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PubMed2004

[Endoscopic thyroidectomy with 150 cases].

OBJECTIVE: To discuss the method, the advantages and disadvantages of endoscopic thyroidectomy. METHODS: Endoscopic thyroidectomy via areola of breasts approach was performed in 150 patients, including 41 cases of thyroid adenoma, 64 cases of nodular goiter, 40 cases of Graves' disease, and 5 cases of thyroid carcinoma. RESULTS: The endoscopic thyroidectomy was successfully carried out in 144 cases, including tumor dissection in 32 cases, one lobe partial thyroidectomy in 54 cases, two lobe partial thyroidectomy in 19 cases, subtotal thyroidectomy in 37 cases of Graves' disease, and radical thyroidectomy in 2 cases of thyroid carcinoma. The operative time length ranged from 50 to 270 min (mean 80 min). There were no complications such as damage to recurrent laryngeal nerve or parathyroid glands. Postoperative hospital stay ranged from 3 to 7 days (mean 4 days). The post-operative following-up for 1 approximately 13 months indicated that all the patients were satisfied with the cosmetic results and the same curative effects as conventional surgery were obtained. However, the operations were converted into open surgery in 6 cases. CONCLUSIONS: Endoscopic thyroidectomy is a safe and effective method of thyroid surgery. Since all the minimal incisions are on concealed parts of the body, the obvious cosmetic effect of this method is guaranteed.

Adolescent↗
PubMed2005

Characteristics of thyroidectomy in Taiwan.

BACKGROUND AND PURPOSE: Thyroidectomy is a common treatment for thyroid disorders in Taiwan, and constitutes a significant percentage of medical expenses. This study investigated the characteristics of thyroidectomy in Taiwan. METHODS: A total of 21 senior general surgeons from 16 medical centers and 5 regional hospitals participated. One surgeon from each hospital reviewed the hospital's medical records of thyroid operations performed in the year 2001. Medical records for 3846 thyroidectomies were retrospectively analyzed, including surgical indications and modalities, complications, pathology reports, and the use of antibiotics. RESULTS: Most of the patients were women (85%). Indications for surgery included proven malignancy (9%), suspicious malignancy (30%), evident compression symptoms (20%), hyperthyroidism (20%), and cosmetic reasons (12%). The majority of patients (78%) underwent a surgical procedure with lobectomy or bilateral thyroidectomy; 13% had unilateral partial thyroidectomy. Prophylactic antibiotics were administered in 46% of procedures, and continued postoperatively in 12%. Postoperative complications occurred in 12% of patients. Hypocalcemia was the most common complication (8%), and its incidence was significantly correlated with the frequency of total thyroidectomy (p < 0.01). Complete pathology reports for the thyroidectomized specimens were available in only 65% of the cases. The frequency of cosmetic reasons for surgery, unilateral subtotal resection, routine antibiotic administration, and incomplete pathology reports were significantly higher in regional hospitals than in medical centers. CONCLUSIONS: Reduction in the high rates of cosmetic reasons for surgery, unilateral partial thyroidectomy, incomplete pathology reports, and use of antibiotic prophylaxis are needed to improve the quality of thyroidectomy in Taiwan.

Adolescent↗
PubMed1986

Total or near total thyroidectomy versus limited resection for radiation-associated thyroid nodules: a twelve-year follow-up of patients in a thyroid screening program.

Controversy continues regarding the extent of thyroidectomy appropriate for patients with radiation-associated thyroid nodules. The incidence of cancer in this group of patients is more than 50% when near total or total thyroidectomy is done and all thyroid tissue is serially sectioned and examined. Tumor multicentricity is common. Is total or near total thyroidectomy warranted in all of these patients? A prospective study and follow-up program of 2118 patients with prior low-dose head and neck irradiation who entered into a thyroid screening program allowed us to examine how the extent of thyroidectomy influenced the clinical course of these patients. Near total or total thyroidectomy was performed in 59 patients (36 had cancer), and limited thyroid resection, that is, lobectomy or less, was done in 78 patients (four of whom had cancer). During follow-up, only three patients have developed recurrent cancer; two had near total thyroidectomy and one had total thyroidectomy at first operation. Two patients with limited thyroid resection have had reoperation for new thyroid nodules, both of whom had benign nodules. We conclude that although limited thyroid resection may leave occult malignancies in unresected thyroid tissue, there is no significant difference in outcome between patients with limited resection and those with near total or total thyroidectomy after a 12-year follow-up of the program. Significant differences in cancer recurrence rats may occur with longer follow-up.

Follow-Up Studies↗
PubMed1997

[Thyroidectomy without drainage].

Recent randomized series did not support routine prophylactic drainage after thyroidectomy. We undertook a prospective study in order to evaluate the effectiveness and the morbidity of a non drainage strategy after thyroidectomy. Between april 1993 and may 1995, one hundred fifty consecutive patients underwent thyroidectomy without drainage. During this period, two thyroid cancers were treated by total thyroidectomy with a modified radical neck dissection and drainage; they are not included in the study. Age range was 16 to 72 years. Sex ratio was 126F/124M. Indication for surgery was: solitary nodule (16), multinodular goiter (56), Graves' disease (21), toxic nodular goiter (34), cancer (8), retrosternal goiter (13), thyroiditis (2). The surgery done was: total lobectomy + isthmusectomy (15), total lobectomy + subtotal controlateral thyroidectomy (42), bilateral subtotal thyroidectomy (84), total thyroidectomy (9). Surgical technique was identical to that used previously by the author when drainage was installed routinely. Patients left the hospital on the first or second postoperative day and were reexamined on day 7 and day 30. There was no mortality, no suffocating hematoma, no reoperation and no laryngeal nerve paralysis. One patient developed a transient hypocalcemia that regressed one month later. Two patients developed a minor hematoma of which one disappeared after two weeks and the other drained spontaneously through the surgical incision on the seventh postoperative day. We conclude that drainage after thyroidectomy has no adverse effects and can be avoided if meticulous surgery is done. Absence of drainage simplifies the early postoperative course, improves the comfort of the patient, decreases hospital stay and reduces hospital cost. However, drainage may be of value in case of hemostatic problems or associated cervical neck dissection.

Adolescent↗
PubMed1998

[Hypoparathyroidism after thyroidectomy. Analysis of a consecutive, recent series].

We analyzed a recent and consecutive series of 254 thyroidectomies performed during the last year to verify the incidence of post-thyroidectomy hypoparathyroidism. 249 patients were included in the study and were divided into 2 groups according to the extension of the thyroidectomy. In the first group of 49 patients treated by lobectomy no one developed hypoparathyroidism. In the second group of 200 patients, of which 53 were treated by subtotal and 147 by total thyroidectomy, postoperative hypoparathyroidism was found in 28 (14%) patients, but it was persistent (lasting six months or longer) in 8 (4%). Global incidence of postoperative hypoparathyroidism was statistically higher in total thyroidectomy vs subtotal thyroidectomy (17% vs 5.66%; p < 0.05); however persistent hypoparathyroidism incidence wasn't statistically higher in total thyroidectomy (5.4% vs 0%; p = n.s.). As far as thyroid disorders that require bilateral thyroidectomy Chi 2-test showed a trend of persistent hypoparathyroidism to be more frequent in patients operated on for Graves' disease and thyroid cancer than in other thyroid disorders.

Adolescent↗
PubMed2001

Thyroidectomy for selected patients with thyrotoxicosis.

OBJECTIVE: To examine the indications for operation and the frequency, efficacy, and outcome of surgical therapy for thyrotoxicosis. METHODS: The medical records of all patients who underwent thyroidectomy between 1990 and 1998 were reviewed. Operative indications, laboratory evaluations, extent of thyroidectomy, pathologic findings, and morbidity and mortality were determined for patients with thyrotoxicosis. RESULTS: Of the 347 patients who underwent thyroidectomy, 54 (16%) had thyrotoxicosis, secondary to Graves' disease (32 patients), toxic multinodular goiter (18 patients), thyroiditis (2 patients), or amiodarone (2 patients). The indications for operation were compressive symptoms or substernal extension or both (35 patients), patient preference (12 patients), thyrotoxicosis (4 patients), or a dominant nodule (3 patients). Most patients received pharmacological preparation, followed by total (32 patients), near-total (13 patients), subtotal (8 patients), or unilateral (1 patient) thyroidectomy. The initial 8 patients with Graves' disease underwent subtotal thyroidectomy, and after a mean 28-month follow-up, 1 was euthyroid; 2, hyperthyroid; and 5, hypothyroid. Associated carcinoma was present in 4 (7%) of the 54 patients. Symptomatic hypocalcemia occurred in 10 patients (19%), with a mean free thyroxine level of 60.49 +/- 16.09 pmol/L vs 40.41 +/- 19.56 pmol/L (4.70 +/- 1.25 ng/dL vs 3.14 +/- 1.52 ng/dL) in 25 patients (46%) with asymptomatic hypocalcemia (P<.05). Vocal cord paresis and a hematoma requiring operative evacuation occurred in 1 patient each. There was 1 mortality in a patient with amiodarone-induced thyrotoxicosis. CONCLUSIONS: Massive thyroid enlargement with compressive symptoms, a dominant nodule, and patient preference are indications for surgical treatment of thyrotoxicosis. Near-total or total thyroidectomy is safe and more effective than subtotal thyroidectomy in preventing recurrence and should be considered in most patients referred for surgical treatment of thyrotoxicosis. Transient postoperative hypocalcemia is common and is related to the severity of thyrotoxicosis.

Adult↗
PubMed2004

Near-total thyroidectomy could be the best treatment for thyroid disease in endemic regions.

HYPOTHESIS: Near-total thyroidectomy, on the basis of its low morbidity rate, is an appropriate treatment option in the surgical management of various thyroid diseases in an endemic region in Turkey. DESIGN: Single-institution study of patients with various thyroid diseases treated by means of near-total thyroidectomy within 2 years in an endemic region, with comparison of the results vs the complication rates of bilateral subtotal and total thyroidectomy reported in the literature. SETTING: Tertiary academic referral center. PATIENTS: One hundred fifty-two patients who underwent near-total thyroidectomy for various thyroid diseases. MAIN OUTCOME MEASURES: Surgical treatments of various benign thyroid diseases were compared according to the complication rates and the achievable benefits of the procedures. RESULTS: In our clinic, near-total thyroidectomy was the principal surgical procedure performed for benign thyroid disease. The temporary recurrent laryngeal nerve palsy rate with respect to the nerves at risk was 3.3% (10 of 304 nerves), whereas temporary hypoparathyroidism was 7.2% (11 of 152 patients). Neither permanent recurrent laryngeal nerve palsy nor permanent hypoparathyroidism occurred. In 1 patient, wound hematoma developed and required re-exploration. Seroma in another patient needed no medical or surgical intervention. Neither wound infection nor mortality were noted. CONCLUSIONS: Near-total thyroidectomy achieves a lower complication rate of hypoparathyroidism and a similar complication rate of recurrent laryngeal nerve palsy and recurrence when compared with the rates reported in the literature for total thyroidectomy. It is an effective and safe surgical treatment option for various benign thyroid diseases.

Adult↗
PubMed1992

Hypocalcemia after thyroidectomy.

Serum calcium, sodium, potassium, chloride, magnesium, phosphorus, osmolarity, total protein, albumin, parathyroid hormone, and calcitonin values were systematically surveyed in 135 patients who underwent thyroidectomy and in 104 control surgical patients. A transient and moderate hypocalcemia developed after operation in thyroidectomized and control patients. Concentrations of other electrolytes, osmolarity, proteins, and albumin followed the same pattern of evolution. After thyroidectomy, the degree and duration of hypocalcemia increased with the extent of thyroid resection. A profound hypocalcemia (less than 2.0 mmol/L) and a marked reduction of the parathyroid hormone concentration (below normal) were present in 12% and 8% of cases after subtotal thyroidectomy and in 22% after total thyroidectomy. Calcitonin values did not increase after thyroidectomy. A slight correlation was observed between the preoperative serum alkaline phosphatase level and the minimal postoperative serum calcium level. It is concluded that post-thyroidectomy hypocalcemia is a multifactorial phenomenon. It is due, at least in part, to hemodilution. A temporary parathyroid insufficiency after subtotal and total thyroidectomy, and an avidity of the skeleton for calcium in hyperthyroid patients, may aggravate the hypocalcemia.

Adolescent↗
PubMed2006

Thyroidectomy and hypoparathyroidism in patients with pharyngoesophageal tumors.

BACKGROUND: Total pharyngolaryngoesophagectomy and gastric transposition (TPLEGT) for pharyngoesophageal (PE) tumors may require thyroidectomy (with or without removal of the parathyroid glands) to obtain adequate margins around the tumor. As a result, a considerable number of patients may have hypoparathyroidism (HP) develop. The objective of this article is to report our experience with different types of thyroidectomy and to describe the relationship of thyroidectomy to HP in TPLETG. These results are compared with data in the literature. METHODS: From 1985 to 2001, 40 patients underwent TPLEGT, with main index tumors in the esophagus (n = 17), hypopharynx (n = 17), and larynx (n = 6). All patients had advanced cTNM or pTNM stages (III or IV). Postoperative HP was diagnosed based primarily on the symptoms and calcium and phosphorus analysis but not on parathyroid hormone (PTH) levels. RESULTS: Total thyroidectomy (TT) was done in 12 (30%) patients and 11 (91.6%) had permanent HP develop. In none of these patients was the parathyroid separated and implanted (fear of a tumor implant). Partial thyroidectomy (PT) (lobectomy and isthmus) was done in 25 (62.5%) patients, and permanent HP occurred in 11 (44%) patients. The thyroid was preserved in three patients, and none had HP develop. Of the 40 patients, 13 (32.5%) had no HP, five (12.5%) had temporary HP, and 22 (55%) had permanent HP. There was a correlation between the type of thyroidectomy, location of primary tumors, and development of HP. Only seven reports in the past 30 years have dealt with TPLEGT, thyroidectomy, and HP. HP occurred in 32.5% of the cases of TT and in 19.5% of the cases of PT. CONCLUSIONS: Permanent HP was very frequent (55%) in our series. In patients who underwent TPLEGT, HP was almost certain when TT was done (91.6%). PT was no guarantee that HP would not occur (44% permanent HP). The frequency of permanent HP based on primary index tumors was 47%, 59%, and 66.6% for esophageal, hypopharyngeal, and laryngeal cancer, respectively.

Adult↗
PubMed2006

Intraoperative parathyroid hormone assay for management of patients undergoing total thyroidectomy.

BACKGROUND: Rapid parathyroid hormone (PTH) assay has been applied to predict hypocalcemia after thyroidectomy compared with conventional close monitoring of serum calcium levels. We evaluated the reliability of intraoperative intact PTH (ioPTH) assay to predict hypocalcemia after total thyroidectomy and sought to develop an algorithm for the management of postthyroidectomy patients. METHODS: Rapid PTH assays were performed before and after thyroidectomy for 92 new patients receiving total thyroidectomy. Preoperative and postoperative serum calcium and standard PTH levels were serially obtained to 6 months after surgery RESULTS: Postoperative hypocalcemia developed in 34 of 92 patients (37%), who showed significantly lower ioPTH values compared with those of normocalcemic patients (mean 9.2 pg/mL vs 31.3 pg/mL). The ioPTH levels were significantly correlated with standard PTH levels (p < .001, r > 0.62), but not with early serum calcium levels within 8 hours after the operation. Sensitivity and specificity of ioPTH levels of <15.0 pg/mL for the prediction of postoperative hypocalcemia were 85% and 84%, respectively. A value of >15.0 pg/mL and <70% decline in ioPTH after thyroidectomy can reliably identify normocalcemic patients during thyroidectomy or patients requiring close monitoring and early calcium supplement CONCLUSIONS: Rapid ioPTH assay can reliably monitor parathyroid function after thyroidectomy and predict postoperative hypocalcemia. The proposed algorithm based on rapid PTH levels will lead to improved prediction of normocalcemic patients.

Adolescent↗
PubMedDate not supplied

The incidence of bilateral well-differentiated thyroid cancer found at completion thyroidectomy.

The purpose of this study was to evaluate the surgical outcome of completion thyroidectomy in patients with presumed unilateral well-differentiated thyroid cancer (WDTC). The medical records of all patients having had unilateral thyroid lobectomy for WDTC, who subsequently underwent completion thyroidectomy, were reviewed. From 1980 to 1991, 60 patients with WDTC underwent completion thyroidectomy. Forty-seven patients had presumed unilateral WDTC, with no evidence of residual disease prior to their completion thyroidectomy. Twenty-five (53%) of these patients were found to have residual neoplastic disease in the neck. In 20 (43%) of 47 patients, a focus of cancer was found in the remaining thyroid lobe and in 5 additional patients no cancer was found in the contralateral lobe, however, unsuspected nodal disease was found. The remaining 13 of the 60 patients presented with either regional recurrence (n = 12) or distant metastases (n = 1) at the time of their completion thyroidectomy. All (92%) but 1 of these 13 patients had cancer in the remaining thyroid lobe. Multifocal disease in the primary lobe was associated with bilateral thyroid cancer (p less than 0.01). Complications were infrequent; transient hypocalcemia occurred in 5 (8%) patients, permanent hypoparathyroidism occurred in 1 (1.7%) patient, and transient recurrent laryngeal nerve palsy occurred in 3 (5%) patients. Residual WDTC was found in 37 (62%) of 60 patients undergoing completion thyroidectomy. Multifocal disease in the primary resected lobe was associated with a high incidence of contralateral thyroid cancer. Completion thyroidectomy is a safe procedure and may prevent the development of regional recurrence by eliminating an unsuspected focus of cancer.

Adenocarcinoma↗
PubMed2006

Identification of patients at low risk for thyroidectomy-related hypocalcemia by intraoperative quick PTH.

BACKGROUND: Transient hypoparathyroidism is a frequent and challenging complication following total thyroidectomy. The aim of the study was to identify patients at risk of developing thyroidectomy-related hypocalcemia and symptoms by means of the intraoperative quick parathyroid hormone (PTH) assay. METHODS: Eighty-one patients undergoing total thyroidectomy were included in the study. Quick PTH levels were measured at induction of anaesthesia and 10 minutes after total thyroidectomy. A sample of 10 patients who underwent unilateral thyroid lobectomy was considered as a control group. The accuracy of intraoperative PTH decline in predicting postoperative hypoparathyroidism was analysed. RESULTS: After total thyroidectomy, 27 patients (33.3%) developed postoperative hypocalcemia. Symptoms were reported by 21 patients (25.9%). The mean percentage decline of intraoperative quick PTH was 81% in hypocalcemic compared with 39% in normocalcemic patients (P<0.001), and it was 83% in symptomatic compared with 42% in asymptomatic patients (P<0.001). Mean proportion decline of quick PTH after unilateral lobectomy was 20%, significantly lower than the 53% registered after total thyroidectomy (P=0.005). Analysis of variation of intraoperative quick PTH with the receiver operator characteristics (ROC) curve showed a 75.7% decline as the cut-off value predicting postoperative hypocalcemia with the highest accuracy (91.4%) (sensitivity: 81.5% specificity: 96.3% positive likelihood ratio: 22; negative likelihood ratio: 0.2). Regarding the prediction of postoperative symptoms, a 79.5% decline was the most accurate (92.6%) cut-off point (sensitivity: 76.2% specificity: 98.3% positive likelihood ratio: 46; negative likelihood ratio: 0.2). CONCLUSIONS: Quick PTH monitoring during total thyroidectomy is a useful means for identifying low-risk patients for postoperative hypoparathyroidism and candidates for early, safe discharge. Furthermore, it is an objective method complementary to the surgeon's judgement of the intraoperative function of parathyroid glands, which should be implanted in the event of a 75%-80% decline.

Adult↗
PubMed2000

Hypomagnesemia and hypocalcemia after thyroidectomy: prospective study.

Hypomagnesemia after total thyroidectomy has not been studied extensively. Our anecdotal experience suggests that it may be important in some patients after thyroid excision. The hypomagnesemic hypocalcemic syndrome has been described in other disease states in which a state of functional hypoparathyroidism exists. This study was designed to determine the incidence of hypomagnesemia after total thyroidectomy and relate it to hypocalcemia and symptoms during the postoperative period. A prospective study of all patients undergoing total thyroidectomy between September 1994 and July 1996 was performed. Patient data, thyroid function, retrosternal extension, initial versus reoperative surgery, operative details, parathyroid resection, and pathology were recorded. Calcium, magnesium, electrolytes, blood count, liver function tests, and albumin were measured prior to surgery and twice daily during the postoperative period. Fifty patients underwent total thyroidectomy: 68% were hypocalcemic, 72% were hypomagnesemic, and 36% were symptomatic during the postoperative period. Hypomagnesemia and gender were associated with hypocalcemia. Volume of fluid and neck dissection were associated with low magnesium levels. Hypomagnesemia and parathyroid resection were risk factors for symptoms after thyroidectomy. No patients developed permanent hypoparathyroidism. Transient hypocalcemia and hypomagnesemia occur frequently after total thyroidectomy. The etiology of this phenomenon is probably multifactorial. Patients are more likely to be symptomatic when both cations are low, and attempting to correct only hypocalcemia may prolong symptoms. It is important to monitor both calcium and magnesium levels after total thyroidectomy and to correct deficiencies to facilitate prompt resolution of symptoms.

Adult↗
PubMed1982

Effect of thyroidectomy on pregnenolone and progesterone biosynthesis in rat adrenal cortex.

The effects of thyroidectomy on pregnenolone and progesterone biosynthesis were investigated in rat adrenal cortex mitochondria and microsomes. The sequential hydroxylations of cholesterol, and the latter's side-chain cleavage, which constitute the limiting step in steroidogenesis, were studied by measuring oxygen consumption rates in the presence of cholesterol derivatives. The addition of (20R)-hydroxycholesterol, (22R)-hydroxycholesterol or (20R,22R)-dihydroxycholesterol stimulated these rates, but addition of cholesterol or (22S)-hydroxycholesterol had little effect. Thyroidectomy significantly reduced oxygen consumption rates in the presence of the sterols by about 30%. Oxygen uptake was small in the presence of respiratory inhibitors; the addition of sterols raised this uptake but subsequent thyroidectomy did not change it. Rat adrenal cortex mitochondria and microsomes converted pregnenolone ino progesterone through 3 beta ol dehydrogenase/delta 4-5 isomerase, in two different successive steps. Values for enzyme activities were 0.18, 0.26 and 0.81 nmol progesterone/min/mg protein for the overall complex, the 3 beta ol dehydrogenase and the delta 4-5 isomerase respectively. All enzyme activities were unchanged by thyroidectomy. Similar results were obtained for corresponding microsomal activities whose values were in the same range. For both microsomes and mitochondria, the dehydrogenase reaction was the limiting step in the enzyme reaction leading to progesterone formation from pregnenolone. The limiting step in corticosteroidogenesis leading to prenenolone formation by an NADPH-dependent step was slowed down by thyroidectomy, probably because the reaction that transfers energy from NADH to NADP was inhibited. The enzyme complex leading to progesterone which involves NAD+ as cofactor, was unchanged by thyroidectomy. Thyroid hormones may therefore affect the availability of the energy mechanisms connected with the proton motive force, since thyroidectomy reduces both the phosphorylative oxidation and energy-dependent hydroxylation reactions involved in steroidogenesis.

Adrenal Cortex↗
PubMed1988

Thyroid cancer: the case for total thyroidectomy.

Since there are no prospective studies concerning the treatment of thyroid cancer, there continues to be a considerable disagreement about the 'best' or most appropriate form of surgical treatment for patients with papillary or follicular thyroid cancer. Some surgeons recommend selective treatment depending upon the type of thyroid tumor and stage of the disease. Some advocate thyroid lobectomy and isthmusectomy, some near total thyroidectomy, and some total thyroidectomy for patients with papillary and follicular thyroid cancer. Total thyroidectomy for thyroid cancer would be the treatment of choice for virtually all patients with thyroid cancers if it could be done without complications. We therefore reviewed 160 consecutive patients who had total thyroidectomy for suspected or proven thyroid cancer to determine the complication rate of total thyroidectomy. One hundred and three patients had primary operations, 57 had reoperations with completion of total thyroidectomy and 124 had thyroid cancer. Serious complications (i.e. vocal cord paralysis or hypoparathyroidism) included two cases of transient bilateral recurrent nerve palsy, two patients with presumed transient unilateral vocal cord paralysis, three recurrent laryngeal nerves that were purposely sacrificed because of invasion of the nerve, and one case of permanent hypoparathyroidism. Two other patients developed postoperative wound infections. Only one of the permanent complications, the case of permanent hypoparathyroidism, could have been avoided by a lesser procedure. The experienced surgeon can perform a total thyroidectomy with minimal morbidity, and this procedure has certain theoretical and practical advantages. It should not be done, however, if it will result in a significant complication rate and, in selected patients, it may be preferable to leave a small amount of thyroid tissue to protect the blood supply to the parathyroid glands or recurrent laryngeal nerve.

Humans↗
PubMed2003

[Endoscopic thyroidectomy for solitary nodules].

INTRODUCTION: The aim of this study was to assess the feasibility and safety of endoscopic thyroidectomy. MATERIALS AND METHODS: Between September 1998 and February 2000, 18 patients with a solitary thyroid nodule underwent endoscopic thyroidectomy in a single institution. Analgesic requirement, return to normal activity, and cosmetic results were compared to 18 consecutive patients who had conventional thyroidectomy. RESULTS: Sixteen females and two males, with a mean age of 43 years (17-66 years) were operated on. Indications for surgery included indeterminate cytology (n = 8), follicular neoplasm (n = 8), Hürthle cell neoplasm (n = 1), and toxic thyroid nodule (n = 1). The mean nodule diameter was 2.7 cm (0.6-7 cm). Sixteen of 18 cases were successfully completed endoscopically with a mean operating time of 220 min (120-330 min). There were no major complication, but three patients developed mild hypercarbia and one patient had an incidental parathyroidectomy. When compared to conventional thyroidectomy, patients undergoing endoscopic thyroidectomy had a significantly superior cosmetic result (P < 0.005) and a quicker return to normal activity (P < 0.05), but there was no difference in analgesic requirement. CONCLUSION: The results of this study seem to confirm that endoscopic thyroidectomy is a technically feasible and safe procedure that leads to an improved cosmetic result and a quicker recovery. However, conventional thyroidectomy is still recommended when thyroid carcinoma is suspected.

Adolescent↗
PubMed2005

Changes in ovarian steroidogenesis in insulin-resistant, type 2 diabetic Goto-Kakizaki rats after thyroidectomy and gonadotropin treatment.

The present study used thyroidectomized insulin-resistant, type 2 diabetic Goto-Kakizaki (GK) rats to assess whether insulin resistance and hypothyroidism modulate ovarian physiology. Animals were treated with daily injections of 5 IU equine chorionic gonadotropin for 5 days starting 1 week after thyroidectomy. Control groups included rats of GK and control (Wistar) strains treated only with equine chorionic gonadotropin or thyroidectomy, or with no treatment (intact). In Wistar rats, equine chorionic gonadotropin injections tended to increase the serum concentrations of luteinizing hormone (LH) and testosterone more in the thyroidectomy group than in intact rats. Similar changes in LH and testosterone were observed in the thyroidectomy + equine chorionic gonadotropin and equine chorionic gonadotropin groups of GK rats, but the LH and testosterone levels in the thyroidectomy + equine chorionic gonadotropin group were significantly higher in GK rats. Expression of ovarian LH receptor messenger RNA (mRNA) was enhanced by thyroidectomy. The LH receptor mRNA levels were significantly higher in the thyroidectomy+equine chorionic gonadotropin group of GK rats than in the corresponding group of control rats. These results indicate that hypothyroidism in animals with insulin resistance and type 2 diabetes promotes LH and testosterone secretions, and suggests that the enhanced-testosterone levels is partially mediated by the enhancement of LH receptor expression and an increase in the serum level of LH.

Animals↗
PubMed2003

Comparison of completion thyroidectomy and primary surgery for differentiated thyroid carcinoma.

AIM: The objective of this study is to analyze the complication rates after the completion thyroidectomy and compare them with primary total thyroidectomy. METHODS: The outcomes of patients with differentiated thyroid carcinoma who were operated over a period of eight years were evaluated. One hundred and forty-one patients underwent completion thyroidectomy and 92 patients had primary surgery. RESULTS: The two groups were comparable in respect of clinical variables. Residual tumor was found in 66 of 141 patients (46.8%) in completion thyroidectomy group. The rate of the two most important complications, permanent recurrent laryngeal nerve palsy and permanent hypoparathyroidism were 3.5 and 4.2%, in completion thyroidectomy group, and 3.3 and 4.3%, in primary total thyroidectomy group. The complication rates were not significantly different between groups. CONCLUSION: In conclusion, completion thyroidectomy can be done safely in a specialized center with acceptable morbidity.

Adenocarcinoma, Follicular↗