Thyroidectomy In Patients Research Articles

Correlation between Ultrasound, Cytology and Anatomo Pathology in Thyroid Nodules

Introduction: Surgical pathologies of the thyroid are frequent; essential tools for its assessment constitute ultrasound, Fine Needle Aspiration (FNA), and Pathological Anatomy (PA) of the resected sample. Objective: To determine the correlation between sonographic, cytological and pathological findings of thyroid nodules in years. Materials and methods: Observational, descriptive and retrospective study of thyroidectomized patients between 2010 and 2014 at Clinical’s Hospital-Uruguay. Results: Sixty-seven patients, 59 women and 8 men, with a mean age of 45 ± 16 years. According to ultrasound findings, the majority corresponded to EU-TIRADS 3 (43%), followed by EU-TIRADS 4 (27%). According to Bethesda classification, the most frequent was indeterminate (48%), followed by benign (32%) and malignant (19%). 54% had benign PA and 46% malignant, papillary carcinoma was the most frequent (61%). Discussion: A significant association between EU-TIRADS 4-5 and the Bethesda classification was demonstrated. The finding of a probably benign (EU-TIRADS 3) or suspicious (EU-TIRADS 4) nodule, whose risk described in the literature of 2-4% and 6-17%, can hide a malignant tumor in up to 1/4 or 6 /10 cases respectively. Sensitivity of ultrasound was 74% and specificity 66%. The ultrasound elements significantly related to malignancy were the solid variant, hypoechoic and the presence of microcalcifications. Bethesda classification categories clearly associated with malignancy were IV, V, and VI. Conclusions: An adequate correlation was demonstrated to differentiate benignity from malignancy when comparing ultrasound findings of thyroid nodules with FNA and PA.

Hypocalcemia After Thyroidectomy in Patients with Prior Bariatric Surgery: A Propensity Score Matched Analysis from a National Administrative Database.

Background: Studies have suggested that patients with prior gastric bypass may be at increased risk for hypocalcemia following thyroidectomy. Unfortunately, most of these studies are limited to case reports and small series. This study represents the largest sample size to date to assess the incidence of post-thyroidectomy hypocalcemia in patients with a history of bariatric surgery. Methods: The TriNetX Research Network was queried to retrospectively identify patients with prior bariatric surgery who underwent total thyroidectomy between 2011 and 2021. The incidence of hypocalcemia following surgery was compared with patients who underwent total thyroidectomy, and hemithyroidectomy with no history of bariatric surgery. Results: We identified 446 patients with a history of bariatric surgery and subsequent thyroidectomy, 29,346 patients with total thyroidectomy, and 19,603 patients with hemithyroidectomy alone. The one-month incidence of hypocalcemia was 54.7% in those with a history of bariatric surgery who underwent thyroidectomy, 43.9% in those with thyroidectomy alone (relative risk, RR = 1.2 [confidence interval, CI 1.1-1.4], p < 0.001), and 8.1% in those with hemithyroidectomy only (RR = 6.8 [CI 6.1-7.4], p < 0.001). Permanent hypocalcemia was documented in 11.4% of patients with prior bariatric surgery who underwent thyroidectomy, 7.7% of those with thyroidectomy only (RR = 1.5 [CI 1.1-1.9], p = 0.003), and 2.9% of patients with hemithyroidectomy alone (RR = 3.9 [CI 3.0-5.2], p < 0.001). Significant differences persisted after matching demographics, prior need for supplementation, and risk factors for hypocalcemia after thyroidectomy. When stratified by bariatric procedure, patients with a history of Roux-en-Y gastric bypass (RYGB) (n = 35) had a greater, although not statistically significant, risk of short-term hypocalcemia (51.4%; RR = 1.2 [CI 0.8-1.6], p = 0.37), and a significantly increased risk of permanent hypocalcemia (20.0%; RR = 2.6 [CI 1.3-5.1], p = 0.005) compared with thyroidectomy alone. Sleeve gastrectomy (SG) (n = 40) was not associated with an increased risk of short-term (40.0%; RR = 0.9 [CI 0.6-1.3], p = 0.62) or permanent (7.5%; RR = 1.0 [CI 0.3-2.9], p = 0.96) hypocalcemia. Conclusions: Prior RYGB, but not SG, may increase the risk of permanent hypocalcemia after thyroidectomy. Additional research is necessary to determine optimal prevention and treatment strategies to reduce morbidity in this population.

Outpatient endocrine surgery practice patterns are highly variable among US endocrine surgery fellowship programs

BackgroundCurrent studies and guidelines have reported that outpatient endocrine surgery is safe. However, none recommend specific postoperative protocols. MethodsAn internet-based survey, developed using expert input, was distributed to current (2021–2022) endocrine surgery fellows in American Association of Endocrine Surgeons–accredited programs (n = 23). Programs with ≤2% same-day discharge rate were compared with those with ≥2% same-day discharge rate. ResultsThe survey response rate was 91% (21/23), representing 20 United States institutions performing >15,000 cervical endocrine operations annually. The same-day discharge rate after total thyroidectomy was not normally distributed across institutions (P < .0001) but appeared bimodal, highlighting dogmatic differences in the pursuit of same-day discharge. Nine programs had ≤2% same-day discharge rate, whereas seven had ≥90% same-day discharge rate. Fourteen (70%) reported minimum observation periods before discharge, without consistency across procedures or institutions. Total thyroidectomy patients were observed longer. Fourteen (70%) reported no geographic restrictions for same-day discharge. In programs with >2% same-day discharge (n = 11), clinical and operative factors inconsistently influenced same-day discharge after thyroidectomy. Living alone precluded same-day discharge in 3 programs. Lateral neck dissection and chronic anticoagulation each greatly reduced same-day discharge in one program and precluded same-day discharge in another. Central neck dissection, Graves’ disease, substernal goiter, continuous positive airway pressure use, difficult/bloody operation, and signal on nerve stimulation had no or minimal effect on same-day discharge. Postoperative medication recommendations varied among programs. Although anticoagulation/antiplatelet agents were similarly held preoperatively across programs, resumption varied. Narcotics were routinely prescribed in 35%. ConclusionSame-day discharge is not uniform across endocrine surgery training programs and is likely primarily driven by surgeon preference. Factors influencing same-day discharge vary significantly among programs.

Branching Patterns of Recurrent Laryngeal Nerve in Thyroidectomy Patients

Background: Historically, the Recurrent laryngeal nerve (RLN) has been considered to branch after it enters the larynx, but numerous studies have demonstrated that it often branches before. The wide variability of this extra laryngeal branching (ELB) has significant implications for the risk of iatrogenic injury. Accurate knowledge of anatomical variations of the recurrent laryngeal nerve (RLN) provides information to prevent inadvertent intraoperative injury.Objectives: Our study aimed to assess extra laryngeal branching of recurrent laryngeal nerve to find out branching patterns of RLN and to study whether there is any correlation between right and left side branching of RLN.Materials and Methods: This was a retrospective analysis conducted on patients of Thyroid surgeries that is total and Near-total thyroidectomies. This cross-sectional study was conducted in Hayatabad Medical Complex Peshawar from 1st Jan 2014 till 31st Dec 2020, with total of 269 patients. We excluded hemi thyroidectomies and recurrent cases.Results: The prevalence of single branching RLN was found to be 29.3% with 79 out of 269 patients. The branching pattern was found not statistically significant with age and gender. Surgeons need to pay special attention to the branching pattern of RLN so as to preserve it during surgery.Conclusion: The anatomy of the RLN is highly variable, and ELB is likely to have been underreported in intraoperative studies. Because of its high likelihood, the possibility of ELB needs to be assessed in patients to prevent iatrogenic injury and long-term postoperative complications.Key Words: Total thyroidectomy, Recurrent laryngeal nerve.Extralaryngeal branching.

Propensity Score Matched Outcome Analysis of Lobar Ablation Versus Completion Thyroidectomy in Low-Risk Differentiated Thyroid Cancer Patients: Median Follow-Up of 11 Years.

Background: Radioactive iodine lobar ablation (RAILA) of the contralateral thyroid lobe has been suggested as an alternative to completion thyroidectomy in patients of differentiated thyroid cancer (DTC) who underwent initial hemithyroidectomy. However, data on long-term outcomes are scarce. In this study, we intended to describe the long-term outcomes of RAILA versus completion thyroidectomy in a cohort of low-risk DTC patients. Methods: Data of patients with low-risk DTC who underwent initial hemithyroidectomy, and were subsequently treated with either completion thyroidectomy or RAILA between 1996 and 2015, were collected and analyzed. The treatment outcomes included ablation rate, recurrence rate, recurrence-free survival (RFS), and adverse events, and were validated by propensity score matching analysis. Results: Of the 1243 patients (median age: 34 years, range: 5-78) with low-risk DTC, 514 patients underwent upfront RAILA while 729 patients underwent completion thyroidectomy followed by remnant ablation. The ablation rate following the first radioactive iodine (131I) cycle was 75.3% [95% confidence interval (CI) 71.3-78.9] in the RAILA group versus 84.1% [CI 81.2-86.6] in the completion thyroidectomy group (p < 0.001). Over median follow-up of 11.4 years (interquartile range: 8.3-15.8), the recurrence rates between the two groups were not significantly different (1.6% [CI 0.7-3.2] vs. 1.0% [CI 0.4-2.1], respectively, p = 0.343). The product limit estimate of RFS at 10 years was 98.6% [CI 97.6-99.6%] in the RAILA group versus 99.1% [CI 98.3-99.9%] in the completion thyroidectomy group (p = 0.391). The outcomes in 497 matched pairs generated through propensity score analysis were similar. None of the patients in the RAILA group experienced permanent hypocalcemia or recurrent laryngeal nerve palsy, while the corresponding rates in the completion thyroidectomy group were 10/729 (1.4%) (p = 0.006) and 5/729 (0.7%) (p = 0.080), respectively. Radiation thyroiditis was seen in 25/514 (4.9%) patients in the RAILA group versus 3/729 (0.4%) in the completion thyroidectomy group (p < 0.001). Conclusions: Upfront RAILA is seen to be a noninvasive, safe, and effective alternative to surgical completion thyroidectomy in low-risk DTC patients in the absence of macroscopic malignancy in the remaining thyroid lobe.

Brain [18F]Fluorodeoxyglucose Metabolism Assessment under Hypothyroidism and Recombinant Human Thyroid-Stimulating Hormone in Comparison with Thyroid Hormone Replacement in Patients Submitted to Total Thyroidectomy

Objective: To compare brain metabolism using [18F]fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) in total thyroidectomy patients during hypothyroidism (levothyroxine withdrawal) or under recombinant human thyroid-stimulating hormone (rhTSH) against levothyroxine intake. Methods: A total of 12 patients were randomly divided into two groups. One group underwent the first [18F]FDG PET/CT brain scan after levothyroxine withdrawal (hypothyroidism condition) and repeated the scan 6 months later during regular levothyroxine intake (replacement condition). The other group underwent the first [18F]FDG PET/CT scan after receiving an rhTSH injection and maintained regular levothyroxine intake (rhTSH condition), and repeated the scan 7 months later during regular levothyroxine intake without rhTSH administration. The intra-group regional brain metabolisms were compared. Results: Under the hypothyroidism condition, brain metabolism was significantly reduced, namely in the bilateral pre-frontal, temporal, anterior cingulate, and primary motor cortices, insula, and striatum (uncorrected voxelwise p &lt; 0.005); No significant differences were found between the rhTSH and replacement conditions. Conclusion: rhTSH administration could be a better option than levothyroxine withdrawal for 131I treatment, serum thyroglobulin measurement, or radioiodine scanning for patient follow-up.

HYPOCALCEMIA AND HYPOPARATHYROIDISM AFTER NEAR TOTAL THYROIDECTOMY:

Background : Post-operative hypocalcemia is a common and usually a transient event after thyroidectomy due to iatrogenic injury to the parathyroid glands. Most of the studies had investigated the frequency of surgical complications in Total thyroidectomy patients. Unfortunately, very few studies had investigated about the hypocalcemia and hypoparathyroidism frequency in near total thyroidectomy patients post-surgically Aims: . We carried out this study to evaluate the hypothyroidism and hypoparathyroidism frequency in thyroid disorder patients who underwent near total thyroidectomy. Methods: We performed a retrospective analysis of 202 patients who underwent near-total thyroidectomy at our institution from May 2017 to April 2022. Institutional Ethical committee approval was taken and Waiver of consent was taken from the head of the surgery department before the data collection. Post near-thyroidectomy patients who were above 18 years old with normal preoperative serum calcium levels (i.e., 8.4-10.2µL) were included. The patients who underwent subtotal thyroidectomy, thyroidectomy with neck dissection, hemi-thyroidectomy, concurrent lymph nodes dissection, complete thyroidectomy following hemi-thyroidectomy, parathyroid auto transplantation and those who received calcium supplementation before surgery were excluded from the study. Therefore, medical records of 478 patients were reviewed and nally 202 patients were included in the study who fullled both the inclusion and exclusion criteria. Conclusion: The results obtained conrm that transient hypocalcemia can be observed after any operation; and particularly responsible is the decrease of the calcium concerning the proteins. We found that post-operative hypoparathyroidism is due to injury to the parathyroid glands (parathyroid ischaemia or surgical ablation of one or more glands). Here we see the delayed serum calcium level &lt; or = 7.5 mg/dl or the delayed serum phosphorous level &gt; 7.4 mg/dl. The results of our study, with 2 patients presenting transient post-operative hypoparathyroidism, contribute in conrming that the extracapsular total thyroidectomy aimed to reduce any injury to the parathyroid and to the recurrent nerves, represent the better operation also for the extended benignant thyroidopathies.

Preradioactive Iodine Thyroglobulin Levels as Predictors of Metastasis in Well-Differentiated Thyroid Carcinoma Patients.

Objective The aim of this study was to determine the cut-off value of thyroglobulin (Tg) levels as a predictor of metastases in post total thyroidectomy patients with well-differentiated thyroid carcinoma (DTC). Materials and Methods A retrospective case-control study with an observational diagnostic approach was done. Subjects were 102 DTC patients divided into a case group with metastases and a control group without metastases. Tg and antithyroglobulin antibody (ATA) levels on thyroid-stimulating hormone (TSH)-stimulated preradioactive iodine were compared with each other. Diagnosis of metastases was based on postradioactive iodine whole-body scan. The cut-off value for Tg preradioactive iodine and the area under the curve (AUC) were obtained from the receiver operating characteristic curve. Result The characteristics and histopathological type of DTC among these two groups were not significantly different ( p = 0.47). The Tg levels in the case and control groups were 106 (2.2-6,000) ng/mL and 2.7 (0.3-10.10) ng/mL, respectively ( p = 0.0001). TSH level in the case group was 50 (30-107) µIU/mL and in the control was 50 (20-100) µIU/mL ( p = 0.224). ATA levels in the case and control groups were 0-3,000 and 0-629 ng/mL, respectively ( p = 0.01). The AUC was 0.976 with a 95% confidence interval of 0.924 to 0.996 and a standard error of 0.016. The cut-off value of preradioactive iodine Tg was 10.1 ng/mL or higher with sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 96.1, 100, 98.0, 100, and 96.2%, respectively. Conclusion Preradioactive iodine Tg level 10.1 ng/mL or higher can be used as a predictor of metastasis in patients with DTC.

Prevention of post-operative nausea and vomiting with honey as a pre-operative oral carbohydrate: A randomised controlled pilot trial

Background Post-operative nausea and vomiting (PONV) is the secondmost common post-operative complication. Prolonged pre-operative fasting is common in Australia despite guidelines recommending reduced fasting to improve patient outcomes, such as PONV. Commercially prepared preoperative oral carbohydrate (OC) drinks may be used to reduce fasting time. In this study commercial products were replaced with honey, an inexpensive and common food item. Design Partially blinded, four parallel arms randomised controlled noninferiority trial compared pre-operative OC loading with overnight fasting. Methods Adult elective laparoscopic cholecystectomy and thyroidectomy patients having two or more risk factors for PONV were allocated into intervention and control groups by simple randomisation. The intervention group ingested 60g of honey in 100 ml of water at least two hours before surgery as pre-operative OC loading to reduce PONV. Participants and assessors to the group assignment were blinded to the study outcomes. Early PONV (0–6 hours) was measured with Rhodes index of nausea, vomiting and retching (R-INVR) and a numeric rating scale (NRS). Results The four groups (N = 142) were control and intervention groups of thyroidectomy patients (n = 72: C = 37, I = 35), and control and intervention groups of laparoscopic cholecystectomy patients (n = 70: C = 37, I = 33) and had similar distributions of variables. The estimated effect size was 140 with a 95 percent confidence interval. The PONV incidence (Pearson χ2 = 4.54; df = 1; p = 0.03) and severity were significantly lower in the laparoscopic cholecystectomy intervention group (R-INVR: Mann–Whitney U = 446.5; p = 0.01; NRS: Mann–Whitney U = 444.5; p = 0.01) and results were not conclusive in the thyroidectomy group (NRS: Mann–Whitney U = 629.5; p = 0.95; R-INVR: Mann–Whitney U = 629.5; p = 0.76). Conclusion Honey could be recommended as an inexpensive pre-operative OC to reduce PONV in adult patients receiving general anaesthesia.

Combined levothyroxine/liothyronine therapy improves quality of life in hypothyroid thyroidectomized patients

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

Effect of a Polyglycolic Acid Mesh Sheet (Neoveil™) in Thyroid Cancer Surgery: A Prospective Randomized Controlled Trial.

Simple SummaryPapillary thyroid cancer (PTC) is the most common type of thyroid cancer. Surgery for PTC involves resection of the thyroid gland and lymph node dissection around thyroid. Lymph node dissection is associated with an increased amount of fluid from the dissection area and chyle leakage due to thoracic duct injury. A polyglycolic acid mesh sheet (Neoveil™) has been proven to prevent postoperative fluid leakage in other surgeries. So, we aim to evaluate whether Neoveil™ can reduce postoperative drainage and chyle leakage in surgery for PTC. With the use of Neoveil™, the amount of drainage significantly decreased on the postoperative 2nd day and postoperative total drainage amount was lower. Triglyceride level was lower in the Neoveil™ group but was not statistically significant. No adverse effect from the Neoveil™ was observed during 9 months follow up. Our study suggests that Neoveil™ can be applied to reduce postoperative drainage in thyroid surgery for PTC.Papillary thyroid cancer (PTC) is the most common type of thyroid cancer. Surgery for PTC involves resection of the thyroid gland and central lymph node dissection. Central lymph node dissection is associated with an increased amount of fluid from the dissection area and chyle leakage due to thoracic duct injury. There are few studies that deal with reducing fluid drainage and preventing chyle leakage after thyroid surgery with central lymph node dissection. A polyglycolic acid mesh sheet (Neoveil™) has been demonstrated to prevent postoperative fluid leakage in other surgeries. This study aims to evaluate whether a polyglycolic acid mesh sheet can reduce postoperative drainage and chyle leakage in papillary thyroid cancer surgery, and this study was designed as a prospective, open-label, randomized controlled trial in a single university hospital. The patients were randomly assigned to having only fibrin glue used in the central node dissection area (control group) or to having a polyglycolic acid mesh sheet applied after fibrin glue (treatment group). A total of 330 patients were enrolled, of which 5 patients were excluded. A total of 161 patients were included in the treatment group, and 164 patients were included in the control group. The primary outcome was the drainage amount from the Jackson-Pratt drain, and the secondary outcome was the triglyceride level in the drained fluid on the 1st and 2nd postoperative days. The drainage amount was significantly lower in the treatment group on the 2nd postoperative day (60.9 ± 34.9 mL vs. 72.3 ± 38.0 mL, p = 0.005). The sum of drainage amount during the whole postoperative days (1st and 2nd days) was also significantly lower in the treatment group (142.7 ± 71.0 mL vs. 162.5 ± 71.5 mL, p = 0.013). The postoperative triglyceride levels were lower in the treatment group but were not statistically significant (92.1 ± 60.1 mg/dL vs. 81.3 ± 58.7 mg/dL on postoperative day 1, p = 0.104 and 67.6 ± 99.2 mg/dL vs. 53.6 ± 80.4 mg/dL on postoperative day 2, p = 0.162). No adverse effects were observed in the treatment groups during the postoperative 9-month follow-up. Our study suggests that polyglycolic acid mesh sheets can be safely applied to reduce postoperative drainage amount in thyroidectomy patients who need lymph node dissection.

The Initial ATA Risk Classification, but Not the AJCC/TNM Stage, Predicts the Persistence or Relapse of Differentiated Thyroid Cancer in Long-Term Surveillance

Background: The American Joint Commission on Cancer on Tumor Node Metastasis (AJCC/TNM) staging system provides adequate information on the risk of differentiated thyroid cancer (DTC)-specific mortality in totally thyroidectomized patients, but its role in predicting persistence and relapse of disease is uncertain. The relatively new 2015 American Thyroid Association (ATA) guidelines recommend stratifying patients at the time of DTC diagnosis with its own risk classification system, in order to identify those at high risk of residual or recurrent morbidity who may benefit from post-operative radioiodine (RAI) administration and/or need additional work-up. Methods: To verify the prevalence proportion of persistence or relapse of disease, a consecutive cohort of 152 patients with a diagnosis of DTC, subjected to total thyroidectomy (+/− post-operative RAI administration as per guidelines indication) and to neck ultrasonography (US), as well as biochemical surveillance for a minimum of 2 years at the Endocrinology Unit of Mater-Domini Hospital (Catanzaro, Italy), was enrolled. The prognostic role of the AJCC/TNM stage and ATA risk classification system was analyzed by logistic regression. Results: At a mean of 9 years after surgical treatment, DTC was found to persist or relapse in 19 (12.5%) participants. The initial risk for these outcomes, based on the ATA classification, was mostly low (53.9%) or intermediate (39.5%). AJCC/TNM stages were predominantly stage I or stage II. Despite a small representation in this cohort, high-risk patients according to the ATA classification had 8-fold higher odds of persistence or relapse of disease than those of low-risk participants, while controlling for potential risk modifiers, including age at DTC diagnosis, male gender, and post-operative RAI administration (p = 0.008). In contrast, the AJCC/TNM stage was not associated with the disease status at the last follow-up visit (p = 0.068 for the 7th Edition; p = 0.165 for the 8th Edition). Furthermore, low-risk participants subjected to post-operative RAI administration had the same probability of persistence or relapse of DTC when compared to those who had undergone total thyroidectomy only. Conclusions: There is a need for the endocrine community to revise the current work-up of DTC. The initial ATA risk classification is a reliable tool for predicting the persistence or relapse of disease in long-term surveillance.

Long-Term Adherence to Levothyroxine Replacement Therapy in Thyroidectomized Patients.

(1) Background: We evaluated the long term adherence to two distinct formulations of levothyroxine (L-T4), liquid or solid, which are differently influenced by concomitant food ingestion. (2) Methods: A total of 106 thyroidectomized patients (82 female, mean age 58.2 ± 13.3 years) on L-T4 replacement therapy in either liquid (n = 52) or solid formulation (n = 54) were administered the four-item Medication Adherence Questionnaire (MAQ). (3) Results: The study population had 59.4% adherers and 40.6% non-adherers. The global MAQ score was significantly better in patients under liquid L-T4 in comparison to those under solid L-T4 (0.42 ± 0.82 vs. 0.83 ± 0.95, respectively, p = 0.0085). The patients on tablet L-T4 forgot to take their medication more frequently than those on liquid LT4 treatment (p = 0.0159) and were more often careless at times about taking their medication (p = 0.007), whilst about one in two thyroidectomized patients preferred tablets for lifetime medication therapy. The global MAQ score was directly correlated with the circulating TSH levels in the whole study population (0.700, p < 0.0001) and inversely correlated with both the FT3 (−0.220, p = 0.0232) and FT4 (−0.327, p = 0.0006) serum concentrations. (4) Conclusions: Long-term adherence to L-T4 treatment was globally satisfactory although it was better for the liquid formulation, which appears to represent an easier-to-manage L-T4 replacement therapy for most thyroidectomized patients, particularly for those with difficulties in taking L-T4 while fasting.

Increased Body Mass Index is Associated With Lower Risk of Hypocalcemia in Total Thyroidectomy Patients

IntroductionHypocalcemia following total thyroidectomy is common due to postoperative parathyroid dysfunction. We sought to identify the impact of obesity on postthyroidectomy hypocalcemia. MethodsWe performed a single-center retrospective study of all total thyroidectomies performed from 2016 to 2019 after implementation of an updated calcium supplementation protocol. Patient characteristics and outcomes were measured including body mass index (BMI), postoperative hypocalcemia (Ca <8.3), and hypocalcemic symptoms. ResultsOverall, 559 total thyroidectomies were performed. A total of 146 patients (26.2%) developed hypocalcemia requiring supplementation adjustment and 116 patients (20.8%) developed mild hypocalcemia symptoms. On multivariable analysis, younger patients, patients with lower preoperative calcium, and lower BMI were more likely to develop postoperative hypocalcemia (all P < 0.05). Similarly, younger patients and patients with BMI <25 were more likely to develop hypocalcemic symptoms (all P < 0.05). ConclusionsYounger age and lower BMI were associated with increased risk of hypocalcemia after total thyroidectomy. These patients may benefit from preoperative and/or increased postoperative supplementation.

The effect of strap muscle transection on voice and swallowing changes after thyroidectomy in patients without laryngeal nerve injury.

Voice and swallowing symptoms are frequently reported after thyroidectomy even without laryngeal nerve injury. We aimed to evaluate the effect of strap muscle transection on voice and swallowing outcome after thyroidectomy. Group 1 (G1) consisted of 17 patients who had their strap muscles transected during thyroidectomy and group 2 (G2) consisted of 17 patients who had their strap muscles preserved during thyroidectomy. None of the patients had laryngeal nerve injury. Voice impairment scores (VIS) and swallowing impairment scores (SIS) were obtained preoperatively and at 1 week and 1, 3 and 6 months postoperatively. Pre- and postoperative vocal cord examinations were performed for all patients. The external branch of the superior laryngeal nerve (EBSLN) was evaluated by intraoperative cricothyroid muscle electromyography. There was no significant difference in VIS and SIS between the two groups. At postoperative week 1, the VIS and SIS for each group were above preoperative values (G1: p = 0.005 and p = 0.035; G2: p = 0.031, p = 0.346, for VIS and SIS respectively). The VIS and SIS scores at 6 months postoperatively were significantly lower than those of the first week postoperatively (G1: p = 0.04 and p = 0.001; G2: p = 0.022 and p = 0.034 respectively) and similar to preoperative values (G1: p = 0.924 and p = 0.086; G2: p = 0.822 and p = 0.187 respectively). Although voice and swallowing complaints increased in the early postoperative period even without recurrent laryngeal nerve and EBSLN injuries, these symptoms are not related with the strap muscle transection.

Effectiveness of Evidence Based Nursing Guidelines on Thyroidectomy Patients Health Outcomes at General Surgery Departments

Effectiveness of Evidence Based Nursing Guidelines on Thyroidectomy Patients Health Outcomes at General Surgery Departments

A study of parathyroid hormone deficiency after total and near total thyroidectomy: its occurrence and time for recovery

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Parathyroid hormone (PTH) deficiency or hypoparathyroidism occurring after total thyroidectomy is not an uncommon postoperative complication. Patients developing PTH deficiency are likely to develop hypocalcemia if not treated in time. These patients will require immediate injectable followed by oral calcium supplements and activated vitamin D (1, 25-dihydroxycholecalciferol or calcitriol). The incidence of hypoparathyroidism reported in the literature varies between 1% to 37%. The aim of our study was to evaluate parathyroid hormone deficiency and the time taken for recovery of parathyroid function in total and near total thyroidectomy patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;An observational descriptive study was carried out at a tertiary care center with 50 patients who underwent total or near total thyroidectomy. Exclusion criteria- Patients in whom PTH was found to be below 10 pg/ml or above 65pg/ml preoperatively, those in whom neck dissection was done previously, those with abnormal calcium levels preoperatively and those on calcium replacement preoperatively.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 12% of patients developed PTH deficiency following total thyroidectomy, but only 2% continued to have prolonged depression of PTH level. A significant relation between fall in PTH on post op evening was found with the development of hypocalcaemia in the post op period.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Immediate post operative PTH can be used as an indicator to predict hypocalcemia in the post operative period in patients undergoing total or near total thyroidectomy.&lt;/p&gt;

Endoscopic thyroidectomy via the combined trans-oral and chest approach for cT1-2N1bM0 papillary thyroid carcinoma.

Recent years there have been witnessed considerable advances in endoscopic selective lateral neck dissection (LND). However, dissection of lymph nodes at level IV and level VI via the chest approach is inherently challenging. In this study, we used combined trans-oral and chest approach for endoscopic thyroidectomy in patients with cT1-2N1bM0 papillary thyroid carcinoma (PTC). Clinical characteristics and surgical outcomes of ten patients with cT1-2N1bM0 PTC who underwent endoscopic thyroidectomy via combination of trans-oral and chest approach between September 2020 and September 2021 were retrospectively reviewed. All 10 patients successfully underwent total thyroidectomy and selective LND via chest approach, while central neck dissection (CND) and supplementary dissection of lymph nodes at level IV were performed via the trans-oral approach. The mean number of positive/retrieved level II, III-IV, and VI lymph nodes were 0.6 ± 1.0/9.8 ± 5.0, 4.6 ± 2.8/23.1 ± 4.7, and 4.9 ± 3.4/10.3 ± 4.6, respectively. Four patients developed transient hypoparathyroidism which spontaneously resolved within 1month. Five patients developed numbness of lateral neck and ear and one patient experienced limb lift restriction. No other complications or tumor recurrence occurred during follow-up. It is feasible to perform total thyroidectomy, CND, and selective LND via combined trans-oral and chest approach, and satisfactory short-term outcomes were observed in this cohort. This approach may offer one more option for cT1-2N1bM0 PTC patients, especially those in whom metastatic lymph nodes at level IV or level VI are detected by preoperative examination.

Endoscopic thyroidectomy to minimize light exposure of an erythropoietic protoporphyria patient: A case report

Introduction and importanceErythropoietic protoporphyria is a rare form of cutaneous porphyria that presents with photosensitivity. During surgery, light shielding is required to prevent acute attacks due to photosensitivity. In this study, we report a case of successful endoscopic thyroidectomy using video-assisted neck surgery (VANS) method for a thyroid tumor in a patient with erythropoietic protoporphyria.Case presentationA 32-year-old woman with a history of erythropoietic protoporphyria and an enlarged left thyroid gland was referred to our hospital. The referring physician had noted a left lobe tumor of the thyroid gland with a maximum diameter of 5 cm. Computed tomography and ultrasonography showed the tumor shape as smooth and well-defined. A lobectomy of the thyroid gland was performed using the VANS method through a 3-cm incision on the skin. Surgical light was not used and exposure to ambient light was minimized by covering the patient's neck with a drape. No acute attack of porphyria or photosensitivity was observed during the surgery or the follow-up. Postoperative complications such as asphyxia, blood loss, or nerve palsy were absent. The patient was discharged 5 days after the surgery.Clinical discussionWhile the VANS method is known to have mainly cosmetic advantages, this case demonstrates that it is also a method that can minimize the exposure of the patient's skin to light with using an additional drape.ConclusionThe VANS method should be considered as an option for thyroidectomy in patients with protoporphyria because it can reduce the exposure to light during surgery.

Transient Hypocalcemia After Total Thyroidectomy: The Obesity Paradox at Work?

IntroductionWith increasing rates of obesity worldwide, a correlation between high body mass index (BMI) and postoperative morbidity after thyroid surgery remains unclear. Postoperative transient hypocalcemia is common after total thyroidectomy due to interruption of parathyroid function. This study examines the relationship between BMI and hypocalcemia after total thyroidectomy. Materials and methodsA retrospective review of prospectively collected data for 1135 patients who underwent total thyroidectomy for cancer, multinodular goiter (MNG), or Graves’ disease between June 2009 and November 2020 at a single institution was performed. BMI groups followed the World Health Organization classification. Hypocalcemia was defined as serum calcium ≤8 mg/dL. Calcium levels measured on postoperative day 0 and the following morning were compared between the BMI groups. ResultsOf 1135 total thyroidectomy patients, 85% were women. The mean age and standard deviation of patients was 49 (± 13) y, with most of Hispanic origin (64%). Overall, 41.5% of patients had cancer, 45% nontoxic MNG, 5.8% toxic MNG, and 12% Graves' disease. Stratified by BMI, 27% of patients were normal, 34% overweight, and 39% obese. Overall, overweight and obese patients experienced less transient hypocalcemia at both time points compared to normal patients postoperatively (P = 0.01 and P = 0.009). Furthermore, overweight and obese patients with Graves’ disease experienced less transient hypocalcemia at both time points (P = 0.04 and P = 0.05). There was no statistical difference in other groups. ConclusionsA protective role of higher BMI or “obesity paradox” for postoperative hypocalcemia may exist in those obese patients after total thyroidectomy.