Post-thyroidectomy Complications Research Articles

Trainee participation does not adversely affect the safety of thyroid surgery: Systematic review and meta‐analysis

Surgical traineeship is essential but must be safe for patients. In thyroid surgery, surgeon volume correlates with improved clinical/economic outcomes. However, it is presently unclear how far does trainee participation affect post-thyroidectomy complication rates in real-world and randomized data. We systematically searched four databases for associations of trainee participation with any post-thyroidectomy outcome. We conducted univariate meta-analyses, sensitivity analyses, and assessed publication bias qualitatively and quantitatively. We included 1 randomized and 15 observational studies from 3755 records, comprising 34 774 thyroid surgical patients. Trainee participation was associated with 12 min longer operative time, but not higher complication rates (hypoparathyroidism, recurrent laryngeal nerve palsy, hematoma, blood loss, return to operating room, hospitalization duration, readmission, and mortality). Sensitivity, publication bias, and multivariate analyses did not change our findings. Real-world and limited randomized data suggest that trainee participation in thyroid surgery is safe, given adequate consultant supervision and appropriate case selection.

Frequency of Hypocalcaemia following total Thyroidectomy

Background: The most common post-thyroidectomy complication is hypocalcaemia. It could be permanent or transitory. Permanent hypocalcaemia has a prevalence of 0-13% and transient hypocalcaemia has a prevalence of 1-6%. Aim: The study objective was to ascertain the prevalence of postoperative hypocalcaemia in patients following total thyroidectomy. Materials and Methods: This cross-sectional study was carried out on 84 thyroid patients who underwent total thyroidectomy in the surgical department of HBS General Hospital, Islamabad for period of nine months during from September 2020 to May 2021. Patients within the age range of 15-69 years and had indicated thyroidectomy caused by carcinoma thyroid, multinodular goiter, and recurrent goiter were enrolled. Inform consent was obtained from each participant. Ethical approval was taken from the institutional ethical committee. Thyroid profile and serum calcium were done for a routine investigation. Serum calcium levels were measured 24 hours, 48 hours, and 7 days after total thyroidectomy. Signs and symptoms in hypocalcaemia patients were recorded on a proforma. Patients with hypocalcaemia were followed for six months. SPSS version 20 was used for data analysis. Results: The mean age of the patients was 46.7 ± 4.6 years with an age range of 16 to 69 years. Of the total 84 patients, 38 (45.2%) underwent total thyroidectomy and 46 (54.8%) underwent a complete thyroidectomy. The prevalence of male and female patients was 22 (26.2%) and 62 (73.8%) respectively. Malignant and benign were present in 71 (84.5%) and 13 (15.5%) respectively. Of the total 84 patients, 68 (81%) developed hypocalcaemia. Out of 68 hypocalcaemia patients, 29 (42.6%) and 39 (57.4%) were from the benign and malignant groups respectively. Conclusion: Postoperatively hypocalcaemia was prevalent following thyroidectomy. Malignant patients (84.5%) were more prevalent compared to benign patients (15.5%) after total thyroidectomy. Careful surgical procedures, parathyroid gland vascularity preservation, and identification are critical in preventing hypocalcaemia following total thyroidectomy. Keywords: Hypocalcaemia; Total thyroidectomy; Complete Thyroidectomy

Recurrent and superior laryngeal nerve injury in thyroid surgery: literature review

Laryngeal nerve injury is considered one of the most common complications after thyroidectomy. It is associated with decreased quality of life because it will result in hoarseness of voice and aspiration. Identification of the risk factors and procedures to decrease the injury is crucial for handling laryngeal nerve injury. We searched the MEDLINE database using PubMed. Two independent reviewers reviewed the resulting papers and reviewed them based on our inclusion criteria. Based on the review results, the incidence of recurrent laryngeal nerve injury is higher than the external branch of the superior laryngeal nerve, but it is mainly due to under-reporting of the external branch of superior laryngeal nerve injury. Cancer surgery, surgeon experience, workload, re-operative procedures, and extent of surgery increased the incidence of the laryngeal nerve injury. Handling of these risk factors combined with visual dissection and inspection and/or intraoperative nerve monitoring decreased the incidence of the nerve injury. In conclusion, laryngeal nerve injury is a common post thyroidectomy complication. Anatomical dissection and visual inspection combined with intraoperative nerve monitoring is the most suitable option in high-risk thyroid surgeries.

Audit of Neurological Complications After Thyroid Surgery

The incidence of permanent neurological complications after thyroid surgery is less than 2% and rarely life threatening. Most of the reported neurological complications are related to changes in voice or breathing difficulty. Symptoms of a foreign body sensation in the throat are an unpleasant and persistent complication, which has rarely been reported after thyroid surgery. Analysis of records of 170 patients undergoing various types of thyroid operations over a 6-year period was done. Postoperative complications with emphasis on the neurological complications were documented. The common post-thyroidectomy neurological complications noted were hoarseness of voice (6 patients), loss of voice pitch (7), breathy voice (8), respiratory stridor (2), and dysphagia to liquids (8). Most of these were transient and recovered spontaneously within weeks. Furthermore, we report a foreign body/sticky sensation in the throat as an atypical neurological complication. It was found to occur in 5 patients and significantly persisted in 3 patients at a 6-month follow-up after surgery. The postoperative symptoms commonly noticed after thyroid surgery were related to the motor innervation component of the external branch of the superior laryngeal or the recurrent laryngeal nerve. These symptoms underwent spontaneous resolution over a few weeks period after surgery in most of the patients. Additionally, we documented a foreign body sensation in the throat in 5 patients which is possibly a sequela of sensory denervation of the supra-glottic mucosa in the region supplied by the internal branch of the superior laryngeal nerve. Unlike motor symptoms, this foreign body sensation persisted in 3 out of 5 patients (60%) at 6 months of follow-up.

Comparison of thyroid surgery experiences of "East" and "West" regions in Turkiye.

OBJECTIVEThis study aimed to evaluate the differences between the types of thyroidectomy surgeries and surgical treatment approaches according to thyroid pathology results, in Turkiye’s two non-endemic regions.METHODSTwo different centers of the country, which differ in many respects and are non-endemic for thyroidal diseases were included in the study. Data on patients from both sexes, who underwent thyroidectomy in the western (1st center) and the eastern (2nd center) regions between 2011 and 2017 have been reviewed.RESULTSTwo hundred and forty patients from Istanbul (1st center) and 992 patients from Van (2nd center); a total of 1232 patients were included in the study. According to the pre-operative ultrasonography and laboratory results, toxic nodular goiter and multinodular goiter were the most common diseases in the first and second centers, respectively. There was a significant statistical difference between the radiological diagnostic findings between the two centers (p<0.001). The rate of bilateral total thyroidectomy in the first center was 82.5% (198 patients), whereas this rate was 58.5% (555 patients) in the second center. The type of surgery may change from center to center, (p<0.001). The most common early post-thyroidectomy complication was hypocalcemia in both centers.CONCLUSIONThe results from only two centers from the western and eastern Turkiye show that there is a difference between the thyroidectomy preferences. Future similar national studies will contribute to the provision of a consensus in surgical treatment of thyroid diseases.

Evaluation of Post-Thyroidectomy Complications in Autoimmune Thyroid Diseases versus Nodular Thyroid Diseases

Abstract Background: Thyroid surgery had been and was the most common endocrine surgical operations. An accurately per-formed operation on thyroid gland requires both experience and technical ability and is considered by many to be at the zenith of endocrine surgery. When thyroid operations are performed without sufficient interest, training, or experience the incidence of preventable complication is high. The mortality rate of thyroidectomy as reported in several large series approaches zero. The morbidity of thyroidectomy, however continues to be a matter of concern. Recent research suggests that surgeons may differ in their ability to perform this refined surgery with sufficient care. Aim of Study: The aim was to to evaluate of post-thyroidectomy complications in autoimmune thyroid diseases versus nodular thyroid diseases. Patients and Methods: The study was a prospective randomized study which was done over 100 patients suffering from thyroid disease into two groups, group (I) 50 patients presented with autoimmune thyroid diseases, group (II) 50 patients presented with nodular thyroid diseases. The patients was subjected to total thyroidectomy under general anesthesia which was performed in General Surgery Department of Faculty of Medicine, Menofia University in the period from April 2019 to May 2020. Operative time was reported from start of skin incision till closure of the wound. The two groups were followed-up for one month post-operative which is the end point of the study. Results: In cases of group (I); during operations there was difficulty dissection in 30 cases (30/50, 60%), excessive bleeding in 35 cases (35/50, 70%), nerve damage in 5 cases (5/50, 10%), tracheal damage in one case (1/50, 2%). While in group (II) difficulty dissection in 5 cases (5/50, 10%), excessive bleeding in 2 cases (2/50, 4%), nerve damage only in one case (1/50, 2%). And statistical analysis revealed the predominance of operative difficulties and complications in group (I) than in group (II) (p=0.01).In group (I), two cases needed to be reopened for hemos-tasis and bleeding control due to excessive bleeding (2/50, 4%) and two cases need the insertion of tracheostomy tube for either nerve damage or tracheal damage (2/50, 4%). While in group (II) only one case needed insertion of tracheostomy tube due to tracheomalacia with huge swelling (1/50, 2%). And the statistical analysis revealed a significant increase in early post-operative complications than in group (A) than in group (A) (p=0.024). Conclusion: From our study we can concluded that surgery in autoimmune thyroid swelling is more dangerous than in multinodular goiter this is because excessive fibrosis that leads to excessive and vigorous dissection that leads to bleeding and mare traumatic complications.

Post-Thyroidectomy Complications and Risk Factors in Tabuk, Saudi Arabia: A Retrospective Cohort Study.

BackgroundThyroid surgery is one of the most commonly performed procedures internationally. There were no studies conducted in Tabuk, Saudi Arabia, on post-thyroidectomy complications and their risk factors.ObjectiveThe aim of this study was to assess post-thyroidectomy complications and determine the risk factors of such complications.MethodsThis retrospective study included all cases that underwent thyroidectomy at King Salman Armed Forces Hospital, Tabuk, Saudi Arabia, from January 2012 to December 2017. Patients with preoperative hypoparathyroidism, chronic kidney disease, or history of dysphonia were excluded. Data were collected from medical records.ResultsThe study showed 182 patients who underwent thyroidectomy operation between January 2012 and December 2017. Temporary hypocalcemia was developed in 116 patients (63.7%) while it persisted in three (1.6%). Change of voice was reported in five patients (2.7%) while two (1.1%) lost a high-pitched voice. Seroma, hematoma, and tracheal injury were documented in 1.6%, 1.1%, and 0.5%, respectively. Multivariate analysis showed that total thyroidectomy was the most significant (four times) risk factor for the development of hypocalcemia as compared to other surgical procedures.ConclusionHypocalcemia was the most frequent post-thyroidectomy complication, whereas voice changes, seroma, hematoma, and tracheal injury are rare complications. Additionally, total thyroidectomy has the highest risk of postoperative hypocalcemia.

Treatment outcome of thyroidectomies performed under local anesthesia for nodular goiter patients attending at Banadir Hospital in Mogadishu Somalia

Background: Thyroidectomy; which involves the removal of total or part of the thyroid glandis a routinely performed surgery that may have perioperative risks and complications which can be life-threatening. Objective: Main objective of this study is to determine the incidence of postthyroidectomy complications at Banadir Hospital, and to put forward the clinical benefits of those which had been performed under local anesthesia.Materials and Methods: Present study; which is prospective in nature, was conducted on 25 patients between 18 and 70 years of age who were scheduled to undergo elective thyroidectomy beginning from May to July, 2017. Blood samples for calcium, albumin, thyroid hormone levels were collected pre-operatively; within 48 hours and 5 days post-operatively. Relevant data had been achieved from the medical achieve of the department.Results: Patients between 20 and 40 years of age occupied the highest percentage of population in the study. Two (8%) patients had records of previous thyroid surgery. Ultrasonographic (USG) evaluations revealed benign thyroid nodule for 23 (92%) patients, as 2 (8%) other patients were confirmed as malignancy on their fine needle aspiration cytology (FNAC) which had suspicious findings on ultrasonographic (USG) evaluations. 21 (84%) patients had pain as the chief complaint. 19(76%) patient operations had been performed under local anesthesia, while 6(24%) patients had undergone operations undergeneral anesthesia. Total thyroidectomy was performed for 10 (40%) patients, whereas the rest (n=15 (60%) were performed with subtotal, near total and partial (lobectomy, nodulectomy) resections. No permanent hypocalcemia was recorded during the postoperative period, though 2 (8%) patients had transient hoarseness due to laryngeal nerve injury and another 2 (8%) patients had findings of surgical site infections.Conclusion: Thyroidectomy procedure could end up with undesired outcomes like nerve paralysis or hypocalcemia even at most experienced hands. Considering that, definite and precise operation should be performed at once to prevent re-operations that could increase the rate of morbidity.International Journal of Human and Health Sciences Vol. 04 No. 03 July’20 Page : 222-225

Study of complications following various thyroidectomy procedures: a tertiary care centre experience in South India

Introduction: Thyroid surgeries comprise one of the more commonly performed procedures by a general surgeon. Today most of the complications of thyroid surgery are related to either metabolic derangements or injury to the recurrent laryngeal nerve injury. Other complications include superior laryngeal nerve injury, infection, airway compromise, and bleeding. At present, mortality for this procedure approaches 0% and overall complication rate is less than 3%. Nonetheless, major complications of thyroidectomy (i.e. compressive hematoma, recurrent laryngeal nerve palsy and hypoparathyroidism) are still fearful complications and account for a significant percentage of medico-legal claims. Patients volume and surgical skill play an important role in reducing the risk of complications. Knowledge about the clinical profiles of thryoidectomy cases and understanding the post thyroidectomy complications are an important milestone in public health. Aims & Objectives: This study intends to identify the incidence of the complications following various thyroidectomy surgeries performed at JSS Hospital, Mysuru and the effect of timely and prompt recognition and intervention in minimizing morbidity. Methodology: This clinical study was conducted between October 2017 and September 2019 and included 70 consecutive patients undergoing various thyroidectomy procedures, at JSS Hospital, Mysuru. All cases were followed up for a period of 6 months. Results: In our prospective observational study 70 cases of patients with thyroid swellings underwent various thyroidectomy procedures. The incidence of thyroid diseases is more common in females than in males.The peak age group in which patients presented to the hospital was in the 4thdecade .The most common histopathological diagnosis was Nodular Colloid Goitre.The most common surgery performed in was Total thyroidectomy in 45 cases out of 70. Transient hypocalcemia was the most common post- operative complication occurring in about 13 out of 70 cases.

Differences in Post-Thyroidectomy Complications in Use of Vessel Sealant Devices Compared to Traditional Methods

Kong, Karen; Hwang, Richard Y. MD; Rolandelli, Rolando H. MD, FACS; Nemeth, Zoltan H. MD, PhD Author Information

Thyroidectomy: post-operative complications and management

Background: Thyroidectomy is a surgical procedure indicated as elective treatment for symptomatic thyroid swellings or neoplasms. Today most of the complications of thyroid surgery are related to either metabolic derangements or injury to the recurrent laryngeal nerve injury. Other complications include superior laryngeal nerve injury, infection, airway compromise, and bleeding. Hence, before any thyroid surgery patient must be precisely informed the possible complications and their remedies. The present study aims to evaluate post-operative complications after thyroid surgery.Methods: In a tertiary care hospital based longitudinal study patients presenting with clinically and sonographically diagnosed thyroid swelling who underwent surgical intervention were enrolled in the study. These patients were evaluated for thyroid profile test, fine needle aspiration cytology (FNAC), pre-operative and post-operative indirect laryngoscopy, serum calcium level and histopathology. Intra operative and post-operative assessment was done for bleeding, hematoma, and surgical site infection.Results: A total of 53 patients were enrolled. Thyroid swelling was more common in females (F: M =5.6:1) mostly presenting in 3rd and 4th decades with mean age of 38.1 years. Hemithyroidectomy was the most common procedure performed (63.6%) followed by total (27.3%) and near total thyroidectomies (5.5%). On histopathological examination most common finding was nodular goiter (49.1%) followed by multinodular goiter (28.3%), follicular adenoma (16.9%) and malignancies (5.7%). The post-operative complications after thyroidectomies were hypocalcemia (16.9%), recurrent laryngeal nerve (RLN) injury (5.7%), and surgical site infection (1.9%).Conclusions: Careful evaluation of post thyroidectomy complications will help in reducing these complications and patient’s safety.

Risk Factors for Post-Operative Thyroid Related Complications in Patient Undergoing Thyroidectomy: A Single Center Study

Background: Thyroid diseases are one of the most prevalent endocrinopathies globally (1). Most of the thyroid diseases treated surgically. The operation duration is under multiple factors can be predicted preoperatively (2). Hypocalcaemia and nerve injury are serious complication after thyroid surgery and we hypothesized it could be prevented by simple measures to avoid such complications. Objective: Was to assess the correlation between thyroidectomy operating time, histo-pathological diagnosis of thyroid disease and pre-operative vitamin D supplementation with post thyroidectomy complications mainly hypocalcaemia and nerve injury. Method: An observational retrospective cohort study with a total of 187 patients who underwent thyroidectomy from October 7th 2013 to January 4th 2018 were included in this study. Data were analyzed for demographic information including age, sex, nationality, height and weight. Information about the use of vitamin D supplementation before or after the operation, the clinical and the histological diagnosis of thyroid diseases, the name of the procedure (partial or total thyroidectomy), and the presence of any complications. Result: The mean age of the patients was 39.7±12.71 years. 81.8%(153) were females and 18.2%(34) were males. 53.5%(100) were given Vitamin-D supplements before or after the surgery. Histopathology showed that the most prevalent type was papillary Carcinoma accounting for 68 (36.4%). No significant association between histological diagnosis and complication of hypocalcaemia and nerve injury. Mean duration of surgery performed was 135.61±47.668. 83 of our patients suffered from hypocalcaemia and 6 suffered from nerve injury. When correlating between duration of surgery with hypocalcaemia and nerve injury, The independent t-test was associated with statistically insignificant effect t(182)= -1.85 , p= 0.066 (>0.05) for hypocalcaemia and t(185)= -0.075 , p= 0.940 (>0.05) for nerve injury. Conclusion: Our study suggested that there was no significant correlation between the duration of surgery as well as histo-pathological diagnosis and the development of post-operative hypocalcaemia and nerve injury.

Disease Free Survival of Well Differentiated Thyroid Cancer: 20 years Experience at a tertiary care center in Lebanon

Background: Thyroid cancer is the most common endocrine malignancy. Although relatively common, to date, there is no study about its prognosis in Lebanon. The objectives of this study were to determine the disease free survival, the recurrence rate and possible predictors of recurrence, as well as the rate of post thyroidectomy complications among patients with differentiated thyroid cancer who received treatment at the American University of Beirut Medical Center.&#x0D; Methods and Findings: retrospective observational study of 480 cases of differentiated thyroid cancer who underwent thyroidectomy between January 1995 and June 2014. The mean age was 42±14 years. 74.4% were females. The mean tumor size was 1.9 cm±1.4. Papillary type was predominant (91%). Males had more extra-glandular extension than females (24.8% versus 10.9% respectively, p=0.001), more lymph node involvement (69.7% versus 52.9% respectively, p=0.017) and more vascular invasion (28.1% versus 14.9%, p=0.007). Around 70% of patients had at least one follow up visit after the surgery; among those, the median follow up duration was 4 years (1month-19years). At last follow-up visit, 78.7% were disease free, 14.9% had residual disease and only 6.3% had recurrent disease. By multivariate analysis, age greater than 45 years was the only independent predictor of persistence or recurrence (p=0.03) whereas both age below 45 years and lack of vascular invasion were significant predictors of disease free survival (p=0.001 and p=0.019 respectively).&#x0D; Conclusion: Differentiated thyroid cancer has an overall good prognosis in this cohort of Lebanese patients. Young age and lack of vascular invasion are the most important predictors of disease free survival.&#x0D; &#x0D; Key words: Differentiated thyroid cancer: disease free survival, prognostic factors, recurrence

Preoperative Preparation of Hyperthyroidism for Thyroidectomy - Role of Supersaturated Iodine and Lithium Carbonate.

Introduction:Thyroidectomy is effective and safe procedure for permanent cure of hyperthyroidism (HT). Iodine preparations are widely used before operation to prevent excess blood loss. Ideal regimen for refractory HT is debated. This retrospective case–control study is designed to study the efficacy of various regimens of preoperative preparations.Materials and Methods:Case records, anesthesia charts, and follow-up details of hyperthyroid patients undergoing thyroidectomy were reviewed and compared with an age- and sex-matched euthyroid patients operated during the same period. Iodine preparations were not used for preoperative preparation. Study group was subdivided based on preoperative regimens of anti-thyroid medications.Results:Of the 168 patients in the study group, procedure time, duration of hospital stay, and overall complication rate were high compared to euthyroid group. Operative blood loss was not high in the study group. There was no difference in rate of complications in the subgroups of the study cohort.Conclusion:Iodine preparations are not mandatory in preoperative preparation of HT. Lithium carbonate is effective in preoperative preparation of refractory HT. Rate of postthyroidectomy complications is not different in patients receiving thionamides alone or in combination with β-blocker.

Hypoparathyroidism, an innate risk of thyroidectomy

Background: The identification and preservation of parathyroid glands (PT) with its intact blood supply is of utmost importance during thyroid surgery. To preserve the PT with intact blood supply, a medial to lateral dissection is advocated, with plane of dissection along the thyroid capsule. One of the earliest and feared complications of thyroidectomy is hypoparathyroidism (HPT). Aim was to study the incidence of temporary and permanent hypoparathyroidism during thyroidectomy.Methods: This was a hospital based prospective study, from 2008 to 2015. 472 cases who underwent thyroidectomy (182 near total and 290 total thyroidectomies) for any indications in general surgery department of a tertiary care centre were included.Results: The incidence of permanent and transient HPT after total thyroidectomy was 3.8 and 09%, where as it was 2.75 and 3.85% after near total thyroidectomy. The results of present study were comparable with other studies.Conclusions: Meticulous dissection, absolute hemostasis, and a thorough knowledge of neck anatomy are the key in reducing the post thyroidectomy complications. Transient or permanent hypo parathyroidism is due to inadvertent gland removal or injury to its vascular pedicle. Dissection close to the thyroid capsule and ligation of capsular branches of thyroid avoiding the main trunk of inferior thyroid artery holds the key.

Analysis of factors affecting the development of hypocalcaemia after multinodular goitre surgery.

Thyroidectomy is acommon surgery performed especially in treatment of multinodular goitre. The most common post-thyroidectomy complication is apostoperative hypocalcaemia, and the percentage of postoperative hypoparathyroidism could reach even 50%. Tested group and methods: Aforward-looking, randomized testing was done on agroup of 113 women being subject to multinodular goitre surgery. In this article, we wish to present an analysis of the results obtained in the control group, focusing on the predicative factors which determine the development of postoperative hypocalcaemia. Obtained results: The rate of postoperative biochemical hypocalcaemia development was significantly higher in the group of patients, where the preoperative calcium concentration was lower than 2,4 mmol/l. In that group, the development of biochemical hypocalcaemia was observed in 93,7% of cases (30 out of 32 patients), in comparison with 65,3% (17 out of 26) in the group of higher preoperative concentration of calcium. The highest risk of occurrence of postoperative hypocalcaemia was borne bythe total thyroidectomy, while the lowest one bythe subtotal thyroid lobectomy of one lobe only. Ahigher preoperative concentration of calcium in blood serum is related to the lower rate of occurrence of postoperative biochemical hypocalcaemia. However, no such correlation was revealed in the case of postoperative symptomatic hypocalcaemia. Lack of correlation was determined between the preoperative concentration of TSH and FT4 in blood serum and therate of occurrence of postoperative hypocalcaemia, both symptomatic and asymptomatic. The performed statistics did not reveal arelation between the postoperative hypocalcaemia and the duration of the surgery, but asignificant correlation was stated with the scope of the performed surgery. Revealing arelation between the rate of occurrence of postoperative hypocalcaemia and the experience of the surgeon performing the surgery was not successful.

Comparison of Postoperative Drain Insertion versus No Drain Insertion in Thyroidectomies: Retrospective case-control study from the Sultan Qaboos University Hospital, Muscat, Oman.

A thyroidectomy is a frequently performed surgical procedure which can result in life-threatening complications. The insertion of a drain after a thyroidectomy has been suggested to prevent such complications. This study aimed to evaluate the use of surgical drains following thyroidectomies in relation to postoperative complications and mass sizes. This retrospective case-control study included all thyroidectomies conducted at the Sultan Qaboos University Hospital, Muscat, Oman, from January 2011 to December 2013. Length of hospital stay, readmission, postoperative complications and mass size were evaluated. During the study period, 250 surgeries were carried out on 241 patients. The majority of patients were female (87.2%). Drains were inserted postoperatively after 202 surgeries (80.8%) compared to 48 surgeries (19.2%) without drains. A total of 32 surgeries (12.8%) were conducted on patients with thyroid masses <1 cm, 138 (55.2%) on those with masses between 1-4 cm and 80 (32.0%) on those with masses >4 cm. The association between drain use and mass size was not significant (P = 0.439). Although postoperative complications were more prevalent in patients with drains, the relationship between these factors was not significant (P >0.050). Length of hospital stay was significantly longer among patients with postoperative drains (P <0.010). The routine insertion of drains after thyroid surgeries was found to result in longer hospital stays and did not reduce rates of post-thyroidectomy complications. Thyroid mass size should not be used as an indicator for the insertion of a drain after thyroidectomy.

Post-thyroidectomy complications. The role of the device: bipolar vs ultrasonic device: Collection of data from 1,846 consecutive patients undergoing thyroidectomy

BackgroundSpecific complications after thyroid surgery, such as recurrent laryngeal nerve injury (RLN) or hypoparathyroidism, are feared because they may give rise to a lifelong disability for the patient. The aim of this study was to evaluate the possible association between the types of device used (bipolar vs ultrasound-based harmonic scalpel defined Harmonic Focus) and major postoperative complications. MethodsDuring a 1-year period, between October 2010 and October 2011, Italian Endocrine Surgery Units affiliated with the Italian Endocrine Surgery Units Association collected data on all consecutive patients older than 18 years who had undergone primary total thyroidectomy, near total thyroidectomy, and completion thyroidectomy. The data were included in a dataset, listing demographic variables, details on the surgical procedure, and 2 major complications of the thyroid surgery: postoperative RLN palsy/hypomobility and hypocalcemia. ResultsOur population comprised 1,846 subjects (78.6% women, median age 52 years). Six hundred four (32.7%) subjects underwent thyroidectomy by bipolar forceps and 1,242 (67.3%) by ultrasonic device. The risk of hypocalcemia in subjects undergoing thyroidectomy by ultrasonic device was similar to those undergoing thyroidectomy by bipolar after adjusting for sex, type of thyroidectomy, and central lymphadenectomy (odds ratio .94, 95% confidence interval .76 to 1.17). Subjects who underwent thyroidectomy by ultrasonic device had a lower risk of RLN paralysis compared with those undergoing thyroidectomy by bipolar forceps also after adjusting for central lymphadenectomy (odds ratio .39, 95% confidence interval .2 to .7). ConclusionThis multicenter study acknowledges the value of the ultrasonic device as a protective factor only for RLN palsy, confirming nodal dissection as a risk factor for postoperative hypocalcemia and vocal folds disorders.

"Clinicopathological features and treatment outcomes of differentiated thyroid cancer in Saudi children and adults".

IntroductionAge is an important prognostic factor in differentiated thyroid cancer (DTC). Our aim was to evaluate differences in clinicopathological features and treatment outcomes among children and adult patients with DTC.Materials and methodsWe studied 27 children (below 18 years) with DTC treated during the period 2000–2012 and were compared with (a) 78 adults aged 19–25 years and (b) 52 adults aged 26–30 years treated during the same period in terms of their clinicopathological features and long term treatment outcomes. Locoregional recurrence (LRR), locoregional control (LRC), distant metastasis (DM), distant metastasis control (DMC), disease free survival (DFS) and overall survival (OS) rates were evaluated.ResultsMean age of children was 13.5 years (range: 5–18), while mean age of adults was 24.6 years (range: 19–30). In children, female: male ratio was 2.85:1, and in adults female: male ratio was 7.1:1 (P = 0.041). No significant difference in tumor size was seen between the two groups (P = 0.653). According to American Thyroid Association (ATA) risk stratification classification, the children (85.2 %) were found to have at high risk as compared to adults P = 0.001. Post-thyroidectomy complications and RAI induced toxicities were observed more in children than adults (P = 0.043 and P = 0.041 respectively). LRR occurred in 6 (22.2 %), 9 (11.5 %) and 3 (5.8 %) in age groups of <18 years, 19–25 years and 26–30 years respectively (P = 0.032); while DM was seen in 10 (37.0 %), 9 (10.3 %) and 5 (9.6 %) in age groups of <18 years, 19–25 years and 26–30 years respectively (P = 0.002). Ten year DFS rates were 67.3 % in age group below 18 years, 82.4 % in age group of 19–25 years and 90.1 % in age group of 26–30 years (P = 0.021).ConclusionAt the time of diagnosis, children with DTC were found to have more aggressive clinicopathological characteristics. Comparatively lower LRC, DMC and DFS rates in children warrants further multi-institutional studies.

Total thyroidectomy for amiodarone-associated thyrotoxicosis: should surgery always be delayed for pre-operative medical preparation?

Amiodarone can induce severe hyperthyroidism that justifies its withdrawal and the introduction of antithyroid drugs. Continuing amiodarone use, failure to control hyperthyroidism and poor clinical progress may require thyroidectomy. This study aimed to evaluate patients' post-operative development and mid-term outcome after thyroidectomy for amiodarone-associated thyrotoxicosis. Prospective case series. Tertiary care centre. We prospectively collected cases of amiodarone-associated thyrotoxicosis requiring thyroidectomy due to failure of antithyroid treatment, despite amiodarone discontinuation. Post-thyroidectomy complications were compared immediately, 30 days and one year post-operatively, and also for scheduled versus emergency surgery cases. Of 11 total cases, nine scheduled thyroidectomy cases had no morbidity after elective surgery. Two cases required emergency surgery for multiple organ failure and cardiac problems. Immediate post-operative complications (mostly haemodynamic) occurred in both cases (emergency vs routine surgery, p = 0.018). In such cases, pre-operative medical treatment is vital to limit peri- and post-operative complications, but surgery should not be delayed if the haemodynamic status deteriorates. Surgery, with careful anaesthesia, is the cornerstone of the treatment.