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PubMedDate not supplied

Modern surgical technique for thyroidectomy.

Extracapsular lobectomy or total thyroidectomy are the surgical techniques normally used to deal with either benign or malignant thyroid diseases needing surgery. Both the well-known pathogenesis of benign surgical pathology and the positive role of post-operative radiometabolic treatment for differentiated carcinomas justify this surgical approach. Of course a complete understanding of anatomic structures and skilled operative techniques are necessary. The thyroid's parenchyma preventive extracapsular devascularization allows a strictly bloodless operative field, which makes it easier to preserve both the superior and inferior laryngeal nerves and the parathyroid glands of both sides. Therefore this procedure can be primarily considered a "vascular" technique. Our surgical technique is thoroughly described here, stressing anatomical landmarks and surgical steps, and maintaining awareness of pathophysiological implications and related operative choices.

Humans↗
PubMed2002

[Detection, identification and visualization of the recurrent laryngeal nerve during thyroidectomy--still a surgical dilemma].

OBJECTIVE: Based on their on experience the authors express their opinion on routine detection and visualization of the NLR during radical surgery of the thyroid gland. They describe standard and alternative steps of surgery leading to protection of the recurrent nerve. MATERIAL AND METHODS: The authors evaluated a group of 735 patients operated during the last thirty nine months which comprised 87% total thyroidectomies, 11.6% total lobectomies, the remainder were almost total operations. The number of visualized nerves was 1367. RESULTS: Unilateral temporary damage of the NLR leading to temporary pareses of the vocal cords was recorded in 19 patients, i.e. 1.39%, bilateral transient paresis in one case, i.e. 0.07%. Permanent damage of one vocal cord after severing of the NLR occurred in 11 patients, i.e. 0.8%, bilateral lesions of the vocal cords were not recorded. CONCLUSION: There are no extensive statistics of thyroid operations without reports on damage of the NLR. With the increasing number of radical operations of the gland also the number of departments increased which recommend unequivocally to seek and visualize the NLR. The authors results support this point of view. They use most frequently a modification of Wang's method and consider as the smallest extent of visualization of the NLR the distance between the branching of the inferior thyroid artery and the entry of the NLR into the larynx.

Humans↗
PubMed2002

Tracheal necrosis and surgical emphysema: a rare complication of thyroidectomy.

We describe the first reported case of tracheal necrosis following a thyroidectomy. This complication resulted in massive subcutaneous emphysema and pneumomediastinum, which required emergency exploration of the neck to decompress the trapped air. We also discuss the suggested etiology and management of this rare condition.

Follow-Up Studies↗
PubMed2002

[The efficacy of radio-iodine-therapy in patients with differentiated form cancer of thyroid gland in various after thyroidectomy].

Results of treatment of 376 patients, ageing 18-76 yrs, were analyzed to investigate the radioiodine therapy (RITH) efficacy for the thyroid differentiated cancer depending on the term of its conduction after the operation. In patients with the thyroid gland residual tissue (THGRT) only the first course of RITH efficacy was 82.6-96.1%, the THGRT and metastases devitalization in regional lymph nodes and lungs was achieved in 72.7-81.6% of patients. The RITH courses number had constituted 2.5-6.3 at average and median summary activity for one patient--11-33.8 GBq. It was suggested that tendency for the courses number and summary activity enhancement in patients with regional and distant metastases was caused by the tumor tissue mass increase according to elongation the period of time between thyroidectomy and RITH conduction. It is necessary to determine the RITH conduction urgency, basing on the risk factors analysis.

Adolescent↗
PubMed2002

Evaluation of an alternative, subclavicular approach to thyroidectomy.

BACKGROUND: After presenting with the common finding of a nodular goiter, many patients refuse surgery because of the potential for a conspicuous anterior neck scar. Despite the development of endoscopic approaches to neck dissections, it can be difficult to remove a large thyroid tumor using such approaches. MATERIAL/METHODS: We attempted thyroid lobectomies via a subclavicular approach in three cases - three women whose ages ranged from 36-45 years old. Each patient was diagnosed with a cytologically-benign nodular goiter with a diameter greater than 60 mm. Subclavicular incisions were made with the length being determined by the size of the tumor and with the thyroid being approached laterally for resection. RESULTS: Despite a maximum tumor diameter of greater than 70 mm, our operative technique was comparable to conventional methods with respect to surgical exposure, safety and operation time. Cosmetically, each patient was satisfied with the post-operative results. CONCLUSIONS: We believe that the subclavicular approach to thyroidectomy is a safe and cosmetically-superior alternative to conventional surgery, even in cases that are too large to approach endoscopically.

Adult↗
PubMed2002

[Post-thyroidectomy hemorrhage].

The aim of the study was to estimate the prevalence and causes of haemorrhages, that required extemporaneous surgical treatment, after goiter operations, in our own material. Between 1984 and 2000, i.e. during 17 years, 7400 patients were operated in our Clinic due to different kinds of goiter. Haemorrhage during post operative period was presented in 46 (0.62%) patients. There were 37 women and 9 men in the analysed material. The age of patients was between 19 and 77 years, and the average age was 50.6 +/- 15.4. The lowest percentage of this complication was observed after operation of non-toxic goiter (0.39%) and the highest in a group of patients operated due to Graves-Basedow's disease (1.02%). Frequent local symptoms were observed, such as: enlargement of circumference of neck, supple haematoma with dyspnoea, and sometimes swallowing difficulties. A decrease in blood pressure was observed in 5 (10.9%) patients. Low molecular weight heparin prophylaxis was applied in 18 (39.1%) patients and in 2 cases disorders of blood coagulability were observed. The quantity of drainage from the wound was between 30 and 610 ml, with average 249.8 +/- 144.69 ml. Time from main operation termination to revision was 20 to 1440 minutes, with average time 346 +/- 285.66 minutes. The most common cause of post-thyroidectomy haemorrhage was bleeding from the thyroid lobe stump, which presented in 28 (60.9%) patients. The most dangerous haemorrhage, because of its intensity, was the bleeding from the upper thyroid artery (6 patients). During the postoperative period 16 patients (34.8%) required blood transfusions, however massive transfusions (4 and more blood units) were performed only in 4 patients. Early complications included: paralysis of recurrent laryngeal nerve in 6 patients and transient hypocalcaemia in one patient.

Adolescent↗
PubMed2002

Thyroidectomy: understanding the potential for complications.

Thyroidectomy is a relatively common procedure. Complications may result from the surgery itself or from secondary metabolic disturbances. Medical-surgical nurses must act quickly and efficiently to detect and treat postoperative complications.

Humans↗
PubMedDate not supplied

Complications in total thyroidectomy: our experience and a number of considerations.

The authors review 1,636 cases of total thyroidectomy with reference to specific complications, classifying them under the headings: major-minor, early-late, transitory-definitive. They report 19 cases of postsurgical haemorrhage, all within 12 hours of the operation, 31 transitory and 15 definitive cases of recurrent laryngeal nerve paralysis, and 14 cases of definitive hypoparathyroidism. As far as the minor complications were concerned, there was a greater incidence of seroma following the use of the harmonic scalpel. The risk factors and physiopathological mechanisms associated with each type of complication are analysed here, above all those responsible for the major and definitive complications. The need for routine preparation of the recurrent nerve, in order to prevent occurrence of postsurgical paralysis is stressed, as is the efficacy of vitamin D in preventing symptomatic postsurgical hypocalcaemia.

Humans↗
PubMed1992

[Prophylactic drainage after thyroidectomy: a randomized trial].

A randomized clinical trial of surgical drainage in thyroid surgery was performed with 97 patients. Using equivalence testing it is reported that morbidity was not significantly different between the two groups and the length of hospital stay was shorter in the undrained group. It is possible to perform thyroidectomy without drainage in a selected population.

Adult↗
PubMedDate not supplied

Does total thyroidectomy induce metabolic bone disturbance?

Bone mineral content of 38 thyroidectomized patients with well differentiated thyroid carcinoma were determined. Seventeen patients were totally thyroidectomized and 21 patients were non-totally thyroidectomized (lobectomy). Thirty-eight healthy males and females were served as age-matched controls. Trabecular bone mineral content of lumbar vertebra was evaluated by quantitative CT method. Bone metabolic parameters in serum were measured. No significant differences were observed in the mean bone mineral content and BMC-index of totally thyroidectomized patients compared with non-totally thyroidectomized patients and control. Serum calcitonin level was not reduced in totally thyroidectomized. It is concluded that after total thyroidectomy, bone metabolic disturbance was not significant, and that when calcitonin remained at its basal level, it had no effects on bone metabolism.

Adult↗
PubMedDate not supplied

[Surgical treatment of post-thyroidectomy laryngeal paralysis].

A not infrequent complication of thyroid surgery is laryngeal nerve palsy with transitory or permanent deficiency of cordal motility. A very frequent cause of this condition is total thyroidectomy. Peripheral mono-or bilateral palsy in these cases may either occur, in adduction or abduction, and be complete or not complete. Therefore, different strategies in order to restore respiratory and phonatory functions are required. The Authors describe the main otorhinolaryngologic procedures used for the surgical treatment of laryngeal palsy, particularly for bilateral adducted ones. Their 10-year experience is also reported.

Adolescent↗
PubMedDate not supplied

Changes in thyroid hormones and serum lipids of aged women following thyroidectomy.

Thyrotropin (TSH), thyroxine (T24) 3,5,3403 triiodothyronine (T23), serum lipid levels and ECG findings in females who underwent thyroidectomy 2-44 years earlier, were compared to those of similar controls with intact thyroid. Pathological ECG is more frequent in thyroidectomized persons who also exhibit higher thyrotropin and lower HDL-cholesterol levels. The results indicate that thyroidectomized state should be regarded and controlled as a possible condition of subclinical hypothyreosis, being a risk factor of cardiovascular diseases.

Aged↗
PubMed2003

[Two successful pregnancies after total thyroidectomy and parathyroidectomy].

A 23-year-old woman presented with a thyroid mass and total thyroidectomy was performed. Histological examination revealed papillary thyroid carcinoma. In the postoperative period severe hypocalcaemia due to permanent hypoparathyroidism developed. After postoperative telecobalt irradiation and substitutional hormone therapy (200-400 micrograms/day levothyroxin and 0.5-1.5 micrograms/day calcitriol) the patient had two successful pregnancies. The adaptation of the two mature newborns was without any complication. During pregnancy, the patient was treated with increased doses of levothyroxine and calcitriol. During lactation, the hormone substitution doses were decreased to those used in non pregnant stage. The authors conclude that the successful pregnancies were largely attributable to adequate dose-adjustments of levothyroxine and calcitriol based on frequent measurements of thyroid hormones and serum calcium.

Adult↗
PubMedDate not supplied

[Multinodular goiter as an organ disease: study of continual nodulogenesis. Biological bases indicating total thyroidectomy].

Multinodular goitre is a very common pathology among people especially female adult and represents more than 90% of the thyroid surgery. We analyzed 37 patients, demonstrating that the whole gland is progressively affected by an incessant nodulogenesis and we confirm the necessity of total thyroidectomy in order to eliminate any persistent pathology.

Adult↗
PubMed2003

Thyroxine effects on serum insulin-like growth factor I levels, anthropometric measures, and body composition in patients after thyroidectomy.

Thyroxine is an important hormone related to growth. To study the effects of thyroxine on serum levels of insulin-like growth factor I (IGF-I), anthropometric measures, and body composition, we studied 28 patients who were receiving thyroxine therapy after thyroidectomy for well-differentiated thyroid cancer. Serum IGF-I levels decreased from 38.3 +/- 19.0 ng/ml (mean +/- SD) to 26.8 +/- 12.8 ng/ml (p <0.001) after withdrawal of thyroxine and increased to 43.8 +/- 20.2 ng/ml (p <0.001) after thyroxine was resumed. The serum levels of TSH, T3, and thyroxine changed accordingly after withdrawal and resumption of thyroxine therapy. Skinfold thickness increased from 21.8 +/- 6.5 mm to 23.7 +/- 6.4 mm (p <0.001) after withdrawal of thyroxine and decreased to 21.5 +/- 6.9 mm after resumption of thyroxine. Similar changes occurred in the circumferences of the waist and hip (p <0.01), but no significant change occurred in arm muscle circumference (18.7 +/- 2.3 cm vs 18.7 +/- 2.3 cm vs 19.0 +/- 2.4 cm). Body composition analysis by bioelectrical impedance showed no significant changes in the percentages of body fat and lean mass. In conclusion, withdrawal of thyroxine from patients with thyroid cancer was associated with an immediate decrease in serum IGF-I levels. However, lean mass did not respond to the changes in serum IGF-I levels.

Adult↗
PubMedDate not supplied

Control results on a sample of patients subjected to total thyroidectomy for papillary carcinoma: proposal for a personal diagnostic-therapeutic follow-up.

Well-differentiated thyroid neoplasms may be included among the most frequently occurring thyroid carcinomas. Papillary ca. is without doubt the best behaved type. The aim of the present work is to perform a retrospective case history study to assess patients with con papillary ca. who have been treated surgically over the last 17 years and have been subjected to periodic checks. A sample of patients was therefore extrapolated who had all undergone total thyroidectomy for papillary ca. of the thyroid. The incidence of local recurrence of the disease was verified, together with the results at distance. Furthermore, the assessments performed were evaluated and compared. From the sample of patients observed we inferred that papillary carcinoma of the thyroid can have a good prognosis over time provided periodic random checks are carried out.

Adolescent↗
PubMed2003

Efficacy of procalcitonin measurement in patients after total thyroidectomy due to medullary thyroid carcinoma.

Procalcitonin (PCT) is a protein synthetized by the thyroid C cells, inside which it is cut into calcitonin (CT) and catacalcin. It remains undetectable in serum in normal conditions. Its level increases during inflammation and in small cell lung cancer. There have been studies suggesting that the PCT level increases in medullary thyroid carcinoma (MTC). So far there have been no reports that would assess the usefulness of PCT detection in MTC. Our aim was to evaluate the usefulness of serum PCT assays in patients with MTC. We investigated 24 patients at 17-78 years of age, all after total thyroidectomy due to MTC. All patients had serum CT concentrations measured by radioimmune assay. The upper limit of the CT level was 60 pg/ml. The serum PCT was evaluated with an immunochromatographic kit. The reaction was considered positive when the PCT level exceeded 0.5 ng/ml. In all cases the C-reactive protein (CRP) serum level was measured. The statistical analysis was performed with Statistica 5.1G. The CT levels in all patients varied from 0 to 1410, mean 603.8 pg/ml. In 8 patients the CT level was within normal range, in 6 patients it was marginally, and in 10 patients markedly elevated. The PCT test was considered positive in 16 patients. There was correlation among serum PCT and CT concentrations (Spearman test, p<0.0001). The PCT levels varied considerably among patients with normal, marginally and markedly elevated CT levels (Kruskal-Wallis test, p=0.0013). All patients had normal CRP values. Fisher's exact test revealed a correlation between serum PCT and CT increase (p=0.04). Further studies on a larger group of patients should be considered; thus, the PCT assay can be considered useful in cases of unclear CT concentration.

Adolescent↗