Days Of Thyroidectomy Research Articles

Preoperative Serum Albumin as Predictor of Outcomes After Thyroidectomy.

Albumin is considered to be a surrogate marker for inflammation and nutritional status. Levels usually decrease after surgery but little is known about the predictive value of preoperative albumin levels in patients undergoing thyroidectomy. This study aimed to investigate the 30-day incidence of postoperative outcomes in thyroidectomy patients with and without preoperative hypoalbuminemia. Retrospective cohort study. TriNetX Database. TriNetX, a federated deidentified database, was retrospectively queried to identify patients who underwent thyroidectomy. Postoperative outcomes within 30 days of thyroidectomy, based on International Classification of Disease, 10th Revision and Current Procedural Terminology codes, in patients with preoperative hypoalbuminemia (≤3.4 g/dL) (cohort 1) were analyzed and compared to patients without hypoalbuminemia (cohort 2). After propensity score matching, 2398 patients were identified in each cohort. Hypoalbuminemia patients were more likely to have postoperative pneumonia (odds ratio, OR: 3.472, 95% confidence interval, CI [2.016-5.978]), acute renal failure (OR: 3.872, 95% CI [2.412-6.217]), venous thromboembolism (OR: 1.766, 95% CI[1.016-2.819]), and surgical site infection (OR: 2.353, 95% CI [1.282-4.32]). Rates of recurrent laryngeal nerve injury were comparable between cohorts. Patients undergoing thyroidectomy with preoperative hypoalbuminemia have a higher prevalence of postoperative complications compared to patients without preoperative hypoalbuminemia. While not routinely assessed, preoperative evaluation of serum albumin levels may help guide expectations and optimal management of thyroidectomy patients.

Causes of Emergency Department Visits Following Thyroid and Parathyroid Surgery

With reimbursement being increasingly tied to outcome measures, minimizing unexpected health care needs in the postoperative period is essential. This article describes reasons for emergency department (ED) evaluation, rates of readmission to the hospital, and significant risk factors for readmission during the postoperative period. To describe the subset of patients requiring ED evaluation within 30 days of thyroidectomy or parathyroidectomy and their associated risk factors. Retrospective chart review in a tertiary care center of adult patients who underwent thyroidectomy or parathyroidectomy between January 1, 2009 and October 7, 2010. Patients were identified from an institutional review board-approved database. Postoperative patients who visited the emergency department (ED) within the first 30 days following surgery were selected and compared with the postoperative patients who did not visit the ED. Thyroidectomy or parathyroidectomy. Statistical analysis evaluated the association of demographic and clinical characteristics between the patients who required ER evaluation and those who did not. Clinical characteristics evaluated included type of surgery, medical comorbidities, and proton pump inhibitor (PPI) usage. Multiple logistic regression predicted the odds of an ED visit based on presence of diabetes, gastroesophageal reflux disease (GERD), or PPI use. Of the 570 patients identified, 64 patients required a visit to the ER a total of 75 times for issues including paresthesias (n = 28), wound complications (n = 8), and weakness (n = 6). Fifteen hospital admissions occurred for treatment of a variety of postoperative complications. A significant association was found between the presence of diabetes (P = .03), GERD (P = .04), and the current use of PPIs (P = .03). When controlling for diabetes and GERD, we found that patients taking PPIs were 1.81 times more likely to visit the ED than patients not taking PPIs (P = .04). Patients taking PPIs are 1.81 times more likely to require ED evaluation than those who are not taking PPIs.

The Early Days of Thyroidectomy

Although the normal thyroid gland is invisible and impalpable, its enlargement gives such an obvious swelling in the front of the neck that this pathology has been observed from ancient times. Old names for the swollen gland included 'bronchocele', which means a cystic mass in the neck, 'struma', (Latin for a swollen gland) and 'goitre', which comes from the Latin word 'gutta', the throat, and which is a term which is still used today. The term 'thyroid' was introduced by the 17th century anatomist Thomas Wharton, of London, and is derived from the Greek word thyreos, a shield, based on its shield-like appearance wrapped over the front of the trachea. He believed that its function was to give women a beautifully rounded neck!

Total thyroidectomy in the treatment of thyroid cancer

Considerable controversy exists about the most appropriate treatment for thyroid cancer. In this report the authors present their experience of 189 patients, all of whom had a total thyroidectomy between June 1980 and December 1993. The age of the patients ranged from 11 to 78 years (mean age: 42 years), there were 144 women and 45 men. Histological types were: 146 papillary, 16 medullary, 10 follicular, eight Hurtle, six insular and three undifferentiated. Coexistent lesions included: 22 thyroiditis, 17 adenomas, one Graves' disease and 22 benign goitre. Fifty-six (29.6%) patients had multifocal papillary cancer (bilateral in 45 cases). Surgical complications included 20 cases of transient recurrent laryngeal nerve palsy, 16 cases of transient and one of permanent hypoparathyroidism, and one respiratory obstruction due to bilateral recurrent laryngeal nerve palsy that required temporary tracheostomy. Two patients were reoperated on due to bleeding. Ninety per cent of patients were discharged within 3 days of thyroidectomy. One hundred and fifty patients were evaluated for 131I treatment by a standardized dosimetry procedure 4 weeks after surgery. Dosimetry was also used to calculate therapeutic 131I doses. Seventy-six patients did not show a 131I uptake above background levels, 56 underwent therapeutic 131I, while in the 18 patients who showed an abnormal uptake of 131I it was decided not to give the therapeutic dose. The authors conclude that total thyroidectomy can be performed with a minimum of permanent disability in patients with malignant thyroid tumours. The theoretical and practical advantages of this kind of surgical strategy make it the treatment of choice for thyroid cancer.

Total thyroidectomy: the treatment of choice for patients with differentiated thyroid cancer.

There is considerable controversy about the most appropriate treatment of patients with thyroid cancer. This report concerns the author's experience with 82 consecutive patients having total thyroidectomy from January 1977 through December 1981. The age of the patients ranged from 21 to 86 years (mean age 44 years). There were 44 women and 38 men. Twenty-four patients (29%) had had previous thyroid operations; ten patients (11%) had coexistent parathyroid adenomas removed; and seven patients (8.5%) had modified radical neck dissections. Thirty-four patients (41%) had a history of radiation to the head and neck, and 12 (35%) of the 34 irradiated patients and 51 (63%) of the entire group of 82 patients had thyroid cancer (45 papillary, five follicular, one medullary). Coexistent lesions in the patients with papillary cancer included Hashimoto's thyroiditis, five patients; parathyroid adenomas, four patients; Graves' disease, one patient; Hurthle cell neoplasm, one patient; and amyloid struma, one patient. If less than total thyroidectomy had been performed, 26 (51%) of the 51 patients with thyroid cancer would have had cancer left in the residual thyroid lobe, and focal cancers in the lobe opposite to the one containing the nodule for which the operation was performed would have been missed in five patients (10%). Five of the 20 patients with unilateral cancer had follicular cancer. Complications included one case of permanent hypoparathyroidism and two cases of transient bilateral recurrent laryngeal nerve palsy. Ninety-six per cent of the patients were discharged within four days of thyroidectomy, 94% by three days, and 79% by two days. Uptake of radioactive iodine was not above background levels in nine (26%) of the 35 patients studied after operation and was less than 1% in the remainder. These data suggest that total thyroidectomy is the treatment of choice for patients with thyroid cancer because residual cancer would persist in the remaining thyroid tissue in at least 61% of patients if only lobectomy had been performed. Total thyroidectomy can be done with minimal permanent disability in patients with benign and malignant thyroid tumors, in patients who have had previous thyroid operations, and in patients with coexistent hyperparathyroidism.

Changes of pyruvate dehydrogenase in rat brain with thyroid hormones.

Thyroid hormone deficiency increased the activity of PDHa (active) in three regions of the rat brain with insignificant changes in the total form; a regional variation was also observed. Treatment of thyroidectomized rats with triiodothyronine restored the enzyme activity to almost control values after 60 days of thyroidectomy in all the three regions. Administration of T3 to control animals decreased the PDHa by 70% without affecting the total form. Results are discussed in relation with insulin sensitivity of various tissues.

POST-THYROIDECTOMY HYPOCALCÆMIA: A FEATURE OF THE OPERATION OR THE THYROID DISORDER?

It has been suggested that post-thyroidectomy hypocalcæmia is related to the presence of a thyrotoxic osteodystrophy for which a high serum concentration of bone alkaline phosphatase is a marker. Changes in serum-calcium (corrected to a standard albumin concentration of 40 g/l), alkaline phosphatase (A.P.), inorganic phosphate, and albumin were studied prospectively in 54 euthyroid patients with drug-treated Graves' disease, and in 17 controls with simple non-toxic goitre, before and serially after partial thyroidectomy. All data were paired and results indicate that the pattern of biochemical change was the same in both types of patient and that the degree of change was not related to the serum-A.P. concentration in the Graves'- disease patients. Of the patients studied within the first 24 h of operation, 5 out of 12 with Graves' disease and raised serum-A.P. (group I), 9 of 20 with Graves' disease and normal serum-A.P. (group II), and 7 of 15 controls (group III) showed a fall in serum-calcium below the lower limit of the reference range. In all three groups there was a highly significant fall in serum-calcium 24 h after operation but there was no significant difference in serum-calcium between the groups either immediately before or 24 h after operation. Serum-calcium returned to pre-surgical concentrations within 7 days of thyroidectomy and serum-A.P. concentrations by 4 to 6 weeks in all groups. There was no evidence that post-thyroidectomy hypocalcæmia is related to thyrotoxic osteodystrophy and the pattern of the biochemical changes was thought to be consistent with release of thyrocalcitonin at operation.

Thyrotrophs of the rat anterior pituitary after different periods of thyroidectomy. A conventional and histochemical electron microscope study

Thyrotrophs (TSH cells) from the anterior pituitary gland of control and 14 and 60 days old neonatally thyroidectomized rats were studied with conventional electron microscopy and with the silver methenamine histochemical technique for the detection of glycoproteins. After 14 days of thyroidectomy the cisternae of the rough endoplasmic reticulum (RER) appeared distended and filled with a granulofilamentous material. After 60 days of thyroid supression “intracisternal granules” appeared together with the filamentous material. After the silver-methenamine technique thyrotrophs from control animals were easily identified from gonadotrophs by the reactivity of the mature secretory granules stored in both cell types. Golgi complexes also gave a positive reaction in normal thyrotrophs. After 14 days of thyroid supression no reaction was detected at the level of the intracisternal granulofilamentous material of the RER, whereas after 60 days all the intracisternal granules and the granulofilamentous material of some cisternae gave a positive reaction. These observations suggest that in normal as well as in short-term stimulated thyrotrophs carbohydrates become attached to proteins at the level of the Golgi complexes, as opposed to long-term stimulated cells, in which such process seems to occur at the RER level.

Diurnal variation of plasma calcium and calcitonin function in the rat.

1. These experiments were designed to investigate the normal physiological role of calcitonin in the control of blood calcium.2. The rat can be adapted to an artificial cycle of alternating 12-hr periods of light and darkness. Since rats eat only in the dark, calcium absorption is confined to the dark period.3. In rats thus adapted, the plasma calcium and phosphate levels show cyclic variation related, among other factors, to the calcium intake.4. The variation observed is modified by the removal of the thyroid gland. This cannot be attributed to deprivation of thyroxine and triiodothyronine because these experiments were carried out within 2 days of thyroidectomy.5. Thyroidectomy raises the plasma calcium and phosphate levels, but only if performed during the dark-fed period. This suggests the existence of a diurnal rhythm in endogenous calcitonin function.6. The magnitude of the falls in plasma calcium and phosphate, produced by exogenous calcitonin, also varies with the time of day. This shows that the rat's responsiveness to calcitonin also varies diurnally.

MECHANISM OF HYPOCALCÆMIA AFTER THYROIDECTOMY FOR THYROTOXICOSIS

The widely accepted hypothesis that parathyroid damage is sufficient to explain the hypocaicæmia which may follow thyroidectomy for thyrotoxicosis cannot be supported. Postoperative hypocalcæmia is related to the age of the patient, the size of the thyroid remnant, and previous thyroid overactivity. Evidence is presented from patients with known parathyroid damage that the postoperative hypocalcæmia in thyrotoxic patients cannot be explained solely on the basis of surgical interference with the parathyroids. A detailed postoperative balance study in a young thyrotoxic man showed avid calcium retention in the first month after operation. A prospective study of thyrotoxic patients showed evidence of bone disease in the majority. The serum-alkaline-phosphatase may be regarded as an index of thyrotoxic osteodystrophy, and it is suggested that when serum-alkaline-phosphatase levels are raised, calcium supplements might be considered as part of the preoperative preparation of the thyrotoxic patient. No evidence to support the possible role of calcitonin as a factor in producing hypocalcæmia after thyroidectomy for thyrotoxicosis has been found. It is considered that the term " hypoparathyroidism " is misleading when used for hypocalcæmia developing within one or two days of thyroidectomy in thyrotoxic patients.

Identification of the thyrotrophs with the gonadotrophs in the anterior pituitaries of thyroidectomized rats.

Along with histological examination of the anterior lobes of the pituitary of the thyroidectomized male rats at time intervals ranging from 10 to 300days, the count of all kinds of adenohypophyseal cells was made in serial sections. The gonadotrophs disappeared while the thyroidectomy cells (TX-cells) became numerous 10days after thyroidectomy. They were enlarged polygonal in shape, and positive to PAS, but not diffusely stained with Paget and Ecclestons' stain (1960). There was evidence to show that the TX-cells were not the modified cells of the typical thyrotrophs, but that derived from large chromophobes. The TX-cells were thereafter degenerated, and decreased in number from the 30th day of thyroidectomy, showing features of dark gonadotrophs of the Golgi-ring type. Some of the, TX-cells began to accumulate colloid substance in their cytoplasm and finally turned into the signet-ring-shaped castration cells which were destined to be destroyed within 300 days. The “immature gonadotrophs” rich in dense granules positive to PAS were additionally transformed from the large chromophobes and rapidly piled up in 120 300 days after thyroidectomy. Prostate weight and cell-height of the epithelia of seminal vesicles were criteria to gonadotrophin concentration in the chronic phase. These data were compatible with the quantitative increase of gonadotrophs after 30 days of thyroidectomy. According to our observation, the TX-cells, transformed into gonadotrophs in chronic phases, suggested that thyrotrophs and gonadotrophs were essentially of the cells of the same kind.

Effect of thyroidectomy and low environmental temperature (4.4 degrees C) upon plasma and pituitary thyrotrophin in the rat.

ABSTRACT The content of thyrotrophin (TSH) in rat plasma and hypophyses was determined by means of the haemagglutination inhibition reaction. Mature female rats maintained at 26° C had a plasma TSH level of 0.94 mU/ml and a mean pituitary TSH level of 68.26 mU/mg. After 10 days of thyroidectomy the plasma TSH increased to 2.15 mU/ml, and to 2.81 mU/ml after 20 days. The TSH/mg of the pituitary glands was reduced to 40.4 mU after 10 days and to 35.0 mU after 20 days. After 25 days of thyroidectomy, L-Thyroxine (L-T4) at level of 2.5 μg/100 g body weight was injected for 1, 3 and 5 days. The plasma TSH level was reduced to 1.59, to 1.48 and 1.06 mU/ml, respectively. The pituitary TSH/mg was 37.5, 38.6 and 77.9 mU, respectively. When rats held at 26° C were exposed to a temperature at 4.4° C for 10 and 20 days, the plasma TSH increased to 2.15 and 2.69 mU/ml, respectively. The pituitary TSH increased to 108.04 and to 240.9 mU/mg, respectively. The combined effect of thyroidectomy and 4.4° C for 10 and 20 days, caused the plasma TSH to increase to 4.37 mU/ml after 10 days then decline to 2.4 mU/ml after 20 days. The pituitary TSH declined to 43.79 and 37.58 mU/mg, respectively. When thyroidectomized rats held at 4.4° C for 20 days were returned to 26° C for 4 days, the plasma level declined to 1.44 mU/ml and the pituitary remained low, 34.90 mU/mg.