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PubMed2005

Comparison of the complications of subtotal, near total and total thyroidectomy in the surgical management of multinodular goitre.

Purpose of the study is to compare complication rates of bilateral subtotal (BST), near total (NTT) and total thyroidectomy (TT) in a cohort of patients undergoing surgery for benign multinodular goitre (MNG). Seven hundred and fifty patients undergoing surgery for MNG were studied with a median follow-up of 53 months (range 18-102). There was no operative mortality in this group and no patients required urgent re-exploration for haematoma. After BST 14 patients (14/170 - 8.2%) developed transient hypocalcaemia and 4 patients (4/170 - 2.4%) had transient and one permanent (1/170 - 0.6%) recurrent laryngeal nerve (RLN) palsy. In NTT group 39 patients (39/320 - 12.2%) developed transient hypocalcaemia and 2 patients (0.6%) transient voice disturbances. None of the patients in this group experienced permanent complications. However, in TT group 78 patients had (78/260 - 30%) transient hypocalcaemia whereas only one patient (1/260 - 0.4%) suffered permanent hypoparathyroidism and 5 patients (5/260 - 1.9%) had temporary RLN injury but none of them remained permanent. There are only 2 (2/170 - 1.2%) recurrences and those patients are in BST group. All of the patients in BST group required at least 100 microg of thyroxine supplementation following the operation. These results demonstrate low permanent complication rates following thyroid surgery. Although the incidence of transient hypoparathyroidism increases with the extent of the resection, permanent complication rates are similar for all three surgical procedures. Even with short follow-up, there is a risk of recurrence with BST and therefore NTT or TT may be the operation of choice for MNG.

Adult↗
PubMed1982

The effect of thyroxine, the antithyroid drug propylthiouracil and thyroidectomy on mineral metabolism in rat tissues.

The administration of thyroxine produces a significant increase in the copper, magnesium, iron and zinc contents of liver, with a concomitant decrease of heart iron. Magnesium in heart tissues was also increased. The administration of antithyroid drugs produces a significant decrease in the concentration of the same metals in the liver with concomitant increases in kidney copper and calcium, and in heart magnesium and calcium. Brain magnesium was found to be significantly decreased after antithyroid treatment and increased to a lesser extent after thyroxine administration. Thyroidectomy did not produce an appreciable effect on minerals in various tissues, except heart zinc which was significantly decreased. These findings suggest the involvement of thyroid hormones in tissue mineral metabolism, especially in the liver.

Animals↗
PubMed1983

A study of thyroid function after subtotal thyroidectomy for Graves' disease: particularly on TRH tests, T3 suppression tests and antithyroid antibodies in euthyroid patients.

Of 305 patients who underwent subtotal thyroidectomy for Graves' disease between 1969 and 1975, recurrent hyperthyroidism was found in 31 (10.2%) and hypothyroidism in 18 (5.9%). The remaining 256 patients were clinically euthyroid, but an elevated serum TSH level was found in 104 (34.1%) and an elevated serum T3 level in 19 (6.28%). In 57 of 133 clinically and biochemically euthyroid patients, a TRH test, T3 suppression test and measurement of antithyroid antibodies were performed. Twenty-nine of the 57 patients (50.9%) showed an abnormal response to TRH. Eight of these (14.0%) showed an impaired or absent response. The T3 suppression test showed that 15 of the 57 patients (26.3%) were non-suppressible. Positive antithyroid antibodies, especially antimicrosomal antibodies, were more frequent in non-suppressible and TRH-non-responsive patients than in suppressible and TRH-responsive patients. It is suggested that after operation for Graves' disease: 1) only half of the clinically euthyroid patients were biochemically euthyroid, 2) of the clinically and biochemically euthyroid patients, there were many with abnormalities in TRH responsiveness and T3 suppressibility, and 3) thyroid functional status is unstable and long careful follow-up is important after operation for Graves' disease.

Adolescent↗
PubMed1991

Evidence for acute release of thyroid peroxidase during subtotal thyroidectomy.

An immediate reduction of thyroglobulin autoantibodies during subtotal thyroidectomy of thyroglobulin antibody positive patients has previously been shown to indicate an acute release of thyroglobulin into the circulation peroperatively. The aim of the present study was to investigate whether thyroid peroxidase was also released by measuring anti-thyroid peroxidase antibodies by a quantitative and antigen specific method both pre- and postoperatively in patients positive for anti-thyroid peroxidase antibodies. Twelve anti-thyroid peroxidase positive patients (11 females, 1 male) referred for surgery of toxic goitre were studied. Median age was 43 years (range 24-64) and median goitre size 86 g (25-165). All patients had been pretreated with antithyroid drugs and were euthyroid at the time of operation. Anti-thyroid peroxidase was measured before operation, 1-8 h, 10 days, 1-3 months, and 12 months postoperatively by a commercial method (DYNO-test, Henning, Berlin). The median anti-thyroid peroxidase level before operation was 1048 kU/l (range 68-10 517 kU/l) and fell during operation to 0.63 (range 0.37-1.28) (p less than 0.01) of initial concentration without further decrease during the next 1-8 h. The comparative decrease in thyroglobulin antibodies was 0.19 (0-0.88). The anti-thyroid peroxidase level was increasing after 10 days, but did not reach initial level until between 3 and 12 months after surgery. However, in 3 of 10 patients anti-thyroid peroxidase had disappeared after 12 months, all of whom had low levels before operation, whereas anti-thyroid peroxidase was 2-4 times higher than preoperatively in 3 other patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Longitudinal study of bone loss after thyroidectomy and suppressive thyroxine therapy in premenopausal women.

The effects of suppressive doses of L-thyroxine on the appendicular and axial bone mineral content were followed for 12-36 months after total or subtotal thyroidectomy in 15 premenopausal women. Compared to age-matched controls, these patients had a more marked bone loss of the spinal bone mineral content (2.6 +/- 1.9% vs 0.2 +/- 1.2% per year). The changes in radial cortical bone density were not significantly different from the control group. We conclude that when a suppressive therapy with L-thyroxine is necessary the rate of bone loss should be monitored at regular intervals.

Adult↗
PubMed1995

Comparative effects of food restriction, fasting, diabetes and thyroidectomy on growth hormone and thyrotropin gene expression in the rat pituitary.

To examine the molecular basis for the decreased pituitary growth hormone (GH) and thyrotropin (TSH) content during restricted feeding, fasting and diabetes, we measured steady-state levels of mRNA for TSH-alpha, TSH-beta and GH in the pituitary from normal rats either fed ad libitum (C), limited to 75%, 50% and 25% (FR75, FR50, FR25, respectively) of ad libitum intake, or deprived of food for 2 and 4 days (F2 and F4, respectively), and also in streptozotocin-diabetic (D) and D insulin-treated animals. The results from these experimental groups were compared with those in thyroidectomized (Tx) rats. Pituitary mRNA was quantified by Northern blot hybridization with cDNA probes specific for rat TSH-alpha, TSH-beta and GH. Although changes in the pituitary GH mRNA during restricted feeding, fasting and diabetes were similar qualitatively to those induced by hypothyroidism, GH mRNA levels in Tx rats (> 10% of C values) were less than in the other experimental groups (p < 0.001). Pituitaries from FR50, FR25 and D rats also contained less GH mRNA than F2 and F4 animals (p < 0.05). Thyroidectomy resulted in a marked increase in both TSH-beta and TSH-alpha mRNAs, the changes in TSH-beta mRNA being greater than those in TSH-alpha mRNA. In contrast, FR50, FR25, F2, F4 and D rats exhibited a decrease in pituitary TSH-beta mRNA (60%, 50%, 35%, 36% and 33%, respectively, of C values; p < 0.01-0.05) and in TSH-alpha mRNA levels (81%, 64%, 46%, 43% and 36%, respectively, of normal values; p < 0.02-0.05), TSH-beta mRNA showing the greater changes.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2004

Diagnostic 131I whole body scanning after thyroidectomy and ablation for differentiated thyroid cancer.

OBJECTIVE: To assess the value of the diagnostic whole body (131)I scan after thyroidectomy and (131)I ablation. DESIGN: Retrospective analysis of all patients with differentiated thyroid cancer treated in one centre between 1990 and 2000. RESULTS: A total of 153 consecutive patients who underwent diagnostic scanning following ablative therapy were identified. This diagnostic scan was positive in 20 patients (13%) and faintly positive in 16 patients (11%). The majority (117 patients) had negative scans. Of the 20 patients with positive scans, four received no further treatment, nine showed no abnormal uptake following a second ablative (131)I dose and seven had uptake in the thyroid bed (six) or in neck nodes (one) after repeat ablation. OUTCOME: In the group with positive scans, the four patients who received no further treatment and the nine with a negative second ablation scan remained disease free during follow-up. No patient with a positive diagnostic scan received additional (131)I therapy which would not otherwise have been given based on the clinical findings, serum thyroglobulin (Tg) values or the presence of anti-Tg antibodies. Ten of the patients with negative scans developed recurrent disease which was always detected clinically or by a rising serum Tg value. CONCLUSIONS: Diagnostic whole body (131)I scans add little extra information and in our experience do not influence patient management. They should be reserved for patients in whom serum Tg levels are unreliable because of the presence of antibodies or when there is clinical suspicion of tumour.

Aged↗
PubMed1977

Echocardiogram before and after subtotal thyroidectomy for hyperthyroidism.

Myocardial contractility was estimated in 27 patients with hyperthyroidism (10 men and 17 women, aged from 16 to 38) by echocardiography. Echocardiographic examination was performed before and on the 7th day after the subtotal thyroidectomy. Thyroid functions (PBI, T3, and T4) decreased significantly after the operation (p less than 0.01). Heart rate and systolic blood pressure showed a slight decrease (N.S.), while diastolic blood pressure showed a slight increase (N.S.), while diastolic blood pressure showed a slight increase (N.S.). Mean AWVs decreased from 35.8 +/- 7.0 mm/sec to 27.6 +/- 5.7 mm/sec and correlated wtih T3 (r=0.4008, p less than 0.05). Mean PWV's also decreased from 53.2 +/- 12.2 mm/sec to 45.2 +/- 11.4 mm/aec and correlated with T3 (r=0.5237, p less than 0.02). DDR decreased from 108.0 +/- 36.8 mm/sec to 85.7 +/- 31.7 mm/sec and correlated wtih T3 (r=0.4008, p less than 0.05). Above results suggest that enhanced myocardial contractility and elevated rate of ventricular filling in hyperthyroidism are suppressed after the operation, and that echocardiography is useful for the evaluation of the clinical course after the operation.

Adolescent↗
PubMed2004

[Consequences of the persistence of large thyroid remnants after bilateral thyroidectomy for differentiated thyroid cancer].

Twenty-three patients submitted to thyroidectomy and before ablative therapy and with cervical uptake >10% were compared to 48 patients with uptake <2%. All but 3 patients with large remnants reached TSH levels >30 mIU/l after thyroxin withdrawal. Cervical pain requiring anti-inflammatory treatment after radioiodine was more frequent in patients with larger remnants (34.7% vs. 10.4%). Remnant ablation was successful in 56% of the individuals with uptake >10% and in 93.3% of those with uptake <2%. The sensitivity of diagnostic scanning for pulmonary metastases was similar (71.4% vs. 77.7%). The specificity of stimulated thyroglobulin at a cut-off of 5 ng/ml was 100% for patients with discrete remnants but only 37.5% for the others. We conclude that significant thyroid remnants (cervical uptake >10%) result in a lower efficacy of ablation, cause more local symptoms after radioiodine, and compromise the specificity of thyroglobulin measurements.

Adult↗
PubMed1975

Effect of thyroidectomy on the activity of alpha-glucosidases and acid hydrolases in the small intestine of rats during weaning.

Adrenalectomy performed on 14-day-old rats delayed the usual increase of sucrase and maltase activity as well as the decrease of acid beta-galactosidase, beta-glucuroindase and N-acetyl-beta-glucosaminidase activity during the third postnatal week. Since these changes were only delayed, the role of the thyroid was explored. Thyroidectomy performed simultaneously with adrenalectomy on 14-day-old rats did not influence the increase in body weight and growth of the small intestine (already slowed down by adrenalectomy), but caused a further substantial delay in the maturation of the enzyme profile of the small intestine. Our results indicate that the thyroid is involved in regulation of the hydrolases studied.

Adrenalectomy↗
PubMed1980

Effect of morphine on the release of thyroid-stimulating hormone stimulated by exposure to cold, thyroidectomy and the administration of thyrotrophin releasing hormone in male rats.

Morphine reduced the release of thyroid-stimulating hormone (TSH) which stimulated by exposure to cold and by thyroidectomy as well as reducing the basal level of TSH in the serum of male rats. Thi inhibitory effect of morphine was antagonized by naloxone which did not enhance the basal or cold-induced TSH release. Pretreatment with morphine did not reduce the release of TSH induced by exogenous thyrotrophin-releasing hormone (TRH) but enhanced it. This effect of morphine was also antagonized by naloxone. The above results suggested that the effect of morphine in reducing levels of serum TSH was not mediated by blocking the effect of TRH on the anterior pituitary gland, but that it was probably mediated by the inhibition of the release of TRH.

Animals↗
PubMed1985

Influences of thyroidectomy and thyroxine replacement on photoperiodically controlled reproduction in quail.

The breeding season in quail ends when they become relatively refractory to long photoperiods. The processes underlying the development of this refractoriness are dependent upon the thyroid gland. Thyroidectomized male Japanese quail transferred from short (8 h light: 16 h darkness; 8L: 16D) to long (20L:4D) daily photoperiods mature their gonads and develop the androgen-dependent cloacal gland at rates only marginally slower than controls. However, when the birds are retransferred to short days thyroidectomized individuals do not show the rapid testicular regression and moult which occurs in controls under such conditions. The testes remain large for a long period, eventually decreasing in size slowly and irregularly. Once such thyroidectomized birds are transferred back to short days the administration of thyroxine has little effect upon the slow rate of gonadal regression but if the hormone is administered during the preceding period of long days normal regression does occur under short days, even though treatment has ceased. This suggests that a process dependent upon thyroid hormones takes place under long day-lengths that ensures the termination of reproduction when they are exposed either to short daylengths or to decreasing daylengths after the summer solstice. This view was substantiated by further experiments in which thyroidectomy was performed after the birds had been exposed to long daylengths. When transferred to 8L:16D normal testicular regression and moult occurred rapidly. Presumably the thyroid-dependent process had proceeded to an adequate extent in these quail before the thyroid glands were destroyed. Further support came from treating intact quail chronically with thyroxine. Its administration to quail on 20L:4D had no observable effect; the testes grew rapidly to maximal size and remained large. However, if the birds were given thyroxine under 12L:12D the gonads first developed to maximal size and then, after about 12 weeks of treatment, regressed spontaneously whether or not thyroxine was still being administered. It seems that thyroxine had made the quail so relatively refractory that 12L:12D was no longer sufficiently stimulatory to overcome the developing inhibition on the photoperiodic system. The results in quail are very reminiscent of the finding that the absolute photorefractoriness and spontaneous testicular regression which develops in starlings under long daylengths is thyroid dependent.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1986

Endocrine changes associated with the termination of photorefractoriness by short daylengths and thyroidectomy in starlings (Sturnus vulgaris).

When starlings (Sturnus vulgaris) are transferred from short to long days, hypothalamic content of gonadotrophin-releasing hormone (GnRH) and pituitary gonadotrophin content eventually decrease, as birds become photorefractory, to values lower than they were on short days. This implies that both should increase as photorefractoriness is terminated some time after transfer from long to short days. Further, since thyroidectomy causes termination of photorefractoriness in birds held on long days, this should also result in an increase in hypothalamic GnRH and pituitary gonadotrophin contents. This study tests these hypotheses. Male starlings were transferred from short to long days for 10 weeks, by which time they should have become photorefractory. One group of birds was then killed; blood was collected, hypothalami and pituitaries were excised, and the stage of moult and testicular weights recorded. The remaining birds were then kept on long days, transferred to short days or thyroidectomized and kept on long days. Groups of birds in each treatment group were killed and sampled 2, 8 and 14 weeks later. Hypothalamic content of GnRH, and pituitary and plasma FSH and prolactin concentrations, were measured by radioimmunoassay. In birds sampled after 10 weeks of long days, hypothalamic content of GnRH was quite low, pituitary and plasma levels of FSH were very low, testes were small and pituitary and plasma prolactin levels were high. In intact birds kept on long days, hypothalamic GnRH content decreased further and remained low. Pituitary and plasma FSH levels remained low, testes remained small and pituitary and plasma prolactin levels decreased slowly.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

Thyroidectomy of nestling starlings appears to cause neotenous sexual maturation.

Nestling starlings (Sturnus vulgaris) were thyroidectomized, in the wild, when 8 days old. They were later brought into captivity and hand reared on a daylength of 16h light: 8h darkness per day. Thyroidectomy dramatically affected somatic development so that even at 23 weeks of age these birds retained the physical characteristics of approximately 3-week-old euthyroid birds. Nevertheless, they appeared to be healthy and were active. Despite retaining juvenile features, these thyroidectomized birds became sexually mature. In males, testicular growth began at 8 weeks of age and by 23 weeks both males and females had well developed gonads.

Aging↗
PubMed1994

Effect of thyroidectomy, and thyroxine and alpha 2u-globulin replacement therapy on testicular steroidogenic and gametogenic activities in rats.

Adult male rats were thyroidectomized and killed after 22 days of treatment. Thyroidectomy lowered the weights of testes and accessory sex organs, decreased the activities of testicular delta 5-3 beta- and 17 beta-hydroxysteroid dehydrogenases (HSD), and diminished spermatogenesis, serum levels of testosterone and alpha 2u-globulin. Supplementation with thyroxine at a dose of 5 micrograms/100 g body weight per day for 21 days or supplementation with alpha 2u-globulin at a dose of 1.5 mg/rat per day for 21 days in thyroidectomized animals partially reversed the decrease in HSD activities and serum concentrations of testosterone and alpha 2u-globulin, while spermatogenesis was restored to normal. The weights of testes and accessory sex organs were also reinstated after supplementation with thyroxine or alpha 2u-globulin in thyroidectomized rats in comparison with thyroidectomized animals. It was concluded that alpha 2u-globulin may be an intermediary in the thyroid hormone control of testicular function.

17-Hydroxysteroid Dehydrogenases↗
PubMed1998

Effect of neonatal thyroidectomy on growth hormone secretion in the rat.

The influence of neonatal thyroidectomy (Tx) on GH production was investigated by means of Northern blot analysis. Tx resulted in a significant decrease in pituitary GH mRNA levels after 10, 15 and 20 days. The changes of pituitary GH mRNA were soon reflected in pituitary GH content. There was, however, no significant difference in pituitary GH mRNA levels and GH content between Tx and sham-operated rats at 5 days old. The pituitary GH cells were significantly decreased in number 15 and 20 days after Tx. These data suggest that GH mRNA is transcribed, independent of thyroid hormone, in the rat anterior pituitary gland during early neonatal life. In addition, the present study ascertained that GH dependence on thyroid hormone is acquired between the 5th and 10th day of neonatal life.

Animals↗
PubMed1981

Thyrotropin releasing hormone (TRH): its changes in discrete hypothalamic areas after treatment with triiodothyronine, thyroidectomy and acute cold exposure.

In order to elucidate the specific thyrotropic area in the hypothalamus, thyrotropin releasing hormone (TRH) content and concentration were measured in discrete hypothalamic nuclei and areas after triiodothyronine (T3) administration (T3 10 micrograms/rat/day for 6 days), thyroidectomy (TX) and acute cold exposure in male rats. In th TX and T3 groups, serum TSH levels were significantly increased in TX group and markedly decreased in T3 and TX with T3 groups as compared to the sham operated control group (Sham). TX produced a slight but nonsignificant decrease in TRH content in most of the hypothalamic nuclei examined as compared with the Sham group. However, a significant increase in TRH contents was seen in the anterior hypothalamic nucleus (AHN), median eminence (ME) and posterior pituitary (PP) in TX with T3 group as compared to the rats with only TX. In the acute cold stress experiments, serum TSH levels were elevated from 15 to 30 min of 4 degrees C exposure. Together with these peripheral changes, TRH content and concentration in the suprachiasmatic nucleus (SC) were increased significantly at 15 min and had returned to the normal level by 30 min after 4 degrees C cold exposure. However, in the paraventricular nucleus (PV) and dorsal premammillary nucleus (PMD), marked decrease in TRH concentrations were observed with this stress. Therefore, 1) decreased TSH release in TX rats treated with T3 was induced by the block of TRH release from the AHN and ME as compared with the TX group, and 2) elevated serum TSH levels in 4 degrees C cold stress might be induced by the release of TRH from the PMD and PV. These experiments demonstrate that the specific hypothalamic area for TSH release was located in some of the anterior and posterior hypothalamic nuclei and in the ME.

Animals↗
PubMed2003

Medullary thyroid carcinoma. Genetic screening and prophylactic thyroidectomies.

Medullary thyroid cancer is a rare, neuroendocrine, tumor. It arises from parafollicular or C-cells with the ability to produce and secrete different bioactive substances like calcitonin (TC) and CEA (1-5) TC is ideal tumor marker in early diagnosis, in patents' follow up and in evaluation of their treatment. TC determinations after ca/pentagastrine stimulation test give us even more accurate results and the procedure is used for biochemical family screening. MTC occurs as a sporadic tumor or in hereditary settings MEN 2A, MEN 2B and FMCT. Germ/line point mutations in RET proto/onkogene are responsible for tumor arise and inheritance of settings. Genetic screening provides information of these RET mutations in family members even before pathologic changes occur. These individuals with MEN 2A, 2B and FMCT characteristic RET mutations are almost certain to acquire MTC (95% penetrance) in their lives and are candidates for preventive total thyroidectomy (TT), with or without central neck dissection (CND). Surgery is still the treatment of choice for MTC and only C-cell hyperplasia and early stage of MTC can be cured. Prophylactic thyroid surgery eliminates the possibility of MTC but doesn't influence appearance of other diseases (PHEO, HPTH) of MEN 2 syndromes.

Adolescent↗