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PubMed1990

Thyroidectomy for amiodarone-induced thyrotoxicosis.

Amiodarone hydrochloride, an iodine-rich drug used in the treatment of tachyarrhythmias, is responsible for the development of thyrotoxicosis in approximately 10% of patients who reside in areas of moderate iodine deficiency. Treatment of amiodarone-induced thyrotoxicosis is difficult since the drug has a prolonged half-life, cardiac decompensation due to underlying heart disease occurs often, and discontinuation of amiodarone therapy may not be possible. We report a patient with severe thyrotoxicosis who received amiodarone for 34 months. Prolonged treatment with methimazole, potassium perchlorate, iopanoic acid, and dexamethasone was unsuccessful in controlling the hyperthyroid state. A near-total thyroidectomy resulted in rapid amelioration of thyrotoxicosis. Since surgery results in rapid control of thyrotoxicosis and permits continued therapy with amiodarone, we suggest that near-total thyroidectomy warrants consideration as definitive treatment for resistant amiodarone-induced thyrotoxicosis.

Amiodarone↗

PubMed1989

[Investigation of the mechanism of hoarseness after thyroidectomy].

Electromyography of the intrinsic laryngeal muscles and laryngeal function measurements were performed on 34 patients with hoarseness after thyroidectomy. It is believed that mild laryngeal nerve paralysis might not give rise to disturbances in vocal cord movement. Causes of hoarseness after thyroidectomy could be mild recurrent superior laryngeal or combined nerve paralysis. During recovery, the vocal cord moved from paramedian position to middle position. Normal vocal cord movements did not mean complete recovery from paralysis, since electromyogram still showed abnormal potentials. It is suggested that vocal cord paralysis be divided into three types: severe, moderate and mild.

Adenoma↗

PubMed1989

[Interhormonal relations in the dynamics of immune response during thyroidectomy].

Wistar rats were immunized with the sheep erythrocytes (SE) within 18 or 60 days after thyroidectomy. The latter led to a sharp drop in concentration of T3, T4 and to 2-3-fold increase in the TTH level. The SE administration failed to induce an increase in the T3, T4 level in operated animals whereas the TTH concentration increased. During the inductive period of immunogenesis a reduction occurred in the antigen-induced glycocorticoid response and the testosterone level in the early period replaced by their increase in later stages after the operation. The intensity of antibody production decreased in the early period and increased later. The data obtained suggest a participation of these changes of the endocrine functions in the mechanisms of thyroidectomy-induced disorders of the immune response.

Animals↗

PubMed1985

Changes in phosphofructokinase and pyruvate kinase in rat brain following thyroidectomy.

Changes in the profile of phosphofructokinase (PFK) and Pyruvate kinase (PK) from rat brain regions were studied following thyroidectomy. A regional variation of thyroidectomy on brain was observed; cerebral hemispheres and cerebellum showed decreased activity of phosphofructokinase and pyruvate kinase. The activity in the brain stem did not change. Administration of triiodothyronine to the thyroidectomized rats restored the activity to near control levels. The results suggest a role of the thyroid hormones in the regulation of glycolysis in brain.

Animals↗

PubMed1985

Postural EMG activity in the soleus muscle of adult rats following thyroidectomy.

An electrode array was implanted for chronic recording of EMG activity in both soleus muscles (SOL) in adult albino rats (Wistar strain) of 250 g mean body weight. After 12-13 days, surgical thyroidectomy was performed and the postural EMG activity in both SOL muscles up to 16 weeks after the operation was quantitatively compared (spikes per minute) with the EMG activity before the operation. The results showed that the EMG activity in the SOL is significantly decreased after thyroidectomy.

Action Potentials↗

PubMed1985

Effects of thyroidectomy, insulin, and phospholipids on cyclic AMP phosphodiesterase in rat adipocyte plasma membranes.

The effect of thyroid status on the cyclic nucleotide phosphodiesterase in adipocyte plasma membranes has been studied. In euthyroid rat fat cells, about 7% of the total cAMP phosphodiesterase was found in the plasma membrane. Thyroidectomy doubled both the enzyme's total activity in this fraction, and its specific activity (60 versus 37 pmol/min/mg) compared to euthyroid rat plasma membrane. In membranes from thyroidectomized rats, phosphodiesterase hydrolyzed cAMP with a single Km of 2 microM, whereas in euthyroid rat membranes, Lineweaver Burk plots were non-linear, with apparent Kms of 0.5 and 5 microM. This phosphodiesterase activity was insensitive to exogenous guanine nucleotides and calcium. In vivo injection of triiodothyronine restored phosphodiesterase activity in plasma membranes from thyroidectomized rats to the values obtained for euthyroid rats. Centrifugation on a 10 to 45% sucrose density gradient of the plasma membrane fractions gave two main peaks of phosphodiesterase activity which hydrolyzed the cAMP in adipocyte plasma membranes from both euthyroid and thyroidectomized rats. The distribution profiles for these activities were very similar in the two plasma membrane preparations. The peaks of phosphodiesterase and 5'nucleotidase activity coincided. Thyroidectomy raised the phosphodiesterase activity of these two peaks, particularly of the first. The cAMP phosphodiesterase activities in both hypothyroid and control plasma membrane preparations were also sensitive to insulin and were activated by phospholipase A2 and three anionic phospholipids. Thyroid hormones therefore regulate the degradation of cAMP in plasma membranes by a mechanism which seems different from the one involved in the action of insulin, and is independent of the membrane phospholipid composition.

3',5'-Cyclic-AMP Phosphodiesterases↗

PubMed1988

Prevalence of parathyroid insufficiency after thyroidectomy: study of 1037 cases.

In 1037 patients undergoing total (827 cases) or partial thyroidectomy (52 cases of subtotal thyroidectomy, 108 of hemithyroidectomy, 50 of enucleation and resection) for each study group the incidence of hypoparathyroidism, its possible causes and technical factors favouring the onset, were examined. In this series postoperative prevalence of hypoparathyroidism was 16.6%. It seems to be directly proportional to the extent of surgery thus confirming the necessity to locate and preserve the parathyroid glands during surgery. This should be as conservative as possible according to the prognosis of the thyroid disease.

Cross-Sectional Studies↗

PubMed1988

[Subtotal thyroidectomy as a superior therapeutic principle in the treatment of endocrine ophthalmopathy: a comparison with retrobulbar irradiation and thyrostatic therapy alone].

In order to investigate the influence of near total thyroidectomy on the course of endocrine ophthalmopathy (E.O.) in patients with Graves' disease, 29 patients with goitre and E.O. were classified before and after (up to 18 months) operation by use of a special ophthalmopathy index. 14 patients without goitre served as controls; they get only antithyroid drug treatment (ADT) (E.O. I and II, n = 7) or additional retoorbital irradiation (E.O. III and IV, n = 7, linear accelerator, 20 Gray). 20 out of 29 operated patients showed an improvement in the E.O., 4 a deterioration, 5 were unchanged. 3 out of 7 not operated patients with mild E.O. showed an amelioration during ADT, 4 no change. Additional radiotherapy in 7 patients with severe E.O. caused an improvement in the clinical condition of 3 patients, 3 patients deteriorated and 1 patient showed no change. It is concluded that adequate near total thyroidectomy has a positive effect on the clinical course of E.O. in patients with Graves' disease and E.O.

Follow-Up Studies↗

PubMed1988

Coping with respiratory obstruction after thyroidectomy for giant goitres in northern Nigeria.

Thyroidectomy for giant goitres in Northern Nigeria is associated with a high incidence of postoperative asphyxia. Tracheostomy may be a life saving procedure in these circumstances, but delay may prove fatal when its need arises insidiously. It is therefore better established prophylactically in patients who are more than likely to develop asphyxia, as in the case of preoperative complications followed by prolonged surgery. During the dry, dust-laden and desiccating Harmattan season of Northern Nigeria, however, tracheostomy poses life-threatening dangers and should be established only in patients who need it for survival. Postoperative asphyxia can be minimised by adopting certain operative techniques which reduce the risks of postoperative haematoma and laryngeal oedema. Establishment of a thyroidectomy team for surgery and for postoperative management improves results.

Adolescent↗

PubMedDate not supplied

The value of L-thyroxine in the supressive therapy of euthyroid nodules and in the prevention of post-thyroidectomy recurrences.

Long-term L-thyroxine (L-T4) suppression therapy was applied to 133 patients with euthyroid nodular goiter (126 females/7 males) and to 148 patients (136 females/12 males) with post-thyroidectomy recurrence between the years 1980 and 1986. The results are interpreted as "Complete Success" if the nodule disappeared, "Partial Success" if it became smaller, "Late Unresponsiveness" if the nodule first decreased then increased in volume and "Unresponsiveness" when it did not change. In the group of euthyroid nodules, complete success was obtained with 150-200 micrograms/L-T4 daily administration. But in the recurrence group the response to the same dose was lower than in the first group and most of them were partial responders. On the other hand, we found highly significant differences in the incidence of postoperative recurrences, between the group of patients subjected to a long term L-T4 suppression therapy with the recurrence and prophylactic therapy with L-T4. While postoperative recurrence was only 6.35% in the long term L-T4 receiving group, it was very high (80.95%) in the non-treated group. Furthermore, in the group of patients taking L-T4 suppression therapy only for a short period, the incidence of recurrence was 12.70%. As a result of this study, we concluded that routine long term L-T4 suppression therapy is necessary both for the treatment of selected euthyroid nodules without any suspicion of malignancy for the prevention of post-thyroidectomy recurrences.

Adolescent↗

PubMed1986

A new approach to the surgical management of paralysis of the laryngeal nerve after thyroidectomy.

Recurrent nerve palsy, immediate or delayed, or unilateral or bilateral, is a recognized complication of operations upon the thyroid gland and is not considered to be remediable as a presumed consequence of division of the nerve (or nerves). Removal of sutures and neurolysis of the nerve have met with variable success in restoration of function. In a prospective study over a period of 14 years, paralysis after thyroidectomy was assessed in 31 patients. Five had undergone previous operations upon the thyroid gland, four of these patients had known unilateral paralysis and 26 underwent operations which involved exploring the nerves. Immediate removal of the sutures was followed by complete recovery in four of the patients. Fifteen nerves of 13 patients with delayed paralysis were operated upon within six months of the original procedure; ligatures were removed in four patients, the nerve of one patient was sutured and the remaining underwent neurolysis. Some recovery of function within six months was seen in 13 nerves. Nine nerves were operated upon up to one year later, three divided nerves were sutured, one suture around a nerve was removed and five nerves were freed from fibrous tissue; recovery of function was seen in only two nerves. Of all the nerves which were sutured, slight mass movement of the corresponding vocal cord was seen in two. The results indicate that immediate paralysis after thyroidectomy should be investigated immediately, not only to excluded severance but also to relieve, if possible, physical involvement of the nerve by suture or ligature; the outcome of the operation is often beneficial. The benefits of neurolysis when the onset of paralysis is delayed due to fibrosis surrounding the nerve is also discussed; earlier intervention is associated with better results. Direct suture of the divided nerve is not recommended.

Female↗

PubMed1987

[Hypocalcemia after thyroidectomy. Pathogenetic and clinical aspects].

Hypocalcaemia may arise after thyroidectomy. This condition has been attributed to various causes but the explanations of the phenomenon are not always convincing. The present study was designed to investigate the frequency of the phenomenon and its causes via the early and tardive monitoring of calcaemia, phosphoraemia, calcitoninaemia, thyroid hormones and TSH. The results obtained reveal that hypocalcaemia is due to postoperative hypothyroidism that is revealed more clearly by the behaviour of TSH than that of the thyroid hormones. Patients must be treated with vitamin D until thyroid hormone function is normalised. The behaviour of PTH after thyroidectomy and in hypothyroidism reveals the appearance of inane hyperparathyroidism secondary to and related to the hypocalcaemia.

Female↗

PubMed1979

[The pathogenesis of tracheal stenosis following thyroidectomy (author's transl)].

The frequency of trachealmalacia or stenoses following operations for struma or recurrent struma initiated our study of the pathogenesis of such changes. This study revealed that mechanical factors, such as compression of the trachea and the like, had been reported in the literature as the causative factors. The present paper investigates to what extent disturbances in the blood supply of the trachea, particularly after ligature of the inferior thyroid artery during thyroidectomy, influence changes in the tracheal mucosa, the connective tissue, and the adjacent cartilage. In twelve experiments on domestic pigs, the blood supply of the cervical trachea was interrupted. After varying periods of survival time, the animals were sacrificed and the tracheas histologically examined. In all cases, ischemic changes in the tracheal mucosa and cartilage could be found in addition to inflammatory reactions with scar formation. It seems justified to conclude that both mechanical factors and disturbances in local blood supply can cause tracheal tissue changes after thyroidectomy. The inferior thyroid artery and its branches also seem to play a central role in the success or failure of tracheal reconstructions following end-to-end anastomoses after stenosis resections. As a consequence, this paper also deals comprehensively with the detailed anatomy of this vessel.

Adult↗

PubMed1979

Propranolol in thyrotoxicosis: II. Serum thyroid hormone concentrations during subtotal thyroidectomy.

Propranolol alone was used to prepare 20 thyrotoxic patients, 19 women and 1 man, for subtotal thyroidectomy. Serum thyroxine (T4) and triiodothyronine (T3) concentrations were measured immediately before, at several stages during and after the surgical procedure. As judged primarily by the cardiovascular response, an average of 80 mg (range 40 to 120 mg) of propranolol qid for 8 days (range 3 to 18 days) was required to prepare the patients. During the various stages of surgical removal there was no change from the initial mean (+/- SEM) T4 concentration of 25.0 +/- 2.5 microgram/dl (321.8 +/- 32.2 nmol/l) or T3 concentration of 4.2 +/- 0.6 microgram/l (6.45 +/- 0.92 nmol/l) (P greater than 0.2). At discharge on the fifth postoperative day values were significantly lower, 12.9 +/- 1.5 microgram/dl (166.0 +/- 19.3 nmol/l) and 1.9 +/- 0.2 microgram/l (2.9 +/- 0.31 nmol/l), respectively (P less than 0.001). There were no operative complications but four patients had transient hypoparathyroidism. After 1 year 2 of 18 patients had permanent hypoparathyroidism and 4 of the 18 followed up for 1 year had permanent hypothyroidism requiring thyroid hormone replacement. There was no instance of recurrent thyrotoxicosis. The authors conclude that during surgical manipulation of the gland no release of thyroid hormones into the circulation was detected and that, using propranolol as the sole agent, thyrotoxic patients can be rapidly and safely prepared for subtotal thyroidectomy.

Adult↗

PubMed1983

[Parathyroid autotransplantation during expanded total thyroidectomy for cancer].

Autotransplantation of the parathyroid gland was performed in 28 out of 95 patients undergoing total thyroidectomy for carcinoma. The autotransplantation was supplementary in 15 patients who kept at least one parathyroid gland in the neck and substitutive in 12 patients who had total cervical parathyroidectomy. After 1 to 30 months' follow-up none of these patients had signs of hypoparathyroidism. The incidence of permanent hypothyroidism after total thyroidectomy was reduced from 7% to 2.1%. However, autotransplantation should be considered as a means of saving any cervical parathyroid that cannot be preserved and has been shown by histopathological examination to have escaped invasion by the carcinoma.

Adult↗

PubMedDate not supplied

Cervical block anesthesia in thyroidectomy.

Seven hundred and sixteen (716) patients with pathological thyroid gland conditions underwent surgical management during the period 1956 to 1981. Of these, 433 (60.0%) cases underwent surgery under cervical block anesthesia. Lobectomy was performed in 47 (10.8%) cases, subtotal thyroidectomy in 91 (21%) cases and bilateral subtotal thyroidectomy in 295 (68.2%) cases. Complications such as phonation changes (hoarseness), swelling and hematoma at the injection sites were observed in 27 (6.2% cases). No mortality nor serious complications, attributable to cervical block anesthesia, were encountered during this time.

Adult↗

PubMed1983

Modified subtotal thyroidectomy for Graves' disease: a two-institution study.

In an effort to decrease the large number of patients who develop hypothyroidism after operations for Graves' disease, an identical modification of the conventional subtotal thyroidectomy (CST) was independently designed and tested in a prospective study at two institutions. The modified subtotal thyroidectomy (MST) essentially consists of leaving an accurately measured 5 gm thyroid remnant and an intact inferior thyroid artery on each side of the neck. By use of MST, euthyroidism, as demonstrated by serial clinical and thyroid function tests, has been achieved in 92% of a combined group of 107 patients followed longer than 2 years (average 62.1 months). Postoperative hypothyroidism developed in only two cases (2%), representing a marked improvement over the 40% to 75% rate of hypothyroidism resulting from CST. Recurrent hyperthyroidism occurred in only six cases, a rate of recurrence indistinguishable from that resulting from the more extensive resection required by CST. Enlargment of total remnant size to a total of 10 gm significantly improves long-term postoperative functional results without risking an increase in recurrence. The functional results obtained after MST are superior to those obtained after treatment with radioiodine and justify renewed interest in the surgical treatment of Graves' disease.

Adolescent↗

PubMed1984

[Secondary resection in primarily omitted thyroidectomy as a prerequisite for multimodal therapy of differentiated thyroid cancers].

From 1.1. 1970 to 31.12. 1982 62 patients underwent secondary thyroidectomy. In 28.3% primary thyroidectomy was omitted due to false negative frozen section. The rate of lesions of the recurrens nerve amounted to 4.8%, the percentage of hypoparathyroidism was 3.2%. The postoperative uptake of radioiodine was 19.4 +/- 16.8%. Uptake of radioiodine and the time interval between the first and second operation were correlated.

Adenocarcinoma↗