Thyroidectomy Group Research Articles

Tension-free thyroidectomy — results of the initial 77 operations

BACKGROUND: Surgeons from all over the world make considerable efforts to reduce thyroid intraoperative complications such as recurrent laryngeal nerves trauma and parathyroid vascular supply damage.AIM: The aim of the study was improving thyroidectomy technique to reduce the rate of postoperative complications.MATERIALS AND METHODS: Inclusion criteria were primary thyroid operation in cases of papillary or medullary cancer, follicular tumours (Bethesda IV) and Grave’s disease. Thyroid volume ranged from 12–70 ml. Tension-free technique of thyroidectomy (TFT) was suggested by the authors of this study. Key points of TFT are the following: the first step is the complete dissection of Berry ligament fibers and terminal branches of lower thyroid arteries and vein. There is only lateral traction while medial traction is not applied at all. Mobilization of the upper parathyroid gland is performed at the medial thyroid surface. Thyroid lobe is extracted out of its bed beginning with the lower pole only after complete dissection of Berry’s ligament, vessels and parathyroid glands. The last step of the operation is the dissection of the upper pole thyroid vessels. The mobilized lobe is easily withdrawn downwards, that leads to space increase between external branch of the superior laryngeal nerve and the upper pole of the lobe. Transient and continuous neuromonitoring as well as optical magnification and headlamps were used during operations. Vocal cords function was controlled before and after surgery (on the first day) by means of ultrasound or endoscopic laryngoscopy. Ionized calcium and parathyroid hormone levels were checked in cases of total thyroidectomy group on the day of surgery, on the 1st and 14th postoperative days.RESULTS: 77 consecutive patients were included into the study (continuous sampling of patients). 33 hemithyroidectomies, 13 hemithyroidectomies with central ipsilateral neck dissection, 21 thyroidectomies, 8 thyroidectomies with central neck dissection, 2 thyroidectomies with central and lateral neck dissection were performed by the same surgeon. All the operations were performed by tension-free technique (TFT). There were no cases of loss of signal from the recurrent laryngeal nerves function during all the operations. One case of postoperative transient hypoparathyroidism finished with normalization of parathyroid hormone and calcium levels in 2 weeks after the operation.CONCLUSION: initial experience in TFT allows to recommend this procedure for further practicing and examination.

The Year in Surgical Thyroidology: Recent Technological Developments and Future Challenges.

Background: The field of surgical and interventional thyroidology is rapidly evolving. In the past few years, we have seen the introduction and establishment of many novel surgical adjuncts, techniques, and disruptive ablative technologies that have impacted the field. Methods: We identified the most influential articles on technological developments in surgical and interventional thyroidology that were published from September 1, 2020, to August 1, 2021. We searched three electronic databases and consulted experts. Results: Major findings are summarized. Continuous intraoperative nerve monitoring (cIONM) lowered the risk of early postoperative vocal cord palsy 1.8-fold and permanent palsy 29 · 4-fold compared with intermittent intraoperative nerve monitoring. Parathyroid autofluorescence yielded a diagnostic odds ratio (OR) of 228.9 for detection of parathyroid glands over visualization, with 96% sensitivity and 92% specificity. There was no significant difference in the incidence of major complications between the transoral endoscopic thyroidectomy vestibular approach (TOETVA) and transcervical thyroidectomy (1.5% vs. 2.1%, p = 0.75), and a higher body mass index did not lead to a significant increase in the odds of cumulative complication with TOETVA for the overweight (OR = 0.52 [95% confidence interval {CI} 0.17-1.58]) and obese groups (OR = 1.69 [CI 0.74-3.88]). Radiofrequency ablation (RFA) for benign thyroid nodules typically resulted in a 50-85% volume reduction with faster recovery times, less pain levels, and higher social and psychological well-being compared with conventional thyroidectomy at 15 months post-treatment, although physical well-being levels were higher in the conventional thyroidectomy group at this time. RFA for papillary thyroid microcarcinoma showed no significant difference in local tumor progression (1.8% vs. 3.3%, p = 0.209), lymph node metastasis (0.6% vs. 0.6%, p = 1.000), recurrence (1.2% vs. 2.4%, p = 0.244), and 4-year recurrence-free survival rates (98.2% vs. 97.0%, p = 0.223) when compared with transcervical lobectomy. Conclusions: cIONM, parathyroid autofluorescence, transoral vestibular approach thyroid surgery, and RFA for benign and malignant thyroid nodules are some of the latest additions to the surgeon's and interventionalist's armamentarium to manage thyroid disease. These technological advancements demonstrate promise to improve outcomes, decrease complications, and enhance a patient's quality of life, but further rigorous studies are needed to define their utility and value.

Corneal Abrasion After Radical Thyroidectomy: A Case Report

Corneal abrasion during radical thyroidectomy is a rare complication and is infrequently addressed in the literature. Here, we present the case of a young female patient who underwent radical thyroidectomy with general anesthesia. During the operation, the eyes were being naturally closed without protection measures, and corneal abrasion of the left eye occurred after the operation. The lesion had completely resolved with no sequelae after treatment. Therefore, preventive measures and attentive care may help reduce the incidence of corneal abrasion in patients undergoing radical thyroidectomy.

Total thyroidectomy versus hemithyroidectomy with intraoperative radiofrequency ablation for unilateral thyroid cancer with contralateral nodules: A propensity score matching study

BackgroundFor unilateral papillary thyroid carcinoma (PTC) patients with contralateral benign nodules, optimal treatment decisions are made according to patient preference and the disease’s pathological features. This study was performed to evaluate the efficacy and complications of hemithyroidectomy with intraoperative radiofrequency ablation (RFA) compared with total thyroidectomy.MethodsPatients with unilateral PTC and cytologically benign contralateral nodules were enrolled from 2014 to 2018. Total thyroidectomy or hemithyroidectomy with intraoperative RFA of the contralateral nodule was offered to patients who had anxiety regarding their disease. The operation-related parameters, transient or permanent nerve injury, hypocalcemia and disease recurrence, were recorded and compared between the two groups.ResultsAfter propensity score matching, 191 patients who underwent total thyroidectomy and 224 contralateral nodules in 191 patients underwent hemithyroidectomy with intraoperative RFA (HTRFA) were included. The volume reduction ratios of the contralateral nodules were 67.7% at 12 months and 95.8% at 24 months. The total thyroidectomy group reported significantly higher hypocalcemia than HTRFA within one year (7.8% vs. 2.6%, p = 0.022). Supplemental levothyroxine was not required in 28.3% (54/191) of the patients one year after HTRFA. With a median follow-up of 4.1 years, three recurrences (1.6%) were observed in the HTRFA, and no recurrence occurred in the total thyroidectomy group (p = 0.246).ConclusionsHemithyroidectomy for unilateral PTC and intraoperative RFA for contralateral nodules were acceptable and effective treatment approaches and did not increase the risk of complications.Graphical

Short-stay thyroid surgery for older patients, is it safe?

Background/Aim. The incidence of nodular thyroid disease increases significantly with age as well as the incidence and aggressiveness of thyroid cancers. The aim of this study was to determine if thyroid surgery for geriatric patients is safe in a short hospital stay surgery setting. Methods. In this retrospective study we have analyzed medical histories of all operated geriatric patients (65 years and older) in which a total or hemithyroidectomy was performed in the period from January 2012 to December 2018. Patients with thyroid reoperations and with simultaneous neck dissections were excluded from the study. The analyzed geriatric patients were divided into hemithyroidectomy and total thyroidectomy groups and were paired with two control age groups (20-44 years and 45-64 years), in a numerical ratio of 1: 1: 1. Results. 976 patients were operated of the thyroid diseases, 214 total thyroidectomies and 33 hemithyroidectomies. In all three hemithyroidectomy groups the average hospital stay was 24 hours, in the total thyroidectomy geriatric group 150 of 214 patients (70.1%) spent 24 hours in the hospital. In the geriatric population, incidence of neck swelling and increased drainage output were higher compared to the control group, and thus the need for longer hospitalizations. Comparing the years, it was shown that subjects with each subsequent year of intervention have a 22% lower chance of developing complications, and regarding pathohistological finding benign thyroid hyperplasia is less likely to develop complications compared to malignant hyperplasia. Conclusion. According to our study total thyroidectomy can be safely performed within the concept of a short hospital stay in patients under 65, while in the elderly, hospitalization days may be extended due to more frequent surgical and non surgical complications, while hemithyroidectomy is safe for all age groups.

HYPOCALCEMIA IN TOTAL VERSUS SUBTOTAL THYROIDECTOMY

Objective: To compare the occurrence of hypocalcemia in patients undergoing subtotal and total thyroidectomy.
 Study Design: Comparative prospective study.
 Place and Duration of Study: Surgical departments of Ayub Teaching Hospital, Abbottabad and Combined Military Hospital, Rawalpindi, from Mar 2018 to Feb 2020.
 Methodology: A total of 171 patients were selected for this study and they were divided into 2 groups. Group 1 consisted of 95 patients undergoing Total thyroidectomy whereas group 2 had 76 patients undergoing Subtotal thyroidectomy. It was a comparative prospective study and the groups were made by convenience sampling. The data was analyzed by SPSS-23.
 Results: In total thyroidectomy group Hypocalcemia was detected after 48 hours in 34 patients (35%) while in subtotal thyroidectomy group hypocalcemia was detected in 20 patients (28%). Tests for hypocalcemia were also done after two months of surgery and low levels were detected in 7 patients (7.5%) who had total thyroidectomy and in 2 patients (5%) in the group undergoing subtotal thyroidectomy. There was no significant difference in hypocalcemia after 48 hour (p=0.22) and 2 months postoperatively (p=0.6) between patients of Total Thyroidectomy and Subtotal Thyroidectomy.
 Conclusion: Total thyroidectomy is not associated with increased risk of permanent hypocalcemia as compared to Subtotal thyroidectomy. Because of its advantages Total thyroidectomy should be the preferred surgical procedure for patients presenting with benign euthyroid multi nodular goiter.

Motor and Functional Recovery Post Radical Thyroidectomy: A Comparative Study of Two Types of Physical Exercises

Bakeground:Thyroidectomy is one of the standard surgical procedures worldwide. Although mortality and morbidity of thyroidectomy are low, some long-term complications continue to represent significant health and social problem. Early physical exercises for these patients are effective in enhancing the neck and shoulder motor function and improving quality of life. Aim: Assess the efficacy of early exercise programs (self rang of motion and active rang of motion exercises) on radical thyroidectomy patients' motor and functional abilities. Design: the researchers used a a comparative design. setting:The researcher conducted the study at the Head and Neck Surgery Unit in Alexandria Main University Hospital, Egypt. Sample:50 radical thyroidectomy patients were included, and each patient was randomly selected to be allocated to one of the two groups, 25 patients each. Tools: Four tools were used: Socio-demographic and clinical data structured interview schedule, The disabilities of the arm, shoulder and outcome questionnaire, shoulder recovery outcome and neck recovery outcome. Methods: researchers used four tools for data collection. exercise programs were applied one week before the operation and continued for two months postoperative. researchers developed verbal and written instruction and gave it preoperatively, and patients were re-assessed by utilizing tools II, III, and IV after applying the program for each group. Results: 88% of self exercises patients were holding against maximal resistance of muscles strength after two months postoperatively compared to 48% of active exercises patients were holding against gravity elimination. Arm circumference measurements were not statistically significant differences between the two groups, neither preoperatively nor postoperatively. In contrast, range of motion of shoulders, shoulder pain, Disailities of Arm,Shoulder and Hand score, ability to lift objects, ability to do work, and overall activity were significantly improved among self-exercise patients than active exercise patients. Conclusion: Significant improvement of the self exercises group concerning functional and motor activity of the shoulder, arm, and neck. Modification of the disabilities of the arm, shoulder, and hand score of self exercises patients. Statistically significant differences between self and active exercise group regarding Neck Dissection Impairment Index after two months postoperative. Recommendations: Patients and their families must be involved in early rehabilitation to prevent complications and improve their daily living activity.

Comparison of the transoral endoscopic thyroidectomy vestibular approach and open thyroidectomy: A propensity score–matched analysis of surgical outcomes and safety in the treatment of papillary thyroid carcinoma

BackgroundThe transoral endoscopic thyroidectomy vestibular approach has been demonstrated to have similar surgical outcomes as open thyroidectomy for selected papillary thyroid carcinomas. This study aimed to evaluate and compare the surgical outcomes and safety of the transoral endoscopic thyroidectomy vestibular approach with those of open thyroidectomy in the treatment of papillary thyroid carcinoma with a diameter between >1 cm and ≤3.5cm. MethodsWe retrospectively reviewed all patients who had papillary thyroid carcinoma that was between >1 cm and ≤3.5 cm in diameter and who had undergone the transoral endoscopic thyroidectomy vestibular approach (n = 96) or an open thyroidectomy (n = 425) from January 2017 to June 2020. We then performed 1:1 propensity score matching, yielding 78 matched pairs. Afterward, surgical outcomes and follow-up data were compared between the 2 matched groups. ResultsCompared with the matched open thyroidectomy group, the papillary thyroid carcinoma group had a significantly longer operative time (P < .001), more blood loss (P < .05), higher postoperative white blood cell count (P < .05), higher C-reactive protein (P < .001), more total drainage volume (P < .001), increased surgical cost (P < .05), better cosmetic satisfaction (P <.001), lower scar self-consciousness (P < .001), and better quality of life (P < .001). We observed no significant differences in the incidence of other outcomes, including the number of retrieved lymph nodes and metastatic central lymph nodes, the rate of intraoperative recurrent laryngeal nerve signal weakened and parathyroid autotransplantation, visual analog scale scores for pain, drainage duration, postoperative hospital stay, rate of complications, and oncologic completeness. We observed no conversion to open thyroidectomy and no intraoperative capsular disruption in the transoral endoscopic thyroidectomy vestibular approach group. There was 1 case of persistent nodal disease in the transoral endoscopic thyroidectomy vestibular approach group. No recurrence was observed in the 2 groups during the follow-up period. ConclusionThe transoral endoscopic thyroidectomy vestibular approach is feasible in selected patients with papillary thyroid carcinoma, not only because it is cosmetically advantageous but also because it is surgical and oncologically safe and may be an optional surgical method for treating papillary thyroid carcinomas having a diameter between >1 cm and ≤3.5 cm.

Comparison of Quality of Life of Patients with Papillary Thyroid Microcarcinoma Treated by Different Modalities

Objective To compare the health-related quality of life(HRQoL)of patients with papillary thyroid microcarcinoma(PTMC)treated by different modalities. Methods The PTMC patients after treatment who came to our department for follow-up from October to December in 2019 were enrolled and assigned into three groups according to treatment modalities:radiofrequency ablation(RFA)group(n=80), hemithyroidectomy(HT)group(n=34), and total thyroidectomy(TT)group(n=35).All patients completed three scales:short form 36-item health survey(SF-36), thyroid cancer-specific health-related quality of life questionnaire(THYCA-QoL), and fear of progression questionnaire-short form(FoP-Q-SF).Multivariate linear regression analysis was employed to adjust for confounders and the quality of life scores were compared among the three treatment modalities. Results In the SF-36, physical component summary(PCS)(P=0.006, P=0.033)and role-physical(RP)(P=0.003, P=0.001)scores of patients in the RFA and HT groups were significantly higher than those in the TT group, whereas PCS(P=1.000)and RP(P=1.000)showed no significant difference between the RFA group and the HT group.In addition, the mental component summary(MCS)score in RFA group was higher than that in TT group(P=0.034).The THYCA-QoL demonstrated that the patients in TT group complained more about scar than the patients in HT(P=0.003)and RFA(P<0.001)groups, and the patients in the RFA group complained less about weight gain than those in the HT(P=0.028)and TT(P<0.001)groups.In the FoP-Q-SF, the scores of the quality of life of patients concerned about disease progression had no significant difference among the three groups(P> 0.05).Conclusion Compared with traditional open surgery, ultrasound-guided RFA has unique advantages in improving patients' quality of life and can be used as an alternative to open surgery for PTMC.

Total or less than total thyroidectomy for multinodular goiter long term follow-up

Objective: Multinodular goiter is a common surgical disease. There is no common consensus regarding the extent of thyroidectomy for multinodular goiter. This study aims to present personal experience on treating patients with multinodular goiter and to compare complication rates and results of total and partial thyroidectomy for multinodular goiter.&#x0D; Material and Method: Three hundred fifty patients underwent thyroidectomy for multinodular goiter between May 2003 and October 2010. All patients were diagnosed as multinodular goiter and were referred to surgery by one endocrinologist. All operations were also performed by one surgeon using microsurgical techniques. Partial thyroidectomy (bilateral subtotal or unilateral total thyroidectomy and contralateral subtotal thyroidectomy) was performed in 65 patients (Group-1) and extracapsular total thyroidectomy was performed in 285 patients (Group-2). All patients are being followed followed from the day they were diagnosed until now by the same endocrinologist. Fisher exact test was used for statistical analysis.&#x0D; Results: In Group-1, one patient had transient vocal-cord palsy and but none had hypoparathyroidism. On the other hand, in Group-2, two patients had transient vocal-cord palsy, five had hypocalcemia (one was permanent), and one had a hematoma. Mortality and wound infection were absent in both groups. The histopathological studies showed that 40 incidental thyroid carcinomas occurred among Group-2 patients. During long-term follow-up, 13 patients had goiter recurrence (n = 65, 20%) in Group-1, whereas none had goiter recurrence in Group-2.&#x0D; Conclusion: There were no statistically significant differences in the complication rate between subtotal and total thyroidectomy groups (p&gt;0.05). However, the recurrence rate was higher (statistically significant) after subtotal thyroidectomy than after total thyroidectomy (p&lt;0.05). Total thyroidectomy eliminated future recurrence of the disease and is also curative in incidental thyroid carcinomas. In addition, it can be safely performed using microsurgical techniques.

Health-related quality of life after transoral robotic thyroidectomy in papillary thyroid carcinoma

BackgroundHealth-related quality of life after transoral robotic thyroidectomy has not been evaluated thoroughly. The purpose of this study was to compare health-related quality of life after transoral robotic thyroidectomy and after conventional thyroidectomy. MethodsThis study is a prospective, cross-sectional, and observational study of 114 patients who underwent transoral robotic thyroidectomy (57 patients) or conventional transcervical thyroidectomy (57 patients) for the treatment of papillary carcinoma. We used 2 questionnaires: the University of Washington Quality of Life questionnaire for head and neck cancer and the thyroid cancer–specific Quality of Life questionnaire (Thyroid Version). The survey was performed preoperatively, and 3 months and 1 year after thyroidectomy. ResultsMean scores for neck appearance were higher after surgery in the transoral robotic thyroidectomy group than the conventional group at both 3 months and 1 year. Anxiety was significantly improved after surgery in both groups. Total scores for health-related quality of life after surgery were similar in both groups. Health-related quality of life and overall quality of life over the previous 7 days as measured by the University of Washington Quality of Life questionnaire were significantly better at 1 year than in the preoperative period in both groups. Before surgery, patients in the both groups regarded anxiety and mood as the most important aspects of health-related quality of life. After surgery, patients in the transoral robotic thyroidectomy group identified anxiety, mood, and speech as the most significant issues, while patients in the conventional group selected anxiety, mood, and neck appearance. ConclusionQuality of life related to neck appearance is higher after transoral robotic thyroidectomy than after transcervical thyroidectomy. However, total scores for health-related quality of life did not differ in the 2 groups after surgery.

Long-term outcomes of lobectomy for papillary thyroid carcinoma with high-risk features.

Lobectomy is not advocated for papillary thyroid carcinoma (PTC) with high-risk features, although there is no high-level evidence showing that this is an inferior strategy. This study aimed to examine the association between the extent of surgery and survival of patients with PTC and high-risk features. Consecutive patients with PTC and at least one high-risk feature treated in 2000-2012 were included in the study. High-risk features were defined as: primary tumour larger than 4cm, gross extrathyroidal extension, macroscopic multifocality, and confirmed nodal metastasis including pathological lateral neck metastasis (pN1b) or more than five central lymph node metastases. Cox proportional hazards models were employed to measure the association between the extent of surgery and disease-specific survival (DSS) in the whole cohort and in a matched-pair analysis. Among a total of 2059 patients with high-risk features, 1224 underwent lobectomy and 835 had total thyroidectomy. Patients who underwent total thyroidectomy had significantly higher rates of bilateral cancer than those who had a lobectomy (79.4 versus 2.7 per cent respectively), macroscopic multifocality (80.8 versus 32.8 per cent) and bilateral neck metastasis (30.9 versus 3.3 per cent) (all P < 0.001). With a median follow-up of 93months, multivariable analysis showed that the extent of surgery was not associated with DSS in the whole cohort (hazard ratio 1.36, 95 per cent c.i. 0.75 to 2.48; P = 0.310). After 1:1 case-control matching of 528 patients, no significant difference between lobectomy and total thyroidectomy groups was observed with respect to the 10-year DSS rate (94.3 versus 95.2 per cent respectively; P = 0.323) or 10-year recurrence-free survival rate (75.8 versus 79.2 per cent; P = 0.784). Lobectomy was not associated with significantly worse outcomes for patients with PTC and high-risk features.

Radiofrequency ablation versus total thyroidectomy in patients with papillary thyroid microcarcinoma located in the isthmus: a retrospective cohort study

Objective This retrospective study aimed to examine the benefits and complications of radiofrequency ablation (RFA) in patients with papillary thyroid microcarcinoma (PTMC) in the isthmus. Methods This retrospective study included patients with PTMC in the isthmus and treated at the Chinese People’s Liberation Army hospital from 05/2014 to 05/2018. The patients were divided into the RFA and total thyroidectomy (TT) groups. The outcomes were operation-related complications, rate of recurrence, metastasis rate, and thyroid carcinoma-specific questionnaire of quality of life (THYCA-QOL). Results Among 218 patients, 115 patients underwent RFA, and 103 underwent TT. The rates of disappearance of the ablation zone at 1, 3, 6, 12, and 18 months after RFA were 0.8% (1/115), 10.4% (12/115), 51.3% (59/115), 90.4% (104/115), and 100% (115/115), respectively. Surgical time, blood loss, hospital stays, and treatment costs were higher with TT than with RFA (all p < 0.001). The final THYCA-QOL score of the RFA group was significantly higher than in the TT group (p < 0.001). Minor pain at the operation site was seen in all patients in the RFA group. No distant metastasis was detected in all patients, but one patient in the RFA group had a recurrence after 6 months. The final THYCA-QOL score of the RFA group was significantly lower than in the TT group (p < 0.001). Conclusion These results suggest that RFA for PTMC in the isthmus had similar outcomes than TT. It will have to be confirmed in future studies.

Surgical Results of Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) Compared to Open Thyroidectomy in Patient with Benign Thyroid Nodule

Background: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is an innovative technique to perform thyroidectomy which provides excellent cosmetic and surgical outcomes. Methods: Between June 2018 to January 2020 all patients pathological diagnosis with benign thyroid nodule in Chiangrai Prachanukroh Hospital were reviewed retrospectively. TOETVA and Open thyroidectomy were performed in 55 cases per each group, respectively. Patient baseline characteristics and surgical results, including postoperative pain, estimate blood loss, operative time, length of hospital stay and postoperative complications, were investigated and compared. Results: TOETVA and open thyroidectomy was performed on 110 consecutive patients. The baseline characteristics were similar in both groups. The mean postoperative visual analog scale for pain score in the first three days was comparable for both groups (4.43 [2.01] vs 3.73 [2.5], P=0.126). Mean estimate blood loss was not statistically different for both groups (20 [76.19] vs 30 [44.28] ml, P=0.302). But the median operative time was longer for the TOETVA group compared to the open thyroidectomy group (120 [61.55] vs 60 [33.70] mins, P=0.00003). Mean length of stay was comparable for both groups (3.7 [0.98] vs 3.43 [1.05] days, P=0.072). For the postoperative complication, 3 patients (5.45%) in TOETVA and 6 patients (10.91%) in open thyroidectomy group has recurrent laryngeal nerve injury. One patient (1.82%) had hypocalcemia in both groups. In TOETVA group, one patient (1.82%) had wound infection and one patient (1.82%) had transient mental nerve injury. Conclusion: TOETVA is an effective and safe surgical approach for benign thyroid nodule with excellent cosmetic outcome. This technique is a reasonable optional treatment for patients who demanded a scarless wound. The surgical outcomes and complication rates were similar but TOETVA is associated with longer operative time.

Initial activity-related long-term outcome of iodine-131 treatment for thyroidectomy patients with differentiated thyroid carcinoma.

To determine the outcome of iodine-131 (131I) treatment regimens in thyroidectomy patients with differentiated thyroid cancer. Based on Taiwan's National Health Insurance Research Database (NHIRD) during the period from January 1, 2000 to December 31, 2010, 390 patients with well-differentiated thyroid cancer who underwent 131I treatment after thyroidectomy were enrolled in this study. Patients were classified into six groups according to the type of thyroidectomy and initial activity regimen of 131I treatment. The clinical outcome of 131I treatment was evaluated by total treatment number and medical expenditure, including costs for hospitalization and laboratory tests together with initial and subsequent 131I treatments. Multiple linear regression analysis was applied to analyze the factor(s) significantly affecting the outcome of 131I treatment. Increased activity of the initial 131I regimen reduced the total treatment number significantly for unilateral total thyroidectomy with initial 100-150mCi 131I, and mildly for bilateral total thyroidectomy with initial 100-150mCi 131I and radical thyroidectomy with initial 30-99mCi 131I. Increased activity of the initial 131I regimen reduced total medical expenditure significantly for unilateral, and mildly for bilateral total thyroidectomy both with initial 30-99mCi 131I. For patients with specific thyroidectomy for differentiated thyroid cancer, a high initial regimen of 131I treatment is more effective than the low activity regimen. An increased activity of the initial 131I regimen significantly reduced the total treatment number and medical expenditure.

Clinical application of the gasless unilateral axillary approach in endoscopic thyroid surgery

Objective: To investigate the efficacy, safety and advantages of gasless unilateral axillary approach (GUAA) in endoscopic thyroid surgery. Methods: A total of 334 patients who underwent the GUAA endoscopic thyroid surgery (GUAA group) or conventional open thyroid surgery (OS group) in the Department of Head and Neck Surgery of Zhejiang Cancer Hospital from January 2017 to June 2018 were retrospectively analyzed. There were 45 males and 289 females, aged from 12 to 72 years old, of whom 139 patients were assigned to GUAA group and 195 patients to OS group. Pathological results included papillary thyroid carcinoma (282 cases), nodular goiter (41 cases) and thyroid adenoma (11 cases). Surgical exploration development curve of GUAA group was drawn and was divided into two parts: the technical exploration stage and the technical stable stage. Surgical efficiency, incidences of complications, and incision satisfaction were compared between GUAA group in technical stable stage and OS group. SPSS 25.0 software was adopted for statistical analysis. Results: The mean age in GUAA group was younger than that in OS group, with a significant difference [(35.3±9.5) years vs. (48.1±10.6) years, t=11.31, P<0.01]. The cases in the endoscope group were divided into technical exploration stage for 51 cases and technical stable stage for 88 cases according to the exploration and development curve. In unilateral radical thyroidectomy and unilateral thyroid lobectomy, the mean operation time [(90.6±18.6) min and (93.5±22.0) min] and postoperative drainage volumes [(121.5±87.6) ml and (155.5±69.1) ml] of GUAA group in the stable stage were more than those of OS group [(61.6±15.6) min and (46.5±8.4) min] and [(93.2±42.3) ml and (78.9±48.7) ml]. The difference was statistically significant (t=12.28, 7.23, 3.35 and 3.05 respectively, all P<0.05), but there were no significant differences in surgical bleeding volumes between two groups [(12.7±6.8) ml vs. (13.5±7.7) ml, t=0.74, P>0.05 and (16.3±14.1) ml vs. (11.9±5.1) ml, t=1.05, P>0.05]. Compared with OS group, GUAA group had the lower incidence of anterior cervical discomfort during swallowing (2.3% vs. 29.2%, P<0.01) and the higher incision satisfaction score (1.1±0.5 vs. 2.8±0.7, t=21.12, P<0.01), however, GUAA group had the higher incidence of supraclavicular (or infraclavicular) numbness after surgery (5.7% vs. 0, P<0.01). And there was no significant difference in the incidences of temporary recurrent laryngeal nerve injury, bleeding, hematoma, infection, lymphatic leakage or chylous leakage after surgery between two groups (P>0.05). Conclusion: GUAA endoscopic thyroid surgery is a safe method with high cosmetic satisfaction.

Conventional thyroidectomy vs thyroid thermal ablation on postoperative quality of life and satisfaction for patients with benign thyroid nodules.

The complications and treatment effects of conventional thyroidectomy and thyroid thermal ablation should be compared in order to identify the best intervention for patients with benign thyroid nodules. Patients (18-50 years old) who had benign thyroid nodules and were eligible for both thyroidectomy and thyroid thermal ablation were randomly allocated (1:1) to either conventional thyroidectomy group or thyroid thermal ablation group. Patients' satisfaction and condition-specific quality of life were measured with the Thyroid-Specific Quality-of-Life Questionnaire Scale (QoL) at the 15th post-randomization month and were set as the co-primary outcome. A total of 450 patients were enrolled and randomized (225 patients in each group). At the 15th month after randomization, more patients in the thyroid thermal ablation group were satisfied with the treatment effects compared to those in the conventional thyroidectomy group. More patients in the thyroid thermal ablation group have a QoL score of 410 (QOL scores ranges from 0 to 410) than patients in conventional thyroidectomy. Eight (4%) of the 209 patients in conventional thyroidectomy group and 6 (3%) of the 208 patients in thyroid thermal ablation group had at least one severe postoperative complication. The time to achieve volume reduction was longer in the thermal ablation group. Thyroid thermal ablation is superior to conventional thyroidectomy in terms of patients satisfaction, post-operative quality of life, and shorter hospital stay but takes longer to achieve BTNs volume reduction. The complication rates between the two groups were similar.

Acromegalia en Paciente con Cáncer Papilar de Tiroides

Introducción: El cáncer de tiroides es la neoplasia endocrina más frecuente y el Carcinoma Papilar de tiroides representa el 80% de los casos. Por otro lado, la acromegalia es un trastorno poco diagnosticado con una incidencia estimada anual de 4 casos por millón de personas. Presentamos un caso en el que se presentan las dos entidades al mismo tiempo en un paciente y la discusión del posible nexo bioquímico.&#x0D; Caso clínico: Mujer de 23 años, con masa nodular pétrea de 3 centímetros, en polo superior de lóbulo derecho de tiroides; sometida a tiroidectomía radical y linfadenectomía cervical bilateral, reporte histopatológico de carcinoma papilar. Evoluciona con cambios visuales en ojo izquierdo, cefalea, amenorrea de 1 año, galactorrea negativa, características morfo-anatómicas de acromegalia, campimetría hemianopsia homónima izquierda. IRM de cerebro lesión sellar y suprasellar hiperintensa en T2 en relación a macroadenoma hipofisario. Bioquímicos: Prolactina 131.20, GH 2.7, ACTH 18.5, IGF1 434, IGFBP 35.8, TTOG para GH que se informa: GH 0 min: 10.7, GH 30 min: 9.24, GH 60 min: 7.9.&#x0D; Evolución: La paciente fue sometida a hipofisectomía transesfenoidal endoscópica parcial. En tratamiento con cabergolina 0.5 mg bisemanal, levotiroxina 225 mcg día y octreótide 20 mg mensual.&#x0D; Conclusión: Se concluye que siendo la acromegalia una enfermedad rara se asocia a cáncer de tiroides, implicando posibles mutaciones en la subunidad ? de la proteína G.

Development of a Rat Model for Evaluating Thyroid-Stimulating Hormone Suppression after Total Thyroidectomy.

We developed an animal model for evaluating thyroid-stimulating hormone (TSH) suppression therapy after total thyroidectomy in rats. Sixty Wistar rats were randomly divided into 6 groups, including a sham-operated group (SO group), a total thyroidectomy group (TD group), and a L-thyroxine (L-T4) treatment I group (TS-I group), II group (TS-II group), III group (TS-III group), and IV group (TS-IV group) (in which rats were treated with 1.4, 1.6, 1.8, and 2.0 μg/100 g body weight, respectively) after total thyroidectomy. HE staining in the TD group and all L-T4-treated rats showed that the resected tissue was normal thyroid gland. No residual thyroid tissue was found in neck tissue of the cross-section of the thyroid gland. Serum T3 levels in the TS-II group were not significantly different from those in the SO group, whereas serum T4 levels were slightly higher than those in the SO group, and serum TSH levels were slightly lower. Rats subcutaneously injected with L-T4 1.6 μg/100 g body weight for 15 days after total thyroidectomy were suitable as an animal model for TSH suppression therapy.

Endoscopic thyroidectomy versus traditional open thyroidectomy for identification of the external branch of the superior laryngeal nerve.

To explore the anatomical features of the external branch of the superior laryngeal nerve (EBSLN) and determine an effective approach for its preservation during endoscopic thyroidectomy (ET). From January 2017 to December 2018, a total of 405 consecutive patients with thyroid disease were retrospectively analyzed. These patients were divided into the ET group and the open thyroidectomy (OT) group according to the surgical approaches. There were 195 cases in the ET group including 43 males and 152 females, and 210 cases in the OT group including 65 males and 145 females. The dissection process of EBSLN, detection rate, distribution of identification methods of the EBSLN and rate of voice change were recorded. There were 205 EBSLNs detected under direct vision in ET group for a detection rate of 88.0%, while 158 EBSLNs were detected under direct vision in OT group for a detection rate of 58.1%. But with the assistant of intraoperative neuromonitoring (IONM), the number of EBSLNs detected visually reached up to 220 in ET group and 226 in OT group, respectively, for a visual detection rate of 94.4% and 83.1%, respectively. There were significant difference in the rate of direct visual identification, total visual identification with IONM. Stratified risk estimation indicated that the tumor size and location were risk factors for the direct visual dissection of EBSLN. Stratified analysis by tumor size indicated that when tumor diameter was ≤ 4cm, the incidence of vocal cord fatigue and total vocal changes in ET group was significantly lower than that in OT group. Recognition and exposure of the EBSLN can be facilitated by the magnification and focusing function of high-definition endoscopy and the advantage of a 30° variable angle. Full exposure of the sternothyroid-laryngeal triangle and fine dissection along the superior thyroid vessels is beneficial for recognizing the EBSLN.