Total Thyroidectomy For Benign Goiter Research Articles

Comparison of the Outcome of Clamp-and-Tie with Ligasure Technique in Total Thyroidectomy

Objective: To compare the outcome of clamp-and-tie with Ligasure technique in total thyroidectomy patients. Material and Methods: A total 60 (30 in each group) patients undergoing near total thyroidectomy for benign goiter were included in this study. After taking informed consent, demographic data (age, gender, duration of goitre, place of living and BMI) were noted. All selected cases were be divided into group A & B by lottery method. In group A patients total thyroidectomy was done by using ligasure while in group B patients, near total thyroidectomy was done by clamp-and-tie technique. Operation time and intra-operative blood loss were measured for each patient. Results: Mean age of patients was 45.60±12.1 years included in this study. Mean disease duration was 7.8±4.5 months. Mean BMI was 24.80±3.61 kg/m2. There were 43 (71.67%) females and 17 (28.33%) male patients. There were 13 (21.67%) patients were from rural area and 47 (78.33%) were from urban area. Mean operative time in group A was 61.33±5.98 hours versus 75.06±6.61 hours in group B (p-value <0.001). Mean intra-operative blood loss was 53.40±6.11 ml in group A versus 81.47±9.29 ml in group B (p-value <0.001). Conclusion: Thyroid surgery with Ligasure resulted in dramatically reduced mean operational time and postoperative blood loss compared to traditional approach. Keywords: clamp-and-tie technique, Ligasure, total thyroidectomy.

The Relationship Between the Serum Level of Vitamin D and Hypocalcemia After Total Thyroidectomy

Vitamin D plays a crucial role in calcium metabolism through the parathormone-dependent process. The deficiency of this important nutrient may be associated with hypocalcemia after thyroidectomy. To evaluate the role of vitamin D in predicting hypocalcemia following total thyroidectomy. In this study, sixty-two patients who underwent total thyroidectomy for benign or malignant thyroid disease were included in this prospective study. Preoperative vitamin D serum levels and parathormone (PTH) levels were determined. The association between preoperative vitamin D status and the development of hypocalcemia was investigated. In this study, 62 patients were evaluated. The mean age of the subjects was 47 years. Of the 62 patients studied, of which 9 were male patients (14.5%), and 53 were female (85.5%), the results of our study showed. In both groups with and without vitamin D deficiency, calcium levels decreased significantly (P=0.01). In our study, it was found that there was no significant relationship between postoperative hypocalcemia and vitamin D deficiency. (P=0.441). After reviewing the data and according to Spearman correlation statistical test, no significant relationship was observed between serum parathyroid hormone (PTH) and calcium after thyroidectomy (P=0.340). Vitamin D deficiency is a risk factor of hypocalcemia after total thyroidectomy for benign goiter. Although post thyroidectomy hypocalcemia is multifactorial, vitamin D deficiency, particularly severe form, is significantly associated with the development of biochemical and clinical hypocalcemia. Vitamin D supplementation can prevent this unwanted complication in such patients.

Hypocalcemia following total thyroidectomy for benign goitre

Thyroidectomy has a complication rate lower than 5%. Most frequently, postoperative hypocalcemia has been observed. the aim of the present study was to assess Hypocalcemia following total thyroidectomy for benign goiter in head, neck, endocrine surgery unit at Alexandria main university hospital. Post-thyroidectomy hypocalcaemia (PTHC) is a recognised postoperative complication with potential wide-ranging implications and healthcare costs. Hypocalcaemia can be asymptomatic; however, clinical manifestations such as paraesthesia and muscle spasms can be distressing for the patient, while persistent untreated hypocalcaemia can be life threatening. Thyroid surgery (total or near total thyroidectomy) can lead to serious complications, including transient or permanent vocal cord palsy or severe bleeding. However, hypocalcemia is the most frequent complication after thyroid surgery. Transient hypocalcemia frequently complicates postoperative care of patients who have undergone thyroid surgery. Post-thyroidectomy hypocalcemia arises because of parathyroid removal, devascularization and damage which induce a state of transient (or permanent) hypoparathyroidism. Additional mechanisms, such as vitamin D deficiency, an acute increase in calcitonin serum levels (because of gland handling during surgery) or an “hungry bone syndrome” are believed to contribute to this process.

P-204 Case report of cutaneous papillary thyroid carcinoma 16 years post total thyroidectomy for benign goiter

P-204 Case report of cutaneous papillary thyroid carcinoma 16 years post total thyroidectomy for benign goiter

Influence of gender and women's age on the prevalence of parathyroid failure after total thyroidectomy for multinodular goiter.

Female gender, particularly of a young age, has been reported as a risk factor for hypocalcemia after total thyroidectomy. There are no studies, however, addressing specifically the influence of women's age and menstrual status on postoperative parathyroid function. Cohort study of consecutive patients undergoing total thyroidectomy for benign goiter between 2000-2017, excluding those with associated hyperparathyroidism, reoperation or conservative procedures. Prevalence of postoperative hypocalcemia (s-Ca <8 mg/dL at 24 hours), protracted (1-month) and permanent hypoparathyroidism (>1 year) were the main variables studied. Complete >1-year follow-up was achieved for all patients developing post-thyroidectomy hypocalcemia. Demographic, disease-related, number of parathyroid glands remaining in situ (PGRIS), biochemical and surgical variables were recorded. The impact of menstrual status on parathyroid function was analyzed by comparing two groups of women using a cut-off age of 45 years. A total of 811 patients were included: 14 percent were males and 86 percent females with a mean age of 53.2 years. The prevalence of postoperative hypocalcemia was ten points higher in women than in men (23.7% vs. 36.4%; P=0.008). Permanent hypoparathyroidism was more common in women than in men (5% vs. 0.9%; P=0.048). Compared to females ≥45 years, young women presented higher rates of all three parathyroid failure syndromes despite similar PGRIS scores. Age <45 years and low PGRIS scores were the only independent variables predicting postoperative hypocalcemia in females. Premenopausal patients presented a higher prevalence of parathyroid failure and permanent hypoparathyroidism with similar PGRIS scores suggesting the presence of a sex-hormone factor influencing post-thyroidectomy parathyroid function.

Impact of pre-operative serum 25-hydroxyvitamin D on post-operative serum calcium in patients undergoing total thyroidectomy for benign goitre: retrospective study of 246 patients.

To determine whether pre-operative serum 25-hydroxyvitamin D has an impact on post-operative parathyroid hormone and serum calcium levels in patients undergoing total thyroidectomy for benign goitre. This single-centre, retrospective study comprised 246 unselected surgical patients who had undergone total thyroidectomy for bilateral, benign, multinodular goitre. The correlation between pre-operative serum 25-hydroxyvitamin D and post-operative serum parathyroid hormone and serum calcium was studied to determine whether low pre-operative serum 25-hydroxyvitamin D was predictive of post-operative hypocalcaemia. Seventy-nine patients (32 per cent) had post-operative hypocalcaemia. Eighteen patients (7.32 per cent) experienced unintentional parathyroidectomy (1 parathyroid gland in 15 patients, 2 parathyroid glands in 3 patients). In univariate analysis, pre-operative serum 25-hydroxyvitamin D was not correlated with post-operative serum calcium (p = 0.69) or post-operative serum parathyroid hormone (p = 0.5804). Furthermore, in multivariate analysis, which took into account unintentional parathyroidectomy, no correlation was found (p = 0.33). Bilateral unintentional parathyroidectomy was statistically associated with post-operative hypocalcaemia (p = 0.032). Pre-operative serum 25-hydroxyvitamin D did not appear to have any impact on post-operative serum calcium in patients undergoing total thyroidectomy for benign goitre.

Early Predictors of Post – Thyroidectomy Hypoparathyroidism

The prospective study included 142 consecutive patients undergoing total thyroidectomy for benign goiter from January 1st 2014 to December 31st 2015. Serum intact parathyroid hormone (iPTH), total calcium (Ca), phosphate (P), and magnesium (Mg) levels have been measured preoperatively and at 1, 6, 24, and 48 h postoperatively. Clinical symptoms of hypoparathyroidism developed in 25 (17.6%) of 142 patients. The best diagnostic accuracy for hypoparathyroidism based on ROC curves was obtained for iPTH at 6h (AUC 0.942; 95% CI: 0.866-1.000, p<0.001) and its percentage change from baseline ΔiPTH at 6h (AUC 0.930; 95% CI: 0.858-1.000, p<0.001). In an multivariate analysis, the preoperative Ca level higher by 0.1 mmol/l, and iPTH level higher by 0.1 pmol/l were associated with a lower risk of hypoparathyroidism, by 68% (p=0.012) and 61% (p=0.007), respectively. A 1% decline in iPTH from baseline increased the risk of hypoparathyroidism by 15% (p<0.001). The most reliable markers indicating a high risk of postoperative hypoparathyroidism are the decline in ΔiPTH at 6h by > 65% or iPTH level at 6h <1.57 pmol /l. A postoperative decline in iPTH levels is an independent risk factor for the development of hypoparathyroidism. Preoperative higher concentrations of Ca and iPTH are protective factors for the development of this disorder.

Value of intra-operative neuromonitoring of the recurrent laryngeal nerve in total thyroidectomy for benign goitre.

This study aimed to evaluate the impact of intra-operative neuromonitoring of the recurrent laryngeal nerve during total thyroidectomy for benign goitre. A single-centre retrospective study using historical controls was conducted for a 10-year period, comprising a series of 767 patients treated by total thyroidectomy for benign goitre. Of these, 306 had intra-operative neuromonitoring of the recurrent laryngeal nerve and 461 did not. Post-operative laryngeal mobility was assessed in all patients by direct laryngoscopy before hospital discharge and at post-operative follow-up visits. In all, 6 out of 461 patients (1.30 per cent) in the control group and 6 out of 306 patients (1.96 per cent) in the intra-operative neuromonitoring group developed permanent recurrent laryngeal nerve palsy. No statistically significant difference was observed between the two patient groups. Intra-operative neuromonitoring does not appear to affect the post-operative recurrent laryngeal nerve palsy rate or to reliably predict post-operative recurrent laryngeal nerve palsy. However, it can accurately predict good nerve function after thyroidectomy.

Effect of Vitamin D Deficiency on Hypocalcaemia After Total Thyroidectomy due to Benign Goiter

IntroductionThe purpose of this study was to analyze the relationship between preoperative serum levels of vitamin D and postoperative hypocalcemia after total thyroidectomy. Material and methodsA prospective observational study was conducted on 113 patients treated by total thyroidectomy due to benign disease. Preoperative vitamin D serum levels and postoperative albumin-corrected calcium and parathormone (PTH) levels were determined. Sensitivity, specificity, positive predictive value and negative predictive value of vitamin D and PTH levels, respectively, in the diagnosis of postoperative hypocalcemia were calculated. ResultsHypocalcemia was diagnosed in 44 (38.9%) patients. Vitamin D levels were significantly higher in the group of patients with normal postoperative calcium (median: 25.4pg/mL; range: 4–60), compared to those who developed hypocalcemia (median: 16.4pg/mL; range: 6.3–46.9) (P=.001). Postoperative hypocalcemia was more frequent in patients with vitamin D<30ng/mL (39/78) (50%), than among those with normal levels (5/35) (14.2%) (P=.001). Sensitivity, specificity, positive predictive value and negative predictive value were 88% and 68%, 43% and 82%, 50% and 71%, and 85% and 80% for vitamin D and PTH, respectively. Vitamin D and PTH showed independent prognostic values on the risk of hypocalcemia. The OR associated with vitamin D<30ng/mL was 4.25 (95% CI: 1.31–13.78) (P=.016), and the OR of PTH<13pg/mL was 15.4 (95% CI: 4.83–49.1) (P<.001). ConclusionVitamin D deficiency is a risk factor of hypocalcemia after total thyroidectomy for benign goiter. The vitamin D level provides independent prognostic information, which is complementary to that given by PTH.

Efecto de la deficiencia de vitamina D sobre la hipocalcemia tras tiroidectomía total por bocio benigno

IntroductionThe purpose of this study was to analyse the relationship between preoperative serum levels of vitamin D and postoperative hypocalcaemia after total thyroidectomy. Material and methodsA prospective observational study was conducted on 113 patients treated by total thyroidectomy due to benign disease. Preoperative vitamin D serum levels and postoperative albumin-corrected calcium and parathormone (PTH) levels were determined. Sensitivity, specificity, positive predictive value and negative predictive value of vitamin D and PTH levels, respectively, in the diagnosis of postoperative hypocalcaemia were calculated. ResultsHypocalcaemia was diagnosed in 44 (38.9%) patients. Vitamin D levels were significantly higher in the group of patients with normal postoperative calcium (median: 25.4pg/mL; range: 4-60), compared to those who developed hypocalcaemia (median: 16.4pg/mL; range: 6.3-46.9) (P=.001). Postoperative hypocalcaemia was more frequent in patients with vitamin D < 30ng/mL (39/78) (50%), than among those with normal levels (5/35) (14.2%) (P=.001). Sensitivity, specificity, positive predictive value and negative predictive value were 88% and 68%, 43% and 82%, 50% and 71%, and 85% and 80% for vitamin D and PTH, respectively. Vitamin D and PTH showed independent prognostic values on the risk of hypocalcaemia. The OR associated with vitamin D < 30ng/mL was 4.25 (95% CI: 1.31-13.78) (P=.016), and the OR of PTH<13pg/mL was 15.4 (95% CI: 4.83-49.1) (P<.001). ConclusionVitamin D deficiency is a risk factor of hypocalcaemia after total thyroidectomy for benign goitre. The vitamin D level provides independent prognostic information, which is complementary to that given by PTH.

NEW SURGICAL CONSULTANTS: IS THERE A LEARNING CURVE?

The purpose of this study was to determine whether newly established surgeons who have completed dedicated post-fellowship training are able to achieve surgical outcomes comparable to their more experienced peers. A cross-sectional study of consecutive patients undergoing total thyroidectomy (TT) or completion thyroidectomy was carried out. Outcomes measured included unplanned return to the operating theatre, postoperative infection, permanent recurrent laryngeal nerve (RLN) injury and permanent hypoparathyroidism. Outcomes were categorized according to whether surgery was carried out by an established surgeon (ES) or a newly appointed surgeon (NAS). Eight hundred and nine TT and completion thyroidectomy procedures were carried out in the period January 2002 to December 2004. Of these, 515 (64%) were carried out by ES and 294 (36%) were carried out by NAS. The overall rate of permanent hypoparathyroidism and RLN injury was 1.4% (12/809) and 0.6% (5/809), respectively. The rate of permanent hypoparathyroidism was not significantly different between the two categories of surgeon (ES 1.35% vs NAS 1.7%; P = 0.7). The incidence of permanent RLN injury was not different between the two groups (ES 0.8% vs NAS 0.3%; P = 0.4). For NAS, the rate of permanent RLN injury for the first two years of independent practice did not differ significantly from 3 to 4 years of practice (0/123 vs 1/171; P = 0.4). Indications for surgery between the two groups were similar, with ES carrying out TT for benign goitre in 42% and cancer in 28%, and NAS 44 and 32%, respectively. Surgical outcomes for the newly established endocrine surgeon following subspecialty training are equivalent to those achieved by more experienced surgeons.

Body mass and body composition after total thyroidectomy for benign goiters.

To date there are no data available as to whether postmenopausal women who undergo total thyroidectomy for benign euthyroid goiter demonstrate changes in body mass or body composition. We prospectively evaluated 8 postmenopausal women (mean age 57 +/- 7; range 48 to 70 years) who underwent total thyroidectomy for benign goiter. All patients were euthyroid preoperatively (serum free thyroxine [FT4] 12.7 +/- 0.6 pmol/L and serum thyrotropin [TSH] 0.98 +/- 0.2 mU/L) and were commenced on adequate thyroxine replacement immediately postoperatively in order to maintain a serum TSH within the normal range (0.5-4 mU/L). Body mass, body composition, and thyroid function were assessed preoperatively, and at 4 and 12 months postoperatively. Body composition was assessed by anthropometry and dual energy x-ray absorptiometry (Lunar DPX-L scanner). Eight healthy postmenopausal women without evidence of thyroid disease matched for age, weight, and estrogen therapy who were followed over the same period were used as controls. All patients were maintained in a euthyroid status throughout the study. No significant changes in body mass or any parameter of body composition were demonstrated at 4 and 12 months postoperatively. Similar findings were recorded in our control group. We conclude that total thyroidectomy in euthyroid postmenopausal women with benign goiter does not result in a significant change in either body mass or body composition if adequate thyroxine replacement is maintained.