Pyramidal lobe, an embryologic remnant in thyroidectomy under loupe magnification: a hospital based cross-sectional study in a tertiary care centre

Abstract

Background: Pyramidal lobe, an embryological remnant is often encountered during thyroidectomy, and its removal is important to prevent the incidence of recurrence. In this context, we evaluated the use of magnifying surgical loupe in increasing the identification rate of pyramidal lobe and levator glandulae thyroideae. Methods: This hospital-based cross-sectional study was conducted in the department of surgery, government medical college, Trivandrum from February 2015 to July 2015. Data were collected from randomly selected patients posted for total thyroidectomy. Demographic variables like age, sex and outcome variables like presence of pyramidal lobe and levator glandulae thyroideae together, its attachment to thyroid, pathology in the thyroid lobe and in the pyramidal lobes were assessed. This study was approved by the institutional ethics committee. Statistical analysis was done with R statistical programming software version 3.2.0. Results: Number of patients included in the study was 45. The median age was 41 years (range 22-57). There were 9 (20%) males and 36 (80%) females. Pyramidal lobes were dissected out in 37(82%) of the patients. These were found attached to left lobe in 27 (71%) of the thyroidectomies. The mean length of pyramidal lobe and levator glandulae thyroideae was 32.5±15.06 mm. Pyramidal lobe was found normal on pathological examination in 76% of the specimens. Conclusions: This study showed that pyramidal lobe and levator glandulae thyroideae can be dissected out in more than 80% of the patients if done under loupe magnification. The adoption of a surgical loupe in the routine operative workflow could potentially reduce thyroid recurrences.