Safety Of Total Thyroidectomy Research Articles

Efficacy & safety of total thyroidectomy as preferred primary treatment option for Graves’ disease

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

Total Thyroidectomy Without Prophylactic Central Cervical Lymph Node Dissection: Is It Oncologically Safe in Patients with Early-Stage Papillary Thyroid Carcinoma

Background: The necessity and the benefits of prophylactic central cervical lymph node dissection (PCLND) in clinically node negative patients with early-stage papillary thyroid carcinoma (PTC) remain controversial. Objective: to evaluate the safety of total thyroidectomy without PCLND in clinically node-negative early-stage PTC. Patients & Methods: 34 patients with T1 or T2 & N0 PTC were included in the study and submitted to total thyroidectomy without PCLND. Post-operatively, all patients received TSH suppression therapy & radio-active iodine (RAI) ablation. Any suspicious local neck recurrence during the follow up was confirmed cytologically and treated by RAI ablation. Results: The mean age was 42.1 years. 55.9% of patients were less than 45 years and 44.1% were 45 years old or more. Male to female ratio was 10:24. T1 was found in 14 cases & T2 in 20 cases. Total thyroidectomy was successfully done for all the cases. Central cervical lymph nodes sampling was done in 5 cases. Excised lymph nodes were found in 8 specimens; 5 cases with lymph node sampling (14.7%) and 3 cases (8.8%) with accidental lymph node excision during thyroidectomy. only 6 of these 8 patients (17.6%) showed positive metastasis (pN1). No recurrent laryngeal nerve injury was reported. In 12 patients (35.3%), temporary hypocalcemia was encountered. The mean follow up period was 34.6 months. There were 2 recurrences (5.9%); 1 in the central & 1 in the lateral neck compartment. All recurrences were treated by RAI ablation. No distant metastasis or mortality was reported. Conclusion: total thyroidectomy without PCLND in clinically node-negative early stage PTC is an excellent treatment option that gives adequate loco-regional control of the disease with low rate of surgical complications. Close follow up for longer periods is needed.

Total Thyroidectomy versus Bilateral Subtotal Thyroidectomy for Bilateral Multinodular Nontoxic Goiter: A Meta-Analysis

Aim: The aim of this meta-analysis is to assess and validate the feasibility and safety of total thyroidectomy (TT) when compared to bilateral subtotal thyroidectomy (BST) for bilateral multinodular nontoxic goiter (BMNG). Materials and Methods: PubMed, Web of Knowledge, and Ovid's database were searched for studies published in English language between January 1990 and December 2014. A meta-analysis was performed to compare the complications and recurrences of TT versus BST. The search terms used were ‘total thyroidectomy', ‘bilateral subtotal thyroidectomy', ‘multinodular nontoxic goiter' and ‘randomized clinical trial'. The reference lists of relevant studies were checked manually to locate any missing studies. Results: Four trials with a total of 1,078 patients were analyzed. Although the incidence of transient hypoparathyroidism was higher in TT than in BST (OR = 2.59, 95% CI [1.58-4.24], p = 0.0002), TT was associated with a significantly lower incidence of recurrence (OR = 0.04, 95% CI [0.01, 0.17], p < 0.0001). There were no statistically significant differences for the presence of transient/permanent recurrent laryngeal nerve palsy and permanent hypoparathyroidism between the two groups. Conclusion: TT is a feasible and safe procedure for patients with BMNG. Although TT involves a significantly higher risk of postoperative transient hypoparathyroidism, it has a lower recurrence rate than BST.

The efficacy and safety of total thyroidectomy in the management of benign thyroid diseases

Background: Total thyroidectomy is currently the preferred treatment for thyroid cancer, multinodular goitre and Graves disease,· however, many surgeons choose not to perform total thyroidectomy to treat benign thyroid diseases owing to the associated risk of postoperative hypoparathyroidism and recurrent laryngeal nerve damage. We followed up 100 thyroidectomies performed for benign thyroid diseases when surgery was indicated. We sought to assess whether the results support the hypothesis that total thyroidectomy is as safe and more effective as subtotal thyroidectomy and can be considered as the optimal surgical approach for treating benign thyroid diseases. Methods: A total of 100 patients underwent thyroidectomy between January 2008 and June 2009. We excluded patients with thyroid cancer or suspicion of thyroid malignancy. We evaluated operative time, intraoperative blood loss, cancer incidence, complication rates, local recurrence rate and long-term outcome after total and subtotal thyroidectomy. Results: All patients were diagnosed before surgery to have benign thyroid disease by fine needle aspirate. The incidence of permanent recurrent laryngeal nerve palsy (unilateral or bilateral) was 0% in both groups, whereas the incidence of temporary unilateral recurrent laryngeal nerve palsy was 4% in cases of total thyroidectomy and 2% in cases of subtotal thyroidectomy. Permanent hypocalcemia occurred in 2% in each group and overall temporary hypocalcemia occurred in 10% ofpatients with total thyroidectomy and 8% ofpatients with subtotal thyroidectomy. Hemorrhage requiring repeat surgery occurred in 2% of patients with total thyroidectomy and 4% of patients with subtotal thyroidectomy. There was no wound infection, and postoperative mortality was 0%. Incidental finding of cancer appeared in 8% of patients with total thyroidectomy and 18% of patients with subtotal thyroidectomy. We observed no disease recurrence during a follow-up of 18 months in patients with total thyroidectomy, while a high rate of recurrence (8%) appeared in patients with subtotal thyroidectomy in the same follow-up period. Conclusion: Total thyroidectomy is safe and is associated with a low incidence of disabilities. Complication rates for recurrent laryngeal nerve palsy and hypoparathyroidism are approximately similar to results of those with subtotal thyroidectomy. Furthermore, total thyroidectomy seems to be the optimal procedure, when surgery is indicated, for benign thyroid diseases as it has the advantages of immediate and permanent cure and no recurrences and higher rate of detection of occult cancer.

Prophylactic thyroidectomy in pediatric carriers of multiple endocrine neoplasia type 2A or familial medullary thyroid carcinoma: mutation in C620 is associated with Hirschsprung's disease

Purpose Prophylactic total thyroidectomy is now recommended after having confirmed RET mutations in children of parents with multiple endocrine neoplasia type 2 or familial medullary thyroid carcinoma. We reviewed our experience to determine the incidence of medullary thyroid carcinoma with respect to age at surgery, the location of the mutation, and its association with Hirschsprung's disease (HD). Methods A retrospective review from 1996 to 2005 revealed 20 children with genetic screening for multiple endocrine neoplasia type 2A or familial medullary thyroid carcinoma who underwent a prophylactic total thyroidectomy with parathyroid gland preservation. Results The median age of the 20 patients (9 boys and 11 girls) included in this study was 8.2 years (range, 3.7-16.9 years) at the time of their surgery. Final pathology revealed normal thyroid tissue (n = 3; median age, 5.9 years), C-cell hyperplasia (n = 13; median age, 10 years), or medullary thyroid carcinoma (n = 4; median age, 8 years). Four children, all with mutations in C620, had a previous diagnosis of HD. At a median follow-up of 3.7 years (range, 1 month to 8.4 years), all patients were well and cancer free. Conclusions There is no correlation between histologic findings and median age at surgery. Hirschsprung's disease was found in 50% of the patients with the RET mutation in C620. In children of C620 parents, symptoms of HD should be actively sought, and if such are found, rectal biopsies should be performed even if mutation results are not yet available. Based on the age of the earliest cancer and the safety of total thyroidectomy, children should promptly undergo surgery after genetic screening and before their fifth year of life.

Safety of total thyroidectomy: review of 100 consecutive cases.

During a 6-year period (June 1982 to June 1988), 100 consecutive total thyroidectomies were performed at Mount Sinai Hospital, University of Toronto, for benign and malignant disease. There were five permanent complications: one deliberate sacrifice of the recurrent laryngeal nerve and four cases of persistent hypoparathyroidism. Four of these five complications occurred in extracapsular carcinoma and resulted from oncologic wide-field resection and/or deliberate sacrifice. One patient with benign disease suffered initially transient hypoparathyroidism which has now become permanent. Interestingly, two patients actually underwent deliberate sacrifice of a recurrent laryngeal nerve; one patient has made a surprising recovery at 16 months postoperative and now has full vocal cord mobility. Our experience suggests that the morbidity of total thyroidectomy relates primarily to the stage of malignancy and extracapsular extension, necessitating en bloc excision accompanied by additional lymph node dissection. The low incidence of permanent complications in benign thyroid disease suggests the feasibility of total thyroidectomy as the operation of choice when surgeons are familiar with the technique and indications.