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PubMed1982

Does calcitonin cause hypocalcaemia after thyroidectomy?

Plasma calcitonin, parathyroid hormone, total thyroid hormones and calcium were measured in 6 patients before, during and after thyroidectomy for hyperthyroidism. In 4 patients, plasma calcium fell postoperatively by 0.23--0.46 mmol/l, but there was no change in calcitonin or parathyroid hormone levels. In one patient, in whom there was a postoperative fall in plasma calcium of 0.55 mmol/l, thyroid hormones rose to a peak at 1 h and calcitonin to a peak at 12 h after resection. However, the rise in calcitonin occurred 8 h after the initial decrease in plasma calcium. In this patient, parathyroid hormone levels showed a slight rise only. It is concluded that, while thyroid hormones and calcitonin may leak from the damaged thyroid remnant after surgery, it is unlikely that calcitonin is important in the production of postoperative hypocalcaemia. However, impaired parathyroid hormone secretion may be a contributing factor.

Adolescent↗

PubMed1984

Hypocalcaemia after subtotal thyroidectomy for thyrotoxicosis.

Eighty-one patients who underwent subtotal thyroidectomy for thyrotoxicosis had a 10 per cent incidence of symptomatic hypocalcaemia (corrected calcium less than 2.0 mmol/l) but only a 1.2 per cent incidence of prolonged hypocalcaemia. In the same patients only one had a transient right sided recurrent laryngeal nerve palsy. These results would seem to confirm the wisdom of lateral ligation of the inferior thyroid arteries to protect the recurrent laryngeal nerve. They lend no support to the suggestion that in order to protect parathyroid function this teaching be abandoned in favour of a policy of ligation of the arteries on the surface of the gland. Nevertheless, injury, devascularization or inadvertent removal of parathyroid tissue must still be the first practical consideration.

Arteries↗

PubMed1995

Total thyroidectomy in the treatment of thyroid carcinoma in childhood.

Between 1974 and 1993 ten girls and six boys aged 6-16 years underwent total thyroidectomy, with therapeutic selective neck dissection in six patients. All were treated after operation with radioactive iodine (131I) for ablation of thyroid tissue remnants. Papillary carcinoma occurred in ten patients, follicular carcinoma in two and medullary thyroid lesions in four. The patients were followed for a median of 11.5 (range 1-20) years with regular determinations of serum thyroglobulin levels and 131I whole-body scanning when indicated. Only one patient had a slight increase in thyroglobulin levels without evidence of disease on further screening. In children with medullary lesions the serum levels of basal and pentagastrin-stimulated calcitonin remained normal. Currently all patients are alive and without disease. Hypocalcaemia lasting for more than 1 year was observed in one patient. Recurrent nerves were not injured accidentally, but because of tumour invasion two of 32 recurrent nerves had to be sacrificed. This surgical approach is safe and well tolerated in children.

Adolescent↗

PubMed2001

Re-operation for bleeding after thyroidectomy and parathyroidectomy.

BACKGROUND: This study was undertaken to determine the frequency and timing of re-operation for bleeding following thyroidectomy (THY) and parathyroidectomy (PARA) as well as the implications of this concerning the safety of ambulatory surgery. METHODS: Patients requiring re-operation after THY and PARA were identified from a computerized database of patients undergoing surgery between 3/l/95 and 12/31/99. The medical records of these patients were reviewed in detail. RESULTS: Six of 918 THY (0.7%) and 4 of 350 PARA (1.1%) required re-operation for bleeding. In two cases the wounds were opened emergently at the bedside due to worsening airway obstruction. One patient required an emergency tracheostomy. There were no deaths. Excluding one patient who bled five days post-operatively, the time interval from the completion of surgery to the identification of postoperative hematoma ranged from 2 to 48 hours, the median being 16 hours. CONCLUSIONS: Postoperative bleeding is an uncommon but unavoidable complication of THY and PARA. If treated promptly, serious consequences can be avoided. The relatively long interval between the initial operation and the development of the hematoma needs to be considered when recommending the performance of these procedures on an ambulatory basis.

Hemorrhage↗

PubMedDate not supplied

Retrieval of the parathyroid glands during thyroidectomy.

A recommended technique of intraoperative search of the removed thyroid lobe or entire gland for attached parathyroid glands is presented. Diligent examination of the thyroid capsule and folds of the thyroid gland is made in the sterile operative field. Any recovered parathyroid gland or glands are then finely sectioned and reimplanted in a location which is not likely to be violated in any future surgical procedure. This technique has significantly reduced the incidence of permanent hypoparathyroidism after total thyroidectomy.

Humans↗

PubMedDate not supplied

Parathyroid gland transplantation after total thyroidectomy with pharyngolaryngoesophagectomy.

Surgical treatment of extensive hypopharyngeal carcinoma often includes total thyroidectomy together with resection of the primary disease. The risk of removing or damaging the parathyroid glands is considerable; this may render the patient permanently hypoparathyroid with all the problems of management. These patients must be on lifelong supplementation and at times, due to failure to take the medication, hypocalcemic crises are precipitated. To avoid this problem, we have been identifying the parathyroid glands intraoperatively and, after pathological confirmation, have transplanted them to the forearm. Three patients who underwent this procedure are presented. All are normocalcemic without supplementation and parathyroid hormone assays on serum from the transplanted forearm show significantly elevated levels.

Aged↗

PubMedDate not supplied

Completion thyroidectomy for thyroid carcinoma.

We have reviewed the charts of 149 patients who underwent completion thyroidectomies for cancer of the thyroid. The purpose of the study was to evaluate extent of residual disease in the thyroid, and morbidity and mortality of the operation. Residual cancer was found in 58% of the cases, the morbidity was low, and there was no operative mortality.

Adenocarcinoma↗

PubMed1985

Thyroid nodules in the irradiated patient--an indication for total thyroidectomy.

Eight patients who received radiation therapy to the head, neck, or chest during infancy, childhood, or adolescence are reported. In these individuals, the presenting abnormality was a nodule of the thyroid gland, which was found to be benign at surgery. All patients were subsequently found to harbor a malignant lesion of the contralateral lobe. On the basis of this study and the discussion presented, we feel that a total thyroidectomy is the indicated therapeutic procedure in previously radiated patients presenting with a cold nodule.

Adult↗

PubMedDate not supplied

Early recurrence of hyperthyroidism in patients with Graves' disease treated by subtotal thyroidectomy.

Prerequisites for surgical treatment of Graves' disease are that it can be done safely and that it is associated with a low incidence of recurrent hyperthyroidism. Early recurrence is especially undesirable. We studied 728 patients with Graves' disease treated by subtotal thyroidectomy using multivariate analysis in order to determine the factors related to early recurrence. The following factors were analyzed: age, sex, duration of medical treatment, weight of resected thyroid tissue, thyroid remnant size, preoperative level of thyroid-stimulating hormone (TSH) binding inhibitory immunoglobulin (TBII), and antimicrosomal hemagglutination antibody (MCHA). "Early recurrence" was defined as TSH suppression observed within the first year after surgery and continuing for at least 6 months. A total of 106 patients (14.6%) had early recurrence. Statistical analyses were performed by the chi-square test for univariate analysis and a logistic model for multivariate analysis. Significant factors were thyroid remnant size, MCHA, and TBII. These results indicated that TBII and MCHA are related to early recurrence of hyperthyroidism, and smaller remnant size is recommended for patients with a high MCHA titer or a high TBII level (or both) in order to avoid early recurrence.

Adolescent↗

PubMed1991

Changing ultrastructure of thyrotrophs in the rat anterior pituitary after thyroidectomy as studied by immuno-electron microscopy and enzyme cytochemistry.

The characteristic ultrastructure of thyrotrophs of the rat anterior pituitary was observed by immuno-electron microscopy and enzyme cytochemistry with increasing time after thyroidectomy (TX). The rough endoplasmic reticulum (ER) became dilated, the intracisternal granules reacted to serum raised against thyroid stimulating hormone (TSH) around 21 days after TX, and lysosomes and peculiar structures with positive acid phosphatase activity were present. The administration of thyroxine (T4) to the thyroidectomized rats resulted in the reformation of secretory granules, a reduction of dilated cisternae of rough ER and the activation of the lysosomal systems. Morphological features indicating that the TX-cells might be derived from growth hormone (GH) cells or cells other than TSH cells, previously suggested by some researchers, were not recognized in the present study. The amount of serum and pituitary TSH was measured by radioimmunoassay (RIA), and correlated well with the morphological changes. These results indicate that the TX-cells are hypertrophied hyperfunctioning TSH cells that have been affected by the lack of negative feedback of thyroid hormone.

Acid Phosphatase↗

PubMed1994

Successful preoperative preparation for thyroidectomy in Graves' disease using lithium alone: report of two cases.

To elucidate the effect of lithium carbonate in the preoperative preparation of patients with Graves' disease, it was given without any other antithyroid medication to two patients as an alternative to thionamide, which had caused adverse effects. The initial dose of lithium carbonate was 600 mg/day, and the final doses were 1200 and 900 mg/day, while the periods of administration were 67 and 27 days, respectively. The highest serum concentrations of lithium during the administration period were 0.83 and 0.43 mEq/l, respectively. This preoperative preparation lowered serum thyroid hormone levels and clinical improvement. A subtotal thyroidectomy was performed uneventfully in both patients, after which the serum lithium levels decreased rapidly and the thyroid hormone levels increased only slightly for a few days. No adverse effects of lithium carbonate were observed. Thus, we conclude that the administration of lithium carbonate alone is an effective and safe method for the preoperative management of Graves' disease when conventional antithyroid drugs show adverse effects.

Adult↗

PubMed1976

Modification of nucleic acid levels per mitochondrion induced by thyroidectomy or triiodothyronine administration.

The authors have determined the liver mitochondrial population (number of mitochondria/nucleus) in young rats, which has been thyroidectomized (T) or thyroidectomized and subsequently treated with triiodothyronine (T3). They have observed that thyroidectomy decreased such a population to 72.3% with respect to the normal one, while the T3 administration (at the dose of 10 mug/100 g body weight every second day, from day 50 to day 60 of age) restored the mitochondria number to 81.8% of normal ones. The average levels of proteins per mitochondrion were 8.90 X 10(-13) g in the liver of normal 60-day-old rats. This content was doubled in T rats of the same age while the levels of nucleic acids or the nucleic acid polymerase activities per mitochondrion were enhanced, notwithstanding that the specific values (referred to mg mitochondrial protein) decreased. The T3 administration severely lowered the content of protein per mitochondrion, and this may indicate that thyroid hormones control the normal assemblage of mitochondrial protein.

Age Factors↗

PubMed1976

The influence of thyroidectomy and of triiodothyronine administration on epithelial cell proliferation in the jejunum of rat.

Mitotic rates in epithelial cells lining the bases of the crypts of Lieberkühn in rat jejunum were measured using a stathmokinetic technique. Two weeks after surgical thyroidectomy the mitotic rate in the jejunal crypt cells was significantly lower than that in control animals. During the four hour period immediately after injection of triiodothyronine into thyroidectomized rats the crypt cell mitotic rate was significantly higher than in control animals.

Animals↗

PubMed1991

(131I)meta-iodobenzylguanidine scintigraphy and selective venous catheterization after thyroidectomy for medullary thyroid carcinoma.

Fifteen patients with medullary carcinoma of the thyroid (MCT), who had persistently elevated levels of serum calcitonin (CT) and carcinoembryonic antigen (CEA) after total thyroidectomy, were studied in order to localize the sites of the recurrent disease. Routine diagnostic examinations, including ultrasonography (US) and computed axial tomography (CAT), were carried out in all the cases. Scintigraphy with radio-iodinated metaiodobenzylguanidine ((131I)-MIBG) was performed in 13 cases; selective venous catheterization (SVC) to reveal a gradient of CT levels was performed in 12 cases. Ten patients underwent both (131I)-MIBG scintigraphy and SVC. US and CAT revealed the sites of recurrent tumor in only 4 out of the total 15 patients. SVC in basal conditions showed the presence of small metastases in 2 cases, and after intravenous stimulus with pentagastrin in 4 others. The MIBG scan showed metastatic foci of sporadic MCT in 2 patients, residual medullary thyroid tissue in 4 others, and a pheochromocytoma in a previously undiagnosed patient with Sipple's syndrome. More particularly, MIBG scan and SVC showed the localization of residual or metastatic tumor in 10 cases. In all 10 cases, results of the MIBG scan and SVC were confirmed as true positive by subsequent surgery and histopathologic examination.(ABSTRACT TRUNCATED AT 250 WORDS)

3-Iodobenzylguanidine↗

PubMed2002

Prognostic value of serial serum thyroglobulin determinations after total thyroidectomy for differentiated thyroid cancer.

Serial weekly serum samples (for 3 weeks) were obtained from 42 patients with differentiated thyroid cancer (DTC, papillary no.=35, follicular no.=6, Hurthle cell no.=1) for serum thyroid hormone, TSH and TG before and after total thyroidectomy. Serum specimens were also obtained one month after radioiodine (131I) therapy followed by suppressive dose of L-thyroxine (L-T4, 2.5 microg/kg). The patients were subdivided into four groups: group I: the DTC was confined to a single solid nodule (no.=1 2); group II: thyroid malignancy invaded local cervical structures but there were no lymph node metastases (no.=8); group III: DTC with lymph node metastases (no.=6); and group IV: DTC with distant metastases (no.=16). In all group I patients serum TG remained undetectable in spite of elevated serum TSH levels at the 3rd week post-surgery (PS). Only one of group II patients had a detectable serum TG value of 5.2 ng/ml (3rd week PS). By contrast, 37.5% of group III patients had detectable serum TG levels, ranging from 3.4 to 16.8 ng/ml (3rd week PS). Lymph node metastases were detected in 5 of these patients by whole body scan (WBS) and removed surgically in 3. As expected, group IV patients had elevated serum TG values ranging 33.0-958.0 ng/ml and distant metastases were confirmed in all of them by WBS. From the calculations through univariate logistic regression comparing TG concentrations at the 3rd week PS from groups I and II vs groups III and IV, we obtained a cut-off value of 2.3 ng/ml with the following efficacy features: sensitivity=74.5%; specificity=95%; positive predictive value=92.3%; negative predictive value=65.5%; and accuracy=73.8%. After 131I and L-T4 suppressive therapy, only 5 out of 36 patients of groups I, II and III had detectable serum TG levels (3.1-7.0 ng/ml) whereas serum TG was detectable in all group IV patients (ranging 2.5-8.6 ng/ml). We concluded that serum TG concentrations above 2.3 ng/ml at the 3rd week PS could be suggestive of lymph node or distant metastases in patients with DTC. Patients with serum TG above this limit could be considered at risk for metastatic disease and higher doses of diagnostic iodine-131 (131I) may be indicated for actinic ablation.

Adenocarcinoma, Follicular↗

PubMed1993

Follow-up evaluation of patients with Graves' disease treated by subtotal thyroidectomy and risk factor analysis for post-operative thyroid dysfunction.

Eight-year follow-up evaluation and analysis of factors related to postoperative thyroid dysfunction were made in 216 patients with Graves' disease treated by subtotal thyroidectomy. The postoperative status of thyroid function were as follows according to hypersensitive TSH level: 65 patients (30.1%) were euthyroid, 25 (11.5%) had overt hyperthyroidism requiring treatment, 14 (6.5%) had subclinical hyperthyroidism with normal thyroid hormone and suppressed TSH, 21 (9.8%) were overt hypothyroid requiring thyroid hormone replacement and 91 (41.1%) had latent hypothyroidism without hormone replacement. In order to know factors related to postoperative thyroid function, age, sex, preoperative levels of TSH receptor antibody (TRAb), thyroid antibody titers, degree of lymphocyte infiltration, duration of medical treatment, weight of the resected thyroid tissue and weight of the remnant thyroid tissue were determined. No factor except thyroid remnant and antimicrosomal antibody titer was related to postoperative thyroid function. The weight of remnant should be less than 6 g to avoid recurrent hyperthyroidism. As recurrence of hyperthyroidism was observed more than 5 yr after surgery, long follow-up is needed.

Adolescent↗

PubMed2006

Occurrence of overt celiac disease in the elderly following total thyroidectomy.

We report the case of a female patient in whom gluten-induced entheropathy was revealed at the age of 71 yr by resistance to treatment with levothyroxine (L-T4), calcium carbonate and alfacalcidol. Hypothyroidism and hypoparathyroidism were the consequence of a total thyroidectomy performed at the age of 65 yr for a large multinodular goiter. Six months after thyroid ablation the patient started to complain of abdominal pain, diarrhea and weight loss. Following, anemia and osteopenia were documented. A progressive increase of replacement therapy for hypothyroidism and hypoparathyroidism was necessary. The clinical presentation suggested a malabsorption syndrome: celiac disease (CD) was diagnosed by serological markers and duodenal biopsy. Following gluten-free diet a normalization of clinical and serological findings was observed, bone mass density improved and a reduction of L-T4, calcium and vitamin D requirements was observed.

Aged↗

PubMed1983

Study of the pituitary-thyroid axis in euthyroid goiter after partial thyroidectomy.

The aim of this study was to investigate the time involved after hemithyroidectomy in reaching a new steady state in thyroid function and the relationship between thyroid hormones, basal TSH levels and TSH response to TRH. The investigations were performed on 35 patients 12-18 months after partial thyroidectomy in the first investigation and after 24-30 months in the second investigation. Tests included T4, T3, FT4, FT3 serum levels, basal serum TSH and TSH response to TRH. None of the patients received thyroid replacement and 38 healthy subjects of comparable age and sex were used as controls. We conclude that: i) the time involved in reaching a new steady state of thyroid function in hemithyroidectomized patients is variable and may take a long time; ii) TSH response to TRH returns to the normal range later than thyroid hormone and basal TSH levels.

Adult↗