Complications Of Total Thyroidectomy Research Articles

Total thyroidectomy versus less-than-total thyroidectomy for papillary thyroid carcinoma of isthmus: a systematic review and meta-analysis.

Papillary thyroid carcinoma of isthmus (PTCI) has a more aggressive nature, a higher rate of lymph node metastasis and tumor recurrence. Clinicians have different preferences for the surgical approach to PTCI, but there are no definitive guidelines. The purpose of this article is to compare the oncologic outcomes and complications of total thyroidectomy and less-than-total thyroidectomy for PTCI using meta-analysis. We searched PubMed, Embase, Cochrane Library, and Web of Science databases for articles that met the inclusion criteria, with an unlimited start date and an end date of February 19, 2023. Exclusion criteria were applied to filter out articles for further analysis. Ultimately, seven articles were used for analysis, all of which were retrospective studies. The MINORS scale was adopted to evaluate the quality of the included literature, and Review Manager 5.4 was used for data analysis. A total of 814 patients were included in the seven articles, including 401 in the less-than-total thyroidectomy group (trial group) and 413 in the total thyroidectomy group (control group). The results of the meta-analysis showed that there was no significant difference in the tumor recurrence rate between the two groups after total thyroidectomy or less-than-thyroidectomy for PTCI (odds ratio, 1.51; 95% confidence interval: 0.49, 4.65; P=0.47), and there was no statistical difference in the incidence of all postoperative complications between the two groups. There may be some limitations in this analysis, such as publication bias and the fact that the included articles were all retrospective studies with a certain degree of heterogeneity. PTCI patients with early staging and no significant lymph node metastases may be able to choose a more conservative surgical approach, which is less-than-total thyroidectomy. Patients with relatively late staging and significant preoperative lymph node metastases or extra thyroidal extension may opt for total thyroidectomy plus lymph node dissection in the central region and, if necessary, lymph node dissection in the lateral cervical region.

Risk factors for postoperative complications in total thyroidectomy

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

A Comparison of Completeness and Complication of Total Thyroidectomy with or Without Neuromonitoring.

Total Thyroidectomy (TT) in true sense is not total as evidenced by remnant uptake in radio-iodine scans and serum thyroglobulin. The aim of this study is to assess the completeness of TT, operating time and recurrent laryngeal nerve injury with and without neuro-monitoring (IONM). Cross sectional analytical study using retrospective data of patients undergoing total thyroidectomy for benign and malignant goiters. Surgeries performed by single surgeon. Patients undergoing TT (2015-22) were grouped into Group A (n = 400) and Group B (n = 400) based on use of IONM. Subgroup of patients (Group A1&B1) who had differentiated thyroid cancer were compared for completeness of thyroidectomy with DxWBS and serum thyroglobulin (TG). Group A and B were compared for operating time and incidence of RLN palsy. Of the 800 RLN at risk transient RLN palsy was lower with IONM (p = 0.048). Mean operating time was significantly higher in Group-B(p = 0.0038). Subgroup A1 showed lower radio-active iodine uptake percentage, higher number of patients with negative scan, TG of < 1ng/mL indicating better completeness of TT. Our study shows better completeness of thyroidectomy, lower incidence of transient RLN palsy and shorter operating time with IONM.

Evaluation of the Morbidity and Complications of Total Thyroidectomy: Systematic Literature Review

This scientific problem is aiming to talk about the evaluation of morbidity and complications of total thyroidectomy. The presented review was conducted by searching in Medline, Embase, Web of Science, Science Direct, BMJ journal, and Google Scholar for, researches, review articles, and reports, published over the past years, which was searched up to June 2021 for published and unpublished studies and without language restrictions. If limitless lookup had comparable findings, we randomly chosen one or two to keep away from repetitive results. Based on the findings and effects of this review, the success of total thyroidectomy will beautify if we furnish large cognizance to advances in intervention, developing new methods and education. Surgeon responsiveness, nursing training will aid too in accomplishing this goal.

920 Improving the Management of Post-Operative Hypocalcaemia In Thyroid Surgery

Abstract Aim Hypocalcaemia is a frequent, and potentially dangerous, complication of total thyroidectomy [1, 2] due to the removal of the parathyroid glands. This quality improvement (QI) project was undertaken in a large Ear, Nose and Throat department in the East of England over a year. The project improved postoperative guideline compliance by optimising the recognition and management of patients at risk of hypocalcaemia. This process focussed on improving parathyroid hormone (PTH) and calcium blood testing, appropriate prescribing and the monitoring and management of hypocalcaemia. Method A baseline audit was conducted to determine initial guideline compliance. The QI process subsequently involved the introduction of a new intraoperative PTH pathway and the amendment of trust guidelines. In addition, there was a focus on improving clinician awareness of guidelines, junior doctor education, communication between operating surgeons and junior doctors and the optimisation of patient handover. Results The measurement of PTH at four hours improved from 42.5% to 52.2%. The project saw a significant improvement in the monitoring of hypocalcaemia (from 22.2% to 83.3% for patients with an intermediate risk of hypocalcaemia) and in the prescribing of prophylactic calcium supplements from 7.5% to 43.5%. Conclusions By optimising postoperative care this QI project improved patient safety as well as impacting on the duration, and overall cost, of inpatient stay.

Retrospective Comparative Study of the Incidence of Hypocalcaemia in Total Thyroidectomy between Ain-Shams University as a Referral Center and Damanhour Medical National Institute

Abstract Background: Post-operative hypocalcaemia is one of the most serious complications of total thyroidectomy with variable degrees of morbidity. Aim of Study: The aim of this study was to to compare the incidenceandto examine several preoperative and imme-diate post-operative factorsfor development of hypocalcaemia after total thyroidectomy in patients who underwent total thyroidectomy in Ain-Shams University and Damanhour Medical National Institute. Patients and Methods: This retrospective study was conducted in Ain-Shams University Hospital and Damanhour Medical National Institute in the period between December 2015 and December 2019. It included 62 patients who under-went total thyroidectomy. The data was collected from patients' files in the Record Department. Results: There were 52 female and 10 male patients. The mean age was 38 years. Multi-nodular goiter was the most common indication of total thyroidectomy. The mean pre-operative serum Ca was 8.1mg/dl in group A and 8.3mg/dl in group B. 3 (9.7%) patients in group A and 7 (22.5%) in group B developed post-operative hypocalcemia. The highest fre-quency of transient hypocalcaemia was on 2nd post-operative day in group A and on 0 day in group B. There was only one patient 3.2% who required calcium and vitamin D supplement for more than six months. Conclusion: Hypocalcaemia is one of the major concerns following total thyroidectomy that can be prevented by me-ticulous surgical technique, identification and preservation of parathyroid glands and its vascularity. Post-operative monitoring of serum calcium & early treatment can prevent significant morbidity.

37 Improving the Management of Post-Operative Hypocalcaemia in Thyroid Surgery

Abstract Introduction Hypocalcaemia is a frequent, and potentially dangerous, complication of total thyroidectomy [1, 2]. This quality improvement (QI) project was undertaken in a large ENT department in the East of England over a year. The project improved postoperative guideline compliance by optimising the recognition and management of patients at risk of hypocalcaemia. This process focussed on improving parathyroid hormone (PTH) and calcium blood testing, appropriate prescribing and the monitoring and management of hypocalcaemia. Method Following a baseline audit the QI process subsequently involved the introduction of a new intraoperative PTH pathway and the amendment of trust guidelines. In addition, there was a focus on improving clinician awareness of guidelines, junior doctor education, communication between operating surgeons and junior doctors and the optimisation of patient handover. Results The measurement of PTH at four hours improved from 42.5% to 52.2%. The project saw a significant improvement in the monitoring of hypocalcaemia (from 22.2% to 83.3% for patients with an intermediate risk of hypocalcaemia) and in the prescribing of prophylactic calcium supplements from 7.5% to 43.5%. Conclusions By optimising postoperative care this QI project improved patient safety as well as impacting on the duration, and overall cost, of inpatient stay.

Risk Assessment in Thyroid Lobectomy and Total Thyroidectomy using Over 100 Thousand Cases.

To assess risk factors and non-thyroid specific postoperative complications for thyroid lobectomy compared to total thyroidectomy. A retrospective, cross-sectional study of adults undergoing a lobectomy or total thyroidectomy using the National Surgical Quality Improvement Program database between 2005 and 2017. Patients not treated by otolaryngologists or general surgeons and with unknown demographic variables were excluded. A total of 106 915 patients were analyzed, 64 763 total thyroidectomies and 42 152 lobectomies. Multivariable analysis demonstrated that total thyroidectomy patients were half as likely to return to the operating room (OR = 0.491 (95%CI 0.445-0.542), P < .001). Within this cohort, patients at greater risk for reoperation had a history of hypertension (OR = 1.225 (95%CI 1.090-1.376), P < .001), a malignant pathology (OR = 1.921 (95%CI 1.734-2.128), P < .001), and smoked (OR = 1.237 (95%CI 1.087-1.407), P = .001). Conversely, diabetes and body mass index did not impact the rate of reoperation when assessing total thyroidectomy and lobectomy. The most frequent non-thyroid specific complications in total thyroidectomy were unplanned intubation (0.5%), urinary tract infection (0.3%), and superficial surgical site infection (0.3%). In thyroid lobectomy, the most common complications were superficial surgical site infection (0.3%) and urinary tract infection (0.2%). Our multi-institutional study indicates specific risk factors for returning to the operating room that may warrant closer follow up after surgery for total thyroidectomy or thyroid lobectomy. We also identified the most common post-operative complications. During pre-operative planning, these findings should be considered by thyroid surgeons to help mitigate risk to patients.

Clinical Utility of Preoperative Vitamin D3 Injection for Preventing Transient Hypocalcemia after Total Thyroidectomy.

Background Postoperative transient hypocalcemia (TH) is a common complication of total thyroidectomy. This retrospective study evaluated the clinical utility of preoperative vitamin D3 injection for the prevention of TH after total thyroidectomy. Methods We included 2294 patients who underwent total thyroidectomy from January 2015 until October 2018 and retrospectively analyzed their data by complete chart review at our hospital. The patients were divided into two groups: vitamin D3 injection (VDI; n = 342) and vitamin D3 noninjection (VDN; n = 1952). TH was defined as serum calcium <8.2 mg/dL and signs or symptoms of hypocalcemia. Results The mean preoperative serum 25-hydroxyvitamin D (25-OHD) levels of the VDI group were significantly lower than those of the VDN group (16.5 ± 6.9 ng/mL vs 19.4 ± 8.7 ng/mL, p < 0.001). Multivariate analysis indicated that the significant risk factors of TH include vitamin D noninjection (hazard ratio (HR): 1.717, 95% confidence interval (CI): 1.282–2.300, p < 0.001), male gender (HR: 1.427, 95% CI: 1.117–1.822, p = 0.004), and capsular extension (HR: 1.273, 95% CI: 1.011–1.603, p = 0.040). Conclusions Preoperative vitamin D3 injection significantly contributed to the prevention of TH after total thyroidectomy. Further prospective or multicenter studies must be conducted to determine the effect of vitamin D3 injection.

Total versus near-total thyroidectomy in Graves' disease: a systematic review and meta-analysis of comparative studies.

Total thyroidectomy (TT), near-total thyroidectomy (NT), and subtotal thyroidectomy (ST) are three surgical procedures for Graves' disease (GD) patients, but most previous studies have only evaluated the complications of TT versus ST or TT/NT versus ST; there is not a meta-analysis of NT versus TT, so whether NT is superior to TT for GD patients still unclear. We comprehensively searched PubMed, Embase, Web of Science, and the Cochrane Library, without restriction to region, publication type, or language, on 10 June, 2020. We conducted this systematic review and meta-analysis of all included studies assessing the two surgical procedures. In total, 528 cases were identified from two randomized controlled trials (RCTs) and three retrospective studies. The incidence of permanent hypoparathyroidism after NT was lower than with TT [odds ratio (OR), 0.22; 95% confidence interval (CI), 0.06-0.80; P=0.02], and there was no statistical difference in the recurrence of hyperthyroidism (OR, 0.33; 95% CI, 0.01-8.12; P=0.50) and other postoperative complications (P>0.05). NT for GD was superior to TT regarding permanent hypoparathyroidism, but there was no significant difference in preventing recurrent hyperthyroidism, as well as the other postoperative complications.

Role of Total Thyroidectomy in Painful (Symptomatic) Hashimoto's Thyroiditis: Descriptive Study.

Hakura Hashimoto described Hashimoto's Thyroiditis (HT) in 1912. In HT, there occurs formation of antibodies against the self (thyroid), which causes enlargement of the thyroid gland as a whole and decreased thyroid hormone levels. Most of the patients with HT are given medical line of management (hypo/hyperthyroidism). The indications for surgical line of management for HT are due to pressure symptoms over the trachea and oesophagus, pain in the thyroid gland and for chance of malignancy. Surgical treatment gives complete relief from pain and pressure symptoms and also prevents the risk of malignancy. To evaluate the outcome and complications of total thyroidectomy in painful (symptomatic) Hashimoto's thyroiditis. It was a Hospital based Descriptive study conducted in tertiary care teaching hospital by ENT Department, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry from Nov 2017 to May 2019. Sample size was 30. All patients with symptomatic (painful) HT was given trail of medical therapy (steroids and NSAIDS), following repeated attempts of failed medical therapy, surgical management (total thyroidectomy) was preferred. Visual Analog Scale (VAS) was used to assess the pain grading pre and post operatively. MS Excel and SPSS trial version 20 software was used to analyze the data. The Wilcoxan Signed Ranked test was used as test of significance to identify the difference between ordinal variables. In this study, all the 30 patients had pain as the predominant symptom. Visual Analog Scale was used to grade the pain in all the patients preoperatively and 2weeks postoperatively. All the patients had significant reduction in the pain following total thyroidectomy, when compared to pre-operative VAS grading. Total thyroidectomy is the technique of choice in surgical treatment of symptomatic Hashimoto's thyroiditis (pain, tenderness and pressure symptoms) which warrants a radical and definitive control of the disease, without any risk of relapse and without the side effects of medical management. Moreover in longstanding cases of HT, the risk of malignant transformation is prevented due to total thyroidectomy. In experienced hands it assures total relief of compressive and painful symptoms and low incidence of/nil major complications.

SAT-389 Clinical and Biochemical Characterization of Risk Factors for Vertebral Fractures in Patients with Hypoparathyroidism

Background: Persistent hypoparathyroidism (PH) is a rare disease due to an impaired secretion of PTH, mostly occurring as a complication of total thyroidectomy. Calcium and calcitriol are currently the most common and inexpensive therapies, although not all the patients easily achieve control of the disease. Recently, our group has reported that BMI at diagnosis can predict calcitriol resistance in PH. Very few studies have been performed with fractures as primary endpoint in hypoparathyroidism, and we still not know if PH could be predisposing to an increased risk of morphometric fractures and possible clinical and biochemical predicting factors. Patients and methods: To that end we retrospectively evaluated the anthropometric, biochemical and fracture characteristics in 71 consecutive patients with PH (F/M= 62/9; median age 58.7 yrs, range: 29-87; 67 with post-surgical PH and 4 with autoimmune PH). All patients were hypoparathyroid from at least one year (median duration of disease: 9 yrs., range: 1-41) and were under standard treatment with calcium and active vitamin D analogs (calcitriol). For each patient anthropometric data (BMI=kg/m2; N= Normal weight patients <25; OO= Obese and overweight patients with BMI > 25) were collected, as well as biochemical parameters, such as calcium (mg/dl) and 25 OH vitamin D (25OHD expressed as ng/ml). We considered well controlled (C) patients with calcium between 8.2 and 9.2 mg/dl and not controlled (NC) under 8.2 or above 9.2 mg/dl. Vertebral fractures (VF) were assessed by a quantitative morphometric approach by using images provided by DXA and classified according to Genant classification. Results: Thirteen out of 71 patients (18%) were fractured. We showed a positive linear correlation in the overall population between BMI and calcitriol intake (p=0.006, CI 95% [1.2-6.9]) while no significant difference in prevalence of VF in OO vs N group (8/40 vs 5/31, p=0.76) was found. However, almost half (6/13, 45%) of patients with VF were OO NC. Moreover, 86% of NC vs only 30% of C fractured patients (6/7 vs 2/6) were OO Discussion: We report a high prevalence of VF in hypoparathyroidism. Moreover, we confirm that increased BMI is associated with higher needs of calcitriol to obtain calcium control. Interestingly, our data suggest for the first time that OO hypoparathyroid patients with NC disease are those at highest risk of fracture. Therefore, in this subset of patients a more intensive and proactive biochemical and bone monitoring should be adviced if these results will be confirmed in larger studies.

Evaluation of Total Thyroidectomy for Treatment of Benign Diseases of Thyroid Gland

BACKGROUND: The controversy of using total thyroidectomy (TT) in treatment of benign thyroid diseases still remains controversial over the rates of complication, mostly recurrence nerve palsy and hypocalcemia, compared to non-total thyroidectomies. The latest reports in this field of research showed that that the number of complications of TT is decreasing as the skills of surgeons increase.&#x0D; AIM: In this study, we reviewed 209 cases of total thyroidectomies for benign thyroid diseases where such surgery was indicated. The results were evaluated whether they support the previous reports that TT is save method of treatment of diffuse multinodular goiters, Graves’ disease thyroid adenomas with diffuse goiters and thyroiditis.&#x0D; METHODS: Two hundred and nine patients, 36 males and 173 females, medium age 47 (17–77) operated with TT between 2016 and 2018 were included in the evaluation study. We evaluated the: Diagnosis, indications for operation, pre-operative medication administration, laryngeal recurrent nerve palsy, hypocalcemia, hypoparathyroidism, and patohistology findings. The follow-up for hypocalcemia and laryngeal nerve palsy was performed 1 year postoperatively.&#x0D; RESULTS: The age of the patients was between 17 and 77 years, medium-range 47 years old. Of 209 patients, 173 (83%) were female and 36 (17%) male with a gender ratio of 1:4.8 males to females. Diagnoses before surgery were established as follows: Multinodular euthyroid goiter (MNEG) n = 106 (48.80%), multinodular toxic goiter n = 12 (5.74%), Graves’s disease n = 6 (2.87%), adenoma with multinodular goiter n = 73 (34.92%), and n = 16 (7.65%) patients with thyroiditis. Recurrence laryngeal nerve palsy (RLNP) occurred in 6 patients (2.87%), temporary within 3 months after the operation in 4 patients (1.92%) and permanent palsy within 6 months and more after an operation in 2 patients (0.95%). Voice hoarseness immediately and within 1 month after the operation was registered in 32 patients (15.3%). RLNP and hoarseness were registered mostly in patients with pre-operative problems, mostly with extra big MNEG. One of the permanent injuries of RLN was bilateral and all others were one sided. All patients were operated with normal pre-operative vocal cord movement findings. Post-operative hypocalcemia was registered in 35 patients (16.74%). Temporary nonsignificant hypocalcemia in 10 (4.78%), temporary significant hypocalcemia in 17 (8.13%), temporary severe hypocalcemia in 6 patients (2.87%), and permanent hypocalcemia in 2 patients (0.95%).&#x0D; CONCLUSION: Many studies have shown that the rate of complications is almost even for TT and NTT done for benign and malignant diseases of thyroid gland. Our data have shown that the risk of post-operative complications with TT is proportional to the number of complicated pre-operative findings of benign thyroid glands.

Calcium-Alkali Syndrome Associated with Hypoparathyroidism Following Total Thyroidectomy

Background: Patients with permanent postsurgical hypoparathyroidism, a complication of total thyroidectomy, often require high calcium supplementation with vitamin D to maintain serum calcium levels. The epidemiology of calcium-alkali syndrome (CAS) in patients with hypoparathyroidism after total thyroidectomy remains unclear. This study aimed to investigate the incidence of hypercalcemia, renal impairment, metabolic alkalosis, and CAS in patients treated for presumed hypoparathyroidism after total thyroidectomy. Methods: Twenty-seven patients with neck cancers who underwent total thyroidectomy without parathyroid autotransplantation between January 2010 and October 2013 at our hospital were consecutively included. All patients received calcium lactate and alfacalcidol for postsurgical hypocalcemia. We defined hypercalcemia as a corrected serum calcium level (cCa) ≥10.5 mg/dL, metabolic alkalosis as a difference in serum sodium and serum chloride ([sNa-sCl]) ≥39 mEq/L, and renal impairment as a ≥50% increase in serum creatine and/or ≥35% decrease in estimated glomerular filtration rate (eGFR) compared to baseline. Results: cCa peaked (11.1 ± 1.5 mg/dL) at a median of 326 days (interquartile range 78–869) after surgery. At peak cCa, [sNa-sCl] was significantly higher (p < 0.01), and eGFR was significantly lower (p < 0.01) than that at baseline. Fifteen patients (55.6%) had hypercalcemia, 19 (70.3%) had alkalosis, 12 (44.4%) had renal impairment, and 9 (33.3%) had CAS. Patients with CAS (mean age 67.1 ± 10.8 years) were older than those without CAS (56.7 ± 13.6 years, p = 0.06). The mean dose of alfacalcidol in the CAS group (3.1 ± 1.2 μg/day) was significantly larger than that in the non-CAS group (2.1 ± 1.0 μg/day, p = 0.03). Conclusions: This retrospective study reveals the high incidence of CAS in patients with hypoparathyroidism after total thyroidectomy. Furthermore, these findings suggest that the serum calcium level, acid-base balance, and renal function should be closely monitored in patients with postsurgical hypoparathyroidism who receive large doses of active vitamin D.

Complications of Total Thyroidectomy in 50 Cases in The Department of Endocrine Surgery in BSMMU

Objective: To determine the complications of the patients undergoing total thyroidectomy.&#x0D; Method: A prospective study was held at Department of Endocrine Surgery in BSMMU from January 2006 to December 2006&#x0D; Method: Fifty patients with multinodular goiter and carcinoma thyroid of both sexes were selected from admitted patient of endocrine surgery department. All patients were evaluated preoperatively and total thyroidectomy was done and post operative was followed up. Out of 50 patients 35 patients were female and 15 patients male, male - female ratio 1 :2.3. 40 patients were carcinoma thyroid, 10 patients were multinodular goiter. The overall incidence of postoperative complication in this series was 4. out of 50 patients 1 patient developed haematoma. 1 patient developed wound infection and 1 patient developed transient tetany on 2nd postoperative day which was improved later on. 1 patient developed a thyroid nodule 6th month after total thyroidectomy for carcinoma thyroid. In long term from total thyroidectomy 40 patients were followed up, 10 patients did not attend an subsequent follow up. Out of 40 patients 36 patients were out of complication.&#x0D; Conclusion: The results are comparable with the current published data and demonstrate that total thyroidectomy can performed with minimum complication rate.&#x0D; Journal of Surgical Sciences (2013) Vol. 17 (1) : 25-29

Feasibility criteria for total thyroidectomy in outpatient surgery

IntroductionFrance is pursuing a policy of cutting healthcare costs, and outpatient surgery is one of the objectives of this policy. Thyroid surgery could be suitable for outpatient management, provided there is an appropriate patient selection process. The aim of this study was to assess the risk factors for postoperative complications in total thyroidectomy (TT). DesignA single-center observational study was carried out from January 2010 to December 2015. MethodCorrelations between, on the one hand, age, gender, obesity, history of surgery, antiplatelet and/or anticoagulation treatment, the surgeon's experience, surgery time, repeated lymph node dissection, and surgical indication (cancer, lymphocytic thyroiditis, Graves’ disease or multinodular goiter) and, on the other hand, onset of postoperative complications (postoperative hypocalcemia, uni- or bi-lateral lesions of the recurrent laryngeal nerves, and premature compressive hematoma) were assessed. ResultsFour hundred and twenty-four consecutive TTs were included. 85 patients showed postoperative hypocalcemia (20.04%), 18 recurrent laryngeal nerve lesion (4.25%), and 4 compressive cervical hematoma (0.94%). Overall morbidity was 24.06%. Risk factors identified for postoperative hypocalcemia comprised: female gender [OR=3.2584; 95%CI (1.5500–7.7515); P=0.0036], surgery time [OR=1.0095; 95%CI (1.0020–1.0172); P=0.0129], and surgical indication for benign adenoma [OR=5.0642; 95%CI (1.7768–14.5904); P=0.0022]. None of the study variables emerged as risk factors for recurrent laryngeal nerve lesion. Repeated dissection increased the risk of re-do surgery for compressive hematoma [OR=25.1373; 95%CI (0.8468–32.2042); P=0.0347]. ConclusionSurgery time, female gender, repeated dissection and total thyroidectomy for benign adenoma are risk factors that should be considered in decision-making for performing TT on an outpatient basis.

Postoperative hypoparathyroidism after total thyroidectomy for thyroid cancer

ObjectivesPostoperative hypoparathyroidism (HPT) is one of the most common complications in total thyroidectomy for thyroid carcinoma. Parathyroid glands (PTGs) are at risk of being damaged during total thyroidectomy and central neck dissection mainly due to inadvertent removal, interruption of the blood supply or hematoma formation. The purpose of this study was to evaluate the efficacy of our surgical procedure to preserve for parathyroid function retrospectively and to clarify the risk factors of HPT after total thyroidectomy for thyroid cancer. Patients and methodsSixty-five patients undergoing total thyroidectomy with central neck dissection for thyroid cancer were enrolled in this retrospective study. Cancers were diagnosed as stage I in 15 patients, stage II in 24 patients, stage III in 19 patients, and stage IV in 7 patients. Lateral neck dissection and upper mediastinal dissection were simultaneously performed in 47 patients and one patient, respectively. Parathyroid glands (PTGs) were preserved in situ in 34 patients. Among 31 patients in whom PTG could not be preserved in situ, two or more PTGs were autotransplanted in 9 patients and one PTG was autotransplanted in 18 patients. PTG was not autotransplanted in 4 patients, since it could not be identified during the surgery. ResultsPostoperative transient HPT and permanent HPT were observed in 44 (68%) patients and in 12 (18%) patients, respectively. Among 34 patients in whom PTGs were preserved in situ, transient HPT and permanent HPT were observed in 17 (50%) patients and in 6 (2%) patients, respectively. Among 31 patients in whom PTG were not preserved in situ, postoperative permanent HPT was observed in all 4 patients without PTG autotransplantation, and 6 (33%) out of the 18 patients who had one PTG autotransplantation. On the other hand, none of the 9 patients who had two or more PTG autotransplantation at the time of thyroidectomy developed permanent HPT (P=0.04). The patients with large tumor (≥40mm) and/or gross extra glandular invasion had a significantly higher risk of permanent postoperative HPT compared with the patients without these pathological features (P<0.01). ConclusionsTwo or more PTG should be autotransplanted in case where PTG is not preserved in situ to prevent postoperative HPT after total thyroidectomy with central neck dissection, especially in cases of large tumor and/or gross extrathyroidal extension.

Risk factors for postoperative complications in total thyroidectomy: A retrospective, risk-adjusted analysis from the National Surgical Quality Improvement Program.

Thyroid cancer incidence is increasing, and with it, an increase in total thyroidectomy. There are limited studies comparing outcomes in total thyroidectomy performed in the inpatient versus outpatient setting.The objective of this study was to perform a comparative analysis of risk factors and outcomes of postoperative morbidity and mortality in total thyroidectomy performed as an inpatient versus outpatient surgery.Retrospective cohort study of data from the 2005 to 2014 multi-institutional, risk-adjusted American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. A multivariate regression model with corresponding odds ratios and 95% confidence intervals was used to determine 30-day morbidity and mortality after total thyroidectomies, and also risk factors of postoperative outcomes.From 2005 to 2014, 40,025 total thyroidectomies were performed (48.5% inpatient, 51.5% outpatient). The 30-day complication rate for all total thyroidectomies was 7.74%. Multivariate logistic regression analysis was performed to control for potential confounding variables. Preoperative factors that affected complications rates for inpatient thyroidectomies included: age ≥70, non-Caucasian race, dependent functional status, history of congestive heart failure, smoking history, bleeding disorder, wound infection, and preoperative sepsis (P < 0.05). In addition, preoperative factors affecting complications in thyroidectomy performed as an outpatient surgery included malignant thyroid pathology (P 0.05).We identified a subset of preoperative conditions that affect risk of complications after total thyroidectomy. Recommendations for patient selection for outpatient total thyroidectomies should be modified to account for pre-existing conditions that increase the risk of postoperative morbidity.

The effect of thyroid gland weight on early complications in total thyroidectomy: Cerrahpasa experience

In this study we aimed to show whether thyroid gland weight has an effect on early and late complications in thyroidectomy done in an experienced center. 721 patients in Istanbul University Cerrahpasa Medical Faculty General Surgery Department, in whom sutureless total thyroidectomy with vessel sealing devices were done, were retrospectively evaluated from January 2012 to December 2015. Reoperations, plonjan goiter, patients with capsule invasion and lymph node metastases who were operated due to thyroid cancer were excluded in the study. Demographic data, operation indications, operation duration, incision length, postoperative complications of the patients were recorded. The complications were recurrent nerve paralysis, hypocalcemia, hematoma and wound infection. These complications were compared according to the thyroid gland weight separately. Also, each complication group was divided into four groups, according to thyroid gland weight, as below 30 grams, 30-60 grams, 60-90 grams and heavier than 90 grams. The effect of thyroid gland weight on postoperative complications was evaluated. 22.2 % of the patients (n=160) were males and 77.8 % (n=561) were females. Mean age of the patients was 48,58±SD (18-85) years. Recurrent laryngeal nerve paralysis was seen in 5.68% (n=82) of the 721 patients, to whom vocal cord examination was done. Hypocalcemia symptoms in 5.54% of the patients (n=40), wound infections in 0.97% (n=7) of the patients and hemorrhage in 0.69% (n=5) of the patients were seen. Mean thyroid gland weight in patients with thyroid surgery complication was 56.1±SD (15-315) grams, while it was 56,94±SD (20-795) grams for noncomplicated thyroid surgery. The complications were divided into four groups. When these groups were compared according to thyroid gland weight separately, it was seen that thyroid gland weight does not affect early complications (p >0,5). Total thyroidectomy, when done in an experienced center, is the suggested surgery, which has 1% complication rate and the least recurrence rate. In our study, there was no statistically significant difference. This may be due to lighter thyroid gland weights in our study.

Total thyroidectomy for Graves’ disease: Compliance with American Thyroid Association guidelines may not always be necessary

Total thyroidectomy (TT) is the preferred operative approach to Graves' disease. Current guidelines of the American Thyroid Association call for the administration of potassium iodide (KI) and achievement of euthyroid state before operation. Small numbers and a mixture of operative approaches spanning several decades hinder previous operative series. We present the outcomes for TT at a single high-volume center. A retrospective cohort study was conducted on 165 patients undergoing TT for Graves' disease from July 2007 to May2012. Mean age was 43 years (range, 17-78), and 128 patients (78%) were female. A total of 95% of patients were on methimazole or propylthiouracil, and 42% remained hyperthyroid at time of TT. Only 3 (2%) patients received KI. Mean operative time was 132 minutes (range, 59-271). Mean gland size and blood loss were 41 g (range, 8-180) and 55 mL (range, 10-1050), respectively. No patient developed thyroid storm. Median follow-up was 7.5 months. Temporary and permanent hypocalcemia developed in 51 (31%) and 2 patients (1.2%), respectively. Temporary and permanent recurrent laryngeal nerve paresis occurred in 12 (7%) and one (0.6%) patient, respectively. Sixty-one (37%) patients experienced at least one complication. On multivariate analysis, patient age younger than 45 years (odds ratio 2.93, 95% confidence interval 1.39-6.19) and obesity (odds ratio 2.11, 95% confidence interval 1.00-4.43) were associated with the occurrence of complications. This high-volume surgeon experience demonstrates no appreciable detriment to patient outcomes when recommendations of the American Thyroid Association for routine use of KI and euthyroid state before thyroidectomy are not met. Transient hypocalcemia and hoarseness are frequent complications of TT for Graves' disease, resolving within 6 months in most patients. Age younger than 45 years and obesity are risk factors for postoperative complications.