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At least 883 records · Page 49Linked to original sources
PubMed2006

Surgical site infections after thyroidectomy.

BACKGROUND: The history of thyroid surgery starts with Billroth, Kocher, and Halsted, who developed techniques for thyroidectomy between 1873 and 1910. Before 1950, the operative mortality rate approached 50%. The advent of general anesthesia and antisepsis and the development of fine hemostatic instruments rendered thyroid surgery safer, but the potential persists for life-threatening complications. This study was designed to identify specific risk factors for the development of surgical site infections (SSIs); to define high-risk patients; to determine the causative organisms; to illustrate the clinical presentation, treatment, and outcome; and to establish management guidelines. METHODS: A prospective analysis was carried out of complications affecting 241 consecutive patients (mean age 65+/-19 years; 76% female) undergoing cervical exploration for thyroid disease from 2000 to 2005, with particular attention to infection, and the pertinent literature was reviewed. RESULTS: Surgical site infections (SSI) affected 2% of patients. The risk of infection depended mainly on the quality of pre-operative and post-operative care and on whether there was a break in sterile technique. The use of drains and pre-operative antibiotics did not affect the incidence of SSI. No pre-operative factor foreshadowed this complication, and the definition of a high-risk population remains obscure. Surgical site infections lengthened the hospital stay. CONCLUSIONS: Effort should be made to improve sterile technique. Appropriate antibiotic coverage is indicated when infection develops post-operatively. The most important element in the management of SSI is adequate drainage of the incision once infection develops.

Aged↗
PubMed1999

Results of subtotal thyroidectomy for Graves' disease.

The objective of this study was to find the factors responsible for hypothyroidism after subtotal thyroidectomy for Graves' disease. Two hundred five patients who were operated on from July 1989 to December 1997 were studied. The mean age of patients was 33.4+/-11.0 (mean +/- SD) years, and 175 (85.4%) were female. Patients were prepared with an antithyroid drug and Lugol's solution preoperatively. Triiodothyronine (T3), thyroxine (T4), thyrotropin (TSH), thyrotropin-binding immunoglobulins (TBII) antimicrosomal antibodies (AMA = 100x 4(M-1)), and antithyroglobulin antibodies (ATA = 100x4(T-1)) were measured 1 week before patients were operated on. Operations were performed according to the standard procedure with 2.5x1x1 cm of thyroid tissue remaining on each side before approximating the thyroid capsule and pretracheal fascia. Hypothyroidism was defined by patients with overt hypothyroidism in laboratory data, and or with T4 to maintain T3 and T4. Two hundred two patients were checked 3 months after being operated on. Latent hyperthyroidism was found in 22, euthyroidism in 55, latent hypothyroidism in 91, hypothyroidism in 34 (16.8%) and none were in overt hyperthyroidism. After a follow-up period of 26.9+/-15 (mean +/- SD) months, 199 patients were reevaluated. Overt hyperthyroidism was found in 2 patients, latent hyperthyroidism in 12, euthyroidism in 97, latent hypothyroidism in 72, and hypothyroidism in 16 (8%). Factors having possible effects on hypothyroidism after longterm follow-up were analyzed. Patient's age, gender, body surface, premedicative T3 and T4, preoperative ATA, and TBII, and the weight of removed thyroid had no effect on the occurrence of hypothyroidism. Preoperative AMA levels, and finding more than 10 lymphoid infiltrations per 10 low-power fields (x40) were significantly different between the hypothyroid and nonhypothyroid groups. A high level of preoperative AMA was the only factor independently causing overt hypothyroidism in the follow-up period. Patients with high preoperative AMA levels have a higher risk of hypothyroidism if only 2.5x1x1 cm remnants are left on each side.

Adult↗
PubMed1999

Short-term effectiveness of low-dose radioiodune ablative treatment of thyroid remnants after thyroidectomy for differentiated thyroid cancer.

Twenty-five patients from a marginally iodine-deficient area with differentiated thyroid cancer who were referred to our unit between 1991 and 1997 had a residual thyroid uptake (RTU) at 24 hours of 5% or more after surgery. None of them underwent reoperation: 8 of 25 had RTU between 5% and 10% and were considered at low risk for both local recurrences and/or distant metastases; 17 of 25 had RTU greater than 10% and up to 30% and refused re-intervention. After detection of their cervical uptake by using a 131I tracer dose of 3.7 MBq (100 microCi), all 25 were treated with 1110 MBq (30 mCi) of 131I. A whole-body scan (WBS) performed 5 days later revealed 131I uptake corresponding to metastatic lymph nodes in the anterior part of the neck in 1 patient and the persistence of only RTU in 24 of 25 patients. RTU and thyroglobulin (Tg) levels were reevaluated 6 months later in all patients and compared to preradioiodine treatment values. RTU, ranging at presentation between 5% and 30%, decreased to below 1% in all but one patient. Serum Tg values, ranging between 1.6 and 108 ng/mL before radioiodine treatment, decreased to below 1.6 ng/mL in all but 4 of them (whose serum Tg was between 2 and 3.4 ng/mL). Our data indicate that 1,110 MBq of 131I can permit complete ablation of 80% of thyroid remnants concentrating up to 30% of radioiodine activity. A relation between this high success rate and iodine deficiency can be hypothesized because an increasing uptake of radioiodine by thyroid remnants could result in overestimation of their size. Therefore, our observations suggest that in iodine deficient areas, a hasty decision to carry out complete thyroidectomy should be avoided, even in the case of thyroid remnants with RTU up to 30%.

Adolescent↗
PubMed2006

Urgent thyroidectomy for acute airway obstruction caused by a goiter in a euthyroid pregnant woman.

Pregnancy constitutes a significant factor for thyroid enlargement. However, acute respiratory failure as a result of airway obstruction from an enlarged thyroid gland is an unusual incident. The case presented here concerns a 27-year-old black woman in her 20th gestational week who underwent an urgent operation for removal of a nontoxic, multinodular, mildly substernal goiter that was causing severe upper airway obstruction leading to acute life-threatening respiratory failure. Diagnosis of an extrathoracic tracheal stenosis was based on spirometry with analysis of the flow volume curve and was confirmed by magnetic resonance imaging of the neck. Despite operational risks to the mother as well as the fetus during gestation, an urgent thyroidectomy was carried out successfully. The postoperative period progressed normally and the patient completed her pregnancy with no further respiratory symptoms.

Adult↗
PubMed2003

Reciprocal interaction between seasonal testis and thyroid activity in Zembra Island wild rabbits (Oryctolagus cuniculus): effects of castration, thyroidectomy, temperature, and photoperiod.

The reproductive cycle of wild rabbits (Oryctolagus cuniculus) living in Zembra Island (North Tunisia) is dependent on an external factor, the photoperiod: the gonads are inhibited by long days and stimulated by short days or melatonin implants. Here we studied the role of an internal factor, thyroid hormones and the possible thyroid-gonadal interrelationships, in animals captured on Zembra Island and maintained in natural conditions of photoperiod and temperature. We determined the seasonal profile of the thyroid and testis cycles and investigated the effects of castration and thyroidectomy on the seasonal testosterone and thyroxine cycles. Plasma thyroxine and testosterone levels followed similar, parallel seasonal patterns, with a peak in autumn (October) and low values from January to August. In thyroidectomized animals, plasma testosterone levels, although significantly higher than those in controls (P < 0.001), remained low throughout the 13 mo of the experiment, and no testicular reactivation was observed in the fall. In castrated animals, despite the increase in thyroxine concentration in the 3 mo following castration (P < 0.01), plasma thyroxine levels remained low during the 2 yr of the study. We then investigated the combined effects of long days (16L:8D) and moderately high temperature (25 degrees C) on these two endocrine axes. In constant gonado-inhibiting conditions (16L:8D), whether the temperature was kept constantly high or allowed to fluctuate naturally, no reactivation of the thyroid and testicular axes was observed in the fall. In control animals, the peaks of testosterone and thyroxine concentrations observed in September were larger (P < 0.001) than those in animals subjected to the same natural photoperiod conditions but with constantly high temperature. The lower level of autumnal testis stimulation (P < 0.001) in animals maintained in conditions of constant high temperature (25 degrees C) may be attributed to the low thyroxine levels induced by high temperature. These results clearly confirm that the thyroid and testicular cycles display similar seasonal variations and show that the thyroid and gonadal axes are strictly interdependent. This study provides the first demonstration, for a given species, that the seasonal reactivation of gonad activity is controlled by the thyroid, and thyroid activity is controlled by the gonads.

Animals↗
PubMed1997

Effect of thyroidectomy on maintenance of seasonal reproductive suppression in the ewe.

Thyroid hormones are essential to end the breeding season in sheep; however, it is not clear whether thyroid hormone action is limited to initiation of seasonal reproductive suppression in the ewe. The purpose of this study was to determine the influence of thyroid hormones on maintenance of anestrus and onset of the subsequent breeding season in the ewe. In both experiments, ewes were thyroidectomized (THX) either soon after they had completed the transition from the breeding season to anestrus or just before the transition into the breeding season (late anestrus). All ewes were ovariectomized and received constant-release silicone elastomer implants of estradiol. Circulating levels of LH were monitored as an index of seasonal changes in reproductive neuroendocrine activity. After thyroidectomy early in anestrus, timing of the subsequent LH rise, indicative of the next neuroendocrine breeding season, was the same among THX and thyroid-intact ewes. As observed previously, LH remained elevated in ewes THX late in anestrus beyond the time associated with development of anestrus. We conclude therefore that thyroid hormones are not needed to maintain suppression of the reproductive neuroendocrine axis once anestrus has been established, nor do they influence the onset of the subsequent breeding season in the ewe. Rather, thyroid hormone action on seasonal alterations of the reproductive neuroendocrine axis in the ewe is restricted to the changes that cause development of anestrus.

Anestrus↗
PubMed2002

Successful thyroidectomy in a patient with Hermansky-Pudlak syndrome treated with recombinant activated factor VII and platelet concentrates.

Hermansky-Pudlak syndrome is a rare autosomal recessive disorder characterized by the absence of platelet dense bodies in association with albinism. We present the use of recombinant activated factor VII (rFVIIa) in a patient with Hermansky-Pudlak syndrome who underwent total thyroidectomy because of a large richly vascularized nodule (10 cm) compressing the trachea. The patient had a prolonged bleeding time (> 20 min) that remained unchanged after platelet transfusions. However, after infusion of platelets plus rFVIIa, it diminished to 5 min. The platelet aggregation response to adenosine diphosphate and collagen was diminished. Since an early age, the patient had repeated nose bleeding and an episode of melena requiring several tampons, cauterization and transfusions of packed red cells. In this case, we used rFVIIa in bolus for 1 day (four doses of 120 microg/kg every 2 h and six doses of 100 microg/kg every 3 h) and transfusion of platelet concentrates beginning just prior to surgery. No evidence of local bleeding complication could be detected during the entire post-operative period. The hemoglobin level remained normal and no transfusions of packed red cells were necessary. No adverse events occurred.

Blood Coagulation Tests↗
PubMed1980

Localizing functioning thyroid following total thyroidectomy by use of a combination scanning technique.

A technique is described using 1-131-sodium iodine and Tc-99m-sodium pertechnetate for localizing functioning thyroid tissue in the neck following total thyroidectomy. The procedure consists of obtaining a 1-131 thyroid scan. If functioning thyroid tissue is found, it can be localized by means of skin markers as well as a swallow using Tc-99m-sodium pertechnetate. The procedure is safe, simple, and cost efficient and provides a means of localizing functioning thyroid that may influence subsequent therapy.

Adenocarcinoma↗
PubMed1991

Radioiodine uptake following thyroidectomy for thyroid cancer. Recurrence or ectopic tissue?

Post-thyroidectomy I-131 sodium iodide scans revealed foci of uptake outside the thyroid bed in two patients. In each case, these areas corresponded to sites where ectopic or aberrant thyroid tissues could be found. The presence of metastatic disease significantly affects the appropriate therapy, as well as the overall prognosis. An appreciation of the potential locations of ectopic thyroid tissues that may mimic metastatic disease and potentially confound diagnosis are stressed.

Adult↗
PubMed1994

Ovarian metastasis from thyroid carcinoma 12 years after partial thyroidectomy mimicking struma ovarii: report of a case.

A 29-year-old woman experienced abdominal swelling 12 years after undergoing partial thyroidectomy for follicular carcinoma of the thyroid with vascular invasion and 6 months after a right cerebral tumor that had caused hemiplegia had been excised. Laparotomy disclosed a solid and cystic right ovarian tumor, 17 cm in greatest dimension, and a 12-cm tumor of the right adrenal gland. Microscopic examination showed a malignant tumor of the thyroid follicular type with frequent mitotic figures; other teratomatous elements were absent. Because of the interval since the thyroid cancer, the diagnosis of a malignant struma ovarii was initially considered. The patient rapidly developed widespread metastatic disease and died, supporting the interpretation that the ovarian tumor was a metastasis from the thyroid neoplasm. This case illustrates that when other teratomatous elements are not identified, the diagnosis of malignant struma ovarii should be made only when the possibility of spread from a prior thyroid neoplasm, possibly one treated many years previously, has been excluded.

Adenocarcinoma, Follicular↗
PubMed2002

Risk of injury to the external branch of the superior laryngeal nerve in thyroidectomy.

OBJECTIVE: To establish in the Mexican population with thyroid disease the risk of injury to the external branch of the superior laryngeal nerve (EBSLN) based on its anatomical position. STUDY DESIGN: Non-randomized comparative clinical trial. METHODS: Seventy-three patients subjected to thyroidectomy because of thyroid nodule in which the EBSLN was identified and classified. The dependent variable was Cernea's classification of the EBSLN, and the independent variables were weight (in grams) of the nodule, side studied, gender, and age. For statistical analysis, chi2 test, Fisher's Exact test, and analysis of multiple variables (analysis of variance) were used. RESULTS: We studied 73 patients; 64 (87.62%) were women and 9 (12.38%) were men (average age, 39.3 years [age range, 17-73 y]; median age, 40 y; mode, 40 y; SD +/- 23.4 y). Regarding location of the EBSLN, for pathological lobes, 78.1% were located in a high-risk position and for nonpathological lobes, 72.7%. Comparative analysis between sides and relation between weight and classification revealed no statistical significance. CONCLUSION: The frequency of high-risk position for EBSLN lesion in our milieu was higher than that reported in series from other countries and races.

Adult↗
PubMed1975

Remnant function after subtotal thyroidectomy for Graves' disease.

Although it has been thought that future thyroid function after subtotal thyroidectomy for Graves' disease was intimately related to the mass of the thyroid remnant, long-term functional results have not been clearly established. These questions were examined in a retrospective study of 86 surgical cases with histologically confirmed Graves' disease. Operation resulted in euthyroidism in 76% of cases. Recurrent thyrotoxicosis appeared in 8%. Hypothyroidism developed in 14 patients (16%), all with estimated remnant weights of less than 8 gm. In each case, hypothyroidism was diagnosed within the first postoperative year. The capability for early diagnosis of hypothyroidism, however, is a significant advantage of surgical treatment. Within the range of estimated remnant weights, a significant and negative correlation was found between remnant size and the subsequent development of hypothyroidism, but neither euthyroidism nor recurrence of thyrotoxicosis could be correlated with remnant size. In the individual patient, therefore, estimated remnant size is of limited value in predicting future thyroid function.

Adolescent↗
PubMed2003

Incidental discovery of pulmonary metastases during I-131 scintigraphy after total thyroidectomy.

We report the case of a 40-year-old man with radiographically silent pulmonary metastases of papillary thyroid cancer discovered during I-131 scintigraphy following total thyroidectomy performed 10 years after unilateral lobectomy. The residual lobe was histologically normal. After a dose of 11.1 GBq (300 mCi), there was no I-131 uptake in the thyroid bed and lung metastases, and serum thyroglobulin became undetectable. Conservative therapy could be associated with a delay in the possibility of diagnosing and treating extrathyroidal metastases.

Adult↗
PubMed2006

False-positive uptake of I-131 in a laryngocele mimicking thyroid remnant after thyroidectomy for papillary thyroid carcinoma.

A 66-year-old woman underwent total thyroidectomy for papillary thyroid carcinoma stage pT4 followed by radioiodine therapy with 3.7 GBq (100 mCi) iodine-131. Radioiodine therapy revealed intense radioiodine uptake of the neck, which was interpreted as thyroid remnant tissue. Follow-up whole-body scans with iodine-131 in hypothyroidism 3 months and 1 year after radioiodine therapy revealed focal uptake in the neck. Computed tomography and gadolinium-enhanced MRI of the neck demonstrated an ovoid lesion in the larynx without gadolinium enhancement. Neither thyroid remnant tissue nor enlarged cervical lymph nodes could be demonstrated either on CT or on MRI. Further examination of the patient in the ear, nose and throat department confirmed the finding of a laryngocele and biopsies demonstrated benign tissue. Follow-up whole-body scans with iodine-131 in hypothyroidism 3 years and after injection of rhTSH 5 years after radioiodine therapy reproduced the focal uptake in the neck. After initial radioiodine therapy thyroglobulin levels were never measurable, not at any of the whole-body scans in hypothyroidism, after rhTSH, or at intermediate follow-up examinations under TSH-suppressive levothyroxine therapy. The patient declined definitive operative revision of the laryngocele and is in good health 8 years after the diagnosis of papillary thyroid carcinoma.

Aged↗
PubMed2004

Prospective study of postoperative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery.

OBJECTIVES: (1) To show that total thyroidectomy (TT) can be performed in multinodular goiter (MG) by surgeons with experience in endocrine surgery with a definitive complication rate of 1% or less; and (2) to analyze the risk factors for complications in these patients. SUMMARY BACKGROUND DATA: There is current controversy over the role of TT in the treatment of MG; although there are potential benefits, high rates of complications are not acceptable in surgery for a benign pathology. PATIENTS AND METHOD: A prospective study was conducted on 301 MGs meeting the following criteria: (1) bilateral MG; (2) no prior cervical surgery; (3) operation by surgeons with experience in endocrine surgery; (4) no associated parathyroid pathology; (5) no initial thoracic approach; and (6) minimum follow-up of 1 year. Age, sex, time of evolution, symptoms, cervical goiter grade, intrathoracic component, thyroid weight, and presence of associated carcinoma were analyzed as risk factors for complications. The chi test and a logistic regression analysis were applied. RESULTS: Complications were presented by 62 patients (21%), corresponding to 29 hypoparathyroidisms, 26 recurrent laryngeal nerve injuries, 4 lesions of the superior laryngeal nerve, 3 cervical hematomas, and 1 infection of the cervicotomy. The variables associated with the presence of these complications were hyperthyroidism (P = 0.0033), compressive symptoms (P = 0.0455), intrathoracic component (P = 0.0366), goiter grade (P = 0.0195), and weight of excised specimen (P = 0.0302); hyperthyroidism (relative risk [RR] 2.5) and intrathoracic component (RR 1.5) persisted as independent risk factors. Definitive complications appeared in 3 patients (1%), corresponding to 2 hypoparathyroidisms and 1 recurrent laryngeal nerve injury. Two cases corresponded to a toxic goiter, and the third to an intrathoracic goiter with compressive symptoms. CONCLUSION: In endocrine surgery units, TT can be performed for MG with a definitive complication rate of around 1%; the main independent risk factors for the development of complications are hyperthyroidism and goiter size.

Clinical Competence↗
PubMed1978

Propranolol in thyrotoxicosis. Cardiovascular changes during thyroidectomy in patients pre-treated with propranolol.

The cardiovascular changes during anaesthesia and thyroidectomy have been studied in seven thyrotoxic patients prepared with propranolol. The heart rate and cardiac rhythm remained very stable throughout surgery. A 20% increase in mean arterial pressure occurred during surgical stimulation. A decrease in cardiac output, due to decreased stroke volume, occurred during surgical stimulation. A decrease in cardiac output, due to decreased stroke volume, occurred during surgery, reaching a maximum of 21% during ligation of the thyroid vessels and returning to pre-operative values by the end of surgery. The fall in cardiac output was accompanied by raised central venous pressure and raised total peripheral resistance.

Adult↗
PubMed1980

Serum thyroglobulin concentrations and 131I whole body scans in the diagnosis of metastases from differentiated thyroid carcinoma (after thyroidectomy).

Measurements of circulating thyroglobulin (hTg) and 131I whole body scan were performed in 101 patients with differentiated thyroid carcinoma who had been subjected to surgical thyroidectomy and 131I ablation of remaining thyroid tissue. All 45 patients with positive scans (i.e. functioning metastases) had elevated hTg concentrations. Of fifty-six patients with negative scans forty-two had undetectable or very low hTg levels and were considered to be free of metastatic thyroid tissue, whereas fourteen showed the presence of non-functioning metastases in the clinical and/or radiological examination. In this group of patients, eleven had elevated serum hTg levels while the other three patients had detectable hTg concentrations within the normal range. These results indicate that serum hTg measurements correlate very well with scan findings and have the added advantage of detecting non-functioning metastases which would not be detected by scanning. We concluded that measurement of serum hTg may be used together with scanning, as the first step in the follow-up of thyroidectomized patients with differentiated thyroid carcinoma.

Adenocarcinoma↗
PubMed1981

The effect of partial thyroidectomy for Graves' disease on serum long-acting thyroid stimulator protector (LATS-P).

The effect of partial thyroidectomy on serum LATS-P has been investigated in twenty-one consecutive patients. Before surgery, LATS-P was detectable in seventeen (81%) but 1 year after operation only five (24%) had activity. The activity did not fall immediately after surgery but declined progressively throughout the year. In no patient was an increase in activity demonstrated; nor did LATS-P appear in those patients who did not have activity before operation.

Adolescent↗