Complications Of Total Thyroidectomy Research Articles

Selim tiroid hastalıklarının cerrahi tedavisinde subtotal ve total tiroidektominin erken ve geç dönem sonuçlarının karşılaştırılması

Comparison of early and late results of total and subtotal thyroidectomy for benign thyroid disease Background: Recently, total thyroidectomy (TT) has been performed and suggested in benign thyroid disease. But it was reported that the complications of total thyroidectomy was more than bilateral subtotal thyroidectomy (BST) this is still a topic of debate. Purpose of the present study is comparison of complications of BST and TT operations in treatment of benign thyroid disease. Materials and Methods: Early and late complications of TT and BST operations were retrospectively evaluated, which were performed in General Surgery Clinic of Konya Training and Research Hospital inbetween 2004-2008. Results:The study involved 96 patients in BST group and 110 patients in TT group. Follow-up period was 69.4±8.3 months in BST group, 52.7±5.3 months in TT group.Transient hypocalcemia were detected in 10 patients (9.1%) in BST group and 7 patients (7.3%) in TT group. Transient recurrent laryngeal nerve paralysis developed in 12 patients (7.2%); 5 patients (5.2%) in BST group and 7 patients (6.4%) in TT group. Hematoma in 4 patients (4.2%), seroma in 3 patients (3.1%), flap edema in 5 patients (5.2%) occured in BST group. In TT group, there had been; hematoma in 1 patients (1.0%), seroma in 5 patients (4.5%), flap edema in 4 patients (4.5%). Permanent hypocalcemia occured in 2 patients (2.1%) in BST group and 3 patients (2.7%) in TT group. Permanent recurrent laryngeal nerve paralysis developed in 1 patient (1.0%) in BST group and 2 patients (1.5%) in TT group. There was no statistically significant difference inbetween the groups about complications and demographic characteristics. Recurrence was seen in 6 patients (6.3%) in BST group. Discussion and Conclusion: TT not increase early and late complications in bengn thyroid diease requiring sugery. BSThas arisk of recurrenceaftersurgeryand thereforemust be carried outagain.Complications in secondary thyroidectomy in patients with prior thyroid surgery are very high.Therefore, if surgery is necessary in benign thyroid diseases should be TT.

The forgotten goiter: casuistic contribution and considerations for the choice of surgical approach

Abstract Aim. A residual mediastinal thyroid (“forgotten goiter”) is a well-known, though uncommon, complication of total thyroidectomy. Materials of study. The authors analyze their experience with three cases of goiter forgotten, observed in a series of 2946 thyroid resections in the period 2005–2010. In the study, a preoperative CT of the chest with three-dimensional reconstruction was always performed to examine the topographical relationships of the lesion. Excision was performed through cervicotomy, cervicosternotomic approach and cervicosternotomy, and posterolateral right thoracotomy. Results. There were no complications. Histological examination was suggestive of malignancy in one case (follicular carcinoma with pulmonary metastases). Discussion. The indication for surgery in cases of forgotten goiter is intrinsic to the diagnosis. Preoperative evaluation with accurate topographic imaging is required in all cases in order to understand the nature and location of mediastinal pathological tissue and to identify the most suitable access route. The cervicotomy is the ideal access for low surgical trauma and is easily extendable into a partial or complete sternotomy. A thoracotomy, on the other hand, which is usually reserved for the right side, must be planned preoperatively.

Total thyroidectomy for Graves' disease treatment.

Graves' disease (GD) is the most common cause of hyperthyroidism, and accounts worldwide for 60-80% of all cases. The diagnosis is based on clinical findings, and is confirmed by the presence of TRAB, suppression of TSH, and elevation of free thyroxin (free T4), and triiodinethyronin (free T3). GD can be treated by antithyroid drugs, radioactive iodine, or surgery. The aim of this study was to review retrospectively the surgical management, in terms of safety and efficacy, in 50 patients operated in the Department of Surgical Sciences since 2005 through 2010 and followed up at the Endocrinology Unit A of the Experimental Medicine Department. We assessed postoperative complications, which included the presence, persistence and development of ophthalmopathy, transient hypocalcemia, permanent hypoparathyroidism and recurrent laryngeal nerve palsy. We analyzed data from 50 patients with GD who were eligible and underwent Total Thyroidectomy (TT). Thirty-nine patients underwent TT for recurrent hyperthyroidism after medical therapy and eleven patients for severe ophtalmopathy. The mean follow up was 41 months (range: 10-70). Eleven patients had ophtalmopathy before surgery. Four patients developed an ophtalmopathy after surgery. Eleven patients presented hypocalcemia, transient in ten patients and permanent in one patient. Five patients developed a transient disphony. Conclusions. Total thyroidectomy is a safe and radical procedure in Graves' disease treatment. Complications of TT are not different than subtotal thyroidectomy if it's performed by expert surgeons.

Total thyroidectomy vs bilateral subtotal thyroidectomy in patients with Graves’ diseases: a meta‐analysis of randomized clinical trials

Conducting total thyroidectomy (TT) or subtotal thyroidectomy (ST) in patients with Graves' disease remains controversial. We performed a meta-analysis based on the published randomized controlled trials to evaluate the complications of TT vs ST. We searched multiple electronic databases for prospective, randomized, controlled trials related to safety and effectiveness of TT vs ST. Relative risk (RR) was estimated with 95% confidence interval (CI) based on an intention-to-treat analysis. We considered the following outcomes: recurrent hyperthyroidism, ophthalmopathy progression, temporary and permanent hypoparathyroidism, temporary and permanent recurrent laryngeal nerve palsy (RLNP) and post-operative bleeding. Four trials with 674 patients (342 with TT, 332 with ST) were analysed. Although the overall rates of ophthalmopathy progression were similar between TT and ST (RR 0·92, 95% CI = 0·50-1·71; P = 0·80), TT was associated with a significant reduction in recurrent hyperthyroidism (RR 0·14, 95% CI = 0·05-0·41; P < 0·01). The pooled RR of post-operative bleeding for TT was similar to that for ST (RR 0·32, 95% CI = 0·05-1·96; P = 0·22). However, comparing with ST, the RR of temporary hypoparathyroidism was significantly higher for TT (RR 2·66, 95% CI = 1·89-3·73; P < 0·01). There was no significant difference in permanent hypoparathyroidism (RR 2·30, 95% CI = 0·78-6·76; P = 0·13), temporary (RR 1·08, 95% CI = 0·47-2·48; P = 0·85) and permanent RLNP (RR 1·54, 95% CI = 0·41-5·73; P = 0·52) between the two groups. With regard to ophthalmopathy progression, post-operative bleeding, permanent hypoparathyroidism, temporary and permanent RLNP, TT is consistent with ST in patients with Graves' disease. However, TT is associated with a reduced incidence of recurrent hyperthyroidism and results in an increase in temporary hypoparathyroidism. Therefore, TT should be proposed for the treatment of Graves' disease.

Late-onset hypoparathyroidism 15 years after thyroidectomy

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

Compare the postoperative complications incidence of benign multi-nodular goiter: A meta-analysis

The aim of our study was to compare the risk of main postoperative complications of patients underwent total thyroidectomy (TT), near total thyroidectomy (NTT) and subtotal thyroidectomy (ST) for treating BMNG. Electronic databases including Cochrane Controlled Trials Register, EMbase, Medline, SCI Expanded-ISI, NTIS, SIGLE and CNKI were searched. Eligible studies were randomized controlled trials which compared the incidence of postoperative complications of TT with ST/NTT for treating BMNG. Data extraction was using predefined data fields and assessment of methodological quality with the GRADE approach. A Mantel-Haenszel random-effects model was used and the effect sizes were expressed by using relative risks and 95% confidence intervals. Four studies including 881 participants that met inclusion criteria were analyzed. Compared with ST/NTT, TT was associated with increased risk of transient RLNI (recurrent laryngeal nerve injuries) (relative risk 2.18, 95% confidence interval 1.08 to 4.42; P 0.05) and permanent hypocalcemia (2.37, 0.35 to 15.97; P > 0.05). The quality of evidence for each individual outcome was ultimately rated as moderate (permanent RLNI and permanent hypocalcemia), low (transient RLNI and transient hypocalcemia). For treating BMNG with thyroidectomy, there were no statistically significant differences in postoperative complications between TT and ST/NTT on a long view.

Vitamin D: Implications for Thyroid Surgery

Thyroid and parathyroid surgeries are performed each year on more than 140,000 adults in the United States. Hypocalcemia is one of the most frequent complications of total thyroidectomy—a procedure used for both benign and malignant pathologies of the thyroid gland. In most situations, disruption of calcium homeostasis is felt to be related to disturbance of the parathyroid glands during exploration. Because the parathyroid glands control the amount of calcium in the blood, postoperative supplementation of oral calcium is routine in these cases. When only one side of the neck is explored, the contralateral parathyroid glands are expected to sustain calcium balance; therefore, routine supplementation has not been the standard. The author and colleagues found unexpected symptomatic hypocalcemia in three patients undergoing unilateral neck exploration of the thyroid gland over a 4-month period. This report addresses how the interprofessional team identified the unexpected problem, examined potential causes and contributing factors, and have changed their approach to care for thyroid and parathyroid surgery patients. One of the initial case examples will be described in detail to illustrate the problem.

Hemostatic Systems in Thyroid Surgery and Complications

IntroductionThere have been significant technological advances for hemostasis in thyroid surgery, that allow more precise and safer vascular sealing than the traditional bond associated with mono- or bipolar electrocoagulation. ObjectiveTo compare the complications in total thyroidectomy using traditional techniques (ligation and electrocoagulation, including LigaSure) compared to the exclusive use of the Ultracision Harmonic scalpel, performing dissection, cutting and hemostasis simultaneously. MethodsRetrospective descriptive non-randomised comparative study with 887 patients who underwent total thyroidectomy by the same surgeon. They were distributed into Group A (traditional techniques in 468 patients, January 1997 to September 2006) and Group B (Harmonic Ultracision in 419 patients, October 2006 to May 2010). ResultsThere was a statistically significant lower incidence of complications in Group B (0.95% versus 4.06% in group A): bleeding (0.24% versus 1.92% in group A), tracheostomy (0% versus 1.28%) and intensive care unit stay (0% versus 4.06%). Improvement of surgical activity parameters was also significant for Group B: shorter operation time (60min versus 180min), fewer hospital stays (4.62 versus 8.5 stays) and increase in operations per month (9.63 versus 4 interventions). Persistent sequelae (recurrent paralysis [0.48%] and hypoparathyroidism [0.47%]) decreased in the second group but the difference was not statistically significant compared to Group A. The cost per patient was lower in Group B. ConclusionsThe Ultracision Harmonic scalpel system is the technique of choice for thyroid surgery.

Sistemas de hemostasia en cirugía tiroidea y complicaciones

Introduction There have been significant technological advances for hemostasis in thyroid surgery, which allow more precise and safer vascular sealing than the traditional bond associated with mono- or bipolar electrocoagulation. Objective To compare the complications in total thyroidectomy using traditional techniques (ligation and electrocoagulation, including LigaSure) compared to the exclusive use of the Ultracision Harmonic scalpel, performing dissection, cutting and hemostasis simultaneously. Methods Retrospective descriptive non-randomized comparative study with 887 patients who underwent total thyroidectomy by the same surgeon. They were distributed into Group A (traditional techniques in 468 patients, January 1997 to September 2006) and Group B (Harmonic Ultracision in 419 patients, October 2006 to May 2010). Results There was a statistically-significant lower incidence of complications in Group B (0.95% versus 4.06% in group A): bleeding (0.24% versus 1.92% in group A), tracheostomy (0% versus 1.28%) and intensive care unit stay (0% versus 4.06%). Improvement of surgical activity parameters was also significant for Group B: shorter operation time (60 minutes versus 180 minutes), fewer hospital stays (4.62 versus 8.5 stays) and increase in operations per month (9.63 versus 4 interventions). Persistent sequelae (recurrent paralysis [0.48%] and hypoparathyroidism [0.47%]) decreased in the second group but the difference was not statistically significant compared to Group A. The cost per patient was lower in Group B Conclusions The Ultracision Harmonic scalpel system is the technique of choice for thyroid surgery.

The Harmonic Scalpel Technique Without Supplementary Ligation in Total Thyroidectomy with Central Neck Dissection

To investigate the safety and efficacy of the no-tie (NT) technique using the harmonic scalpel (HS) in terms of the operating time and complications in total thyroidectomy with central neck dissection (CND). Recently, the HS has been used as an alternative to conventional hand-tied ligation for hemostasis in thyroid surgery, which is a time-consuming procedure. Limited data have been published on the evidence of its safety in total thyroidectomy accompanied by CND without supplementary hand-tied ligation. Sixty-five consecutive thyroidectomized patients were enrolled in this study. The final pathology in all the patients was thyroid papillary carcinoma. All patients underwent total thyroidectomy with CND. The NT technique using HS group consisted of 31 patients. The conventional hand-tied ligation technique group comprised 34 patients. The following variables were examined: operating time, intraoperative bleeding, incidence of perioperative complications (hemorrhage, hematoma, seroma, recurrent laryngeal nerve palsy, hypoparathyroidism, and injury to the adjacent structures including the trachea and esophagus), the number of pathologically proven lymph nodes, total amount of drainage, duration of drain placement, and time of hospital discharge. The use of the HS reduced the operating time of total thyroidectomy with CND by an average of 43.12 minutes (P < 0.001). The number of pathologically proven lymph nodes was 7.32 +/- 1.66 in the NT group and 6.85 +/- 1.76 in the CT group (P = 0.274). No significant difference was observed in the overall perioperative complications, such as postoperative bleeding, temporary recurrent laryngeal nerve palsy, and temporary hypoparathyroidism, between the 2 groups. No permanent recurrent laryngeal nerve palsy and hypoparathyroidism occurred in either group. The NT technique with the HS is a relatively safe and effective method in total thyroidectomy combined with CND. Moreover, the HS significantly reduced the operating time.

Comparison of complications of total thyroidectomy in malignant vs. benign thyroid tumors

17012 Background: Total thyroidectomy (TT) is the procedure of choice for many benign and malignant thyroid diseases. There is still controversy regarding the use of total vs. sub TT for benign dis...

Serum intact parathyroid hormone as a predictor of hypocalcaemia after total thyroidectomy

Hypocalcaemia from hypoparathyroidism is a complication of total thyroidectomy. The aim of the present study was to determine whether an early postoperative level of serum parathyroid hormone (PTH) after total thyroidectomy predicts the development of significant hypocalcaemia and the need for treatment. Patients undergoing total thyroidectomy had their serum level of intact PTH checked 1 h after removal of the thyroid gland. Serum calcium level was checked on the following morning. Oral calcium and/or calcitriol was commenced if the patient developed hypocalcaemic symptoms, or if the corrected serum calcium level was <2.0 mmol/L. Seventy-nine patients were included in the present study. Thirteen patients had symptoms of hypocalcaemia on postoperative days 1 or 2 and 66 patients remained asymptomatic. The postoperative intact PTH, day 1 calcium and day 2 calcium was 0.32 +/- 0.60 pmol/L, 2.01 +/- 0.11 mmol/L, and 2.02 +/- 0.16 mmol/L, respectively, for the symptomatic group and 1.98 +/- 1.25, 2.21 +/- 0.13, and 2.19 +/- 0.14, respectively, for the asymptomatic group. Calcium support was given to 25 patients, of whom 14 also required calcitriol. Serum PTH 1-h after total thyroidectomy is a reliable predictor of hypocalcaemia and can allow safe early discharge of patients from hospital.

Tireoidectomia total para bócio multinodular

INTRODUÇÃO: Preservar tecido tireóideo em cirurgias para bócio multinodular (BM) não evita a complementação hormonal e pode gerar recidiva. A reoperação aumenta em até 20 vezes o risco de complicações. Propomos no BM, a tireoidectomia total (TT) como tratamento definitivo quando existe acometimento bilateral do parênquima posterior à veia tireóidea média. OBJETIVO: Avaliar e justificar a utilização da TT em portadores de BM. MATERIAL E MÉTODO: Estudo retrospectivo de 1.789 pacientes submetidos a tireoidectomias de 06/90 a 12/00. A indicação cirúrgica foi avaliada conforme a apresentação clínica, a extensão da tireoidectomia, a incidência de câncer e as complicações. RESULTADOS: A TT foi realizada em 81,2% de 872 portadores de BM atóxicos, 93,9% de 33 BM tóxicos e 93,9% de 66 bócios recidivados. Houve hipoparatireoidismo transitório ou definitivo, hematoma e lesões transitórias ou definitivas do nervo recorrente em respectivamente 11,5%, 0,5%, 0,4%, 2,7% e 0,2% dos pacientes com BM atóxicos, e 8,3%, 8,3%, zero, 5,0% e 5,0% dos com B recidivados. Complicações definitivas da TT para BM atóxico foram semelhantes à tireoidectomia não total, porém inferiores da TT para B recidivado. Ocorreu aumento da indicação da TT para BM atóxico, com a utilização da veia tireóidea média como referência anatômica, de 53,3% inicialmente para 93,6% atualmente, com elevação do diagnóstico de câncer de 11,1% para 19,8%. CONCLUSÃO: TT é o tratamento de escolha para o BM, quando acomete extensamente a glândula, isto é, posteriormente às veias tireóideas médias; com baixo índice de complicações definitivas.

Influence of the Refinement of Surgical Technique and Surgeon’s Experience on the Rate of Complications after Total Thyroidectomy for Benign Thyroid Disease

Background: In recent years, many surgeons dealing with endocrine surgery have increasingly performed total thyroidectomy for benign thyroid disease. However, total excision of the thyroid in the treatment of benign lesions has been surrounded by even more controversy than its role in cancer treatment. The complication rate appears to be higher when the operation is done by inexperienced surgeons who have no special skills in endocrine surgery using proper techniques. The aim of this study is to determine whether surgeons experience and the refinement of surgical techniques are associated with postoperative recurrent laryngeal nerve (RLN) palsy or hypocalcemia after total thyroidectomy for benign thyroid disease.Methods: A total of 68 consecutive patients who underwent total thyroidectomy for benign thyroid disease were reviewed. Twenty-six of these were from between January 1998 and June 1999 (first period) and 42 from between June 1999 and September 2000 (second period). Patients were divided into two subgroups according to different periods and different surgical techniques to identify the RLNs and the parathyroid glands. RLNs function was evaluated pre-and post-operatively by an otolaryngologist, and serum calcium levels were measured at the postoperative follow-up. Results: During the first period of the study, transient hypocalcaemia was determined in 8 (31%) patients. Hypocalcaemia was clinically symptomatic in 5 (19%) patients. Transient RLN palsy developed in 4 (15%) patients. Unilateral permanent RLN palsy due to operative injury was observed in 1 (4%) patient. During the second period, we noted transient hypocalcemia in 11 (26%) patients and symptomatic hypocalcemia in 6 (4%) patients. Serum calcium levels returned to normal within 4 weeks after operation in all patients. Neither transient nor permanent RLN palsy was observed during this period.Conclusions: Complications of total thyroidectomy can be minimized with increasing experience and the refinement of surgical technique.

Place of total thyroidectomy in rhinolaryngologists' surgical treatment of thyroid disease.

Total thyroidectomy is more frequently performed and is becoming more widely accepted as the treatment of choice for more surgical diseases of the thyroid gland. Improvement in anesthesia, presurgical and post-operative care, as well as more meticulous surgical technique, have decreased the complications associated with this operation. As is demonstrated, morbidity and complications of total thyroidectomy are no more frequent nor severe than when subtotal thyroidectomy is performed. This allows boadening of the indications for total thyroidectomy to include more cases which will be better controlled, but for which total thyroidectomy had been withheld because of the fear of increased morbidity.