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PubMed1977

[Value of total thyroidectomy with cervical dissection in the treatment of differentiated thyroid cancers].

Study of 52 cases of differentiated carcinoma of the thyroid treated by anatomically total thyroidectomy with block dissection of the cervical nodes indicated three amin findings: examination by puncture for cytological examination would have missed 8 micro-carcinomas; unilateral excistion would have bee inadequate in 12 patients; lymph node excision confined to detectable lymphadenopathies would have left neoplastic tissue in place in 8 cases. In the light of these advantages from an oncological standpoint, the complications of total thyroidectomy with bilateral block dissection are few and can be avoided in most cases.

Adolescent↗

PubMedDate not supplied

Complications of 867 thyroidectomies performed in a region of endemic goiter in Turkey.

This article aims to define the incidence of complications in 867 thyroidectomies performed by residents with attending surgeons' supervision as part of a training programme, in a region of endemic goiter. Seven hundred and nine patients were female and 158 were male. The age of the patients ranged between 6 and 76 and mean age was 32.5. Cases were divided into two groups according to their disease nature. Group 1 included 805 patients with nodular colloidal goiter (NCG) and adenomas. The remaining 62 cases, 25 with recurrence of goiter (RG), 21 with thyroid malignancy (TM) and 16 with thyroiditis formed group 2. While the overall complication rate was 11.3% (93 cases) in group 1, it was 20.9% (13 cases) in group 2. The mortality rate was zero in both groups. The incidence of complications of 867 thyroidectomies performed by residents with the attending surgeons' supervision was within acceptable limits especially as far as group 1 was concerned. However we suggested that attending surgeons themselves, disregarding residents training, should perform the operation in special cases such as recurrent goiters, thyroid carcinomas with positive regional lymph nodes and thyroiditis with regional adhesions.

Adolescent↗

PubMed1997

[Basedow's disease--thyroidectomy or subtotal resection?].

Postoperative complications and long-term results were retrospectively investigated after near total thyroidectomy due to Graves' disease in 73 patients. Postoperatively one permanent recurrent nerve palsy and one hypoparathyroidism were seen. Two patients had a postoperative bleeding and one patient had a wound infection. No patient died. After a median follow up time of 67 months 65 patients (89%) were seen. A recurrent hyperthyroidism developed 3% of the patients and 80% were hypothyroid. These results demonstrate the effectiveness of near total thyroidectomy in Graves' disease. With no mortality and low morbidity excellent long-term results could be achieved.

Adolescent↗

PubMed1997

Temporary voice changes after uncomplicated thyroidectomy.

Voice characteristics were studied before and after thyroidectomy in patients with intact vocal fold motility. The speaking voice was acoustically analysed in 47 patients and phonetograms were made in 17 patients. Eight parameters were measured and the pre- and postoperative values compared. The results show that the most affected parameter was the pitch of the speaking voice. The fourth postoperative day there was, on average, a lower SFo and a smaller Fo range during speaking. Postoperatively a progressive normalisation took place. After three months there were no more statistical differences and, looking at the individual measures, the SF0 of all patients fell within 2 semitones from their preoperative level. Vocal quality was also altered in the first postoperative examination, as shown by the higher jitter and smaller harmonics. These measures normalised after two weeks. In the same way, the evaluation of the limits of the voice by means of the phonetogram, showed that the maximal performances in the intensity and pitch domain were decreased in the earliest postoperative period. Information about temporary voice change is useful in patients undergoing thyroidectomy.

Female↗

PubMed1997

Recurrent laryngeal nerve paralysis: a complication of thyroidectomy.

OBJECTIVE: To study factors related to recurrent laryngeal nerve (RLN) paralysis, a major complication of thyroidectomy. DESIGN: Retrospective study of outcome of patients' medical records. PATIENTS AND METHODS: Records of 361 patients who underwent thyroidectomy by otolaryngologists at Ramathibodi Hospital were reviewed for RLN paralysis. MAIN OUTCOME MEASURES: RLN injury was analyzed in relation to types of surgery, RLN identification, and histopathology. The analysis was based on the number of RLNs at risk. RESULTS: The incidence of permanent RLN paralysis was 2.38%. Both the permanent RLN paralysis and temporary RLN paralysis were significantly related to the histopathologic findings of malignancy (p < .005). The positive identification of RLN and the types of surgery were not found to be significant factors in either permanent RLN paralysis or temporary RLN paralysis. CONCLUSIONS: There was insufficient evidence to support that the identification of RLNs during surgery would be a significant factor in reducing the likelihood of RLN paralysis. However, RLNs should be identified to avoid iatrogenic injury and subsequent paralysis. Meticulous surgical technique should be applied in patients whose results of fine-needle aspiration biopsy suggested malignancy, as there is the possibility of difficult surgery and potential iatrogenic RLN paralysis in this group of thyroid patients.

Adolescent↗

PubMed1997

[Role of total thyroidectomy in benign multinodular benign goiter].

The Authors report a review of the Literature and their personal series to evaluate the role of total thyroidectomy in the surgical management of non-toxic multinodular goiter. On the basis of the data obtained, the Authors consider total thyroidectomy the therapy of choice for this pathology.

Adolescent↗

PubMed1998

Papillary thyroid carcinoma: justification for total thyroidectomy and management of lymph node metastases.

Papillary thyroid carcinoma (PTC) is the most common epithelial thyroid tumor and comprises approximately 80% of all thyroid cancers. In this article, the authors discuss the data showing that total thyroidectomy is the treatment of choice of clinically significant PTC, and review an algorithm for the management of lymph node metastases. Although the prognosis for patients with PTC is generally good, appropriate surgical management (total thyroidectomy plus 131I and life-long TSH suppression) can further reduce recurrence and cancer death rates significantly.

Algorithms↗

PubMed1994

Parathyroid function following ligation of the inferior thyroid arteries during bilateral subtotal thyroidectomy.

A randomized controlled trial was performed to compare two techniques of bilateral subtotal thyroidectomy for non-toxic nodular goitre with regard to postoperative parathyroid function. The 50 patients in group 1 underwent ligation of the trunks of the inferior thyroid arteries. In group 2 (50 patients) the branches of these arteries were suture-ligated at the thyroid capsule. Total calcium, ionized calcium and parathyroid hormone levels were determined before operation, and 6, 24 and 72 h after surgery. Ninety-one patients were seen at follow-up 5-10 months after operation. Ten patients in group 1 and 12 in group 2 required calcium and/or vitamin D supplementation for symptomatic hypocalcaemia in the immediate postoperative period. At follow-up only one patient in each group had mild hypoparathyroidism. No statistically significant differences were found between groups regarding total calcium, ionized calcium and parathyroid hormone levels. Truncal ligation of the inferior thyroid arteries during bilateral subtotal thyroidectomy does not cause hypoparathyroidism or hypocalcaemia.

Calcium↗

PubMed2006

Thyroid nodules: does the suspicion for malignancy really justify the increased thyroidectomy rates?

Thyroid nodules are frequently diagnosed today, mainly due to the wide use of neck ultrasonography (US). The majority of these are benign; suspicion for malignancy is an indication for surgery, while benign thyroid nodules may be managed conservatively. There is evidence that a large percentage of patients with thyroid nodules (many diagnosed incidentally) are over-treated. Careful and accurate identification of patients with thyroid nodules highly suspicious for underlying malignancy would allow a more reasonable therapeutic approach and would result in a reduction of the number of unnecessary thyroidectomies. Fine-needle aspiration cytology (FNAC), in conjunction with high-resolution thyroid US, are currently the most accurate and cost-effective diagnostic approach for the evaluation of patients with nodular thyroid disease. Radionuclide thyroid scanning should be used selectively. By increasing the use of FNAC, it is expected that the number of unnecessary thyroidectomies will be further diminished, thereby avoiding over-treatment, without exposing the patients to the risk of under-treatment for a highly curable cancer. However, accurate preoperative diagnosis of thyroid cancer within a thyroid nodule is not always possible and, although the problem of unnecessary surgery can further be diminished, it cannot be completely eliminated.

Adolescent↗

PubMed2005

Thyroglobulin assay 4 weeks after thyroidectomy predicts outcome in low-risk papillary thyroid carcinoma.

BACKGROUND: Thyroidectomy followed by administration of large activities of 131I is the treatment of choice for differentiated thyroid carcinomas. Due to its good prognosis, some authors argue that papillary thyroid cancer with a diameter of up to 10 mm can be treated by surgery alone. In the new TNM classification started in 2002, the T1 group now encompasses all tumours with a diameter up to 20 mm, which widens the indications for a conservative approach. In this instance, prognostic markers are needed to better select patients before planning non-aggressive treatment. Serum thyroglobulin plays a pivotal role in thyroid carcinoma management after thyroid ablation (i.e., surgery and radioiodine) but is of limited value before these treatments. However, thyroglobulin assay performed after surgery but before radioiodine treatment has been proven to be useful in predicting the presence/absence of distant metastasis. PATIENTS AND METHODS: Our study was undertaken in patients affected by pT1 papillary thyroid carcinoma to evaluate the predictive value of post-surgery thyroglobulin assay on 1) restaging immediately after radioiodine treatment and 2) restaging at 12 months. We selected 156 patients affected by pT1 histologically proven papillary thyroid carcinoma, submitted to total thyroidectomy. Serum thyroglobulin was assayed by a specific immunoradiometric method 4 weeks after surgery, just before radioiodine administration. Cut-off levels were selected by receiver operating characteristic curve analysis. Thyroglobulin levels were compared to the results of a post-radioiodine treatment scan and 12-month restaging. RESULTS: Globally, 23 out of 156 patients showed persistent/recurrent disease (15%). Post-surgery thyroglobulin levels above 4.50 microg/L identified 94% of patients with metastasis at post-dose scan, and a level below 3.20 microg/L identified 86% and 93% of relapsed and disease-free patients at 12-month restaging, respectively. Multivariate analysis and Spearman rank correlation showed that the N-status and post-surgery thyroglobulin level are independent prognostic factors. CONCLUSIONS: The post-surgery thyroglobulin level could be systematically assayed in patients with pT1-papillary thyroid carcinoma and taken into account in planning treatment.

Adult↗

PubMed2000

Influence of hypovolemic and hypertonic treatments on plasma vasopressin levels and fluid balance in the thyroidectomy-induced hypothyroid rats.

OBJECTIVES: This study was undertaken to investigate the effects of hypovolemic and hypertonic treatments on plasma vasopressin (AVP) levels and fluid balance in thyroidectomy-induced hypothyroidism in the rat. The influence of hypothyroidism on AVP responsiveness to hypertonic and hypovolemic stimuli were compared. MATERIALS & METHODS: Adult male rats were divided into two groups. The rats were surgically thyroidectomized (hypothyroid) or sham-operated (euthyroid). Two weeks later these groups were further divided in three subgroups each containing six rats. The first subgroup consisted of unchallenged rats. The second group underwent hypovolemic treatment by using I.P. 700 mg polyethylene glycol. The third subgroup consisted of hypertonic (1.5 M NaCl; 1 ml/100 g) stimulated animals. All rats were decapitated and trunk blood collected in heparinized tubes. Plasma samples were stored at -20 degrees C until assayed. Plasma AVP, T3 and T4 levels were measured by radioimmunoassay. Hematocrit values and plasma Na and K concentrations were also determined. RESULTS: In the hypothyroid rats, hypovolemic treatment significantly reduced the expected increases in plasma AVP levels (p<0.05) compared to the respective intact animals. In the hypertonic group, similar increases occurred in plasma AVP levels of hypothyroid and euthyroid rats. Hematocrit values and plasma Na concentrations were not significantly different in the hypothyroid rats compared to euthyroid rats. CONCLUSION: In conclusion, thyroidectomy-induced hypothyroidism may affect AVP response to hypovolemic stimulus although it has no important effect on basal AVP levels nor AVP response to hypertonic stimulus.

Journal Article↗

PubMedDate not supplied

Isolation period prediction in patients with differentiated thyroid carcinoma treated after thyroidectomy by radioiodine-131.

In patients with differentiated thyroid carcinoma (DTC) who after thyroidectomy underwent radioiodine-131 ((131)I) treatment for the ablation of the thyroid remnant, isolation period is considered as the period of time needed for patients' radiation dose rates to be reduced below specific adopted dose rate release limits. The aim of our study was to determine mathematical equations for the prediction of the isolation period in these patients and of their discharge from special isolation rooms in nuclear medicine departments. In order, to predict the duration of the isolation period, we studied twenty-eight patients with DTC and total thyroidectomy having no metastases, who underwent (131)I ablation treatment for a minimal residual thyroid remnant. The administered (131)I activity was 5.22 +/- 0.68 GBq, ranging from 3.66 to 6.21 GBq. Dose rates, as mean +/- SD, at a distance of 1 m from the patients were 277 +/- 44 microSv/h, immediately after (131)I administration, 72 +/- 18 microSv/h at 24 h and 23 +/- 9 microSv/h at 48 h. Whole body (131)I retention was 0.261 +/- 0.05 (range 0.168-0.385) at 24 h and 0.082 +/- 0.03 (range 0.041-0.149) at 48 h, calculated as the ratio of dose rate at 24 h and 48 h versus the initial dose rate after (131)I administration. Isolation period was calculated by a mono-exponential fitting in dose rate decay data according specific dose rate release limits. For a dose rate release limit of 30 microSv/h at 1 m, isolation period was 42.7+/-7.2 h (range 31.2-56.6 h). Seventy-five percent of the patients satisfied this limit within 48 h and 25% between 48 h and 72 h. This isolation period was positively correlated with the whole body (131)I retention and the dose rates at 24 h and 48 h, but not always with the administered activity or the initial dose rate, measured immediately after (131)I administration. On the contrary, a strong negative correlation was found between patients' isolation period and dose rate release limits between 3 and 60 microSv/h at 1 m. This study indicates that isolation period is variable but can be predicted by multiple formulas, since it depends strongly on the adopted dose rate release limits, (131)I dose rates and whole body retention at 24 h and 48 h after (131)I treatment. For a dose rate release limit of 30 microSv/h at 1 m, isolation period is sufficient for 72 h for all of our patients, while 75% of them had dose rates below that limit within 48 h.

Journal Article↗

PubMed1976

Recurrent hyperthyroidism after thyroidectomy.

For 53 patients with toxic recurrent goiter (TRG), the interval between thyroidectomy and recurrent hyperthyroidism range from six months to 50 years (average, 12.4 +/- 11.9 years). Recurrent hyperthyroidism may occur in older patients for whom cardiac decompensation may be the initial manifestation. Reports on surgically treated hyperthyroid patients may underestimate the incidence of TRG unless follow-up is extended for many years.

Adolescent↗

PubMed1998

Usefulness of microsurgery to isolation of recurrent laryngeal nerve and parathyroid during thyroidectomy operations.

The authors report their experience of the application of microsurgical techniques in total and subtotal thyroidectomy operations from January 1984-January 1997. Four hundred and eighty-six patients with thyroid diseases were operated upon with both traditional and microsurgical techniques. The comparison of results shows that microsurgical skills are effective in reducing the dangers and important complications in both laryngeal nerves and parathyroids.

Adolescent↗

PubMed1987

Malignant struma ovarii treated by ovariectomy, thyroidectomy, and 131I administration.

A 36-year-old woman presented with an intraperitoneally disseminated malignant struma ovarii, diagnosed by histopathology and 131I scintigraphy. The serum thyroglobulin level was elevated, and immunoperoxidase staining for thyroglobulin was positive for disease both in the tumor cells lining the follicles and in the colloid. The patient was treated successfully by a bilateral ovariectomy followed by a total thyroidectomy and administration of radioactive iodine. The clinical behavior and the presence of thyroglobulin in both serum and tumor tissue demonstrate the similarity between neoplastic thyroid tissue in the ovary and in the thyroid gland.

Adult↗

PubMed1977

Hypothyroidism following partial thyroidectomy for thyrotoxicosis and its relationship to thyroid remnant size.

One hundred and twenty-two patients were reviewed 1-7 years after partial thyroidectomy for thyrotoxicosis by two surgeons who had left thyroid remnants of different size. There was no significant difference in the prevalence of hypothyroidism or in the serum levels of thyroxine, tri-iodothyronine or thyroid-stimulating hormone between the two groups of patients. The overall prevalence of hypothyroidism was 16 per cent.

Adult↗

PubMed1977

A case of myasthenia gravis with thyrotoxicosis treated by combined subtotal thyroidectomy and total thymectomy.

Thyrotoxicosis occurring in conjunction with myasthenia gravis is rare. The usual treatment consists of medical control of the thyrotoxicosis, then thymectomy and later subtotal thyroidectomy. The case reported here concerns a 19-year-old girl who had surgical treatment for both lesions on the same occasion. With proper medical preparation, modern anaesthesia and respiratory care, the surgical treatment of both lesions can be accomplished in one stage.

Adult↗

PubMed1979

Tracheal collapse after thyroidectomy.

Tracheal collapse after thyroidectomy is uncommon; when it occurs, complete airway obstruction is often sudden, unexpected and fatal. In this paper a patient treated for tracheal collapse by tracheostomy and followed up for 1 year is described and, from a review of the literature, a further 9 cases are presented. The aetiology of the condition, the patient at risk and the technique of management are discussed.

Adult↗