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PubMedDate not supplied

[Ultrasonic dissector for total thyroidectomy: results of prospective randomized study].

In the last years, the introduction and employment in surgery of the dissectors of last generation (ultrasounds, radiofrequency, etc.) have contributed to a remarkable improvement and simplification of the performances and the surgical techniques. The present study has the aim to verify, on the basis of the experience made in the last two years and through a careful comparisons with operations performed in the usual way, the advantages of employment of ultrasonic dissector in thyroid surgery and if besides such advantages it is possible to obtain real and substantial reductions of the complications. To such aim a randomized perspective study has been lead, confronting two groups of 60 patients, submitted to total thyroidectomy in Chair of General Surgery and Surgical Physiopathology of the University of Palermo-Complex Operating Unit of General Surgery. In all patients have been considered age, sex, histological diagnosis, length of the incision, time (from the incision until suture of skin), entity of the bleeding, hospital stay, post-operative consequences and total costs of thyroidectomy. The elaboration of the obtained data shows the advantages following to the use of the dissectors of last generation: reduction of the times, reduction of the complications, better tolerance of the operation by patients, better rationalization of the resources.

Adult↗
PubMed2005

Prospective analysis of 518 cases with thyroidectomy in Turkey.

OBJECTIVE: Thyroid malignancies can present in different manners, among them as asymptomatic solid nodule being the most puzzling. Nodules have been found in the 60-70 % of autopsy specimens and it is very important to rule out the malignancies in such cases. Incidence of carcinomatous changes is reported in 5-15 % of solitary nodules. We present the results of prospective study on 418 thyroidectomies with the aim to review the experience of our unit, to establish the correlation between clinical presentation and histopathology, to discuss the malignancy rates and surgical complications. PATIENTS AND METHODS: Five hundred eighteen consecutive cases of thyroidectomy 419 female (80.8 %), and 99 male (19.2 %) patients performed between January 2002 and October 2004 were included in this prospective study. RESULTS: In 71 (13.7 %) cases the malignancy was found by paraffin specimens, the highest prevalence of malignancy being found in patients with nodular goiter (NG-18 %) followed by 14.6 % in multinodular goiter (MNG). The sensitivity of preoperative fine needle cytology (FNAC) was 83.3 % with false positive rate of 1.3 %. Complications were seen in 5.2 % of cases of which 4 (0.7 %) had hypoparathyroidism and 7 (1.3 %) had recurrent laryngeal nerve injury. All patients observed came from endemic area. Family history nearly doubles the risk of malignancy. CONCLUSIONS: In an endemic area the nodular goiter is the most common. Preoperative cytology, although sensitive, gives a considerable number of false positive results. Results of thyroid surgery at a high volume centre are satisfactory with very low rates of recurrent laryngeal nerve and parathyroid injury. Probability of malignant transformation in a long standing thyroid swelling should always be kept in mind. There appears to be an increase in prevalence of thyroid malignancies in Turkey after Chernobyl disaster.

Adult↗
PubMed2005

Profound refractory hypocalcemia after thyroidectomy in a patient receiving chronic oral bisphosphonate therapy.

The use of oral bisphosphonates in the primary care setting is increasing, most commonly to preserve bone density and prevent the development or progression of osteoporosis. We report a case of profound hypocalcemia occurring in a patient who underwent thyroidectomy while receiving chronic oral risedronate therapy for osteoporosis. In addition, the hypocalcemia was refractory to treatment for several days, necessitating a prolonged hospital stay. A review of the literature yielded no similar cases to date. We propose that the frequently observed transient hypocalcemia after thyroidectomy was exacerbated by the alterations in calcium homeostasis produced by bisphosphonate therapy and urge cessation of these agents for several weeks prior to surgery. A review of the relevant literature is provided.

Aged↗
PubMed2006

Emergency thyroidectomy in a patient with severe upper airway obstruction caused by goiter: case for regional anesthesia.

A case of severe airway obstruction caused by a giant malignant goiter is presented. The patient had emergency thyroidectomy under regional anesthesia (bilateral superficial cervical plexus block). The procedure was well tolerated and the intraoperative course was uneventful. The anesthetic challenges are discussed and a case is made for regional anesthesia as a safe and reliable anesthetic option for thyroidectomy in this situation.

Aged↗
PubMed2006

The effects of the prophylactic tropisetron-propofol combination on postoperative nausea and vomiting in patients undergoing thyroidectomy under desflurane anesthesia.

PURPOSE: To evaluate the efficacies of tropisetron and tropisetron-propofol combination in the prophylaxis for postoperative nausea and vomiting in patients undergoing thyroidectomy under desflurane anesthesia. (This combination has apparently not been previously investigated for this particular surgery and anesthesia.) METHODS: Prospective, randomized, double-blind study. One hundred five patients aged between 19 and 68 years were included in the study. Group T received 5 mg of tropisetron (tropisetron group. n=35), group TP (tropisetron-propofol group, n=35) received 5 mg of tropisetron and 0.5 mg/kg of propofol and group P (placebo group, n=35) received saline, immediately after anesthesia induction. The anesthesia induction regimen was applied to all patients, and anesthesia was maintained with 5-7% desflurane and 66% N 2 O in O 2 . RESULTS: Group TP reported a lower incidence of postoperative nausea and vomiting (17%) than those in groups T and P (42.8% and 77%, respectively). The postoperative antiemetic requirements were significantly higher in the placebo group compared to the other two groups (p<0.05). CONCLUSION: The tropisetron-propofol combination is more effective than tropisetron alone in the prevention of postoperative nausea and vomiting after thyroidectomy.

Adult↗
PubMedDate not supplied

Total thyroidectomy in amiodarone-induced thyrotoxicosis. Preoperative, intraoperative and postoperative considerations.

A female patient was admitted to our Department for total thyroidectomy in amiodarone-induced thyrotoxicosis. The drug was prescribed for ventricular arrhythmia and atrial paroxysmal fibrillation in dilated cardiomyopathy due to chronic aortic regurgitation with left ventricular dysfunction (ejection fraction 35%; Class Functional NYHA III) and moderate-severe respiratory insufficiency. The cardiologist-anesthetist team has allowed to evaluate the surgical-cardiovascular-anesthesiologic risks and the balance between the improvement by the amiodarone administration for the arrhythmia, and the discontinuation of this treatment in order to prevent aggravation of the thyrotoxicosis. These hypotheses were subsequently discharged for the two reasons listed below: - several other antiarrhytmic drugs (that didn't show equivalent efficacy as amiodarone in preventing or converting such ventricular and atrial arrhythmias) may be proposed in the place of amiodarone. However, this could expose the patient to an arrhythmia; - a clear proof that the suspension of amiodarone can allow restoring normalization of the thyroid function doesn't exist. Therefore, the patient has been successfully submitted to the surgical intervention and in the follow-up we brought her back to a state of normalized thyroid function and cardiovascular conditions. In patients that cannot safely discontinue amiodarone or when medical therapy is ineffective in controlling thyrotoxicosis, thyroidectomy is the treatment of choice.

Aged↗
PubMed2006

[Endoscope-assisted thyroidectomy with minimal incision in neck].

OBJECTIVE: To explore the feasibility of endoscope-assisted thyroidectomy with minimal neck incision. METHODS: Endoscope-assisted thyroid surgeries had been accomplished through incision above sternal notch and in submental area respectively from August 2003 to August 2005, including 11 partial lobectomy, 3 lobectomy, 2 two-sides partial lobectomy, 1 isthmectomy. RESULTS: In this group, 12 cases approached through above sternal notch, 5 cases approached through the submental area, and all were successful. The mean length of incisions was 2.3 cm (range from 1.5 cm to 3.0 cm). No one was converted to open surgery. The mean time of operation was 61.3 minutes (range from 30 minutes to 120 minutes). The mean volume of hemorrhage during the operation was 15.6 ml (range from 10 to 40 ml). The mean volume of drainage of post-operation was 22.5 ml (range from 6 ml to 40 ml). The mean length of stay was 4. 5 days (range from 3 days to 6 days). There were no hoarseness and no low serum calcium. Following visits were performed after operation from 1 month to 12 months, and there were no stiff feelings on skin. The cosmetic outcomes of the incisions were good, except 1 case for scar physique. CONCLUSIONS: Endoscope-assisted thyroidectomy was safe and feasible with good cosmetic outcome. The selection of approach with minimal incision depends on the location of neoplasm.

Adult↗
PubMed2006

Postoperative analgesic effects of lornoxicam after thyroidectomy: a placebo controlled randomized study.

The purpose of the present study was to determine the postoperative analgesic effects of lornoxicam and the reduction in tramadol consumption. Fourty patients of ASA class I-II, 18-70 years of age, undergoing thyroidectomy were assigned in a randomized manner into two groups: GroupL received 8 mg of lornoxicam i.v. at the end of the operation followed by 8 mg of lornoxicam b.i.d., i.v. for 24 hours postoperatively. GroupP received 4 ml of saline solution i.v. at the end of the operation and the same amount b.i.d., i.v. for 24 hours postoperatively. The requirements for supplemental analgesics were recorded at 0-6, 6-12 and 12-24 hour intervals. Postoperative pain scores were evaluated at 15th min. and 1, 2, 4, 6, 8, 12, 18 and 24th hours using Visual Analogue Scale (VAS). The time to first analgesic requirement was significantly longer in GroupL compared to GroupP (101.7 vs 37.9 min, p<0.001). Pain scores were significantly lower in GroupL compared to GroupP at 15th min, 1, 8 ,12 and 18th hours. Twenty four hour analgesic consumption was significantly lower in GroupL compared to GroupP (p<0.05). The amount of tramadol consumed in GroupL was 60% lower compared to GroupP (100 mg and 250 mg (mean), respectively). 100% of the patients in GroupL and 60 % of the patients in GroupP needed supplemental analgesics. The degree of satisfaction with postoperative pain management was excellent in 95 % of patients in GroupL and 25 % of patients in GroupP. Eighteen patients in GroupP and 9 patients in GroupL had nausea (p=0.002), and fifteen patients in GroupP and 8 patients in GroupL had vomiting (p=0.025). Lornoxicam decreased the opioid need, the incidence of nausea and vomiting and postoperative pain scores. Moreover, it was observed that the time needed for the first analgesic requirement was prolonged following thyroidectomies.

Adolescent↗
PubMed2006

[Minimally invasive video-assisted thyroidectomy (MIVAT)].

Minimally invasive video-assisted thyroidectomy (MIVAT) was published in 1998. In this paper authors describe their initial experiences with this new technique, which is the first publication in their country on this topic based on authors knowledge. Ten patients were selected for MIVAT. Selection criteria were nodule size less than 30 mm, thyroid lobe volume less than 20 ml, no thyroiditis, no previous neck surgery or irradiation. The procedure was carried out through a 20-25 mm central incision above the sternal notch. Dissection was performed under endoscopic vision, using endoscopic, some special and conventional instruments. Authors performed 1 total thyroidectomy, 6 lobectomies, 2 lobectomies with subtotal resection on the opposite side, and 1 resection of thyroid isthmus. Mean operative time was 77 minutes. No conversion to open procedure was performed. No recurrent laryngeal nerve palsy or postoperative hypocalcemia were observed postoperatively. The mean hospital stay was 2 days. The cosmetic result and the postoperative distress were considered very good by the patients. The authors conclude that MIVAT is a safe and feasible procedure. The indications are limited, but in this small group of patients offer excellent cosmetic results with less postoperative distress.

Adult↗
PubMed2006

[Effect of electroacupuncture on bispectral index of electroencephalography in patients undergoing subtotal thyroidectomy].

OBJECTIVE: To investigate the effects of electroacupuncture on bispectral index (BIS) of electroencephalography in patients undergoing subtotal thyroidectomy. METHODS: Sixty patients were equally randomized into group A given electroacupuncture combined with cervical plexus block (CPB) and group B given CPB alone. After needling sensation was reached in bilateral "Hegu" and "Neiguan" acupoints, 5 min of high frequency electrical stimulation by electrical stimulation device followed with CPB was applied to group A, while only CPB was performed in group B. Visual analog scale (VAS) and verbal stress scale (VSS) were monitored, complication and adverse reaction were observed and BIS, mean arterial pressure (MAP), heart rate (HR) and arterial oxygen saturation (SaO2) were monitored continuously in the perioperative period. RESULTS: HR increased and BIS decreased in group A, both were lower significantly than those in group B (P < 0.01); MAP, the complementary dosage of fentanyl and lidocaine used and scores of VAS and VSS were also lower in group A than those in group B (P < 0.01). CONCLUSION: Electroacupuncture could enhance the anesthetic effect of CPB, lower the BIS value during subtotal thyroidectomy.

Acupuncture Analgesia↗
PubMed1991

Thyroidectomy and parathyroidectomy in the dog and cat.

Thyroidectomy has become a fairly common surgical procedure in small animals because of the increasing incidence of thyroid tumors. Surgical removal of the thyroid gland can be routine or quite challenging, depending on the species (cat vs. dog) and the size and aggressiveness of the tumor. Many problems may be encountered with these patients, associated both with the disease and with the surgical treatment. Both thyroid and parathyroid tumors result in many alterations in the animal's homeostasis. These alterations must be recognized by the surgeon to maximize the chance of a successful outcome. This chapter deals with thyroidectomy and parathyroidectomy in dogs and cats. Indications for surgery, pathophysiology of thyroid and parathyroid neoplasia, preoperative care, surgical procedures, and postoperative care and complications will be discussed.

Animals↗
PubMed1991

[Complications after total thyroidectomy in thyroid carcinoma].

Authors report the postoperative complication rate in 52 patients who had undergone total thyroidectomy for cancer between 1984 to 1989. Total thyroidectomy has been performed in 9.8% of patients surgically treated for nodular thyroid pathology. Patients age average 49 years in a range 16-75; they were 49 women and 3 men. In 50% of cases we found papillary cancer, follicular in 40%, medullary 4% and anaplastic 6%. We shared postoperative complications in two mean groups: 1) aspecific complications as cardiocirculatory failure, respiratory failure, wound infections or collections, granulomas, keloids; 2) surgery related complications such as hypocalcemia, dysphagia, recurrent++ paralyses. The first group, we noticed just one case of respiratory mechanical failure due to severe tracheomalacia that required a temporary tracheostomy performed at the end of surgical procedure; we did not notice any death due to cardio-circulatory or respiratory failure, nor did we notice any postoperative hemorrhage; one patient presented a wound seroma, two patients presented granulomas due to subcutaneous stitches, and three developed papulous drug-induced erythema. The second group, eight patients developed a transient hypocalcemia beginning on the second postoperative day, without relevant tetanic crisis, well treated by calcium administration; only two of these patients developed permanent hypoparathyroidism. In 3 cases we had to perform exeresis of a laryngeal inferior nerve involved by the cancer, while in 5 more cases we noticed a transient monolateral paralysis that disappeared in 2 or 3 months. Three patients presented dysphagia before intervention and healed post-surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1991

Influence of thyroidectomy on seminal vesicular glycosidases of young albino rats.

Impact of thyroidectomy (hypothyroidism) on few glycosidases was studied in the seminal vesicles of young albino rats. Thyroidectomy was performed at 30 days post partum. Seminal vesicular beta-D-glucosidase, beta-D-galactosidase, and N-acetyl-beta-D-galactosaminidase exhibited a similar response of decreased activities under short- (30 days) and long-term (60 days) hypothyroid conditions. On the other hand, N-acetyl-beta-D-glucosaminidase registered a temporal biphasic response of increased and decreased activities in the seminal vesicles of rats subjected to short- and long-term hypothyroidism, respectively. The data obtained in the present study suggest that thyroid hormones have specific influences on different glycosidases in the seminal vesicles of rats and euthyroid status is essential for the maintenance of normal activities of these enzymes.

Animals↗
PubMed1990

[The parathyroid risk in thyroid surgery. Argument against the early postoperative prescription of vitamin D. Experience with 729 thyroidectomies in 1988].

729 consecutive patients underwent thyroidectomy in 1988 in the same institution, including 477 (68%) bilateral resections and 242 (33%) total thyroidectomies. An effort was made to see and save all 4 parathyroids and their blood supply. Early post-operative hypoparathyroidism was defined at day 5, by serum calcium less than 8 mg/dl. and serum phosphate less than 4 mg/dl or by serum calcium only if greater than 7.5 mg/dl. Patients afflicted with early hypoparathyroidism were given calcium tablets without any vit D for 1 year at most. Follow-up, checking serum Ca, P and i PIH was done on a 3 months basis during 1 year. Permanent hypoparathyroidism was defined by persistence of the above-mentioned criteria after 1 year, and eventually vit D was started. 27 patients (5.6% our of 477 bilateral thyroid resections) experienced early post-op hypoparathyroidism. Inciting factors were previous thyroid surgery (4), radioiodine treatment (2), modified neck dissection (2), sternal split with mediastinal node clearance (1), visualization of 1 parathyroid gland only (3 redo cases) and autotransplantation of more than 1 parathyroid (1 case). 1 patient was lost for follow-up. 25 others recovered a normal parathyroid function. 1 is permanently hypoparathyroid (1 redo case with other risk factors). Painstaking parathyroid dissection allows a 0% rate of permanent hypoparathyroidism after primary surgery, if vit D is not given in the early post-operative period. We suggest that avoidance of early vit D prescription in cases of early post-operative hypoparathyroidism, leading to mild sustained hypocalcemia, stimulates the spared parathyroid glands (including a possible 5th) and therefore allows full recovery of the parathyroid function.

Humans↗
PubMed1990

Completion thyroidectomy for initially misdiagnosed thyroid cancer.

Intraoperative frozen sections fails to diagnose thyroid carcinoma accurately in 16% of cases. In such instances, we recommend that completion thyroidectomy be performed in the patient who has invasive carcinoma, is less than 70 years old, and has a reasonable life expectancy. The procedure should be carried out immediately if the error in diagnosis is discovered within a week; otherwise the procedure should be delayed until 3 to 4 months later. At that time, the recurrent laryngeal nerves and at least two parathyroid glands should be dissected and preserved. A paratracheal lymph node dissection should also be performed and the lower jugular lymph nodes should be sampled. If these jugular lymph nodes are found to be positive, a modified radical neck dissection should be added. The morbidity associated with the completion thyroidectomy is minimal. Postoperatively, a 131I scan of the neck should be carried out and ablative doses of radioactive iodine can be given if the uptake in the thyroid bed is greater than 1.5%. Subsequently, all patients are given thyroid suppressive therapy and are monitored closely. This approach will reduce the local recurrence rate and improve the long-term survival.

Adenocarcinoma↗
PubMed1990

Propylthiouracyl-induced hypothyroidism results in reversible transdifferentiation of somatotrophs into thyroidectomy cells. A morphologic study of the rat pituitary including immunoelectron microscopy.

Two-month-old female Fischer-344 rats were rendered hypothyroid by ingestion of propyl-thiouracyl (PTU) (0.1% in drinking water) and sacrificed 3, 7, 14, and 28 days after the start of PTU administration as well as 3, 7 and 14 days after interruption of a 14-day PTU treatment. Controls received no PTU. The pituitaries were studied by histology, immunohistochemistry, electron microscopy, and immunoelectron microscopy, using the immunogold double-labeling technique. In the course of hypothyroidism, pituitary thyrotrophs had undergone the well-known thyroidectomy change. In addition, a contingent of growth hormone (GH) cells lost their large secretory granules, enlarged, displayed progressive dilation of rough endoplasmic reticulum, thereby transforming into thyroidectomy cells. These bihormonal thyrosomatotrophs contained gH in their secretory granules and thyrotropin in the dilated rough endoplasmic reticulum as documented by the immunogold double-labeling method for GH and thyrotropin. After discontinuation of PTU treatment, a rapid increase in size, number and GH labeling of secretory granules and simultaneous involution of distended rough endoplasmic reticulum with reduction of thyrotropin labeling took place in thyrosomatotrophs. A practically complete restitution of normal pituitary structure was seen in 2 weeks. Results implicate that, contrary to previously accepted concepts, adenohypophysial cells may not be irreversibly committed to one morphologically recognizable cell line.

Animals↗
PubMed1990

[Thyroid function after thyroidectomy for benign goiter. 200 cases explored by ultrasensitive TSH].

Based on a retrospective study of a series of 200 thyroidectomies for benign goitre and a mean follow up period of 12 Months, the authors analysed post-operative thyroid function and correlated it with the degree of surgical excision (47 unilateral lobectomies, 91 classical subtotal bilateral lobectomies and 62 extended bilateral subtotal lobectomies). After a presentation of the results in comparison with data from the literature, the timing and threshold for the institution of replacement therapy are examined and the need for prolonged clinical and laboratory monitoring is also stressed. In terms of changes in laboratory criteria only monitoring of spontaneous changes in US TSH allows opotherapy to be avoided or conversely to accurately define the conditions for institution of definitive replacement therapy. The justification of total thyroidectomy in the treatment of multihetoronodular goitres almost totally involving the glandular parenchyma is acknowledged.

Adolescent↗
PubMed1990

[Follow-up of a population of patients who underwent partial thyroidectomy for benign thyroid pathology].

Natural history of partial thyroidectomy for thyroid disease has been studied in a population of 1196 consecutive cases surgically treated from 1977 to 1982. Follow-up analysis on this population (from six to eleven years) was carried out for appearance of recurrence. Generally, the recurrence incidence was small (only 9.9% of total population) but high frequency was observed for Graves' disease (46%) and lymphocytic chronic thyroiditis (21%). The substitutive/suppressive therapy administration did not influence recurrence of disease. Our results suggest that suppressive therapy does not modify the natural course of non cancerous thyroid pathology residual to partial thyroidectomy.

Adenoma↗