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PubMed2005

Same-day discharge after total thyroidectomy: the value of 6-hour serum parathyroid hormone and calcium levels.

BACKGROUND: The purpose of this study was to determine whether patients who undergo total thyroidectomy will have postoperative hypocalcemia develop when they reach the critical 6-hour serum levels defined as parathyroid hormone (PTH) > or =28 ng/L and simultaneous corrected calcium > or =2.14 mmol/L. METHODS: This was a prospective study involving 70 consecutive total thyroidectomy patients. There were 51 women and 19 men involved in the study. The mean age was 49.3 years (range, 21-76 years). Patients who had completion thyroidectomy or neck dissections were excluded. Patients undergoing parathyroidectomy at the time of thyroidectomy were also excluded. PTH and corrected calcium levels were measured postoperatively at 6, 12, and 20 hours. RESULTS: Hypocalcemia developed in 24% (17 of 70) of the patients. Of the 53 patients who remained normocalcemic, 68% (36 of 53) reached the 6-hour critical level. None of the hypocalcemic patients (0 of 17) attained the 6-hour critical level (chi-square test p < .0001). This translates into a specificity of 100% (95% confidence interval [CI], 80.5% to 100%) and a positive predictive value of 100% (95% CI, 90.1% to 100%). CONCLUSIONS: The simultaneous evaluation of PTH and corrected calcium levels 6 hours after thyroidectomy allows for an accurate prediction of the trend of serum calcium. This study enables us to confidently consider same-day discharge for most of our thyroidectomy patients.

Adult↗
PubMed1994

Practical management of post-thyroidectomy hematoma.

Thyroid diseases and surgery for thyroid neoplasms are both very common. Several complications of thyroidectomy are well known. Some of these are quite disturbing, such as recurrent laryngeal nerve injury and permanent hypoparathyroidism. However, postoperative hematoma often in the recovery room may be fatal. Close observation and early intervention are of utmost necessity in the post-thyroidectomy period. In a series of 600 thyroidectomies performed over a period of 11 years, eight patients developed postoperative hematoma. Seven of them underwent re-exploration, while one patient was treated conservatively. Two patients had second re-exploration for hematoma reaccumulation. All patients recovered very well after re-exploration except one elderly patient who required ventilatory support due to poor pulmonary reserve; after a week of ventilatory support and a tracheostomy, she too recovered well. One patient had the hematoma re-explored as late as 24 hours after the operation, while the remainder were re-explored within 4-6 hours after the initial procedure. Because of the extent of edema of the larynx and pharyngeal wall, it is very important that a senior, experienced person perform intubation in these patients. It is also very important to recognize that when the patients lie down flat, they may develop acute airway distress; hence, one must be prepared to intubate them emergently. We recommend close recovery room observation after thyroidectomy and early exploration and evacuation of hematoma in all patients who develop postoperative hematoma. A conservative approach may be considered in selected patients with minimal hematoma and no progression. However, it generally takes a long time for the hematoma to resorb. A better understanding of the complications of thyroidectomy will minimize morbidity and make thyroidectomy a safer procedure and a surgical triumph.

Adolescent↗
PubMed1999

[Thyroidectomy and lymphadenectomy].

In benign goiter, thyroidectomy is only indicated in patients with nodular alterations of the complete thyroid gland. There is no evidence indicating that total thyroidectomy could improve the postoperative results in patients with Graves' disease. In Germany, thyroidectomy with cervicocentral lymph node dissection is the standard procedure for all differentiated thyroid carcinomas. However, there are no data to prove that this approach is superior to less radical procedures. Avoidance of reoperations and optimal conditions for effective postoperative radioiodine therapy are arguments for this aggressive strategy. In patients with medullary carcinoma or with detected ret-proto-oncogene mutations, thyroidectomy with cervicocentral lymphadenectomy should be the initial operation. The cervicolateral and mediastinal compartments should be dissected when clinically obvious lymph node metastases are present in patients with differentiated carcinomas. In patients with medullary carcinomas, persistently increased calcitonin levels after the initial operation are sufficient indication for this procedure. Thyroidectomy is an important part of the multimodal approach in patients with anaplastic carcinomas. The operative technique of thyroidectomy is presented as well as the technique of cervical lymphadenectomy in consideration of the lymphatic drainage of the thyroid gland.

Adenocarcinoma, Follicular↗
PubMed2005

Incidental parathyroidectomy during thyroid surgery: an underappreciated complication of thyroidectomy.

The aim of this study was to investigate the incidence, risk factors, and clinical relevance of incidental parathyroidectomy during thyroid surgery. Prospective analysis of data in patients following thyroidectomy, specifically regarding the presence of parathyroid parenchyma in the thyroidectomy specimens, the underlying thyroid pathology, and the presence of postoperative hypocalcemia (biochemical/clinical). The clinical records of 158 patients who underwent thyroid surgery during a 2-year period were reviewed. Pathology reports were carefully reviewed for the nature of the underlying thyroid disease, the presence, number, and size of incidentally resected parathyroid gland(s), their location, and possible parathyroid pathology. Serum calcium levels were measured preoperatively, on the day of surgery, and on postoperative days 1, 2, and 7 or even later as needed. Two groups of patients were studied: a group with incidental parathyroidectomy following thyroidectomy (group A) and a group without incidental parathyroidectomy after thyroidectomy (group B). Total/near-total thyroidectomy was the procedure of choice and was performed in 154 patients; total lobectomy and contralateral subtotal lobectomy was performed in the other 4 patients. Elective central neck lymph node dissection was performed in four patients with neck lymphadenopathy. Inadvertently removed parathyroid tissue was found in 28 cases (17.7 %); in 6 of these patients (21%) the parathyroid tissue was intrathyroidal. The percentage of women in group A was significantly higher than in group B (93% vs. 58.5%, P = 0.0002). There was no statistically significant difference between the two groups (A and B) regarding the preoperative (presumed) diagnosis, the histologic diagnosis of thyroid disease (benign versus malignant), the type/extent of surgery, or the presence of thyroiditis. Biochemical and clinical hypocalcemia was observed in 6 (21%) and 2 (7%) patients in group A, respectively, and in 30 (23%) and 8 (6%) patients of group B, respectively. There was no statistically significant difference regarding the occurrence of postoperative hypocalcemia (clinical/biochemical) between the two groups (P = 0.33). Incidental parathyroidectomy is not uncommon following thyroidectomy and in a significant percentage of cases it may be due to the intrathyroidal location of the parathyroid glands. Incidental parathyroidectomy was not found to be associated with postoperative hypocalcemia (biochemical/clinical). Incidental parathyroidectomy may be considered as a potentially preventable but clinically minor complication of thyroid surgery.

Adolescent↗
PubMed2006

Video-assisted thyroidectomy: report on the experience of a single center in more than four hundred cases.

BACKGROUND: We report on our series of patients selected for video-assisted thyroidectomy (VAT) over a 7-year period and discuss the results obtained. METHODS: Video-assisted thyroidectomy is a gasless procedure performed under endoscopic vision through a single 1.5-2.0-cm skin incision, using a technique very similar to conventional surgery. Eligibility criteria were these: thyroid nodules < 35 mm; thyroid volume < 30 ml; no previous conventional neck surgery. Small, low-risk, papillary thyroid carcinomas (PTC) were considered eligible. RESULTS: A total of 473 VATs were attempted on 459 patients. Locoregional anesthesia was used in 15 patients. Conversion was necessary in 6 (difficult dissection in 1 case, large nodule size in 3, gross lymph node metastases in 2). Thyroid lobectomy was successfully performed in 110 cases, total thyroidectomy in 343, and completion thyroidectomy in 14. In 66 patients with carcinoma, central neck nodes were removed through the same access. Concomitant parathyroidectomy was performed in 14 patients. Pathology showed benign disease in 277 cases, PTC in 175, and medullary microcarcinoma in 1. Postoperative complications included 8 transient recurrent nerve palsies, 64 transient hypocalcemias, 3 definitive hypocalcemias, 1 postoperative hematoma, and 2 wound infections. Postoperative pain was minimal and the cosmetic result excellent. In patients with PTC no evidence of recurrent or residual disease was shown. CONCLUSIONS: Indications for VAT are still limited (20% of patients who require thyroidectomy). Nonetheless, in selected patients, it seems a valid option for thyroidectomy and it could be considered even preferable to conventional surgery because of its significant advantages, especially in terms of cosmetic result.

Adolescent↗
PubMed2004

Microscopic thyroidectomy: a prospective controlled trial.

The purpose of this prospective study was to evaluate microsurgical thyroidectomy by comparing it with traditional thyroidectomy. Before surgery, patients were assigned either to the microscopic thyroidectomy group (MT group), with the use of the surgical microscope, or the traditional thyroidectomy group (TT group), without the use of visual magnification. Outcome measures were operative time, intraoperative bleeding and complication rates including injury to the recurrent laryngeal nerve (RLN), the external branch of the superior laryngeal nerve (EBSLN) or the parathyroid glands. Ninety-eight patients underwent thyroid surgery (58 patients in the MT group, 40 patients in the TT group). The two groups were similar in age, sex, surgical procedures and histological findings. There was no difference between the two techniques regarding the operative time and the amount of blood loss. Neither permanent nerve palsy nor persistent hypocalcemia occurred in either group. Transient nerve palsies (RLN and EBSLN) were lower in the MT group (1.7%) compared to the TT group (7.5%), but the difference did not reach statistical significance (P>0.05). Overall transient hypocalcemia was significantly lower in the MT group (1.7%) compared with the TT group (12.5%, P=0.032). If the population was restricted to total thyroidectomy, the rate of transient hypocalcemia was 4.1% in the MT group and 33.3% in the TT group, respectively (P=0.022). In conclusion, microsurgical thyroidectomy is a feasible and efficacious surgical procedure. It significantly reduces the complications without increasing the operating time in thyroid surgery procedures. A major advantage of this technique is the possibility of attaching a camera to the microscope, thereby greatly facilitating teaching.

Adult↗
PubMed2006

Inadvertent parathyroidectomy during thyroid surgery: the incidence of a complication of thyroidectomy.

BACKGROUND AND AIMS: Incidental parathyroidectomy is a complication of thyroid surgery. The aim of this report is to explore the incidence, risk factors, and clinical relevance of inadvertent parathyroidectomy during thyroidectomy. MATERIALS AND METHODS: Patients who underwent thyroidectomy between January 1998 and June 2005 were evaluated. Pathology reports were reviewed for the presence of parathyroid tissue in the thyroidectomy specimens. Information regarding diagnosis, operative details, and postoperative hypocalcemia were collected. RESULTS: Three hundred and fifteen thyroid procedures were performed: 163 total thyroidectomies, 124 near-total thyroidectomies, and 28 lobectomies. The findings were benign in 240 and malignant in 75 cases. Incidental parathyroidectomy was found in 68 (21.6%) cases: 58 were benign and 10 were malignant. One and two parathyroids were accidentally removed in 46 and 22 patients, respectively. Parathyroid tissue was found in intrathyroidal (33%) and extracapsular (27%) sites. Total/near-total thyroidectomy was not associated with increased risk of incidental parathyroidectomy (P=0.646), and there was no association of inadvertent parathyroidectomy with postoperative hypocalcemia (P=0.859). Thyroid malignancy was associated with decreased incidence of incidental parathyroidectomy (P=0.047). CONCLUSION: Inadvertent parathyroidectomy, although not uncommon, is not associated with postoperative hypocalcemia. The type of surgical procedure does not increase the risk of incidental parathyroidectomy, while thyroid malignancy may reduce the incidence of inadvertent parathyroidectomy.

Adult↗
PubMed1986

Post-thyroidectomy hypocalcemia. Incidence and risk factors.

Two hundred twenty-one patients undergoing thyroidectomy were analyzed for factors increasing the risk of postoperative hypocalcemia. Eighty-three percent of all patients experienced hypocalcemia postoperatively, with 13 percent requiring some treatment for symptoms. Patients with advanced thyroid cancer, Graves' disease, or other manifestations of preoperative hyperthyroidism had significantly increased rates of hypocalcemia compared with patients with small cancers or benign euthyroid disease. Total thyroidectomy, repeat thyroidectomy, and thyroidectomy plus neck dissection all significantly increased the incidence of permanent hypocalcemia, whereas lobectomy or subtotal thyroidectomy for benign euthyroid disease were low risk operations. Inadvertent excision of more than one parathyroid gland during thyroidectomy also significantly increased the rate of permanent hypocalcemia.

Adolescent↗
PubMed1982

Effect of thyroidectomy on the rat adrenal cortex enzyme activities involved in corticosterone and aldosterone biosynthesis.

The effect of thyroidectomy on corticosterone and aldosterone biosynthesis, in rat adrenal cortex, were investigated in vitro. Thyroidectomy slowed down by about 30% the activity of microsomal 21 hydroxylase and mitochondrial 11 beta hydroxylase, the two stages leading to corticosterone formation from progesterone. The plasma corticosterone concentration also diminished in thyroidectomized rat. The mitochondrial enzyme system catalyzing the conversion of corticosterone into aldosterone included both 18 hydroxylase and 180H dehydrogenase. In the absence of thyroid hormone, values of both enzyme activity slowed down by about 30%. Thus thyroidectomy induced a general decrease in all mitochondrial hydroxylation processes requiring NNADPH as energetic cofactor. Mitochondrial NADPH was mainly synthesized by the activity of NADP+ malic enzyme and pyridine nucleotide transhydrogenase; the activity of both enzymes was determined in submitochondrial particles from adrenal cortex of normal and thyroidectomized rats. The activity of NADP+ malic enzyme and non energy-dependent transhydrogenase in the direction of NADPH formation dropped significantly after thyroidectomy, thus reducing the amount of NADPH available for hydroxylating mechanisms. The results should be compared to the large rise in th cytosolic malic enzyme level caused by thyroidectomy. The latter also ensured that the transhydrogenase reaction did not vary in the direction of NADP+ formation. Further, the drop in NADPH synthesis after thyroidectomy was coupled with a decrease in phosphorylation rate of added ADPH by adrenal cortex mitochondria of thyroidectomized rat. These findings might account for the general decline in the energy-dependent processes involved in steroidogenesis, a decline mainly due to the lowering of the H+ ions gradient driving ATP and NADPH synthesis through electron transfer.

Adrenal Cortex↗
PubMed2004

Voice changes after thyroidectomy without recurrent laryngeal nerve injury.

BACKGROUND: Injury of the inferior laryngeal nerve is not the only cause of voice alteration after thyroidectomy; many patients notice minimal changes immediately after operation, without evidence of inferior laryngeal nerve damage. We hypothesized that there may be other causes for voice modification, such as injuries of the superior laryngeal nerve, prethyroid strap muscles, and cricothyroid muscles. We describe voice changes after total thyroidectomy, without inferior laryngeal nerve injury, using a computer program to objectively compare different patterns of voice. STUDY DESIGN: Forty-six consecutive patients who underwent total thyroidectomy were studied between March 1997 and December 1999. Acoustic voice analysis was performed preoperatively and at the second, fourth, and sixth postoperative months using a microphone adapted to a personal computer. Parameters measured were intensity of the voice (Shimmer) and fundamental frequency (Fo). RESULTS: No complications occurred during operation or in the postoperative period. Voice fatigue during phonation was the most common symptom after thyroidectomy. Forty patients (87%) stated that their voices had changed since the operation, and common complaints were voice alteration while speaking loudly, changes in voice pitch, and voice disorder while singing. Changes in the Fo and Shimmer values in smokers versus nonsmokers were similar (Fo overall, p = 0.56; Shimmer overall, p = 0.66), as were the same parameters in benign and malignant pathologies (Fo overall, p = 0.66; Shimmer overall, p = 0.67). CONCLUSIONS: Voice changes after uncomplicated thyroidectomy occur and can be objectively measured. This is important in the preoperative counseling of patients before thyroidectomy, for ethical and legal purposes.

Adult↗
PubMed2004

AMES prognostic index and extent of thyroidectomy for well-differentiated thyroid cancer in the United States.

BACKGROUND: The optimal extent of thyroidectomy for well-differentiated thyroid cancer is controversial. It has been suggested that surgeons use the Age, Metastases, Extent and Size (AMES) risk classification to decide between partial thyroidectomy (PT) or total thyroidectomy (TT). METHODS: The Surveillance, Epidemiology and End Results database was used to identify patients who underwent PT or TT for well-differentiated thyroid cancer between 1992 and 1997. Age, distant metastases, extrathyroidal extension, tumor size, AMES risk group, gender, histologic subtype, and lymph node metastases were analyzed by using logistic regression models to evaluate whether surgeons use these factors to determine extent of thyroidectomy. RESULTS: Of 9,226 patients, most patients had small cancers confined to the thyroid gland. Of these, 79.9% were AMES low-risk, and 83% underwent TT. Age 40 years or older (40 to 49 years: odds ratio [OR], 0.75, 95% confidence interval [CI], 0.65 to 0.86; 50 years or older: OR, 0.66; 95% CI, 0.58 to 0.75) was associated with a lower likelihood of TT, as were female gender (OR, 0.80; 95% CI, 0.70 to 0.92) and follicular histology (OR, 0.65; 95% CI, 0.55 to 0.78). Extrathyroidal extension (OR, 3.85; 95% CI, 3.09 to 4.80), regional lymph node metastases (OR, 6.98; 95% CI, 5.45 to 8.93), distant metastases (OR, 7.29; 95% CI, 2.69 to 19.8), AMES high-risk group (OR, 2.82; 95% CI, 2.36 to 3.38), and larger tumor size (OR, 1.27; 95% CI, 1.01 to 1.59) were associated with greater likelihood of TT. In multivariable analyses, only age, extrathyroidal extension, and regional and distant metastases were associated with extent of thyroidectomy; AMES risk group and tumor size were no longer significant. CONCLUSIONS: Most patients undergo TT for well-differentiated thyroid cancer regardless of AMES risk grouping. In contrast to AMES risk-group classification, younger patients are more likely to undergo TT compared with older patients. Although extrathyroidal extension and distant metastases were associated with TT in accordance with AMES criteria, tumor size had no independent influence. Regional lymph node metastasis, not an AMES criterion, increased the likelihood of TT. Some components of AMES risk-group classification are used by surgeons to choose the extent of thyroidectomy.

Adenocarcinoma, Follicular↗
PubMed1998

Impaired Na+,K+ATPase activity in red blood cells in euthyroid women treated with levothyroxine after total thyroidectomy for Graves' disease.

In patients suffering from hyperthyroidism dependent on Graves' disease, a reduction in Na+,K+ATPase activity has been demonstrated in red blood cells (RBCs), as well as an inverse correlation between this enzymatic action and free triiodothyronine (FT3) levels. The restoration of normal FT3 values also brings about a normalization of Na+,K+ATPase activity in erythrocytes. These results have made it possible to hypothesize that the thyroid hormones control Na+,K+ATPase activity and that this control is manifested by means of variations in the number of ouabain-binding sites. For this reason, the measurement of the activity of the Na/K pump can be considered as a further indicator of the peripheral effects of thyroid hormones. With a view to assess the relation between the course of treated hyperthyroidism and Na+,K+ATPase activity during antithyroid therapy and after surgical thyroidectomy followed by replacement therapy, we studied 24 patients affected by Graves' disease (group Graves [GG]). They were compared with 24 female Graves' patients who underwent total thyroidectomy for nontoxic and diffuse nodular goiter (NDNG) (group control [GC]) and with 24 normal healthy women (group normal [GN]). When Graves' hyperthyroidism was diagnosed, the Na+,K+ATPase activity in RBCs was impaired in all GG patients. Thionamide treatment restored the normal activity of the Na/K pump, accompanied by normalization of the number of ouabain-binding sites. One hundred eighty days after thyroidectomy, in conditions of clinical and biochemical euthyroidism due to replacement therapy with levothyroxine, the activity of Na+,K+ATPase in RBCs was once again reduced in GG, while appearing normal in GC and GN (1.77 +/- 0.16 mmol Pi h(-1) L(-1) RBCs v 2.09 +/- 0.26 v 2.09 +/- 0.24, P < .05). Different instrumental or biochemical parameters, such as glycemia, serum lipids, ions, serum alkaline phosphatase (AIPh), serum creatine phosphokinase (CPK), blood pressure, and heart rate, were evaluated and appeared normalized in GG and GC 180 days after surgery. We conclude that (1) in patients suffering from Graves' disease, subjected to total thyroidectomy followed by levothyroxine replacement therapy, there is a reduction in the activity of the Na+,K+ATPase on erythrocytes 6 months after the surgical approach; and (2) a similar alteration is not observed in patients subjected to thyroidectomy for NDNG. These findings allow the formulation of the hypothesis that (1) treatment with levothyroxine for 180 days after thyroidectomy in GG is not long enough to restore the normality of all the peripheral indicators of action of the thyroid hormones; and (2) levothyroxine replacement therapy is unable to guarantee euthyroidism in all the tissues in GG (eg, during hematopoiesis in the bone marrow).

Adult↗
PubMed2002

Video-assisted thyroidectomy.

BACKGROUND: In 1998, we developed a technique for video-assisted thyroidectomy (VAT). In this article we report on the entire series of patients who underwent VAT and discuss the results obtained. STUDY DESIGN: Forty-seven patients were selected for VAT. Eligibility criteria were: thyroid nodules of 35 mm or less in maximum diameter; estimated thyroid volume within normal range or slightly enlarged; small, low-risk papillary carcinomas; neither previous neck surgery nor irradiation; and no thyroiditis. After a learning period, VAT was proposed also for completion thyroidectomy (of previous video-assisted lobectomy) and nodules with maximum diameter up to 45 mm. The procedure is performed by a totally gasless video-assisted technique through a single 1.5- to 2.0-cm skin incision. Dissection is performed under endoscopic vision using a technique very similar to conventional operation. RESULTS: Fifty-three VATs were attempted on 47 patients. Thirty-three lobectomies, 10 total thyroidectomies, and 6 completion thyroidectomies were successfully performed. Six patients with papillary carcinoma underwent central neck lymph node removal by the same access. Mean operative time was 86.8 minutes for lobectomy, 116.0 minutes for total thyroidectomy, and 77.5 minutes for completion thyroidectomy. Conversion rate was 7.5%. Postoperative complications included one transient recurrent nerve palsy, three transient symptomatic postoperative hypocalcemias, and one wound infection. The cosmetic result was considered excellent by most of the patients who successfully underwent VAT. CONCLUSIONS: VAT is feasible and safe and allows for an excellent cosmetic result. Not all patients are eligible for this procedure, but in selected cases it can be a valid option for the surgical treatment of thyroid diseases.

Adenocarcinoma, Follicular↗
PubMed2006

Morbidity after total thyroidectomy for benign thyroid disease: comparison of Graves' disease and non-Graves' disease.

The purpose of this study was to review the safety of total thyroidectomies for benign thyroid disease, with special emphasis on the comparison between Graves' disease and non-Graves' disease. In this study, 107 patients who underwent total thyroidectomies for clinically benign thyroid disease performed by the same surgeon between January 1987 and December 2004 were enrolled; 48 had Graves' disease and 59 had non-Graves' disease. The rates of temporary vs. permanent hypoparathyroidism, hematoma requiring surgical intervention, and temporary vs. permanent recurrent laryngeal nerve palsy (RLNP) after total thyroidectomy for benign thyroid disease were 34.6% vs. 3.7%, 6.5%, and 6.5% vs. 1.85%, respectively. The rates of permanent hypoparathyroidism and temporary RLNP in the Graves' disease group were significantly different when compared with the non-Graves' disease group (8.3% vs. 0% and 11.5% vs. 2.5%, respectively). However, comparing the rates of temporary hypoparathyroidism, permanent RLNP, and postoperative hematoma, there was no statistically significant difference. Compared with total lobectomy, the rates of postoperative hematoma increased significantly for total thyroidectomy (6.5% vs. 0.48%). Total thyroidectomy for non-Graves' benign thyroid disease may be performed with minimal morbidity as has been advocated by many authors. For patients with Graves' disease in this study, however, the complication rates of permanent hypoparathyroidism and temporary RLNP were significantly increased. Therefore, we suggest that total thyroidectomy for Graves' disease should be performed by an experienced surgeon.

Graves Disease↗
PubMed2002

Minimally invasive video-assisted thyroidectomy for papillary carcinoma: a prospective study of its completeness.

BACKGROUND: The effectiveness of minimally invasive video-assisted thyroidectomy (MIVAT) in papillary thyroid carcinoma is still debated. Some are concerned about this procedure in patients with thyroid cancer. This prospective study aimed to demonstrate that near-total thyroidectomy can be performed by MIVAT with similar results compared with open thyroidectomy. METHODS: A total of 33 patients with a thyroid nodule proven to be a papillary thyroid carcinoma underwent a near-total thyroidectomy. They were randomly assigned to group A (n = 16) or group B (n = 17) who were treated either by MIVAT or conventional near-total thyroidectomy, respectively. Iodine-131 thyroid bed uptake and serum thyroglobulin were measured 1 month after operation. Data were analyzed by unpaired t test and Mann-Whitney statistic methods. RESULTS: . Mean iodine-131 uptake was 5.1 +/- 4.9% in group A and 4.6 +/- 6.7% in group B. Mean thyroglobulin serum levels were 5.3 +/- 5.8 ng/mL in group A and 7.6 +/- 21.7 ng/mL in group B. The differences were not statistically significant. CONCLUSIONS: The results of this study showed that the completeness obtained with MIVAT is similar to that obtained with open thyroidectomy, with the great advantage of a minimal neck wound. No conclusions can be drawn in terms of influence of MIVAT on the outcome of the patients with small papillary thyroid carcinoma.

Adult↗
PubMed2003

Prevalence of long-term upper aerodigestive symptoms after uncomplicated bilateral thyroidectomy.

BACKGROUND: Subjective nonspecific upper aerodigestive symptoms (UADS) are not uncommon after thyroidectomy. Their type, duration, and prevalence, however, have not been investigated in a controlled design. The objective of this study was to investigate the prevalence of UADS after thyroidectomy. METHODS: A consecutive cohort of 60 patients who had undergone uncomplicated total (n = 38) or near total (n = 22) thyroidectomy were investigated retrospectively at a mean of 4 years after surgery. An independent unblinded researcher interviewed each patient and asked for the presence or frequency of voice changes, cough, dysphagia, neck strangling, and annual incidence of common colds, before and after thyroidectomy. Sixty patients, matched for age, sex, and smoking habits, who had undergone laparoscopic cholecystectomy during the same years served as control subjects. RESULTS: The prevalence of UADS was similar before thyroidectomy (13%) and cholecystectomy (15%). After operation, UADS had a higher prevalence among thyroidectomized patients: nonspecific voice changes (28% vs 3%), neck strangling (22% vs 0%), and impaired swallowing (15% vs 3%) (P < or = .02 in each). Neck strangling was associated with voice changes and dysphagia (P < or = .03 each). CONCLUSIONS: Subjective UADS are common long after thyroidectomy. These symptoms may be related to injury to the extrinsic perithyroidal neural plexus innervating the pharyngeal and laryngeal structures.

Adult↗
PubMed2000

Truncal ligation of the inferior thyroid arteries does not affect the incidence of hypocalcaemia after thyroidectomy.

OBJECTIVE: To assess the effect of truncal ligation of the inferior thyroid arteries during bilateral subtotal thyroidectomy on the incidence of hypocalcaemia after thyroidectomy. DESIGN: Prospective non-randomised study. SETTING: Teaching hospital, Turkey. SUBJECTS: 216 patients who had bilateral subtotal thyroidectomy for non-toxic nodular goitre between 1990 and 1996. INTERVENTIONS: The trunk of the each inferior thyroid artery was simply ligated during bilateral subtotal thyroidectomy. MAIN OUTCOME MEASURES: Clinical examination, and measurement of serum calcium, ionised calcium, and inorganic phosphate concentrations before and after operation. RESULTS: Four patients (2%) had low concentrations of total and ionised calcium during the postoperative period. On physical examination three of them had spasms of the facial nerve, as seen in tetany. They were given calcium supplements orally and their laboratory results returned to reference ranges within 180 days. No patients developed permanent hypocalcaemia. CONCLUSION: Truncal ligation of the inferior thyroid arteries during bilateral subtotal thyroidectomy has no effect on the incidence of hypocalcaemia after thyroidectomy.

Adolescent↗
PubMed1999

Normal thyroid pathology in patients undergoing thyroidectomy for finding a RETgene germline mutation: a report of three cases and review of the literature.

Genetic screening for germline RET proto-oncogene mutation in hereditary medullary thyroid cancer (MTC) is accurate and allows for preventive total thyroidectomy to be performed early in patients who are gene carriers. We report 3 children who underwent preventive total thyroidectomy based on the finding of a RETgene germline mutation, but who had no evidence of MTC or C-cell hyperplasia on permanent histology, even after calcitonin immunostaining. Review of the English literature of patients undergoing preventive thyroidectomy for a positive RETgene germline mutation, shows that 3.4% of these patients (a total of 209 patients) had normal thyroid glands. Also, 8.6% of patients undergoing preventive total thyroidectomy with prophylactic central neck node dissection had cervical node metastases. We conclude that preventive thyroidectomy in patients screened early for germline RETgene mutation allows for earlier diagnosis and treatment of patients, sometimes even before any hyperplasia or neoplasia can be demonstrated because cervical node metastases can occur early and be demonstrated even with small tumors (< 1 cm), we recommend prophylactic central neck node dissection at the time of preventive thyroidectomy.

Adolescent↗