Subtotal Thyroidectomy Research Articles

Safety of thyroidectomy as day care surgery at a rural setting in Eastern Uganda.

The practice of day care surgery is less embraced in many low-middle-income countries (LMIC), and even less for some procedures considered major such as thyroidectomy. Here we examine the safety of day care thyroidectomy at Kyabirwa Surgical Center, a stand-alone day care surgery center in rural Eastern Uganda. This was a retrospective cohort study conducted between 2019 and 2023. All patients who had day care thyroidectomy were included. Demographics, diagnosis, investigation findings, pathology reports, and surgery outcomes were collected. Postoperative follow-up data up to 30days were also collected. Data were analyzed using R version 4.3.2. A total of 51 patients underwent same-day thyroidectomy, with an average age of 44.9±12.1years and 98% female. Procedures included total thyroidectomy (5, 9.8%), subtotal thyroidectomy (26, 51.0%), and lobectomy (20, 39.2%). Average size of the glands was 7.9±2.21cm. The majority 46 (90.2%) were of benign pathology. All patients were discharged by the evening of the same day. Complications encountered included hypocalcemia (1), hypertrophic scar (1), seroma (2), and transient recurrentlaryngeal nerve injury (1). Overall complications rate was 9.8%. Gland size was statistically significant between patients with no complications (7.68±2.06cm) versus complications (9.90±2.82, p<0.05). With overall low complication rates, these findings suggest that thyroidectomy can safely be performed on a day care basis in a rural LMIC setting with suboptimal health care delivery.

Long-term effect of postoperative radioactive iodine therapy on parathyroid function in patients with differentiated thyroid cancer.

The study aimed to assess the impact of postoperative radioactive iodine (RAI) therapy on parathyroid function in patients who underwent total or subtotal thyroidectomy for differentiated thyroid cancer (DTC). Data from 150 patients treated with RAI for DTC and 76 patients with low-risk DTC not receiving RAI were retrospectively analyzed. Clinical characteristics, preoperative and 1-month postoperative biochemical parameters, and adjusted calcium, phosphorus, parathyroid hormone (PTH), and 25-hydroxyvitamin D3 (25-OH-D) levels at 3months, 1year, 3years, and 5years post-RAI (or in the low-risk group) were recorded. A total of 226 DTC patients were included in the study (80.5% female, mean age 42.7 ± 13.2years). Total thyroidectomy was performed in 97.3% (n = 220) of patients, with central lymph node dissection (CLND) in 41.6% (n = 94). No significant preoperative differences in PTH, aCa, P, Mg, or 25-hydroxyvitamin D3 levels were observed. However, patients receiving ≥ 3.7GBq (or 100mCi) RAI (n = 70) had lower calcium and PTH levels at the end of the first year following RAI treatment (p = 0.048, p = 0.032). The non-RAI group showed significantly higher calcium levels at one month postoperatively (p = 0.031) and lower rates of CLND and neck dissection. No significant differences in biochemical parameters were found at the five-year follow-up, except for one patient who developed normocalcemic hyperparathyroidism after RAI. High-dose RAI therapy may lead to transient decreases in calcium and PTH levels in the early post-treatment period. However, long-term parathyroid function appears to remain unaffected in DTC patients, regardless of the RAI dose administered. Nonetheless, close monitoring of calcium and PTH levels is recommended, particularly in the early post-treatment period, to promptly manage any potential transient hypoparathyroidism.

Frequency and outcomes of parathyroid preservation in total thyroidectomy.

Objective: To determine the frequency and its outcome of parathyroid preservation in total thyroidectomy. Study Design: Case Series study. Setting: Department of Otorhinolaryngology, HMC, MTI, Peshawar. Period: 23rd June 2022 to 23rd Dec 2022. Methods: A total of 246 patients who underwent thyroidectomy were included in the study and followed up to determine the preservation of parathyroid gland, hypocalcaemia and recurrent laryngeal nerve injury. Results: The mean age of the sample was 37.7 + 12.3 years. There were 52.8% male patients and 47.2% female patients. 28.9% of patients had thyroid nodule and subtotal thyroidectomy was the most performed procedure Parathyroid gland preservation was recorded in 72%. On follow up, hypocalcemia was recorded in 16.3% and recurrent laryngeal nerve injury in 20.3%. Conclusion: Hypocalcemia and RLNI are significantly common after thyroidectomy. Hypocalcemia was significantly high in patients with low non preserved parathyroid gland. More research on high sample size and addressing other effect modifiers are recommended with intervention to preserve parathyroid gland.

The anatomical relationship between recurrent laryngeal nerve and inferior thyroid artery in thyroidectomy patients.

Objective: To identify the anatomical relationship of recurrent laryngeal nerve with inferior thyroid artery. Study Design: Prospective Clinical study. Setting: Department of Surgery, Kishwar Fazal Teaching Hospital. Period: July 2019 to February 2023. Methods: Total 64 patients underwent subtotal thyroidectomies for proven benign goiters were enrolled. Results: Out of these 64 patients, 8 were male and 56 were female, male to female ratio 1:7 with median age 34 years. In 64 patients, 128 dissections were performed and in all patients (RLN) and its relation with Inferior Thyroid Artery (ITA) was identified. On right side of neck in 63 (98.43%) patients out of 64 (100%) patients RLN found deeper to ITA and in one (1.56%) patient it was found superficial to ITA. On left side of neck in 61 (95.31%) patients out of 64(100%) patients it was deeper to ITA and in 3 (4.68%) patients the nerve was superficial to ITA. Identification of RLN was difficult in 16 (12.5%) dissections and the reason was adhesions and huge multinodular goiter. Conclusion: During thyroid surgery, the connection between RLN and ITA is significant to surgeons. When it comes to RLN security, visible anatomical identification is still the gold standard.

Surgical Outcomes in Thyroidectomy for Patients with Graves’ Disease: A Randomized Controlled Trial

Background: Thyroidectomy is a preferred protocol for patients with Graves’ disease. However, it may be a challenging option in post-surgical management of various factors. There, this study aims to compare the surgical outcomes of total thyroidectomy and subtotal thyroidectomy in patients with Graves’ disease to provide evidence-based surgical decision-making. Methods: This randomized controlled trial was conducted at Sheikh Zaid Hospital, Rahim Yar Khan, October 2023 to April 2024; enrolled 120 patients diagnosed with Graves’ disease using a simple random sampling technique were assigned to Group A (n=60) and B (n=60) who underwent total thyroidectomy, and subtotal thyroidectomy respectively. Preoperative assessments and surgeries were performed while postoperative outcomes, complications, and thyroid function tests were also monitored and represented using independent t-tests while a p&lt;0.05 was considered significant. Results: It was revealed that operative time was significantly higher for total thyroidectomy than subtotal thyroidectomy 125.60±14.56 and 97.54±12.56 respectively, suggesting significantly lower time consumption in subtotal thyroidectomy procedure (p=0.001). Patients who underwent subtotal thyroidectomy had a significantly shorter hospital stay compared to those who underwent total thyroidectomy (p=0.02). Moreover, levels of triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH) were significantly different between the two groups. Patients who underwent subtotal thyroidectomy had significantly lower T3 and T4 levels and higher TSH levels compared to those who underwent total thyroidectomy (p&lt;0.05). Conclusion: Subtotal thyroidectomy demonstrated favorable outcomes, including shorter operative time, lower rates of postoperative complications, and thyroid function tests compared to total thyroidectomy. These findings help and support the consideration of subtotal thyroidectomy as a viable surgical approach for patients with Graves' disease. Keywords: Grave Disease, Thyroidectomy, Thyroxine, Triiodothyronine.

7355 A Case of High-Risk Thyroid Tumor Markers Found in Subcutaneous Thyroid Implants in a Patient with Benign Thyroid Pathology

Abstract Disclosure: J. Fedorko: None. S. Fatima: None. A.P. Amblee: None. C.A. Poku: None. Background: While fine needle aspiration (FNA) remains the primary diagnostic tool for thyroid malignancies, the utilization of molecular markers has become increasingly common in the workup of thyroid nodules. They play a useful role in distinguishing between malignant and benign pathology when cytology is indeterminate and in formulating treatment plans. The vast majority of research for these genetic markers is conducted in cases with thyroid malignancy. However, there have been numerous cases where these genetic markers were identified in benign thyroid tissue. Case: A 73-year-old male with left hemithyroidectomy (benign left nodule) presented 6 years later with new superficial neck nodules along the midline, left thyroid bed and R thyroid lobe. FNA of the right thyroid nodule was benign. Three months later the patient underwent an excision of the midline neck nodules which revealed thyroid tissue arranged in nests of fibrotic tissue without definite features of papillary thyroid carcinoma. Molecular analysis (Thyroseq) was positive for HRAS, E1F1AX and TERT mutations thus metastatic follicular carcinoma was suspected. The patient underwent complete thyroidectomy. Pathology revealed normal thyroid tissue and a diagnosis of thyroid neck implants was made. Given the benign pathology, the plan was for close follow-up with neck imaging every 6 months. Discussion: Thyroid tissue implants can rarely be caused by previous surgical interventions, especially partial thyroidectomy. There is literature documenting similar clinical cases in which subcutaneous thyroid implants are found in patients after undergoing total or subtotal thyroidectomy. In one case series, there were cases in which thyroid implants were discovered 26 years post-surgery, with most of the cases reporting benign pathology. Given our patient’s presentation and clinical history, the possibility remains that his subcutaneous tissue findings were caused by his prior partial thyroidectomy. A recent article reviewed 60 publications and &amp;gt;8000 patients for the prevalence of high-risk tumor markers (RAS mutation, RET/PTC, and PAX8/PPAR-gamma chromosomal rearrangements) in benign thyroid tissue. They concluded that prevalence findings were highly variable, warning providers to exercise caution when using these genetic markers to guide diagnosis and treatment decisions. Conclusion: While certain high-risk genetic tumor markers are increasingly used to help identify thyroid malignancies, it is important to keep in mind that these genetic markers are not exclusively found in cancerous tissue, and should not be used as the sole diagnostic tool for diagnosis and treatment. While it is imperative that metastatic disease is ruled out, it is essential to consider other pathologies when evaluating recurrent thyroid and neck masses in patients with a history of benign thyroid lesions. Presentation: 6/3/2024

Влияние послеоперационного гипотиреоза на гормональную регуляцию сперматогенеза и функциональное состояние семенников у экспериментальных животных

Abstract: the aim of the study was to determine the effect of postoperative hypothyroidism on spermatogenesis in experimental dogs. Materials and Methods: experimental studies were performed on 20 mongrel male dogs. The study was randomized, 3 groups were identified. The first group was a control group, 4 dogs served as controls. Hemithyroidectomy was performed in the second group, subtotal thyroidectomy was performed in the third group. The operations were performed under general anesthesia. The testes, thyroid gland and blood were the objects of the study. In the postoperative period, biochemical and histological analyses of the removed thyroid gland tissue and testicles of the examined dogs were performed. The determination of hormones in the blood before and after surgery was carried out using a chemiluminescent analyzer Roche Codas E601 (Switzerland). Results: in the course of the study, in the postoperative period, experimental dogs had a decrease in testosterone in serum by 15% on day 5-8, and from 15% to 30.1% on day 20; in dogs after subtotal thyroidectomy, this indicator was 41.1% on day 20 (p &lt; 0.005). Changes in FSH and prolactin in the blood were different in all groups. The FSH index had a significant increase on day 5-8, and a decrease on day 20, and the prolactin index on the contrary: a decrease on day 5-8 and an increase on day 20. The hormonal activity of the thyroid gland was reduced, especially after subtotal thyroidectomy. Morphological studies have shown a marked decrease in the activity of the spermatogenic layer and interstitial edema of the testes on 5-8 days in both groups. On the 30th day, in both groups after surgery, there was a noticeable decrease in both the spermatogenic layer and the interstitial cells of the testes. Conclusion: the results of experimental studies have shown that as a result of hemithyroidectomy and subtotal thyroidectomy, there is a noticeable change in the regulation of spermatogenesis and structural and functional changes in the testes of experimental animals, especially in the iodine-deficient region. Keywords: postoperative hypothyroidism, spermatogenesis, semens, hormones, hemitireoidectomy.

Extent of surgery in the surgical treatment of graves' disease: subtotal vs. total thyroidectomy and comparison of the long-term results

Extent of surgery in the surgical treatment of graves' disease: subtotal vs. total thyroidectomy and comparison of the long-term results

Comparing total thyroidectomy and subtotal thyroidectomy for benign thyroid disorders: A retrospective cohort study

Comparing total thyroidectomy and subtotal thyroidectomy for benign thyroid disorders: A retrospective cohort study

Comparison of the Outcome Between Ligasure and Conventional Suture tie Techniques in Patients Undergoing Thyroidectomy

Objective: To compare the outcome between ligasure and conventional suture tie techniques in patients undergoing thyroidectomy. Study setting and duration: This study was conducted in the department of general surgery, DHQ hospital Dera Ghazi Khan, over a period of one year from September 2022 to September 2023. Subject and methods: This randomized controlled study was conducted on 60 patients divided in two groups, group a (ligasure technique and group b (conventional suture technique) having age 30-65 years either male or female gender presented to undergo thyroidectomy. Patients undergoing chemotherapy, recurrent cases and bleeding diathesis (INR &gt; 1.5) were excluded. The participants were randomly assigned to group A and group B through draws method using sealed opaque envelopes. All the surgical procedures were performed as per institutional protocol by consultant surgeon with ? 5-year post-fellowship experience. All the patients received anesthesia as per hospital protocol. Results: This study was conducted on 60 patients divided in two groups equally, group a (ligasure technique) and group b (conventional technique). The mean age in group A was 47.80±11.54 years and 44.83±10.38 years in group B. among patient in group A 10 (33.3%) patients had total thyroidectomy while 20 (66.7%) patients had subtotal thyroidectomy and in group B 12 (10%) patients had total thyroidectomy while 18 (60%) patients had subtotal thyroidectomy. Group A had significantly shorter operative time (62.07±3.09 mins vs 69.70±3.18 mins, P = 0.0001) as compared to group B. According to the comparison of total blood loss between both groups, group A had significantly lower blood loss (56.27±2.50 ml vs 68.57±2.92) as compared to group B. Conclusion: It can be concluded that ligasure technique had better outcomes as compared to conventional suture tie technique. The mean operative time and blood loss was significantly lower in ligasure technique as compared to conventional suture technique. Keywords: Conventional technique, ligasure, mean operative time, post-operative blood loss, thyroidectomy

Incidence and risk factors for recurrent laryngeal nerve injury after thyroid surgery

ObjectivesInjury to the recurrent laryngeal nerve (RLNI) is a known possible morbidity after thyroid surgery. The clinical presentation varied in severity, from changes in voice quality and swallowing in unilateral cases to airway compromise in bilateral cases. In minor cases, vocal fold paralysis (VFP) may occur unnoticed. Although many intraoperative measures have been implemented to minimize nerve injury, the risk remains, either transient or permanent. This study evaluated the incidence and potential risk factors of recurrent laryngeal nerve injury after thyroidectomy.MethodsRetrospective data analysis was conducted on 1368 patients who underwent thyroidectomy at the National Guard Hospital, King Abdul-Aziz Medical City, Jeddah, Saudi Arabia, between January 2008 and December 2021. Evaluations were conducted on the pathological features, surgical procedure type, and state of the recurrent laryngeal nerve during surgery as contributing to recurrent laryngeal nerve injury. All patients underwent preoperative and postoperative indirect laryngoscopy examinations with or without videostroboscopy. Physiological testing of the RLN using neurostimulation and laryngeal palpation (NSLP) or intraoperative neuromonitoring (IONM) was performed in all cases. VFP was considered present when vocal fold mobility was absent or significantly reduced.ResultsA total of 1368 patients (2177 nerves at risk) who underwent thyroidectomy and fulfilled the inclusive criteria (809 bilateral, 559 unilateral) were evaluated. A total of 62% of patients were more than 45 years old, and the mean age was 48.36 ± 13.03 with a male-to-female ratio of 1:3.6. Eight-hundred one (58.6%) patients underwent total or subtotal thyroidectomies (1602 nerves at risk). Two-hundred seventy-six patients underwent hemithyroidectomy (276 nerves at risk), and 291 patients underwent completion or redo surgeries (299 nerves at risk). Of these 1368 patients, post-surgery laryngoscopy showed reduced or absent vocal fold mobility in 47 (3.4%) patients. Forty-three out of 47 patients had unilateral vocal fold paralysis, and 4 had bilateral VFP. When we analyzed the three risk factors statistically significant for postoperative RLN palsy, age (OR, 1.01; 95% CI, 0.98–1.05; p = 0.365) became non-significant. The other risk factors (extent of surgery and histopathological diagnosis) remained statistically significant (p = 0.004 and 0.031). After adjustment, the extent of surgery, including total thyroidectomy and revision surgery, was strongly associated with a higher risk of odds of postoperative RLN palsy. Physiological RLN stimulation was performed in all cases with NSLP or INOM, and no significant association was observed in the incidence of VFP (p = 0.365). In most cases, symptoms were spontaneously resolved with recovery of vocal fold movement within a few months.ConclusionIn this study, 3.4% of the recurrent laryngeal nerve showed postoperative dysfunction either transient or permanent VFP. Intraoperative identification of the nerve remains the gold standard of care during thyroidectomy. Neuromonitoring aids in detecting the nerve, particularly in severe cases, but does not reduce the nerve injury compared to NSLP.

HYPERTHYROIDISM AND GRAVES' DISEASE: OPHTHALMOLOGICAL MANIFESTATIONS AND SURGICAL TREATMENT.

Introduction: Hyperthyroidism, characterized by the excessive production of hormones by the thyroid gland, can lead to various systemic complications, including ophthalmological manifestations such as Graves' Orbitopathy (GO). Graves' Disease, one of the main causes of hyperthyroidism, is often associated with these ocular complications, which include ocular protrusion, diplopia, and periorbital swelling. Surgical treatment, including total or subtotal thyroidectomy, emerges as an option to control the progression of hyperthyroidism and improve associated ophthalmological symptoms. **Objective**: To analyze the ophthalmological manifestations of hyperthyroidism and Graves' Disease, as well as evaluate the effectiveness of surgical treatment in managing these complications. **Methodology**: The review followed the PRISMA checklist to ensure rigor and transparency. Searches were conducted in PubMed, Scielo, and Web of Science databases using five descriptors: "Hyperthyroidism," "Graves' Disease," "Graves' Orbitopathy," "Surgical Treatment," and "Ophthalmological Manifestations." Inclusion criteria encompassed articles published in the last 10 years, studies focused on surgical treatment for GO, and works explicitly addressing the ophthalmological manifestations of Graves' Disease. Exclusion criteria included studies that did not discuss surgical treatment, non-peer-reviewed articles, and publications older than a decade. **Results**: The analysis revealed that Graves' Orbitopathy frequently manifests with symptoms such as ocular protrusion, diplopia, and periorbital edema, significantly impacting patients' quality of life. Thyroidectomy proved effective in reducing hormone levels, resulting in symptomatic improvements for many patients. However, outcomes varied, and surgical intervention was not always associated with complete resolution of ophthalmological manifestations. **Conclusion**: Surgical treatment of hyperthyroidism and Graves' Disease can provide significant relief from ophthalmological manifestations, though it does not guarantee complete resolution of symptoms. Surgery should be considered within a multidisciplinary context, taking into account the severity of ocular symptoms and response to conservative treatment. The review highlighted the need for integrated treatment strategies to optimize outcomes for patients with ophthalmological complications associated with hyperthyroidism and Graves' Disease.

Surgical Outcomes in Thyroidectomy for Patients with Graves’ Disease: A Randomized Controlled Trial

Background: Thyroidectomy is a preferred protocol for patients with Graves’ disease. However, it may be a challenging option in post-surgical management of various factors. There, this study aims to compare the surgical outcomes of total thyroidectomy and subtotal thyroidectomy in patients with Graves’ disease to provide evidence-based surgical decision-making. Methods: This randomized controlled trial was conducted at Sheikh Zaid Hospital, Rahim Yar Khan, October 2023 to April 2024; enrolled 120 patients diagnosed with Graves’ disease using a simple random sampling technique were assigned to Group A (n=60) and B (n=60) who underwent total thyroidectomy, and subtotal thyroidectomy respectively. Preoperative assessments and surgeries were performed while postoperative outcomes, complications, and thyroid function tests were also monitored and represented using independent t-tests while a p&lt;0.05 was considered significant. Results: It was revealed that operative time was significantly higher for total thyroidectomy than subtotal thyroidectomy 125.60±14.56 and 97.54±12.56 respectively, suggesting significantly lower time consumption in subtotal thyroidectomy procedure (p=0.001). Patients who underwent subtotal thyroidectomy had a significantly shorter hospital stay compared to those who underwent total thyroidectomy (p=0.02). Moreover, levels of triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH) were significantly different between the two groups. Patients who underwent subtotal thyroidectomy had significantly lower T3 and T4 levels and higher TSH levels compared to those who underwent total thyroidectomy (p&lt;0.05). Conclusion: Subtotal thyroidectomy demonstrated favorable outcomes, including shorter operative time, lower rates of postoperative complications, and thyroid function tests compared to total thyroidectomy. These findings help and support the consideration of subtotal thyroidectomy as a viable surgical approach for patients with Graves' disease. Keywords: Grave Disease, Thyroidectomy, Thyroxine, Triiodothyronine.

Changes in Liver Function and Lipid Profile during Underactive Thyroid Phase in Patients after Subtotal Thyroidectomy

Changes in Liver Function and Lipid Profile during Underactive Thyroid Phase in Patients after Subtotal Thyroidectomy

Evaluation of early postoperative complications after thyroidectomy: A retrospective study

Objectives: This study aimed to report our experience in early postoperative complications of thyroid surgery. Patients and Methods: This study was conducted by retrospectively analyzing the files of 196 patients (145 females, 51 males; mean age: 48.0±18.9 years; range, 18 to 86 years) who underwent thyroid surgery between January 2017 and December 2021. Patients under the age of 18, patients with preexisting hypocalcemia, vocal cord paralysis, Horner's syndrome, tracheal or esophageal injuries, previous history of thyroid surgery (lobectomy, subtotal thyroidectomy), and patients whose files could not be reached were excluded from the study. Patients’ demographic data, preoperative indications, surgical technique, and early postoperative complications were recorded. Results: The most common surgical indication was multinodular goiter, with a rate of 33.7% (n=66). As the surgical technique, total thyroidectomy was performed in 127 (64.8%) patients, 54 (27.6%) patients underwent isthmelobectomy, and 15 (7.6%) patients underwent neck dissection combined with total thyroidectomy. Of the neck dissection patients included in the study, 12 (6%) were bilateral central, and three (1.6%) were lateral neck dissection. Early postoperative complications developed in 89 (45.4%) patients who underwent thyroid surgery. No complications were observed in 107 (54.6%) patients. Hypocalcemia was the most common complication with 33.1% (n=65). Hypocalcemia was followed by recurrent laryngeal nerve injury in 10.2% (n=20). Hematoma was observed in 3% (n=6), seroma in 3.5% (n=7), and wound infection in 1% (n=2). Tracheal damage, hoarseness, and chylous fistula were not observed among the patients included in the study. Conclusion: With close postoperative follow-up, a multidisciplinary approach to complications, and high surgical experience, the rates of complications developing in the early period due to thyroid surgery are reduced. Thyroid surgery is a safe surgery with low morbidity and mortality rates when suitable conditions are provided.

When an ectopic and hyperfunctional thyroid nodule appears 2 decades after subtotal thyroidectomy: A case report

When an ectopic and hyperfunctional thyroid nodule appears 2 decades after subtotal thyroidectomy: A case report

Incidental Thyroid Carcinoma in Thyroidectomy Specimen with Clinical Correlation in Iraqi Patients

Abstract Background: Incidental thyroid carcinoma is a clinically unsuspected carcinoma that was discovered by histopathological examination of a thyroidectomy specimen removed for benign diseases. Objectives: To evaluate the frequency of incidental thyroid carcinoma in the thyroidectomy specimens and how to avoid its sequel in Iraq. Materials and Methods: A retrospective study of 104 cases of total and subtotal thyroidectomy for benign diseases was collected from Al-Sader teaching hospital during 2019–2022, reviewed by two pathologists for incidental primary malignancy, and analyzed using SPSS version 27. Results: Incidental thyroid malignancy was detected in 10.54% of all cases. It had been found in 13.8% of multinodular goiter (MNG) cases. Eight cases out of eleven (72.7%) of incidental malignancies were detected in total thyroidectomy specimens and the same percentage of them were detected in MNG cases. Ten out of eleven cases (90.9%) of incidental carcinoma were papillary carcinoma type (six cases were micropapillary type and four cases were conventional type of papillary carcinoma) with one case of follicular carcinoma. Conclusion: MNG does not mean the absence of carcinoma in the thyroid gland. Total thyroidectomy is the best surgery to avoid complications of unsuspected carcinoma and the sequel of another surgery.

Frequency and Risk Factors of Tracheomalacia in Patients Undergoing Thyroidectomy.

It was a descriptive cross-sectional study to determine the frequency and risk factors of tracheomalacia in patients undergoing thyroidectomy. One hundred and forty-nine patients underwent thyroidectomy at MTI-Khyber Teaching Hospital Peshawar between 1st January 2021 and 1st March 2022. The frequency of post-thyroidectomy tracheomalacia and possible associated factors were determined. The inclusion criteria were patients of either gender, between 18 to 70 years fulfilling criteria of clinically diagnosed cases of thyroid disorders who underwent subtotal, hemi, near or total thyroidectomy for their respective thyroid diseases. Post-thyroidectomy tracheomalacia was recorded in 18 patients (12.1%): Seventeen patients were aged less than 30 (p-value 0.038) and 14 (77.8%) patients had a duration of surgery > three hours (p-value <0.001). Young female patients with multinodular goitre who had a longer duration of surgery developed post-thyroidectomy tracheomalacia more frequently. Hence, the incidence of post-thyroidectomy tracheomalacia can be markedly reduced with proper preoperative assessment and postoperative measures. Key Words: Thyroid gland, Thyroid disorders, Tracheomalacia, Thyroidectomy.

Thyroidectomy Effects on the Body Mass Index and Thyroid-Stimulating Hormone: A Systematic Review and Meta-Analysis.

Thyroidectomy is common and is performed for malignancy, goiters with pressure symptoms, and certain types of Grave's disease. Weight and body mass index (BMI) following thyroidectomy were discussed controversially. This meta-analysis aimed to assess weight and BMI following thyroidectomy. A systematic literature search was conducted in PubMed, Medline, and Google Scholar with interest in articles that assessed body weight and BMI following total or subtotal thyroidectomy. The search engine was limited to the period from inception up to January 2024. Keywords "total thyroidectomy", "subtotal thyroidectomy", "Graves' disease", "multinodular goiter", "differentiated thyroid carcinoma", and "toxic nodules" were used. Out of the 634 articles retrieved, 89 full texts were screened, and only six studies (five retrospective and one prospective cohort) fulfilled the inclusion and exclusion criteria. No differences were evident regarding weight and BMI before and after thyroidectomy (odds ratio: -0.63, 95%CI: -1.50 to -0.24, P-value for the overall effect: 0.15; and odds ratio: -0.12, 95% CI: -0.41 to -0.16, P-value for the overall effect: 0.40 respectively). No heterogeneity was observed (I2 for heterogeneity: 0.0%). No association between thyroidectomy (when performed for differentiated thyroid carcinoma and hyperthyroidism), weight, and BMI was found. Further studies assessing thyroid-stimulating hormone (TSH) levels, radioactive iodine therapy, and thyroxine dose are needed.

Complications of thyroidectomy: Insights from a single-centre study in northeast India

To study and compare the frequency of post-operative complications associated with thyroid surgeries indicated for various benign and malignant pathologies and assess the outcome of management of such complications in a tertiary care hospital in Northeast India. An analytical study was done at a tertiary care hospital in Assam over a period of 1 year from May 2022 to June 2023. Data was collected from 53 patients who underwent surgery at this hospital. Hemithyroidectomy, subtotal, near-total, and total thyroidectomies were performed in 31(58.4%), 2 (3.7%), 6 (11.3%) and 14 (26.4%) cases respectively. The overall rate of complications was 39.6%. Permanent hypocalcaemia was observed to be the most common complication, followed by transient hypocalcaemia and transient recurrent laryngeal nerve palsy. The complications were found to be more frequent in surgery for malignant thyroid disease. There was no mortality in our study. A better understanding of thyroid gland anatomy, meticulous haemostasis and Identification of Recurrent laryngeal nerve and parathyroid glands lead to favourable post-operative outcomes. Appropriate post-operative care with early identification and management of complications plays an essential role in reducing the duration of postoperative hospital stay and limiting patient morbidity.