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PubMedDate not supplied

[First clinical experience of radio-endovascular functional thyroidectomy in the treatment of diffuse toxic goiter].

To suppress Thyroid pathologic activity in diffuse toxic goitre the authors have for the first time resorted to roentgenoendovascular functional thyroiedctomy. This method consists in vascular isolation of the thyroid by superselective catheterization of the left and right thyroid arteries followed by their material occlusion. For embolization a wide spectrum of nonlyzed synthetic, organic, and inorganic materials were used. The operation was carried out in 32 patients with stages III-IV diffuse toxic gotre. The advantages of this technique over subtotal thyroidectomy are emphasized. A stable clinical and hormonal remission and reduction of thyroid size to first degree were observed in all the patients for more tham 1.5 years after roentgenoendovascular intervention.

Adult↗
PubMedDate not supplied

[The pathogenesis of hypocalcemia after thyroidectomy].

After thyroidectomy, either total or partial, hypocalcaemia can occur in some cases temporary and in other permanent. For explaining transient hypocalcaemia are reported some pathogenetic mechanism can assume particular aspects in hyperthyroid subjects. Permanent hypocalcaemia is substantially due to anatomical lesions to the parathyroid glands. On the other hand, in subjects with hypothyroidism postoperative, a reduced concentration of circulating calcium can coexist with normal values or even elevated of parathormone. The condition of euthyroidism is basic for the resumption of the calcium homoeostasis.

Humans↗
PubMed1993

Horner's syndrome following a thyroidectomy.

A case of Horner's syndrome following a thyroidectomy for a benign multinodular goiter is presented, the literature reviewed, and possible explanations are discussed. Theories to explain this phenomenon include: local trauma to the sympathetic chain during retraction of the carotid sheath, anatomical variations which leave a patient susceptible to damage to the sympathetic chain, postoperative hematoma compressing the sympathetic chain, and ischemic damage to the sympathetic chain.

Aged↗
PubMedDate not supplied

[Post-operative examination of 2930 thyroid glands: observations on primary carcinoma. Incidental carcinoma and the preoperative diagnostic assessment of thyroidectomy for cancer].

The histological examinations performed in our Institute in the years 1985-1991 and concerning thyroid diseases pertain to 2930 patients. These were considered clinically benign in 2463 cases and malignant in 467. After histological control, the actually benign cases resulted to be 2335, whereas carcinomas were 588 (495 papillary, 61 follicular, 17 anaplastic, 15 medullary). Six lymphomas and 1 fibrosarcoma have been also observed. A comparison between clinical and morphological diagnosis for thyroids thought to be clinically benign has shown a diagnostic overlapping of 93.8%, with absolute agreement for Basedow's diseases, whereas thyroiditis is the disease most often not diagnosed preoperatively. Incidental carcinomas were 132, with an attendance related directly to the number of samples randomly taken from the surgical specimen. In 538 cases of carcinoma it has been possible to evaluate the intraglandular spread of the tumor: bilateral multifocal cases were 18.4%, with an incidence of latero-cervical metastases (41.4%) nearly twice as that observed in monolateral cases (24.2%). Post-surgical examination of the whole gland in 381 patients treated with a total thyroidectomy for carcinoma has discovered 20 false positive cases: 11 were operated on only according to clinical and instrumental examinations, 2 on the basis of just the cytological results, and 7 on the basis of cytologically positive evidence though refuted by intraoperative frozen sections. In the 381 cases taken into account, intraoperative frozen sections have been done 256 times: the results have been confirmed by the histological post-surgical examination of the whole gland in 94.5% of the cases. No false positive cases did occur. False negative cases were 7, due to inadequate sampling (in the operating room or in the pathology lab). Delayed diagnoses were 4, whereas truly false negative cases have been in all 3 (1.2%). The greater part of our data has been disaggregated in two different periods (1985-1988 and 1989-1991) to point out any change with time in the parameters under observation. The most relevant reflections relating to the time were the following: (1) per cent increase of bilateral multifocal carcinomas (13.9 vs. 21.8%), (2) per cent decrease of latero-cervical metastases in monolateral carcinomas (31.8 vs 17.7%), (3) frank decrease in the median value of incidental carcinomas' diameters (2.2 cm in the first vs. 0.6 cm in the last year), (4) frank decrease of false positive cases among patients operated on without prior cytological or histological verification (6/21 vs. 1/27), (5) remarkable improvement of the rate of correlation between intraoperative frozen section diagnosis and post-surgical histological examination (92.1 vs. 97.4%).(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1993

TSH-receptor antibody (TSH-R Ab) variations in patients undergoing subtotal thyroidectomy for Graves' disease: a prospective study.

Variations in circulating TSH-R Ab were correlated to the thyroid function outcome in a group of 43 patients who received subtotal thyroidectomy for Graves' disease. There were 36 females and 7 males, ranging in age from 18 to 63 years (mean +/- SD = 41.3 +/- 9.5 years). All patients were operated on by the same surgeon, with the same surgical technique, leaving a remnant of 4-5 grams of thyroid. When a condition of subclinical hypothyroidism was found after surgery, thyroid function was tested again within 2-3 months. Thus, in cases with persisting elevated TSH levels, L-thyroxine was administered. During follow-up a progressive decrease in the prevalence of euthyroid patients was documented (51.2% at 3 months, 30.2% at 2 years, 28% at 4 years), with a parallel increase in cases of subclinical and overt hypothyroidism. Two patients with persisting detectable TSH-R Abs showed recurrent disease within 2 years after surgery. No case of relapse was observed among patients who became TSH-R Ab negative. TSH-R Abs remained detectable in 68% of euthyroid and in 63.6% of subclinical hypothyroid patients before L-thyroxine administration, whereas TSH-R Abs remained positive in only 30% of patients with overt hypothyroidism, and became undetectable in most patients with subclinical hypothyroidism after L-thyroxine was begun. The persistence of TSH-R Abs in patients who have undergone surgery for Graves' disease should be considered a risk condition for relapse. These patients must be carefully followed-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Effects of castration and thyroidectomy on expression of lectin-binding sugar moieties and endolectins in mouse submandibular glands. A glycohistochemical study.

The aims of this study were to assess histochemically by means of biotinylated lectins and neoglycoproteins the effects of castration and thyroidectomy on the expression of carbohydrate moieties and endogenous sugar-binding proteins (endolectins), respectively, in submandibular glands of mice. Characteristic binding patterns depending upon the type of lectin were observed primarily in the granular convoluted tubules. For the first time carbohydrate-binding sites were also localized in this glandular tissue. Moreover, the endocrine status was found to affect the histochemical expression of sugar moieties of glycoconjugates as well as endolectins, thus modifying both sides of presumed protein-carbohydrate interactions. Further work is needed to identify these molecules and to understand better their endogenous roles.

Animals↗
PubMed1993

[Identification and preservation of the parathyroid glands in thyroidectomy using methylene blue].

The risk to the parathyroids in thyroid surgery is widely known. Postoperative parathyroid insufficiency occurs because of accidental devascularization of one or several glands, or infarction due to manipulation, or resection within the thyroid lobe. The prevention of this complication requires a careful surgical technique which limits any injury of the parathyroids. A simple, safe and cheap method to improve the identification of these glands is the preoperative intravenous infusion of methylene blue, that results in a distinct staining of the parathyroids. The authors describe their experience with this useful procedure which helps to reduce the incidence of hypoparathyroidism after total and near total thyroidectomy.

Adolescent↗
PubMed1993

[Lateral access in thyroidectomy. Technique and indications].

The technique of thyroidectomy, systematically carried out, by the authors, with a lateral approach since 1987 in thyroid reoperations for benign and malignant relapses and sometimes even in primary operations, is presented. The authors point out that lateral way is both technically advantageous in reoperations and moreover oncologically in prethyroid muscles's malignant involvement, but it does not represent an alternative to median access that, in the first instance, is the elective one. Because of the lateral vascular ligatures, in order to preserve the recurrent nerve, its location is mandatory.

Humans↗
PubMed1995

[Conditions of the remaining thyroid tissue after partial thyroidectomy].

The authors have realized a retrospective study about 246 patients who underwent partial thyroidectomy for a benign nodule or goiter between 1982 and 1991. Recurrence was analized with the method of Kaplan-Meier and concerned 11% of the patients at 3 years and 30% at 8 years. The statistical analysis showed that only patients with postoperative hormonal treatment were at risk of recurrence. This treatment was not randomized. Other studied factors (sex, age, type of surgery, pathological results, TSH level) are not correlated with recurrence. Surgical management is discussed.

Adult↗
PubMed1996

[Subtotal thyroidectomy. A treatment to keep in mind in amiodarone-induced thyrotoxicosis].

Amiodarone is an antiarrhythmic drug, frequently used in cardiology, which may produce secondary effects on the thyroid function. These effects can range from subtle changes in peripheral hormones without clinical manifestations, to severe forms of hypothyroidism or hyperthyroidism. The evolution of amiodarone-induced-hyperthyroidism can be mild, requiring only the withdrawal of the drug, or very severe, requiring an aggressive therapy with multiple drugs which may in some cases be fatal in spite of this therapy. Recently, the increase in the usage of this drug has produced reports of severe amiodarone-induced-thyrotoxicosis requiring surgery in some cases (subtotal or total thyroidectomy). A case of amiodarone-induced-thyrotoxicosis in its more aggressive form, which required intensive pharmacological treatment ultimately combined with surgery, is presented here.

Adult↗
PubMed1996

The management of post-thyroidectomy hypocalcemia.

Postoperative hypocalcemia was studied in 40 patients undergoing total thyroidectomy for a malignancy or massive goiter. Parameters evaluated included serum calcium, phosphate and magnesium levels. All patients exhibited a postoperative decline in serum calcium, however, the lowest serum calcium level was not seen until 48 hours after surgery. Serum calcium levels returned to normal in five to six days after surgery in 37 patients. Five patients required calcium supplementation for either symptomatic hypocalcemia or serum calcium levels lower than 7.0 mg/dl. Only three of these five patients were discharged home on oral calcium supplements. In this series, we discovered that the critical period for monitoring of serum calcium was 24 to 96 hours after surgery. If serum calcium replacement was not needed in the first 72 hours after surgery, it would not be needed during the remainder of the patient's hospital course. In addition, we found that serum magnesium levels should also be monitored in the postoperative period and corrected if low.

Adult↗
PubMed1995

[Complications of thyroidectomy: hemorrhage].

The authors report their experience in haemorrhage after thyroid surgery. Haemorrhagic complications occurred in 5 cases in a series of 1803 sequential thyroidectomies (incidence: 0.27%). In particular, incidence was 1.9% after interventions for thyroid neoplasias (adenoma and carcinoma) and 0.18% after interventions for non-neoplastic thyroid pathology. Haemorrhage occurred always after "total" operations, even if monolateral. Causative and contributing factors, precautions and measures helpful in reducing the incidence and the potential dangerousness of haemorrhagic complications are discussed.

Adenoma↗
PubMed1996

[Is total thyroidectomy and lymph node excision as therapy of differentiated thyroid gland carcinomas in childhood justified?].

The extent of radical resection of differentiated thyroid carcinomas in children (< 18 years) is discussed controversially because of good prognosis, on the one hand, but a high rate of lymph node metastases, greater tumor size, lung metastases and tumor recurrences on the other. Because of our data we advocate thyroidectomy, cervical lymph node dissection and postoperative 131J-therapy as the treatment of choice in patients with manifest disease in order of further detection and/or treatment of lung metastases. Limited radicality (i.e. hemithyroidectomy) should be reserved for children with small and occult tumors.

Adenocarcinoma, Follicular↗
PubMed1996

[Preventive thyroidectomy in hereditary medullary thyroid gland carcinoma].

Screening for hereditary medullary thyroid carcinoma (MTC) includes both calcitonin stimulation tests and DNA analysis. Positive results of these diagnostic procedures are indicators for the presence of neoplastic C-cell hyperplasia or an asymptomatic MTC. Thyroidectomy and lymphadenectomy of the first compartment are mandatory in both conditions even in young children.

Adolescent↗
PubMed1977

Muscarinic cholinergic receptors in rat heart. Effects of thyroidectomy.

The effects of thyroid status on muscarinic cholinergic receptors in the rat myocardium were investigated. The potent muscarinic antagonist [3H]quinuclidinyl benzilate was used to identify muscarinic cholinergic receptors in rat heart particulate fractions from control, hypothyroid, and hyperthyroid rats. Thyroidectomy increased specific [3H]quinuclidinyl benzilate binding to heart particulate fractions by about 60% as compared to euthyroid rat cardiac preparations. Administration of triiodothyronine to euthyroid rats decreased specific binding to muscarinic cholinergic receptors by about 20%. Scatchard analysis revealed that the cardiac particulate fraction from thyroidectomized rats contained 134 fmol of [3H]quinuclidinyl benzilate binding sites per mg of protein, as compared with 85 fmol/mg of protein found in the heart preparation of thyroidectomized rats chrinically treated with triiodothyronine. The equilibrium dissociation constant for the interaction of receptors with quinuclidinyl benzilate was the same (1 nM) in the heart particulate fractions derived from these two groups of rats. The results of this study demonstrate that thyroid hormone can regulate the number of cardiac muscarinic cholinergic receptors. Thus, the parasympathetic nervous system may participate in the cardiovascular abnormalities in different thyroid states.

Animals↗
PubMedDate not supplied

[Dynamics of changes in the concentration of thyroid hormones in in rat blood after subtotal thyroidectomy, internal, or external irradiation].

Thyroidectomy or administration of high activities (> 1.1 Mbq) of 131I to rats causes initial decrease in blood concentration of thyroid hormones which returns to the normal level. Administration of lower doses (< 1.1 Mbq) of radioactive iodine or external radiation (1, 3, 6 Gr) did not cause similar changes. Data obtained that: 1) thyroid gland is relatively radioresistant organ with high reparative function after surgical or radioactive damage; 2) alterations of thyroid status after the external radiation are not related to a direct action of radiation on the thyroid gland.

Animals↗
PubMed1996

[Post-thyroidectomy osteoporosis].

Thyroxine and calcitonin secreted by the thyroid gland are reduced in 26 cases patients with thyroid cancer after total or subtotal thyroidectomy. Since calcitonin participates in bone mineral metabolisim, bone mineral density (BMD) was examined in these patients treated in the past 10 years. It was found that serum calcitonin level was decreased, and the degree of reduction positively correlated with BMD (r = 0.78, P < 0.005). Osteoporosis developed about 10 years of age earlier. Most patients did not constantly receive thyroid tablets after excision of the thyroid. The resulting hypothyroidism led to ovarian dysfunction in female patients as shown by lowered level of estradiol. It is therefore indicated to administer thyroid tablet and calcitonin to prevent osteoporosis.

Adult↗
PubMed1996

[Alterations of plasma beta-EP and cortisol contents in thyroidectomy under acupuncture anesthesia and acupuncture anesthesia combined with tetrahydropalmatine].

Acupuncture anesthesia sometimes fails to give sufficient analgesia which may be overcome by appropriate combination of non-narcotic analgetics. We measured beta-endorphin (beta-EP) and cortisol contents in thyroidectomy under acupuncture analgesia (12 cases) and acupuncture anesthesia combined with tetrahydropalmatine (12 cases) by RIA. The results showed that the increase of beta-EP and cortisol in the latter group was less than that of the former, which proved that terahydropalmatine exerted a potentiating effect on acupuncture analgesia.

Acupuncture Analgesia↗