after anaesthesia occurred in 85% of patients with granisetron alone and 98% with granisetron plus dexamethasone; the corresponding incidence for the period 3 to 24 hours after anaesthesia was 86% and 98% (P < 0.05; Fisher's exact probability test). No clinically serious adverse events were observed in any of the groups. In conclusion, prophylactic use of granisetron/dexamethasone combination is more effective than granisetron alone for preventing PONV in women undergoing thyroidectomy.

Adult↗
PubMed2000

Scarless endoscopic thyroidectomy: breast approach for better cosmesis.

An original technique for performing endoscopic thyroidectomy using a breast approach to avoid an operative scar in the neck was developed. The subcutaneous space in the breast area and the subplatysmal space in the neck were bluntly dissected through a 15-mm incision between the nipples, and CO2 was insufflated at 6 mm Hg to create the operative space. Three trocars were inserted at the breast, and dissection of the thyroid and division of the thyroid vessels and parenchyma were performed endoscopically using an ultrasonically activated scalpel. Four hemithyroidectomies and one partial resection of the thyroid for five female patients with thyroid adenomas 5 to 7 cm in diameter were successfully performed using this procedure. There were no conversions to open surgery or complications. No scars were apparent in the neck, and all patients were fully satisfied with the cosmetic results. Endoscopic thyroidectomy using a breast approach and low-pressure subcutaneous CO2 insufflation is a feasible and safe procedure, which results in satisfactory cosmetic results.

Adenoma↗
PubMedDate not supplied

The inferior non recurrent laryngeal nerve: a major surgical risk during thyroidectomy.

It is now widely established that systematic intraoperative location and diligent dissection of the recurrent inferior laryngeal nerve during thyroidectomy are the keystones to assure its anatomic and functional preservation. The possibility of abnormal routes, like a non-recurrent cervical course of the inferior laryngeal nerve is an additional major argument for its systematic identification to avoid surgical damage. In 2517 cervicotomies performed between 1992 and 1997 for at least right thyroid lobe excision or parathyroid glands exploration, 20 cases of non recurrent laryngeal nerve were identified (0.79%). The embryological nature of such a nervous anatomical variation results originally from a vascular disorder, named arteria lusoria in which the fourth right aortic arch is abnormally absorbed, being therefore unable to drag the right recurrent laryngeal nerve down when the heart descends and the neck elongates during embryonic development. The surgeon must be aware of the possibility of a non recurrent laryngeal nerve, which arises directly from the cervical vagus and therefore represents a severe potential pitfall during thyroidectomy. Given the absence of reliable clinical symptoms and signs or investigations indicating preoperatively the possibility of a non recurrent nerve, guidelines are given to prevent intraoperatively this major surgical risk.

Aorta↗
PubMed2000

[Prophylactic thyroidectomy in carriers of RET oncogene mutation carriers].

BACKGROUND: Medullary thyroid cancer may be inherited dominantly. Germline mutations in the RET oncogene which code for a receptor tyrosine kinase cause MEN2. Thyroidectomy is recommended in family members who carry a mutation. MATERIAL AND METHODS: We have thyroidectomized four children from three families, 12, 10, 7 and 6 years old, because of germline mutations. RESULTS: The 12-year-old had developed a minimal medullary cancer with microscopic lymph node metastases; the others showed variable degrees of C-cell hyperplasia. The mutations were located on exon 10 (C620F) in the two patients from one family, on exon 11 (C634R) in the second family and on exon 14 (V804M) in the third family. In the families with the codon 620 and codon 634 mutations, only medullary thyroid cancer has been diagnosed. In the family with the codon 804 mutation, the index patient has been operated for a pheochromocytoma. The longterm clinical course seems more favorable in the family with the codon 620 mutation than in the two other families. With knowledge of the family mutations, we found that two out of nine family members we previously have thyroidectomized following calcitonin testing did not carry the family mutation. INTERPRETATION: Genetic diagnostic is a safe and reliable predictive test for familial medullary thyroid cancer and should be carried out in any individual with this cancer. Thyroidectomy is recommended in gene carriers at the age of six.

Adolescent↗
PubMed2000

[Thyroidectomy for Graves' disease].

In the late 19th century, surgeons in central Europe attempted to perform thyroidectomy for Graves' disease. Theodor Billroth, Theodor Kocher, and their colleagues made numerous contributions to progress in surgical methods. Preoperative arterial ligation, lobectomy, and second-stage operations were performed to reduce operative mortality rates. Lobectomy and partial resection of the contralateral lobe were performed in the 1900s, and subtotal thyroidectomy, which became the standard procedure of the day, was performed in the 1920s. Developments in medical therapy, such as iodine (1923) and thiouracil (1943) administration, also decreased postoperative mortality and morbidity rates. In 1954, radioiodine therapy was found to yield satisfactory results in achieving remission of Graves' disease. Currently, surgery for Graves' disease is indicated only in patients with large goiters or who require rapid remission.

Graves Disease↗
PubMed2001

Intravenous tramadol compared to propacetamol for postoperative analgesia following thyroidectomy.

We compared the efficacy and side effects of propacetamol (P), an injectable prodrug of acetaminophen, 2 g and tramadol (T), a weak synthetic opioid, 1.5 mg.kg-1, given intravenously following thyroidectomy. 80 patients were randomly assigned to blindly receive one dose of P or T on request in the PACU. Residual pain was treated with i.v. PCA morphine. Pain and patient satisfaction were assessed with Visual Analog Scales. Demographic and peroperative data were comparable in both groups. Although the morphine consumption was comparable (p = 0.71), the decrease in VAS pain scores was significantly higher following tramadol (p = 0.03). More patients complained of nausea and vomiting (p = 0.01) during the first two hours following injection of tramadol, but there was no difference throughout the whole study. Oversedation was not observed in any group. We conclude that a single dose of tramadol provides a better quality of analgesia than propacetamol during the first six hours after thyroidectomy, but fails to ensure optimal analgesia, since VAS pain scores failed to fall below 3 despite the use of supplemental morphine.

Acetaminophen↗
PubMedDate not supplied

Complications of thyroidectomy for benign disease.

BACKGROUND: Goitre is a common ailment seen in mountainous regions, like the periphery of Abbottabad. Thyroidectomies are very common in our center. METHODS: This study was done to find out the complication rate of thyroidectomies. RESULTS: 189 cases were operated in Ayub Hospital Complex, Abbottabad during July 96 and Dec. 99. All patients were with benign disease and any case found to have malignancy were excluded from the study. The overall complication rate for all the categories was 15%. In total 5 patients died within one month of surgery.

Female↗
PubMedDate not supplied

Video-assisted total thyroidectomy.

During the last few years, video-assisted neck surgery (VANS) became one option for thyroid and parathyroid surgery. Reports on VANS were limited to partial resection of the thyroid gland. In this study, we described total thyroidectomy in a patient with Graves' disease. The patient had a thyrotoxic periodic paralysis and methimazole-induced hepatic toxicity as well as hepatitis B virus. Two incisions of 3.5 and 3 cm were placed in the right and left subclavicular regions, respectively. A third incision of 0.5 cm was made just to the right of the midline for the camera. Devascularization of the thyroid gland was performed by using ultrasonically activated shear. Tubal drains were inserted on both sides. The patient suffered from temporary postoperative hoarseness with the voice but had a normal calcium level. The drains were removed on the first postoperative day. The use of VANS may provide a new method for total thyroidectomy with a better cosmetic outcome.

Adult↗