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PubMed2005

Should total thyroidectomy become the preferred procedure for surgical management of Graves' disease?

This study aims to evaluate our institution's experience with thyroidectomy for Graves' disease, with an emphasis on indications and long-term outcomes. The study cohort consisted of 103 patients (mean age 34.3 [+/-13.9] years), who underwent thyroidectomy for Graves' disease between 1991 and 2002. Clinical and follow-up data were obtained by retrospective review of medical records and by contacting treating physicians or patients. The most common surgical indications were patient preference (26%), cold nodule (24%), eye symptoms (20%), large goiter size (18%), allergy to antithyroidal medications (15%), and age younger than 16 years (14%). Thyroidectomies performed included 45 (total or near-total), 57 subtotal, and 1 lobectomy. Transient complications included hypocalcemia in 42 patients, and recurrent laryngeal nerve palsy in 5 patients. There was no difference in the frequency of hypocalcemia in patients undergoing total or subtotal resections. One patient developed permanent hypocalcemia and 2 permanent recurrent laryngeal nerve (RLN) injury. Only 3 patients who underwent subtotal resections remain off thyroxine and 2 developed recurrent hyperthyroidism approximately 17 and 54 months after surgery. Subtotal thyroidectomy is associated with a high rate of hypothyroidism and large remnants have potential for recurrence. Total or near-total thyroidectomy obviates these disadvantages and can be performed without increased complication rates, thus appearing to be the preferred extent of thyroidectomy for Graves' disease.

Adolescent↗
PubMed1979

Delayed hypocalcemia after thyroidectomy for Graves' disease is prevented by parathyroid autotransplantation.

Late hypocalcemia appears associated with thyroidectomy for Graves' disease more frequently than with thyroidectomy for other conditions. Of 62 total thyroidectomies done by a single surgeon, 28 were done for carcinoma, 18 for benign disease (primarily nontoxic nodules with a history of radiation therapy to the head and neck (RT)) and 16 for Graves' disease. Mean calcium concentrations measured two months or more after surgery were 9.38 +/- 0.07 (SEM)mg/% for patients with cancer, 8.79 +/- 0.31 mg/dl for patients with Graves' disease and 9.38 +/- 0.08 mg/dl for patients with other benign diseases. No patient without Graves' disease developed late hypocalcemia. In contrast, six of 16 patients with Graves' developed significant late hypocalcemia requiring calcium therapy. The incidence of hypocalcemia after total thyroidectomy for Graves' disease was significantly greater than that seen in other conditions (p < 0.01). Since no parathyroids were removed in the patients with Graves' disease, and since branches of the inferior thyroid artery were invariably ligated distal to the parathyroids, we hypothesized that the late hypocalcemia might be associated with a peculiarity in scar formation in the presence of this autoimmune disease. Accordingly, parathyroid autotransplantation was performed synchronously as a prophylactic measure in nine subsequent patients undergoing total thyroidectomy for Graves' disease; no instance of late hypocalcemia has occurred in this group. The decreased incidence of late hypocalcemia is highly significant (p < 0.01). Although the precise etiology of late hypocalcemia after thyroidectomy for Graves' disease remains undetermined, this experience indicates that synchronous parathyroid autotransplantation is beneficial in preventing this complication.

Calcium↗
PubMed1977

Hypocalcemia after thyroidectomy: mechanisms and management.

Hypocalcemia persists as a problem after thyroidectomy. We reviewed our experience with 245 thyroidectomies to define the spectrum of hypocalcemia, elucidate the mechanisms of hypocalcemia, and formulate a rational basis for its management. Postoperative hypocalcemia occurred in 8.6% of all patients undergoing thyroid surgery with incidence the highest in patients with total thyroidectomy for cancer (28%) and those with subtotal thyroidectomy for thyrotoxicosis (23%). Incidence was low in patients having subtotal thyroidectomy for other diseases (1.5%) and lobectomy (0%). The high incidence of hypocalcemia following subtotal thyroidectomy for thyrotoxicosis but not for other diseases suggests that a mechanism other than removal or damage of the parathyroids is responsible for the hypocalcemia. This may well be thyrotoxic osteodystrophy. This hypocalcemia usually occurs early, is of moderate degree, and is transient. Management includes calcium gluconate for acute symptoms and calcium lactate with vitamin D2 for chronic symptoms.

Calcium↗
PubMed2006

Is lack of placement of drains after thyroidectomy with central neck dissection safe? A prospective, randomized study.

OBJECTIVE: Selective use of drains after thyroidectomy has been suggested in the literature. Although the safety of thyroidectomy without drains has been reviewed, there is little specific data available to identify the safety of thyroidectomy combined with central neck dissection (CND) without drains. This study aims to determine the feasibility and safety of thyroidectomy without drains, especially in cases of combined CND. STUDY DESIGN: Prospective, randomized study. MATERIALS AND METHODS: One hundred ninety-eight consecutive thyroidectomized patients were enrolled in this study. Drain group (n = 101) consisted of 41 hemithyroidectomies (HT), 28 total thyroidectomies (TT), and 32 total TT with CND. No-drain group (n = 97) consisted of 42 HT, 18 TT, and 37 TT with CND. The following variables were examined: perioperative complications (hemorrhage, hematoma, seroma), intraoperative bleeding, operation time, volume of resected thyroid gland, time of hospital discharge after operation, duration of drain placement, and total amount of drainage (drain group). RESULTS: There were no significant differences in age, sex, volume of resected thyroid gland, types of operation, operation time, and histopathlologic diagnosis between two groups. In the drain group, overall perioperative complications occurred in seven (7/101, 6.9%) patients. In the no-drain group, overall perioperative complications occurred in nine (10/97, 10.3%) patients. There was no significant difference in overall perioperative complications between the drain and no-drain groups, even in cases of performing CND. Time of hospital discharge after operation was significantly shorter in the no-drain group than the drain group (P < .05). CONCLUSIONS: We conclude that thyroidectomy without drains is safe and effective even in combination with CND and appears to confer several advantages over the routine drainage method. In addition, we achieved significant reduction of hospital stay, which led to a reduction in costs for the patients.

Adolescent↗
PubMed2006

Late-onset medullary carcinoma of the thyroid: need for genetic testing and prophylactic thyroidectomy in adult family members.

OBJECTIVE: Sporadic late-onset medullary carcinoma of the thyroid is quite rare. Usually, the patient presents with a thyroid mass or neck node metastasis along with high levels of calcitonin and preoperative fine needle aspiration biopsy suggestive of medullary carcinoma of the thyroid. The role of genetic testing in such individuals, along with testing of other family members, remains somewhat unclear at this stage, especially in patients presenting with familial medullary thyroid carcinoma. Genetic testing with RET proto-oncogene mutational studies is very popular in familial medullary thyroid carcinoma, especially in children, with routine prophylactic thyroidectomy. However, its indications in adults remain unclear at this time. CASE STUDY: Recently, a 69-year-old woman presented with a thyroid mass and underwent total thyroidectomy and central compartment dissection. She was found to have medullary carcinoma of the thyroid. The patient had four children, three of whom were found to have a RET mutation similar to their mother's, V804M. In view of the RET mutation, the three children were offered prophylactic thyroidectomy at ages 42, 45, and 47. The patient's son was noted to have extensive C-cell hyperplasia in both lobes of the thyroid. The other two individuals had benign pathology with no evidence of C-cell hyperplasia. CONCLUSIONS: There is no definite consensus of opinion about the need for prophylactic total thyroidectomy in adults with RET mutation. The rarely reported 804 mutation is, however, a predictor of medullary carcinoma of the thyroid. One individual in this group had extensive C-cell hyperplasia, suggesting that he would have developed medullary carcinoma of the thyroid in the future. Prophylactic thyroidectomy should be recommended in patients with RET mutation and a family history of medullary carcinoma of the thyroid; however, its role in adult family members needs to be evaluated with larger registry of prophylactic thyroidectomy. Whether these adults with rare 804-mutation could be observed and followed with serial calcitonin, ultrasound, or calcitonin stimulation tests remains to be studied.

Adult↗
PubMed1996

Completion total thyroidectomy in the management of differentiated thyroid carcinoma.

BACKGROUND: Completion thyroidectomy is the removal of any thyroid tissue that remains after a less than total thyroidectomy. This procedure has been commonly performed when the final histopathology of the excised ipsilateral thyroid lobe reveals papillary or follicular carcinoma of the thyroid. Complete thyroidectomy carries little morbidity if performed by experienced surgeons using a lateral approach. The purpose of this study is to reinforce the usefulness of a lateral approach. METHODS: A retrospective analysis over a 5 year period at the Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) yielded 19 patients who underwent completion thyroidectomy. This group represents 23% of 82 patients who underwent total thyroidectomy for differentiated thyroid cancer (DTC) during that period. The residual thyroid tissue was excised through a lateral approach and could be resected safely, preserving the recurrent laryngeal nerve (RLN) and the parathyroid glands. RESULTS: A lateral approach dissection could be performed with ease in a virgin area. Excision of residual thyroid tissue could be performed safely even in cases with prior partial lobectomy or bilateral subtotal resection. Tumour was found in 52% of the re-operative specimens: in three out of four of those after a previous partial lobectomy, in six out of 12 of those after a total lobectomy, and in one out of three of those after a prior bilateral (although incomplete) thyroid resection. Postoperative complications included transient RLN palsy (n = 2) and transient hypoparathyroidism (n = 4). CONCLUSIONS: Completion thyroidectomy using a lateral approach is safe in re-operative thyroid surgery.

Carcinoma, Papillary↗
PubMed2006

Completion thyroidectomy for malignancy after initial minimal access thyroid surgery.

BACKGROUND: Minimal access thyroid surgery (MATS), carried out through a lateral 2.5-cm incision, provides excellent clinical and cosmetic outcomes when carried out for small (<3 cm), single nodules. However, if the final pathology shows thyroid malignancy and a completion thyroidectomy is required, the small lateral incision requires conversion to a standard collar incision and the second operation must be carried out in the presence of previous lateral dissection. The aim of this study is to determine if there is any demonstrable disadvantage to completion thyroidectomy for malignancy after MATS when compared with the same procedure after conventional hemithyroidectomy. METHODS: This retrospective cohort study examined all patients undergoing completion thyroidectomy for malignancy in the University of Sydney Endocrine Surgical Unit from January 2002 to January 2005. Outcome measures were complication rates, final scar length and patient's self-assessment of scar appearance. RESULTS: A total of 106 patients underwent MATS during the study period, 11 of whom required completion thyroidectomy for malignancy. During the same period, 42 patients required completion thyroidectomy for malignancy after previous conventional hemithyroidectomy. There was no difference in complication rates between the two groups. The two complications in the study consisted of one case of flap oedema (control) and one case of keloid scar (MATS). Mean final incision length, scar appearance and patient's satisfaction with scar did not differ between the two groups. CONCLUSION: There is no demonstrable disadvantage when completion thyroidectomy for malignancy is required after MATS.

Adult↗
PubMed2004

Investigation on the histopathological effects of thyroidectomy on the seminiferous tubules of immature and adult rats.

INTRODUCTION: This study aimed to investigate the histopathological effects of thyroidectomy on both immature and adult rat testes. MATERIALS AND METHODS: Male albino Wistar rats, 4 weeks old and weighing between 45 and 55 g, were used for this study. The experimental groups were as follows: 2-week control group (group I); 2-week thyroidectomy group (group II); 4-week control group (group III); 4-week thyroidectomy group (group IV); 6-week control group (group V), and 6-week thyroidectomy group (group VI). The control groups included both sham-operated and untreated rats. In groups II, IV and VI, total thyroidectomy was performed under ether anesthesia in all rats at 4 weeks of age. The rats were killed in the 2nd, 4th and 6th weeks, respectively, following the thyroidectomy. The testes of each animal were evaluated histologically. RESULTS: In group II, spermatogenesis progressed to meiosis but round spermatids were found to be decreased and pachytene spermatocytes were observed to be increased when compared to group I. Giant pachytene spermatocytes were seen. There were also many degenerated cells of intermediate origin in the seminiferous epithelium. In groups IV and VI, spermatogonia and primary spermatocytes were normal in appearance, but there was widespread degeneration of the other spermatogenic cells. In addition, some closed lumina covered by degenerated and dead cells were observed. In group II, the mean outer diameter, luminal diameter and area occupied by seminiferous epithelium decreased by 19.74, 32.18, and 28.12%, respectively. In group IV, these data decreased by 23.9, 16.52, and 48.5%, respectively, and in group VI, by 21.10, 19.76 and 40.29%, respectively, when compared with the control groups. These data were statistically significant (p < 0.001). CONCLUSIONS: Thyroid hormones could have a marked influence on the seminiferous tubules of both immature and adult rats, and their permanent lack results in a depression in seminiferous tubule growth as shown by the reduced outer and luminal diameters and area occupied by the seminiferous epithelium, which could give rise to degenerative changes in the spermatogenic cells of thyroidectomized rats. In addition, all these changes could also result from both the inability of Sertoli cells to support spermatogenic cells and the diminished levels of GH and FSH.

Age Factors↗
PubMed1990

Changes in selected brain neurotransmitters and their metabolites in the lamb after thyroidectomy during the last two trimesters of gestation or the early neonatal period.

To evaluate in a development context the effect of congenital hypothyroidism on concentrations of the neurotransmitters norepinephrine, dopamine, and serotonin (5HT) in selected brain areas of the ovine fetus, we studied the effect of thyroidectomy at three ages on the concentrations of these neurotransmitters and their major metabolites, homovanillic acid and 5-hydroxyindoleacetic acid. Fetuses underwent thyroidectomy at 90-95 or 105-115 d gestation (term = 147-150 d) or 1-5 d after birth. Approximately 25 d after thyroidectomy, at d 120-125 or 130-135 of gestation or 25-30 d after birth, respectively, the ewes were killed and fetal brains removed. Neurotransmitters and their metabolites were measured by HPLC with electrochemical detection. Thyroidectomy in the 2nd trimester increased 5HT in five brain areas: anterior hypothalamus, dorsal medial hypothalamus, pons, medulla, and cerebellum. Thyroidectomy in the 3rd trimester increased 5HT in the pons and medulla, increased norepinephrine in the dorsal medial hypothalamus and pons, and increased homovanillic acid in the posterior hypothalamus. Thyroidectomy in the newborn period decreased NE in the anterior hypothalamus, ventral medial hypothalamus, and midbrain, decreased 5-hydroxyindoleactic acid in the posterior hypothalamus, lateral hypothalamus, dorsal medial hypothalamus, and ventral medial hypothalamus, and decreased homovanillic acid in the dorsal medial hypothalamus and ventral medial hypothalamus. From these data we conclude the following: 1) Hypothyroidism causes changes in neurotransmitter concentrations only in selected brain areas of the ovine fetus, rather than causing generalized and similar changes in all brain areas; and 2) 5HT 5-hydroxyindoleacetic acid concentrations are affected more often than the other neurotransmitters evaluated, perhaps because the 5HT neurotransmitter system is developing at these times.

Animals↗
PubMed2005

Thyroidectomy does not cause globus pattern symptoms.

Post-thyroidectomy patients often complain of globus pharyngeus type symptoms. One of the organic pathologies recognized as causing globus pattern symptoms is goitre. We conducted a prospective questionnaire-based study in the thyroid clinic at Hull Royal Infirmary to examine the relationship between goitre, thyroidectomy and globus pattern symptoms by using the Glasgow-Edinburgh Throat Scale. A questionnaire-based study in which 41 consecutive patients due to undergo thyroidectomy prospectively completed the questionnaire pre-operatively and 12 months post-operatively. A subset of 25 randomly selected patients also completed the questionnaire three months post-operatively. Globus symptoms were not worsened by thyroidectomy at three or 12 months. Indeed two of the questioned parameters were significantly improved at three months, and six at one year (p < 0.023). In conclusion, thyroidectomy does not exacerbate globus pharyngeus symptoms. Indeed, in the absence of other clinical causes, when a patient has a World Health Organization (WHO) 2 goitre or greater, thyroidectomy may improve them.

Adult↗
PubMed2003

Comparison of different thyroidectomy techniques for benign thyroid disease.

Extent of thyroidectomy in the management of benign thyroid disease remains controversial. In this clinical study, three different thyroidectomy techniques were compared by means of the complication, short period recurrence and L-thyroxin requirement rates. Two hundred consecutive patients who had bilateral subtotal thyroidectomy (BST) (n = 71), unilateral total lobectomy + contralateral subtotal lobectomy (Dunhill Procedure (DP)) (n = 71), or total thyroidectomy (TT) (n = 58) for benign thyroid disorders were included in this study. One patient was re-operated due to bleeding in BST group. Wound infection was observed in 1 patient both in BST and DP group and 2 patients in TT group. Temporary hypocalcaemia was seen in 14 (19.7%) of BST group, in 19 (26.7%) of DP group, and in 14 (24.1%) patients of TT group (p>0.05). Transient recurrent laryngeal nerve palsy developed in 1 patient both in DP and TT group. One patient of DP group had secondary thyroidectomy due to postoperative diagnosis of papillary carcinoma. There was no significant difference in the mean durations of hospitalization between the groups. Mean postoperative follow-up periods were 27.7 months (6-56), 34.8 months (8-55), 26.5 months (6-54) in BST, DP and TT groups, respectively. While all patients were administered L-thyroxin in TT group, 26 (36.6%) patients in DP group and 34 (47.8%) patients in BST group needed no L-thyroxin supplementation and L-thyroxin requirement rates were not different in either group. We think that total thyroidectomy should be adopted for benign thyroidal diseases, because its complications are no different than those for BST and DP. If individual factors and patient's preference are not in favor of lifelong L-thyroxin supplementation, however, DP may be carried out for benign thyroidal diseases instead of BST.

Adolescent↗
PubMed2006

Long-term outcome in 46 gene carriers of hereditary medullary thyroid carcinoma after prophylactic thyroidectomy: impact of individual RET genotype.

OBJECTIVE: In children with RET proto-oncogene mutation, curative treatment of medullary thyroid carcinoma (MTC) is possible by prophylactic thyroidectomy. Recommendations on the timing and extent of thyroidectomy are based upon a model that utilises genotype-phenotype correlations to stratify mutations into three risk groups. DESIGN: We evaluated the long-term outcome (mean follow-up 6.4 years, 15 patients more than 10 years, 26 patients more than 5 years) of operated gene carriers stratified into two risk groups (levels 1 and 2) based on the biological aggressiveness of MTC. RESULTS: In 46 RET gene carriers, prophylactic thyroidectomy was carried out between the ages of 4 and 21 years. Level 1 mutations were harboured by 11 patients (codons 790, 791, 804 and 891). Histology was completely normal in two patients; in seven patients C-cell hyperplasia (CCH) and in two patients T1 tumours were diagnosed. All patients with level 1 mutations were cured. Level 2 mutations were harboured by 35 patients (codons 618, 620, 630 and 634). Histology of these patients showed CCH in 11 patients, T1 tumours in 21, T2 tumour in 1, T3 tumour in 1 and Tx in 1 patient. Histology showed no lymph node involvement. Five patients with level 2 mutations failed to be cured; in two patients, persistence of MTC was diagnosed directly after thyroidectomy and in three during follow-up. In two patients carrying a 634 mutation, other endocrinopathies (hyperparathyroidism and bilateral pheochromocytoma) manifested during follow-up. CONCLUSIONS: If prophylactic thyroidectomy is done at early ages, cure rate is high. Timing and extent of prophylactic thyroidectomy can be modified by individual RET mutation.

Adolescent↗
PubMed1995

Responses of prepubertal and mature rams to thyroidectomy.

Thyroidectomy of seasonally breeding birds and mammals prevents the return to a state of sexual quiescence at the end of the breeding season. In starlings, thyroidectomy also causes premature sexual maturity. In this study, the effect of thyroidectomy upon the time of sexual maturity of prepubertal (8 week-old) ram lambs was examined. Thyroidectomy of four prepubertal and six mature rams was performed early in the spring. These and sham-operated controls were maintained in ambient photoperiods (south-west England). Scrotal circumference and serum LH, FSH, prolactin and thyroxine were measured every 2 weeks. In both the prepubertal lambs and the mature rams, scrotal circumference increased significantly within 5 weeks of thyroidectomy. FSH concentrations increased significantly in the mature rams after thyroidectomy. The relatively high FSH concentrations of thyroidectomized animals at the start of the experiment were maintained, but the FSH concentrations of intact lambs decreased during the late spring. These results provide the first indication that the timing of puberty in seasonally breeding mammals is a thyroid-dependent phenomenon.

Animals↗
PubMed1993

Thyroidectomy progressively renders the reproductive system of starlings (Sturnus vulgaris) unresponsive to changes in daylength.

If starlings (Sturnus vulgaris) are transferred to long days soon after being thyroidectomized, they show gonadal maturation but no subsequent photorefractoriness, suggesting a specific role for thyroid hormones in the development of photorefractoriness. This study tests an alternative hypothesis: that following thyroidectomy all gonadal responses to photoperiodic changes are progressively inhibited. Photoperiodic responses of starlings were examined at two different times after thyroidectomy. Transfer of thyroidectomized birds to long days 4 weeks after thyroidectomy caused testicular growth but at a slower rate than in intact birds, whereas, in thyroidectomized birds kept on short days, testicular growth was greater than in corresponding intact birds. Thirteen weeks after thyroidectomy, there was little or no response to an increase or a decrease in daylength in thyroidectomized birds, whereas intact birds showed marked testicular growth or regression respectively. The results support the hypothesis that the reproductive system gradually becomes unresponsive to changes in daylength during the weeks following thyroidectomy. This long-term effect may mean that earlier conclusions regarding the effects of thyroidectomy need to be reassessed.

Animals↗
PubMed2003

Postoperative parathyroid hormone level as a predictor of post-thyroidectomy hypocalcemia.

OBJECTIVES: To evaluate levels of parathyroid hormone following total thyroidectomy in order to ascertain its ability to predict postoperative hypocalcemia. To establish standardized criteria permitting the safe discharge of total thyroidectomy patients within 13 hours of surgery. METHODS: This is a prospective study in which parathyroid hormone levels were tested in 54 consecutive patients who underwent total thyroidectomy. Levels were measured postoperatively at 6, 12, and 20 hours. Corrected calcium levels were also measured at 6, 12, and 20 hours in accordance with the preexisting protocol. RESULTS: Statistical analysis demonstrates that patients with corrected calcium levels greater than or equal to 2.14 mmol/L and parathyroid hormone levels greater than or equal to 28 ng/L at 12 hours post-thyroidectomy can be discharged without further need for calcium monitoring. The analysis also demonstrates that patients with 12-hour parathyroid hormone levels less than or equal to 20 ng/L are at significant risk of developing hypocalcemia. CONCLUSION: Parathyroid hormone levels in conjunction with corrected calcium values are accurate predictors of the calcium trends of post-thyroidectomy patients. Implementation of this protocol can result in shorter hospital stays for the majority of post-thyroidectomy patients, which can translate into substantial cost savings for the health care system.

Adult↗
PubMed1999

Total thyroidectomy is the recommended treatment for all Papillary Thyroid Carcinoma (PTC).

Surgical treatment of well differentiated carcinomas of the thyroid gland remains a discussed topic and there is still no evidence of global and total harmony in the appropriate surgical procedure to be applied in the approach of these tumors. The major unresolved debate concerning the ideal surgical management of PTC focuses on the extent of thyroidectomy. The most common recommended options range from thyroid lobectomy to a total extracapsular thyroidectomy. Controversy concern not only the extent of thyroidectomy but also the indications for, and the extent of cervical lymph node dissection. To date, there are no controlled prospective trials comparing the results of different surgical treatments of PTC. There are, however, several large retrospective reports that have addressed the extent of thyroidectomy in the management of patients with PCT1. The purpose of this review article is to demonstrate that total thyroidectomy seems to be the optimal treatment for most patients with clinically significant PTC. We also emphasize that the ability to perform thyroid surgery safely is of paramount importance with an excellent long-term prognosis. To determine the ideal treatment surgeons must weigh the risk-complications of a more aggressive surgical resection (total thyroidectomy) versus the risk of morbidity, mortality, recurrence rates and difficulty in following patients who undergo less gland resection (lobectomy). It is mandatory to expand efforts to identify high-risk patients more accurately, thereby facilating more rational approaches to treatment.

Carcinoma, Papillary↗
PubMed2001

[Total thyroidectomy in the surgical treatment of thyroid disease a retrospective clinical study].

BACKGROUND: Thyroid diseases constitute a group of benign and malignant affections, among which the most represented is multinodular goitre. Nowadays, an important question regards routine total thyroidectomy as the treatment of choice for all thyroid diseases. The aim of the present study is to verify if total thyroidectomy can always represent an option for modern surgery of thyroid disease. METHODS: One hundred-thirty-seven patients underwent operations for thyroid disease during an 11-year period. Fifty-three patients underwent total thyroidectomy, 27 affected by a benign pathology and 26 by a malignant one. RESULTS: Both short term and long term results have been analysed. CONCLUSIONS: In conclusion, the authors affirm that a complete resection of the gland is mandatory for the surgeon in the treatment of malignant diseases because the primary aim for oncologic surgery of the thyroid is the reduction of local recurrence and the increase of survival. As far as benign diseases are concerned, some surgeons affirm that morbility of non-total operations is lower than total thyroidectomy; anyway, the authors affirm that the most important factor to prevent morbility after total thyroidectomy is an appropriate surgical technique. In this way, both the identification of parathyroid glands and the identification preparation of recurrent nerve are considered the most valid method to prevent lesions. Another factor in favour of total thyroidectomy is represented by the risk of carcinoma on the residual tissue.

Adult↗
PubMed2002

[Post-thyroidectomy hypocalcemia. Personal experience].

BACKGROUND: The study evaluates the incidence of both early and protracted post-thyroidectomy hypocalcemia over a 6-year period (1995-2000) in a series of 330 consecutive thryoid operations. The aim was to identify the profile of patients with the greatest risk of permanent parathyroid functional insufficiency and a suitable treatment protocol. METHODS: Having performed a statistical ana-lysis of all the variables, we divided the entire population of 330 patients into 4 groups based on the extent of demolition, the method of organotherapeutic replacement with L-Thyroxine and the (eco-radioguided) procedure used to identify the parathyroids: 59 patients undergoing subtotal thyroidectomy; 155 patients undergoing total thyroidectomy who commenced replacement organotherapy from postoperative day 15-30; 94 patients undergoing total thyroidectomy who commenced replacement organotherapy from postoperative day 1; 22 patients undergoing total thyroidectomy who underwent routine intraoperative parathyroid assay. RESULTS: The results show that the impact of more radical surgery in determining hypocalcemia, in particular protracted hypocalcemia, represents the most striking characteristic of patients with the greatest probability of permanent parathyroid insufficiency. We emphasise that early correction of postoperative hypothyroidism can drastically reduce the incidence of both early and protracted hypocalcemia. CONCLUSIONS: In conclusion, hypoparathyroidism is an exceptional event, whereas hypocalcemia is relatively common after total thyroidectomy. The effects of the early correction of postoperative hypothyroidism are undoubtedly beneficial, as is the use of eco- and radioguided methods for the intraoperative identification of the parathyroid glands, although they are not free from limits and criticism.

Adult↗