Temporary Hypocalcemia Research Articles

Incidental Parathyroidectomy After Thyroid Surgery: A Single-Center Study.

Hypoparathyroidism with hypocalcemia is the most frequent complication after thyroid surgery. Many risk factors have been involved in the development of this complication, with conflicting results. Incidental parathyroidectomy (IP) may be a frequent cause of postoperative hypocalcemia. In this study, we have evaluated the risk factors associated with the IP in a single-center cohort of patients undergoing thyroid surgery. The incidence and the risk factors for IP were evaluated in 799 patients scheduled for surgical treatment for thyroid disease between January 2018 and December 2023. Parathyroid hormone levels and serum calcium levels, together with the histological specimens, were evaluated in all patients. Post-operative temporary hypocalcemia was present in 239 (29.9%) patients. A total of 144 patients (21.9%) had an incidental parathyroidectomy. Younger patients (<40 years) had the highest risk of having an incidental parathyroidectomy (RR 1.53 (95% CI 1.084-2.161), OR 1.72 (95% CI 1.091-2.710), p = 0.014). Moreover, thyroid cancer (RR 1.4 (95 CI 1.114-1.882) OR 1.68 (95% CI 1.145-2.484), p < 0.05) and the neck dissection (RR 1.75 (95% CI 1.409-2.198) OR 2.38 (95% CI 1.644-3.460), p < 0.001) were strongly associated with the risk of incidental parathyroidectomy. Younger female patients with thyroid cancer and neck dissection were at the highest risk of incidental parathyroidectomy. A meticulous surgical dissection, together with imaging methods for the detection of the parathyroid glands, may reduce the incidence of this complication.

Implication of surgical loupes on complications following thyroidectomy: a meta-analysis.

To determine the effectiveness of surgical loupes in reducing postoperative RLN palsy and hypocalcemia following thyroidectomy. PubMed, Scopus and Google Scholar databases were searched between 2000 and 2024. Studies were included if they reported at least one complication outcome following thyroidectomy using surgical loupes. The outcome measure was the log odds ratio, with negative log odds indicating results favouring the experimental group. The model utilized the DerSimonian-Laird estimator, and Wald-type tests. The qualitative data synthesis included 813 patients from 6 included studies, including 410 patients with surgical loupes and 403 patients without surgical loupes. There was a statistically significant reduction in the rate of temporary RLN palsy in the surgical loupe group log(OR) = - 0.87 [(- 1.58, - 0.15), DL (Dersimonian and Laird method), REM (random effects model), CI (confidence interval) = 95%], or a 41.8% lower probability. The rates of permanent RLN palsy log(OR) = - 0.31 [(- 1.45, 0.82), DL, REM, CI = 95%], temporary hypocalcemia log(OR) = - 0.34 [(- 1.25, 0.57), DL, REM, CI = 95%], and permanent hypocalcemia log(OR) = - 0.85 [(- 2.24, 0.54), DL, REM, CI = 95%] were not statistically significant between the two groups, although there were trends toward decreases in these rates in the loupes group. Surgical loupe use during thyroidectomy can lead to a 41.8% lower probability of temporary RLN palsy compared to operating without loupes. 3a.

Risk Factors for Transient and Permanent Hypoparathyroidism Following Thyroidectomy: A Comprehensive Review.

Hypoparathyroidism is a common complication following thyroidectomy, resulting in significant disturbances in calcium homeostasis due to low parathyroid hormone (PTH) levels. This comprehensive review examines the risk factors associated with transient and permanent hypoparathyroidism post-thyroidectomy, emphasizing surgical, patient-related, and perioperative factors. Transient hypoparathyroidism, characterized by temporary hypocalcemia resolving within weeks to months, is often managed with short-term calcium and vitamin D supplementation. In contrast, permanent hypoparathyroidism persists beyond six months post-surgery, necessitating lifelong supplementation and potentially PTH replacement therapy. The review delves into the anatomy and physiology of the parathyroid glands, mechanisms leading to hypoparathyroidism, and incidence rates. Surgical factors such as the extent of thyroidectomy, surgeon expertise, and intraoperative parathyroid gland preservation are critical in determining the risk of hypoparathyroidism. Patient factors, including age, sex, pre-existing conditions, and perioperative management, influence outcomes. Diagnostic and monitoring strategies, along with management protocols for both transient and permanent hypoparathyroidism, are discussed. Prevention strategies, emerging research, future surgical techniques, and intraoperative monitoring directions are highlighted to improve clinical outcomes. This review aims to enhance understanding, inform surgical practices, and optimize postoperative care to minimize the incidence and impact of hypoparathyroidism in thyroidectomy patients.

Initial versus Staged Thyroidectomy for Differentiated Thyroid Cancer: A Retrospective Multi-Dimensional Cohort Analysis of Effectiveness and Safety.

The optimal surgical approach for differentiated thyroid cancer remains controversial, with debate regarding the comparative risks of upfront total thyroidectomy versus staged completion thyroidectomy following the initial lobectomy. This study aimed to assess the complication rates associated with these two strategies and identify the optimal timing for completion thyroidectomy using a multi-dimensional analysis of four cohorts: an institutional series (n = 148), the National Surgical Quality Improvement Program (NSQIP) database (n = 39,992), the TriNetX repository (n > 30,000), and a pooled literature review (10 studies, n = 6015). Institutional data revealed higher overall complication rates with total thyroidectomy (18.3%) compared to completion thyroidectomy (6.8%), primarily due to increased temporary hypocalcemia (10% vs. 0%, p = 0.004). The NSQIP analysis demonstrated that total thyroidectomy was associated with a 72% increased risk of transient hypocalcemia (p < 0.001) and a 25% increased risk of permanent hypocalcemia (p < 0.001). TriNetX data confirmed these findings and identified obesity and concurrent neck dissection as risk factors for complications. A meta-analysis showed that total thyroidectomy increased the rates of transient (RR = 1.63) and permanent (RR = 1.23) hypocalcemia (p < 0.001). Institutional and TriNetX data suggested that performing completion thyroidectomy between 1 and 6 months after the initial lobectomy minimized permanent complication rates compared to delays beyond 6 months. In conclusion, for differentiated thyroid cancer, total thyroidectomy is associated with higher risks of transient and permanent hypocalcemia compared to staged completion thyroidectomy. However, performing completion thyroidectomy within 1-6 months of the initial lobectomy may mitigate the risk of permanent complications. These findings can inform personalized surgical decision-making for patients with differentiated thyroid cancer.

Lower Rates of Hypocalcemia Following Near-Infrared Autofluorescence Use in Thyroidectomy: A Meta-Analysis of RCTs.

Iatrogenic injury of the parathyroid glands is the most frequent complication after total thyroidectomy. To determine the effectiveness of near-infrared autofluorescence (NIRAF) in reducing postoperative hypocalcemia following total thyroidectomy. PubMed, Scopus, and Google Scholar databases were searched. Randomised trials reporting at least one hypocalcemia outcome following total thyroidectomy using NIRAF were included. The qualitative data synthesis comprised 1363 patients from nine randomised studies, NIRAF arm = 636 cases and non-NIRAF arm = 637 cases. There was a statistically significant difference in the overall rate of hypocalcemia log(OR) = -0.7 [(-1.01, -0.40), M-H, REM, CI = 95%] and temporary hypocalcemia log(OR) = -0.8 [(-1.01, -0.59), M-H, REM, CI = 95%] favouring the NIRAF. The difference in the rate of permanent hypocalcemia log(OR) = -1.09 [(-2.34, 0.17), M-H, REM, CI = 95%] between the two arms was lower in the NIRAF arm but was not statistically significant. NIRAF during total thyroidectomy helps in reducing postoperative hypocalcemia. Level of evidence-1.

Comparison of Perioperative Outcomes in Patients with Graves' Disease Undergoing Total Thyroidectomy With or Without Near Infrared Autofluorescence Imaging.

Background: The impact of near-infrared autofluorescence (NIRAF) imaging on postthyroidectomy hypocalcemia is controversial. As patients with Graves' disease are at increased risk, our aim was to compare postoperative parathyroid function in these patients undergoing total thyroidectomy (TT) with or without NIRAF imaging. Methods: This was a retrospective "before and after" study, comparing outcomes of patients who underwent TT without or with NIRAF imaging at a single center. Primary outcome was the incidence of temporary hypocalcemia and secondary outcomes, rates of incidental parathyroidectomy on final specimens and permanent hypocalcemia. Analyses were performed using Mann-Whitney U and chi-Square tests. Continuous data are expressed as median (interquartile range). Results: There were 85 patients in NIRAF and 100 patients in non-NIRAF group. Groups were comparable regarding age, gender, body-mass index, and thyroid weight. Number of parathyroid glands identified intraoperatively was 3 in both groups (p = 0.47). Intraoperative parathyroid implantation rate was 16.5% in NIRAF and 6% in non-NIRAF group (p = 0.02). Incidental parathyroidectomy rate on final pathology was 12.9% in NIRAF and 32% in non-NIRAF group (p = 0.002). The rates of temporary (11.7% vs. 16%) and permanent hypocalcemia (2.4% vs. 2%) were similar between the two groups, respectively (p = 0.66). Conclusion: To our knowledge, this is the first comparative study investigating the impact of NIRAF on postoperative parathyroid function after thyroidectomy for Graves' disease. The rate of incidental parathyroidectomy on final pathology was lower with use of NIRAF, without an impact on temporary or permanent hypocalcemia rates compared to conventional technique.

Isthmusectomy for papillarythyroid carcinoma in the isthmus: The less the better

BackgroundAppropriate surgical treatments of papillary thyroid carcinoma (PTC) located in the isthmus (PTCI) remains controversial. This study evaluated the outcomes from isthmusectomy in single PTCI and compared it with those for patients who underwent total thyroidectomy. Material and methodsThis study enrolled 89 PTCI patients who underwent total thyroidectomy or isthmusectomy plus bilateral central lymph node dissection (BCLND). Patients were divided into Group A (n = 48) with total thyroidectomy plus BCLND and Group B (n = 41) with isthmusectomy plus BCLND. We compared the effects of different surgical modalities and clinicopathological characteristics on the prognosis of PTCI, and conducted a multivariate analysis to assess risk factors for bilateral central node metastasis for PTCI. ResultsThere was no significant difference in postoperative recurrence-free survival (RFS) between Group A and Group B (P = 0.574). Temporary hypocalcemia occurred more in Group A than Group B (χ2 = 4.608, P = 0.032). There was no significant difference in metastatic lymph nodes between the 2 groups. However, there are 8 patients occurred bilateral central node metastasis in group A, and 6 in Group B (16.7% vs. 14.6%, respectively, P = 0.793). Multiple logistic analysis suggested that tumor size greater than 1.0 cm (OR = 9.72, 95% CI: 2.06–56.59, P < 0.001), and tumor located in the center of isthmus (OR = 5.19, 95% CI: 1.04–2.58,P < 0.001) were risk factors for bilateral central node metastasis. ConclusionsOur results reveal that isthmusectomy plus BCLND may be a simple but feasible approach for selected PTCI patients, resulting in a better quality of life than total thyroidectomy plus BCLND.

Complications of Thyroid Cancer Surgery in Pediatric Patients at a Tertiary Cancer Center.

The incidence of complications and risk factors for hypocalcemia after pediatric thyroid cancer surgery has not been clearly defined in the literature because most reports fail to distinguish between benign and malignant disease. The trend away from total thyroidectomy (TT) to thyroid lobectomy in low-risk disease means there is a need to clearly define the complication profile of malignant disease. After institutional review board (IRB) approval, a retrospective chart review was undertaken at Memorial Sloan Kettering Cancer Center for pediatric patients undergoing surgery for well-differentiated thyroid cancer from 1986 to 2021. Clinicopathologic characteristics and complications were evaluated. Multivariable analysis was performed to identify factors independently associated with postoperative hypocalcemia. The study identified 307 pediatric patients with well-differentiated thyroid carcinoma (median follow-up period, 61 months). Of these patients, 69% underwent TT and 31% received a partial thyroidectomy. Among them, 40% had N0 disease, 28% had N1a disease, and 33% had N1b disease. Postoperatively, no patients experienced a neck hematoma, 1.6% had temporary unilateral vocal cord palsy (VCP), and 0.7% had permanent VCP due to recurrent laryngeal nerve (RLN) invasion. Temporary and permanent hypocalcemia occurred in respectively 32.6 % and 5.2 % of the patients. Multivariable analysis identified central neck dissection (CND) (odds ratio [OR] 3.30; p < 0.001) and N1 disease (OR 2.51; p = 0.036) as independent risk factors for temporary hypocalcemia and N stage (OR 3.64; p = 0.018) as a risk factor for permanent hypocalcemia. Pediatric thyroid cancer surgery results in low complication rates despite nodal metastases. Vocal cord paralysis is rare unless disease is found to be invading the RLN intraoperatively. Both N stage and CND are independent risk factors for hypocalcemia, helping to identify high-risk patients.

Assessment of Post-operative Complications in Patients Undergoing Thyroid Surgery in a Tertiary Care Hospital in Eastern India.

Background Thyroid surgeries, among the most common surgical procedures globally, present with varied complications. This study is aimed at identifying the complications and selected variables associated with thyroid surgery. Methods In this cross-sectional, retrospective, record-based study, a total of 107 patients who underwent thyroidectomies and satisfied the inclusion criteria, were recruited using convenience sampling technique. This study was conducted at a tertiary care hospital from January 2021 to December 2021. Data were collected from medical records using a researcher-created data extraction form after ethical approval from the institutional ethics committee. The data were analyzed using Epi Info software (Atlanta, GA: Centers for Disease Control and Prevention), with a p-value of <0.05 considered to be statistically significant. Results Of the 107 patients who underwent thyroidectomies, 92 (85.9%) reported one or more complications. Complications were most common (90.2% of patients) in the 25-34 years age group and among females (83.3%). The most common complications were dysphagia (30.84% of patients), voice change (21.50%), and respiratory obstruction (8.41%). Temporary hypocalcemia developed in 3.74% of these patients, while tracheal injury and hematoma were documented in 3.74% and 1.87%, respectively. Tobacco users (14.9%), alcohol users (16.8%), those eating a non-vegetarian diet (61.9%), and those eating saturated fats (13.0%) suffered more complications. Family history (p=0.03) was found to be significantly associated with complications. Conclusion The most common post-thyroidectomy complications in this group of patients were dysphagia and voice change, while hypocalcemia, tracheal injury, and hematoma were rare complications. Tobacco users and alcohol users reported more complications. Complications were more common in those with a family history of thyroid disease and those who were underweight.

Surgical Treatment of Hyperthyroidism Can Be Performed Safely Before a Euthyroid State is Achieved.

Background: The 2016 American Thyroid Association guidelines recommend that hyperthyroid patients should be euthyroid before thyroidectomy. This recommendation is based on low-quality evidence. In this retrospective cohort study, we compare peri- and post-operative outcomes of patients with hyperthyroidism who were controlled versus uncontrolled at the time of thyroidectomy. Methods: A retrospective cohort study was performed on 275 hyperthyroidism patients at a single institution from December 2015 to November 2022. Patients were defined as hyperthyroid if they had a diagnosis of hyperthyroidism with at least one suppressed thyrotropin (TSH). Patients were considered uncontrolled if triiodothyronine or thyroxine (T4) was elevated immediately before surgery. Patient demographics, perioperative data, and postoperative outcomes were compared with Chi-square and Wilcoxon Rank Sum tests, as appropriate. Results: Of the 275 patients, 84.3% were women and 51.3% were uncontrolled at time of surgery. Controlled patients had higher median [interquartile range] TSH (0.4 [0.0, 2.4] mIU/L vs. 0.0 [0.0, 0.0] mIU/L, p < 0.001) and lower free T4 (fT4) (0.9 [0.7, 1.1] ng/dL vs. 3.1 [1.9, 4.4] ng/dL, p < 0.001), respectively. Uncontrolled patients were more likely to be diagnosed with Grave's disease (85.1% vs. 67.9%, p < 0.001) and to undergo surgery due to medication intolerance (12.1% vs. 6%) or history of thyroid storm (6.4% vs. 1.5%) (p = 0.008). Uncontrolled patients were also more likely to take a larger number of preoperative medications (2.3 vs. 1.4, p < 0.001). No patient in either group experienced thyroid storm precipitated by surgery. Controlled patients had shorter operative times (7.3% vs. 19.8% <1 hour, p < 0.014) and decreased median estimated blood loss (15.0 [5.0, 30.0] mL vs. 20.0 [10.0, 50.0] mL, p = 0.002). Both groups experienced similar, low rates of postoperative complications, apart from an increase in temporary hypocalcemia in the uncontrolled group (13.4% vs. 4.7%, p = 0.013). Conclusion: Our study is the largest to date examining the postoperative outcomes of patients with uncontrolled hyperthyroidism who undergo thyroidectomy. Our results affirm that thyroidectomy in actively thyrotoxic patients is safe and will not precipitate thyroid storm.

Redo thyroidectomy: A modified technique to eliminate complications

Introduction: Reoperation is the most challenging task in thyroid surgery because of the high risk of complications. This study aims to demonstrate the efficacy of a modified thyroidectomy technique in decreasing associated complications to almost zero in recurrent thyroidectomy. Methods: This single-group cohort study enrolled consecutive patients who had a recurrent thyroidectomy. The patients were examined for vocal cord motility preoperatively. The procedures were done by high-volume surgeons using a modified thyroidectomy technique, which included the following steps:1) Finding and preserving parathyroid glands before searching for the recurrent laryngeal nerve; 2) Expecting the recurrent laryngeal nerve in any area of the neck until it is found; 3) Starting the dissection in the suprasternal notch to find the recurrent laryngeal nerve in the tracheoesophageal groove; 4) If the nerve was not found in the suprasternal notch, the search would continue at the nerve's expected entrance to the cricoid cartilage. Results: In total, 195 cases with redo thyroidectomy were enrolled in this study. Female patients (173, 88.7%) were predominant compared to males (22, 11.3%). The most common ultrasonographic finding was multinodular goiter in 138 cases (70.7%). Most of the cases underwent total thyroidectomy (160, 82%), and thyroid lobectomy was performed in 35 cases (18%). In all the cases that underwent total thyroidectomy, both recurrent laryngeal nerves were explored, and the concerned lateral recurrent laryngeal nerve was seen during the thyroid lobectomies. There was no injury to recurrent laryngeal nerves, and only 15% of the cases suffered from temporary hypocalcemia. Conclusion: Recurrent thyroidectomy without significant complications is possible when conducted by high-volume surgeons, and a modified technique is used.

Effect of Microdissection of Inferior Thyroid Artery on Post-operative Hypocalcemia in Total Thyroidectomy.

Hypocalcemia is one of the most common complication after bilateral thyroid surgery. Reported rates range from 5 to 35% and 0.5 to 4.4% for transient and permanent hypocalcemia respectively. Various methods have been devised to reduce the post-operative hypocalcemia and range from modification of surgical techniques to use of loops and avoidance of inadverant neck dissections. We conducted a randomised control trial of 50 patients divided into two groups, to evaluate the effect of microdissection and ligation of distal branches of inferior thyroid artery (group B) on incidence of temporary and permanent hypocalcaemia in patients of total thyroidectomy versus its ligation distally close to the thyroid capsule(group A). Postoperative mean total serum calcium levels were lower in group A as compared to group B (9.13mg/dl vs. 9.33mg/dl at 24h; 8.77 vs. 9.10 at 3rd day and 8.58 vs. 8.96mg/dl on 10 th day) with p > 0.05. The value of ionized serum calcium as recorded on 3rd day was 4.39mg/dl for group A and 4.72mg/dl for group B with p value ≤ 0.001 (Table 2). 19 patients in group A required calcium supplementation for 6months with incidence of transient hypocalcemia at 76% while 11 patients in group B had calcium supplementation for 6months with incidence of 40% and difference was significant statistically. Microdissection technique is better for preventing the temporary hypocalcemia and hence decreasing the hospital visits of the patient when compared to the ligation of inferior thyroid artery distally close to the thyroid gland. The incidence of permanent hypocalcemia doesn't varies significantly between both techniques.

Prevalence and Outcome of Post- thyroidectomy Hypocalcaemia: A Prospective Clinical Study

Aims: (1) To record the incidence of post-thyroidectomy hypocalcaemia. (2) To correlate blood calcium levels with symptoms of hypocalcaemia. (3) To find out the type of hypocalcaemia whether temporary or permanent. (4) To assess the risk factors for development of hypocalcaemia. Design: Prospective analysis of 50 consecutive patients undergoing thyroid surgeries. Materials &amp; Method: All patients undergoing any thyroidectomy in the department of general surgery were followed for a period of 3 months. The type of surgery, Histopathology and clinical diagnosis to predict the outcome of post-operative hypocalcaemia was validated. The influences of Patient factors, intra-operative identification of RLN and parathyroid were also observed. Results: The overall prevalence of hypocalcaemia was 28% of which 12 patients had temporary and 2 had permanent hypocalcaemia. Only 12 patients developed clinical symptoms. Hypocalcaemia typically ensues during the early post-operative period (24-48 hrs). Hypocalcaemia was significantly associated with the type of surgery (p=0.0293), Histopathology (p=0.0312) and clinical diagnosis (p=0.0008). Age, Sex and identification of RLN and Parathyroid did not play a significant role in predicting the outcome of post-operative hypocalcaemia. Conclusion: Hypocalcaemia either transient or permanent can be debilitating and lead to significant morbidity. Temporary hypocalcaemia is common after surgery for malignancies. Histopathology, clinical diagnosis and extent of surgical resection influence the outcome of hypocalcaemia. Early measurement of serum calcium and albumin levels can ensure early management and prevent complications of hypocalcaemia.

Is Preoperative Ultrasonographic Thyroid Gland Volume a Good Predictor of Postoperative Complications in Thyroidectomy?: A Prospective Cohort Study

Introduction: Thyroidectomy is a commonly performed surgical procedure, especially in areas with a high prevalence of thyroid disorders. Accurate estimation of thyroid volume is crucial for evaluating and managing these conditions, as thyroidectomy in patients with enlarged thyroids can lead to specific concerns regarding optimal preoperative, intraoperative, and postoperative care. Aim: To assess the relationship between thyroid volume and thyroidectomy complications, specifically Vocal Cord Paralysis (VCP) and hypocalcaemia, using preoperative ultrasound and ellipsoid volumetric analysis. Materials and Methods: A prospective cohort study in the General Surgery ward at a Government Medical College, Kottayam, Kerala, India. A total of 70 patients (64 females and six males) with benign thyroid swelling underwent total Thyroidectomy between June 2020 and December 2020. Follow- up was conducted for one year until December 2021. Thyroid gland volume was assessed using ultrasound and calculated using the ellipsoid formula. Based on volume, patients were classified into two groups: 1) &lt;50 mL (mild enlargement), and 2) &gt;50 mL (moderate to severe enlargement). Preoperative examination of vocal cords was performed by the Department of Otorhinolaryngology. Serum calcium levels were measured 48 hours postoperatively, or earlier if symptomatic. Hypocalcaemia was defined as corrected calcium &lt;8.4 mg/dL. The association between thyroid gland volume and complications was analysed to determine if volume could be an effective factor in patient morbidity. Data were entered into Microsoft Excel and analysed using Statistical Package for the Social Sciences (SPSS) version 16.0. Chi-square test was used for qualitative analysis, with a significance level set at p&lt;0.05. Results: The mean thyroid volume for patients with volumes &lt;50 mL and &gt;50 mL was 26.9 mL and 103.2 mL, respectively. Temporary hypocalcaemia (resolving within six months) was significantly higher in patients with volumes &lt;50 mL (p=0.044). Temporary VCP was significantly more frequent in patients with larger volumes (p=0.027). No intraoperative complications were observed in the present study. Conclusion: Thyroid gland volume appears to be an important factor influencing thyroidectomy complications. Smaller thyroid volumes are associated with an increased risk of postoperative hypocalcaemia, while larger volumes are associated with a higher risk of VCP.

Morbidity Associated With Surgical Removal of Substernal Thyroid Goiters.

Surgical excision of substernal thyroid goiters (STG) can be challenging while minimizing postoperative morbidity. Postoperative complication rates associated with transcervical and transthoracic approaches (i.e., partial or total sternotomy) for STG compared to multinodular goiters (MNG) limited to the neck (i.e., non-substernal) remains unclear. This study examines postoperative morbidity related to surgical approaches in the removal of STG and MNG. A retrospective review of prospectively collected data of 988 patients with STG and non-substernal MNG from a single institution between 2010 and 2021 was performed. Patients were stratified by STG and conventional non-substernal MNG limited to the neck excised by transcervical and transthoracic approach. Postoperative complications including neck hematoma requiring return to the operating room, permanent recurrent laryngeal nerve injury and hypocalcemia, and transient or temporary recurrent laryngeal nerve injury and hypocalcemia were identified. Demographics including age, sex, and race, among others, were analyzed. Of the 988 cases, there were 887 (90%) MNG and 101 (10%) STG. Of the STG cohort, 11 (11%) required a partial sternotomy and 4 (4%) required a total sternotomy. Permanent complication rates for non-substernal MNG and STG patients were 1.5% and 0.9%, respectively. Only transient or temporary hypocalcemia rates were statistically different between the STG and MNG cohorts (9.9% versus 3.8%, P<0.001). Regardless of transcervical or transthoracic approach, postoperative complications associated with the surgical removal of STG are low in the hands of experienced, high-volume thyroid surgeons.

Techniques for Treating a Single Cold Thyroid Nodule

Background: The goal of this article is to raise awareness of malignancy and surgical options for the solitary inflection point of the cold nodule thyroid. Methods: People mentioned after the community or hospitalized straight via Observational Patient Treatment Tartary care hospital kpk with a diagnosis of a single cold nodule thyroid gland were accounted for in the study. Results: The patients' ages varied from 15 to 65, with a mean of 35 10 years, and 90% were female. Sixty-four percent of patients had problems in the right lobe of the thyroid gland, whereas only two percent had problems in the isthmus. Each patient had had surgery and was deemed euthyroid. In 50% of patients, FNAC revealed adenomatous colloid goiter, while in 5%, FNAC revealed papillary cancer of the thyroid gland. Mainly, lobectomy with isthmusectomy was done (95%), whereas complete thyroidectomy was done (5%). Adenomatous colloid goiter was found in 45% of patients, whereas 9% had thyroid cancer that forms in follicles, and 3% had cancer of the follicle based on the histopathology report. In 7% of those who needed it, complete thyroid removal was accomplished. Postoperatively, 5% of patients had an infection at the surgical site, and 3% experienced temporary hypocalcemia. People didn't die outright or anything like that. Conclusion: Women are more likely to have a single cold nodule in their thyroid gland. The most effective surgical procedure is a combination of lobectomy and isthmusectomy. When a single cold nodule develops in the thyroid, papillary carcinoma is the most prevalent kind of cancer that may develop there. Keywords: Techniques, Treating, Cold Thyroid, Nodule

TH8.8 Retrospective study on the safety of thyroid surgery with confirmed benign histology in a UK district general hospital

Abstract Aim With increasingly aging population, more thyroidectomies are being performed in the elderly. These surgeries may be suspected to be unsafe as majority of the geriatric population suffer from comorbidities. Our local study explored the safety of thyroid surgery with confirmed benign histology in the elderly, with the post-operative complication rates being the primary outcome measures. Methods The study group included patients over 75 years who had thyroid surgeries with confirmed benign histology in a UK district general hospital from January 2010 to January 2022. We then analysed the rates of complications including temporary hypocalcemia, permanent hypocalcemia, vocal cord palsy and haematoma. Results 41 elderly patients underwent thyroid surgery with confirmed benign histology in our facility within the period. 78% of them had thyroid lobectomy and the commonest indication for surgery was benign multinodular goitre. There were no haematomas, no permanent vocal cord palsies and no cases of permanent hypocalcemia. Only 3(7.3%) patients had transient hypocalcemia, and 2(4.9%) had vocal cord palsy which all resolved before 6 months. Conclusions Our study has demonstrated that it is generally safe to perform thyroidectomy in the elderly population with low hypocalcemia and vocal cord palsy rates as compared to the British Association of Endocrine and Thyroid Surgeons’ report of 10.2% and 7.8% for hypocalcemia and early cord palsy rates respectively in all age-groups. Nevertheless, we would advocate appropriate patient selection in terms of ASA classification. For example, 50% of those who had post-operative vocal cord palsy in our study had an ASA of 3.

Early and Late Complications after Thyroid Surgery: A Retrospective Study in 163 Patients

Objective: The aim of this study was to evaluate the early and late (6 months after surgery) complications in patients undergoing thyroid surgery.&#x0D; Material &amp; methods: A retrospective study was done from January 2015 to December 2019 in the Department of ENT &amp; Head Neck Surgery, Enam Medical College &amp; Hospital. One hundred and sixty three patients with both benign &amp; malignant thyroid disease underwent surgical treatment was selected for this study. Patients were followed up for six months and peroperative &amp; postoperative complications were evaluated.&#x0D; Results: Out of 163 patients 132(80.9%) cases were benign and 31(19.1%) cases were malignant. Total thyroidectomy was done in 71(43.56%) patients and hemithyroidectomy was done in 82(50.3%) patients and 10(6.13%) patients had other thyroid surgery. 29(17.80%) patients develop complications after thyroid surgery. Most common post operative complication was hypoparathyroidism with a incidence of 17(10.43%). 15(9.20%) patients developed temporary hypocalcaemia and 2(1.23%) patients developed permanent hypocalcaemia. Others complications were recurrent laryngeal nerve (RLN) palsy 2(1.23%), superior laryngeal nerve (SLN) palsy 3(1.84%), wound infection 2(1.23%), haematoma 1(0.61%) and hypertrophied scar 4(2.45%).&#x0D; Conclusion: Hypocalcaemia was the most frequent post-thyroidectomy complication, while voice change, seroma, haematoma, wound infection and hypertrophied scar are additional complications. Surgeons have to pay attention to curtail the complications during thyroid surgery.&#x0D; Bangladesh J Otorhinolaryngol 2022; 28(1): 50-55

The Effectiveness and Quality of Life Outcomes by Transoral Endoscopic Vestibular Thyroidectomy Using Intraoperative Indocyanin Green Fluorescence Imaging and Neuromonitoring-A Cohort Study.

Background: Transoral endoscopic vestibular thyroidectomy (TOEVT), a variant of natural orifice transluminal endoscopic surgery, offers a scar-less thyroid to young females. However, few studies have compared the effectiveness and quality of life (QoL) outcomes of the TOEVT with open thyroidectomy (OT). This is the first study in the Middle East and North Africa region that compares the effectiveness, safety profile and QoL outcomes between TOEVT with OT. Methods: We reviewed the medical records of consecutive patients with TOETV and OT at Zulekha Hospital Sharjah and Dubai United Arab Emirates, between 1 January 2019 and 1 April 2021. The data for demographics, type of surgery, operative time, blood loss, post-operative nodule size, hospital stay and post-operative complications were analyzed. We used an SF-36 questionnaire pre- and postoperatively for the assessment of QoL in both groups. Findings: Out of a total of 41 OT and 32 TOEVT procedures, 59 patients (31 TOEVT and 28 OT) fulfilled the inclusion criteria. There were 45 women and 14 men with an average age of 41 years. The mean operating time was 126 min in TOEVT and 96 min in OT (p = 0.000). The mean thyroid size was 5.55 cm in TOEVT and 8.76 cm in OT (p = 0.000). Lastly, the mean intraoperative blood loss was 39 cc and 95.7 cc in TOEVT and OT, respectively (p = 0.001). There was one temporary hypocalcemia and seroma in TOEVT, four cases of temporary hypocalcemia and one with minor bleeding in OT. The post-operative QoL significantly improved in all patients. However, the QoL improved more significantly in the TOEVT group for bodily pain, vitality, role emotions and cosmetic concerns (p = 0.000). Conclusion: The safety profile and effectiveness of the TOEVT is comparable to the OT procedure. However, TOEVT has an additional advantage of being scarless and offers a better QoL.

Prediction of long-term dependence on vitamin D analogues following total thyroidectomy for Graves' disease.

This study aimed to identify patients at risk of long-term hypocalcaemia following total thyroidectomy for Graves' disease, and to determine the thresholds of postoperative day 1 serum calcium and parathyroid hormone (PTH) at which long-term activated vitamin D treatment can be safely excluded. This study was a retrospective analysis of 115 consecutive patients undergoing total thyroidectomy for Graves' disease at a university referral centre between 2010 and 2018. Outcome measures were the day 1 postoperative adjusted calcium and PTH results, and vitamin D analogue need at 6 months postoperatively. Logistic receiver operating curves were used to identify optimal cut-off values for adjusted serum calcium and serum PTH, and sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Temporary hypocalcaemia was observed in 20.9% of patients (mean day 1 serum adjusted calcium 2.2±0.14mmol/l and PTH 4.15±2.42pmol/l). Long-term (>6 months) activated vitamin D analogue therapy was required in five patients (4.3%), four of whom had normal serum PTH and one with undetectable PTH at 6 weeks post surgery. No patient with a day 1 postoperative calcium >2.05mmol/l and detectable PTH required vitamin D supplementation at 6 months post surgery (100% sensitivity, PPV 50%, NPV 100%). The biochemical postoperative day 1 thresholds identified in this paper have a 100% NPV in the identification of patients who are likely to require either no or only temporary activated vitamin D supplementation. We were able to identify all patients requiring activated vitamin D supplementation 6 months postoperatively from the day 1 postoperative serum calcium and PTH values, while excluding those that may only need temporary calcium supplementation. These threshold levels could be used for targeted follow-up and management of this subset of patients most at risk of long-term hypocalcaemia.