Unilateral Thyroidectomy Research Articles

Outcome and postoperative complications in 73 dogs with thyroid carcinoma with gross vascular invasion managed with thyroidectomy.

Excellent outcomes have been reported following thyroidectomy for thyroid carcinoma in dogs, but outcomes for thyroid carcinomas with gross vascular invasion are poorly described. This study describes the clinical outcomes and complications in dogs with thyroid carcinomas with gross vascular invasion undergoing thyroidectomy. Medical records of dogs that underwent thyroidectomy between January 1st 2010 and December 31st 2019 were reviewed at 10 hospitals. Signalment, diagnostic data, primary and adjuvant treatments performed, and outcome were abstracted. Survival was calculated using Kaplan-Meier analysis. Multiple logistic regression was used to identify variables associated with disease-specific survival. Seventy-three dogs were included, of which 58 underwent unilateral thyroidectomy and 15 underwent bilateral thyroidectomy. Complications were reported in five dogs (three major, two minor; 6.8%) intraoperatively and 12 dogs (two major leading to death, 10 minor; 16.4%) postoperatively. Seven (9.6%) dogs developed locoregional recurrence at a median of 238 days postoperatively (range: 15-730 days). Distant metastasis was suspected or confirmed in nine dogs (12.3%) at a median of 375 days postoperatively (range: 50-890 days). Twenty-seven dogs (37%) received adjuvant therapy (chemotherapy: n=21; radiotherapy: n=6). Thirty-nine dogs were euthanized or died, with 20 deaths related to disease (n=10) or of unknown cause (n=10), 19 due to unrelated causes, and nine lost to follow-up. Median overall and disease-specific survival were 621 days and not reached respectively. One-year disease-specific survival rate was 82.5%. No variables were associated with disease-specific survival in our dataset. Surgery may be considered for loco-regional therapy in dogs with thyroid carcinoma with gross vascular invasion.

Clinical Analysis of 76 Cases of Differentiated Thyroid Isthmic Carcinoma after Operation

Objective: To investigate the clinicopathological features and surgical treatment of differentiated thyroid isthmus carcinoma. Methods: The clinical data of 76 patients with differentiated thyroid isthmus cancer diagnosed and operated in our hospital from January 2015 to January 2019 were retrospectively analyzed. Results: 16 cases of single focus, 60 cases with unilateral or bilateral multiple lesions, 76 patients. Bilateral thyroidectomy and bilateral CLN dissection were performed in 57 cases, unilateral thyroidectomy plus isthmus resection plus lateral total resection and bilateral central lymph node dissection in 17 cases. 2 cases underwent bilateral thyroidectomy plus bilateral CLN dissection plus unilateral neck lateral lymph node dissection. Lymph node metastasis occurred in 42 cases and lymph node metastasis in 40 cases, including 16 cases of unilateral central lymph node metastasis, 24 cases of bilateral central lymph node metastasis, and 2 cases with lateral cervical lymph node metastasis. 16 cases of single isthmus thyroid cancer, unilateral CLNM in 7 cases (43.75%), bilateral CLNM in 4 cases (25%), no metastasis in 5 cases (31.25%), and no lateral lymph node metastasis. Hypocalcemia occurred in 7 cases and temporary hoarseness occurred in 3 cases, which returned to normal within 3 - 6 months. All 76 patients were followed up. No permanent hypoparathyroidism, cervical lymph node recurrence, distant metastasis or death occurred in all patients. Conclusion: The treatment of differentiated thyroid isthmic carcinoma should be based on the pathological diagnosis, with bilateral thyroidectomy and bilateral CLN dissection as the main treatment. For patients with single focus, diameter ≤ 1 cm and low-risk group, if the above reasons are excluded, isthmus + unilateral gland resection and bilateral central lymph node dissection are feasible.

The area under the waveform of electromyography for monitoring the external branches of the superior laryngeal nerve during thyroid surgery.

Injuries to the external branches of the superior laryngeal nerve (EBSLN) are difficult to identify during thyroidectomy. Monitoring the low amplitudes of the EBSLN during surgery has proven to be complicated. Therefore a new parameter, the area under the waveform (AUW), was designed to improve monitoring efficiency. The aim of this study was to determine the effectiveness of using AUW to monitor the EBSLN during thyroidectomy. A total of 927 patients and 927 recurrent laryngeal nerves (RLN) and EBSLNs who underwent monitored unilateral thyroidectomy were included. Standardized intraoperative neuromonitoring procedures were followed. RLN injuries were confirmed using stroboscopic laryngoscopy after surgery. EBSLN injuries were identified by means of observing changes in cricothyroid muscle (CTM) twitches when stimulated. Amplitude and AUW changes were assessed using statistical analysis. The correlations between AUW and amplitude were verified using the ratio of the two parameters to determine any decreases that were observed in the number of nerve injury cases. The receiver operating characteristic (ROC) curve was used to estimate the prediction of nerve injury. The overall injury rates of the RLN and EBSLN were 3.56% and 2.05%, respectively. The AUW for the RLN and EBSLN presented linear correlations with amplitude. In the RLN injury cases, no significant difference was observed between the two parameters (P>0.05). In the cases with EBSLN injuries, the AUW decreased 64.5%±14.1%, on average, which was a greater decrease compared to that observed for amplitude 49.7%±22.2% (P<0.0001). The summary of the EBSLN injury prediction included, amplitude vs. AUW, AUC: 0.918 vs. 0.994; P<0.0001, and Youden's index: 31.54% vs. 49.58%. The AUW demonstrated consistency with the change in amplitude, and the observed changes were significant. The use of the AUW allowed successful predictions for both RLN and EBSLN nerve injuries. Also, the sensitivity of AUW was greater than amplitude for predicting EBSLN injuries.

Incidence and risk factors of inadvertent parathyroidectomy during thyroid surgery: A single-center retrospective study

Context: Thyroidectomy is considered a relatively safe surgery with morbidity of <5% when undertaken by experienced surgeons. Inadvertent parathyroidectomy (IP) means pathology report has found parathyroid tissue in the thyroid specimen, and it was reported to range from 2.9% to 31%. Aims: The aim of this study is to measure the incidence rate and to evaluate the significant relationship between risk factors and IP during thyroid surgery. Settings and Design: A retrospective chart review study was carried out in King Fahad Armed Forces Hospital, Jeddah, between June 2015 and December 2019. Subjects and Methods: All consecutive patients undergoing unilateral or bilateral thyroidectomy were enrolled in this study. Histopathology reports were reviewed to identify the specimens that included parathyroid tissue and underlying thyroid disease, and these were compared to patients with no parathyroidectomy in terms of gender, pathological features, re-operation, Hashimoto thyroiditis, extrathyroidal extension, and central neck dissection. Statistical Analysis Used: Statistical analysis was carried out using the Statistical Package for the Social Sciences. Results: Retrospective analysis of 181 consecutive thyroidectomy cases reveals that 34 (18.7%) patients had IP. Significant risk factors for IP included extra-thyroid extension (P = 0.008), total thyroidectomy (P = 0.017), and Hashimoto thyroiditis (P = 0.021). Other risk factors, including gender, malignancy, central neck dissection, and re-operation, were not statistically significant in this study. Conclusions: IP during thyroid surgery is not uncommon (18.7%). Total thyroidectomy, hashimoto thyroiditis, and extrathyroidal extension of the tumor were found to be significant risk factors. We recommend more meticulous intra-operative identification of parathyroid glands, particularly for patients with these risk factors.

Chronic diarrhea in west highland white terrier caused by hyperthyroidism

A 8-years old, female West Highland White Terrier, with a 7-month history of diarrhea and sometimes hematemesis, polyuria and polydipsia. The antibiotic, antihelminthic, antiprotozoal, vitamin and diet changing was given by the previous veterinarian, diarrhea was stopped for a while but the diarrhea reappear. The clinical symptoms was chronic diarrhea, polyuria, and polydipsia. Physical examination revealed a swelling in ventrolateral neck area suspected a enlarge thyroid gland in right side. Blood analyses performed a markedly elevated thyroxine (T4) level and increased alkaline phosphatase (ALP). An urinalysis revealed decreases specific gravity (hypostenuria). From an examination, the diagnose hyperthyrodism has been made. The dog was treated by unilateral thyroidectomy. Histopathology of thyroidectomy was thyroid adenoma. A month after surgery, diarrhea was gone and polyuria and polydipsia was better

Complications and outcomes associated with unilateral thyroidectomy in dogs with naturally occurring thyroid tumors: 156 cases (2003-2015).

To describe complications and outcomes of dogs undergoing unilateral thyroidectomy for the treatment of thyroid tumors. 156 dogs undergoing unilateral thyroidectomy for a naturally occurring thyroid tumor. Dogs that underwent a unilateral thyroidectomy in 2003 through 2015 were included in a multi-institutional retrospective study. For each dog, information gathered through evaluation of electronic and paper records included perioperative complications, short-term outcome (survival to discharge from the hospital vs nonsurvival), and long-term outcome (survival time). In the perioperative period, complications occurred in 31 of the 156 (19.9%) dogs; hemorrhage was the most common intraoperative complication (12 [7.7%] dogs). Five of 156 (3.2%) dogs received a blood transfusion; these 5 dogs were among the 12 dogs that had hemorrhage listed as an intraoperative complication. Immediately after surgery, the most common complication was aspiration pneumonia (5 [3.2%] dogs). One hundred fifty-three of 156 (98.1%) dogs that underwent unilateral thyroidectomy survived to discharge from the hospital. One hundred-thirteen dogs were lost to follow-up; from the available data, the median survival time was 911 days (95% confidence interval, 704 to 1,466 days). Results indicated that unilateral thyroidectomy in dogs with a naturally occurring thyroid tumor was associated with a perioperative mortality rate of 1.9% and a complication rate of 19.9% and that hemorrhage and aspiration pneumonia were the most common complications. Long-term survival of dogs undergoing unilateral thyroidectomy for the treatment of thyroid tumors was not uncommon.

Thyroidectomy as Treatment of Choice for Differentiated Thyroid Cancer.

Background Despite a large amount of data, the optimal surgical management of differentiated thyroid cancer remains controversial. Current guidelines recommend total thyroidectomy if primary thyroid cancer is >4 cm, while for tumors that are between 1 and 4 cm in size, either a bilateral or a unilateral thyroidectomy may be appropriate as surgical treatment. In general, total thyroidectomy would seem to be preferable because subtotal resection can be correlated with a higher risk of local recurrences and cervical lymph node metastases; on the other hand, total thyroidectomy is associated with more complications. Methods This is a retrospective study conducted on 359 patients with differentiated thyroid cancer, subjected to total thyroidectomy. Our aim was to correlate clinical and pathological features (extrathyroid tumor growth, bilaterality, nodal and distant metastasis) with patient (gender and age) and tumor (size and histotype) characteristics. Moreover, we recorded postoperative complications, including hypoparathyroidism and laryngeal nerve damage. Results In our study, we found a high occurrence of pathological features indicating cancer aggressiveness (bilaterality, nodal metastases, and extrathyroid invasion). On the other hand, total thyroidectomy was associated with relatively low postsurgical complication rates. Conclusions Our data support the view that total thyroidectomy remains the first choice for the routine treatment of differentiated thyroid cancer.

Association between postoperative cough and thyroidectomy: a prospective study

BackgroundThis study sought to determine whether thyroidectomy is associated with self-reported cough through a prospective analysis.MethodsPatients undergoing unilateral thyroidectomy were prospectively enrolled. The control group was selected to avoid the effect of general anaesthesia. The experimental group consisted of 300 patients (202 females and 98 males) who underwent thyroidectomy, with a mean age of 48.6 years, and the control group consisted of 103 patients (53 females and 50 males) who underwent other head and neck operations, with a mean age of 50.3 years. All patients were required to complete the Leicester Cough Questionnaire (LCQ) preoperatively and 2 weeks postoperatively.ResultsThe postoperative mean total LCQ scores in the experimental and control groups were 17.9 ± 5.0 and 19.8 ± 4.2, respectively; the difference was significant (p = 0.014). Adverse event analysis showed that patients in the experimental group scored significantly worse on items for chest or stomach pains, phlegm, feeling in control of coughing, sleep disturbances, coughing bouts, frustration, and feeling fed up with coughing. In the analysis of the three LCQ domains, a significant difference was noted in the physical domain between the two groups (p < 0.001). In the one-way analysis of variance, the factors of sex and anaesthesia time were associated with the postoperative LCQ score; in further multifactor analysis of variance, only the factor of sex was significantly related to the postoperative LCQ score.ConclusionThyroidectomy may be associated with postoperative cough, and a higher number of female patients complained of cough and related symptoms.

A comparison of transoral vestibular and bilateral areolar endoscopic thyroidectomy approaches for unilateral papillary thyroid microcarcinomas.

IntroductionA transoral (TO) vestibular approach is a new remote access approach to avoid cutaneous scars in an endoscopic thyroidectomy (ET). And transoral endoscopic thyroidectomy (TOET) has been widely used in papillary thyroid microcarcinomas (PTMCs).AimTo evaluate and compare endoscopic thyroidectomies with central neck dissection using a bilateral areolar (BA) approach and TO approach in patients with unilateral PTMCs.Material and methodsIn total, 92 papillary thyroid cancer (PTC) patients undergoing an endoscopic unilateral thyroidectomy with central neck dissection via a TO (n = 48) or BA (n = 44) approach were retrospectively enrolled from August 2017 to December 2018. Differences in various factors, such as clinical characteristics, surgery-related parameters, including operative complications, and hospital durations and costs, were compared.ResultsNo significant between-group differences in the age and sex of the patients or the side, body mass index, total operative time, operative bleeding, superior parathyroid preservation in situ, operative complications, and postoperative day of discharge were found (all p > 0.05). The mean central neck dissection time, amount of postoperative drainage, extubation time, and inferior parathyroid preservation in situ were lower in the TO group as compared with these parameters in the BA group (all p < 0.05). The number of central lymph nodes resected and hospitalization costs were higher in the TO group as compared with those in the BA group (all p < 0.05).ConclusionsAn ET via the TO approach may be a good choice for unilateral PTMCs because of the shorter central neck dissection time, reduced postoperative drainage, better cosmetic satisfaction, and higher number of lymph nodes removed.

Oncologic outcomes in patients with 1-cm to 4-cm differentiated thyroid carcinoma according to extent of thyroidectomy.

Recent guidelines advocate unilateral thyroidectomy for low-risk 1-cm to 4-cm differentiated thyroid cancer (DTC). This study was designed to examine the association between the extent of thyroidectomy and oncologic outcomes in patients with 1-cm to 4-cm DTC. From April 1978 to December 2011, 16 057 patients with DTC underwent thyroidectomy at Yonsei University Hospital. Among them, 5266 (32.8%) patients were classified as having 1-cm to 4-cm DTC and were enrolled in this study. Clinicopathologic features and prognostic results (disease-free survival [DFS] and disease-specific survival [DSS] rates) were analyzed by retrospective medical record review. The mean follow-up duration was 57.3 ± 58.1 months. Of tumor subtypes in the study group, papillary thyroid carcinoma was the most common (97.5%) and follicular thyroid carcinoma occurred at a rate of 2.5%. In this study, the mean tumor size was 1.84 ± 0.74 cm. Patients had extrathyroidal extension (69.3%), multiplicity (35.1%), bilaterality (26.4%), central lymph node metastasis (53.0%), and lateral neck node metastases (19.9%). Of the 5266 patients, 4292 (81.5%) underwent total thyroidectomy and 974 (18.5%) had lobectomies. Recurrence rates in the total thyroidectomy and lobectomy groups were 5.7% and 9.4%, respectively. The lobectomy group had lower DFS (P = .007) and higher DSS (P = .034) than the total thyroidectomy group. A multivariate analysis for DFS revealed that tumor size, N classification, and extent of thyroidectomy were independent risk factors. On multivariate analysis, independent risk factors for DSS were age, sex, tumor size, and M classifications. Although extent of thyroidectomy does not affect DSS, total thyroidectomy is beneficial for reducing recurrence in patients with 1-cm to 4-cm DTC. However, if such tumors have such low-risk features as being unifocal, intrathyroidal, and lymph node metastasis-negative, extent of thyroidectomy does not affect oncologic outcome and lobectomy may be sufficient.

Prospective Evaluation of Surgical Management Strategy of Thyroid Diseases in Assiut University Hospitals, A Clinical Audit

AbstractBackground: Thyroid surgery is the mainstay of the treatment of surgical goiters. Treatment modalities for the surgical management of goiter include lobectomy, sub-total thyroidectomy, near-total thyroidectomy and total thyroidec-tomy.Aim of Study: To compare current surgical management of thyroid diseases in Assuit University Hospital with man-agement guidelines, planning for improving our management of thyroid diseases and correct obstacles to achieve reduction in the morbidity and mortality result from thyroid diseases.Patients and Methods: Our study included 60 patients who were admitted to General Surgery Department with any thyroid disease during a period of six months and managed surgically. All patients had neck ultrasound and FNAC was done for suspicious cases for malignancy. Benign solitary nodular goiter was managed by unilateral lobectomy and isthmusectomy. MNG was managed by total and sub-total throidectomy. Malignant goiter was managed according to cytology with total thyroidectomy being done for most cases. Controlled toxic goiter was managed by total or sub-total thyroidectomy. All cases were subjected to pre-and post-operative layrngoscopic examination for assessement of vocal cord mobility. Post-operative histopathology is amust in all cases.Results: Mean age of the studied patients was 39.18±11.75 years with range between 15 and 63 years. Out of 60 patients, 49 (81.7%) patients were females and 11 (18.3%) patients were males. 17 (28.3%) of the studied had toxic manifestations and 15 (25%) patients were on anti-thyroid medications. Iodine deficiency was noticed in 9 (15%) patients while 7 (11.7%) patients had endemic goiter. Out of the studied patients, 5 (8.3%) patients had family history of thyroid disease.Unilobar enlargement presented in 12 (20%) patients while 48 (80%) patients had Bilobar thyroid enlargement. Diffuse goiter presented in 4 (6.7%) patients and nodular goiter in 56 (93.3%) patients, 13 (21.7%) solit all patients were subjected to thyroid function tests (TSH, free T3 and T4) before and after thyroidectomy. It was noticed that there were significant improvement in level of TSH, free T3 and free T4 after thyroidectomy (p<0.05).FNAC was done in 41 (68.3%) patients. Total thyroidec-tomy was performed in 43 (71.7%) patients while 10 (16.7%) and 7 (11.7%) patients had subtotal thyroidectomy and uni-lateral lobectomy with isthmusectomy respectively. The most frequent complications post-operatively were hoarseness of the voice and choking occurred in 18 (30%) and 16 (26.7%) patients respectively. Injury of RLN occurred in 5 (8.3%) patients.All of those patients received replacement therapy and none of them received chemotherapy or iodine therapy.Post-operative complications were frequent in those patients had total thyroidectomy where hoarseness of the voice, chocking and injury of recurrent laryngeal nerve oc-curred in 13 (30.2%), 12 (27.9%) and 5 (11.6%) patients respectively.In case of subtotal thyroidectomy 4 (40%) patients had choking and 4 (40%) patients had hoarseness of the voice. Only one patient from those had unilateral thyroidectomy had post-operative complication in form of hoarseness of the voice.Duration of surgeon experience was less than 5 years in majority of cases (56.7%) while in 16 (26.7%) and 10 (16.7%) patients duration of surgeon experience was 5-10 and more than 10 years respectively. With experience less than 5 years, post-operative complications were; 3 patients had R.L.N. injury, 12 patients had hoarseness of voice, and 10 patients had chocking. With surgical experience between 5 to 10 years, complications were; 2 patients had R.L.N. injury, 4 patients had hoarseness of voice, and 5 patients had chocking. While with experience more than 10 years, the complications were so minimal with only 2 patients had transient hoarseness of voice and chocking.In case of controlled toxic goiter; 15 (75%), 3 (15%) and 2 (10%) patients had total, subtotal and unilateral thyroidec-tomy respectively. In case of simple goiter; 7 (58.3%) patients had total thyroidectomy, 4 (8.3%) patients had unilateral thyroidectomy and 1 (8.3%) patient had subtotal thyroidectomy.21 (75%) patients from those with multinodular goiter had total thyroidectomy, 6 (21.4%) had subtotal thyroidectomy and 1 (3.6%) patient had unilateral thyroidectomy.Conclusion: In our study, no major difference was noticed between our surigal management strategy of thyroid diseases and international guidelines. Pre-operative assessement was focused with neck U/S and FNAC being the most important investigations. Choice of the type of operation was based on the type of thyroid disease and the risk of post-operative complications was considered.post-operative complications in the form of RLN injury, hypothyroidism and hypo-parathyroidism were markedly decreased.

Tailored surgery according to molecular analysis in differentiated thyroid carcinomas

Papillary thyroid carcinoma (PTC) is an often indolent disease implying a long survival and in most of the cases an excellent prognosis, but there is still a limited percentage of cases where, in spite of their pre-operative conventional staging, these tumors could better be treated through a more selective surgical approach. Small PTC in fact are generally considered as "low risk" tumors but using simply a TNM classification might lead to a limited surgery such as unilateral hemithyroidectomy, in particular according to the most recent guidelines of the American Thyroid Association. On the other hand though, an absence of the mutation could allow simplifying the follow-up of these patients, for example avoiding unnecessary radioactivated iodine therapy after surgery or even limiting to a unilateral thyroidectomy the operative procedure for these cases. Molecular testing has a peculiar interest for surgeons in two different ways: (I) with respect to diagnosis, in order to reduce the number of indeterminate citologies; (II) with respect to prognosis after both cytology and histology, in order to improve risk stratification and help the surgeon in developing a tailored surgical therapy. The aim of this review is the second issue: how to implement the concept of a tailored surgery according to molecular analysis in differentiated thyroid carcinomas (DTC).

How I Do It: New Dissector Device Allows for Effective Operative Field in Transoral Endoscopic Thyroid Surgery Using Vestibular Approach.

Minimally invasive thyroid and parathyroid resections are rarely performed. Promising new endoscopic transoral approaches to the anterior neck (transoral endoscopic thyroidectomy vestibular approach [TOETVA]) have been described with good results and few complications. This study evaluates a new device to allow the safe entrance of trocars in the subplatysmal space for TOETVA in a cadaver model. The technique was performed in 4 unilateral thyroidectomies in female cadavers. The technical steps consisted of a 10-mm incision made at the center of the oral vestibule followed by subplatysmal hydrodissection. The blunt dissector is a metallic stick with an olive at the end and promotes progressive gain in subplatysmal space enlarging the operative field. The instrument was inserted creating a space below the platysma to the anterior neck and the strap muscles. Three trocars were inserted in the vestibular area. The dissection begins by cutting the linea alba cervicalis. The isthmus was dissected and transected. Anatomical structures as the superior thyroid artery, parathyroid glands, and the recurrent laryngeal nerve could be safely identified with magnified vision. Optimal operative field due to subplatysmal dissection by the device allowed for exposition of thyroid and parathyroid glands in all cases. Unilateral thyroidectomy was performed in a mean of 54 minutes with excellent aesthetic results. The new device is a promising feature to allow safe transoral thyroid surgery in a cadaver model. Further studies in clinical series are needed to evaluate the broad application of the device.

NMR-based metabolomics to select a surgical method for treating papillary thyroid carcinoma

OBJECTIVE:This study aims to investigate differences in the metabolomic profiles of patients who received different surgeries for papillary thyroid carcinoma (PTC).METHODS:Two surgical methods, i.e., unilateral and total thyroidectomy, were employed according to different disease conditions. Sera from patients who were treated with levothyroxine sodium tablets before and after surgery was analyzed with a Bruker 500 Hz nuclear magnetic resonance (NMR) spectrometer. Data were analyzed via principal component analysis (PCA) and partial least squares discriminate analysis (PLS-DA) with SIMCA-P+ 11.0 software, and metabolites were obtained and compared. The first and second principal components were selected from PCA, PLS-DA, and orthogonal partial least squares discriminate analysis (OPLS-DA). A p-value less than 0.05 was considered statistically significant.RESULTS:There were significant differences in serum metabolomics before and after surgery. Compared with unilateral thyroidectomy, total thyroidectomy reversed some highly increased metabolite levels (e.g., taurine and betaine). More significant variations in abnormal metabolites were noted after total thyroidectomy than after unilateral thyroidectomy (e.g., alanine, choline, hippurate, and formic acid).CONCLUSIONS:The choice of surgical method for PTC patients should be based not only on the tumor condition but also on the potential consequences of metabolic variations. Total thyroidectomy reversed some increased metabolite levels but led to accumulation of some other metabolites due to the loss of thyroid function; thus, metabolic disturbances caused by thyroid hormone deficiency should be prevented in advance.

Application of Straight Line Tunnel With Less Subcutaneous Separation in Transthoracic Endoscopic Thyroidectomy

The objective of this paper was to evaluate the value of straight-line tunnel application in transthoracic endoscopic thyroidectomy. Forty patients were given 3-port transthoracic endoscopic thyroidectomy from March 2011 to June 2014. Preoperative diagnoses found 20 cases of nodular goiter, 16 cases of adenoma, and 4 cases of thyroid calcification. We used a metal rod to free skin flap in a straight way toward the neck, and a straight-line tunnel was created to obtain a good view. All 40 cases involving endoscopic thyroidectomy were performed successfully, 28 were performed with unilateral subtotal thyroidectomy, 5 were performed with unilateral thyroidectomy, 5 were performed with bilateral partial thyroidectomy, and 2 were performed with radical thyroidectomy for carcinoma. One is anaplastic thyroid carcinoma (ATC) and the other is follicular thyroid carcinoma. Operation time was 78.5 ± 18.6 minutes, intraoperative blood loss was 40.2 ± 15.6 mL, intraoperative flap-freeing time was 14.3 ± 3.8 minutes, and the diameter of the thyroid tumor was 3.8 ± 2.5 cm. Postoperative hospital stay was 3.5 ± 2.0 days. One patient got voice hoarseness and recovered in 3 months. Two patients suffered from transient hypocalcemia and recovered without treatment. No subcutaneous effusion or seroma was observed. No recurrence was found during the 12- to 36-month (mean: 28 months) follow-up. One patient felt chest numbness 3 months after the surgery. Thirty-two patients were very satisfied with the cosmetic appearance and 8 patients were satisfied. The application of straight-line tunnel in transthoracic endoscopic thyroidectomy is a simple, safe, feasible procedure with less trauma, seroma, and skin contraction.

Analysis of the benefits and risks of 1 to 4 centimetre well-differentiated thyroid carcinoma with lobectomy

Objective Study and analyze the benefits and risks of unilateral thyroidectomy for 1 to 4 cm thyroid cancer in primary surgery. Methods The patients who underwent thyroidectomy for 1 to 4 centimeters WDTC (May 2014 to June 2015) were retrospectively reviewed, and the patients with preoperatively known high-risk characteristics were excluded. One hundred and seventy-one patients would have been eligible for lobectomy as the initial operation based on current American Thyroid Association guidelines. The proportion of patients who need secondary surgery was estimated basing on pathological characteristics. Result In this group, 49% patients would have to undergo a secondary surgery if they took lobectomy as the initial operation. Conclusions Patients with 1 to 4 centimeters WDTC who accept unilateral thyroidectomy may take the risk of secondary surgery. Surgeons and patients need to balance the relative benefits and risks of initial TT versus lobectomy before the operation. Key words: Thyroid neoplasms; Guidebooks; Two-stage thyroidectomy; Treatment outcome

Tumor Multifocality Is a Candidate to Influence Management When Unsuspected Sporadic Medullary Thyroid Carcinoma Is Discovered after Unilateral Thyroidectomy

Tumor Multifocality Is a Candidate to Influence Management When Unsuspected Sporadic Medullary Thyroid Carcinoma Is Discovered after Unilateral Thyroidectomy

Pathologic features of metastatic lymph nodes identified from prophylactic central neck dissection in patients with papillary thyroid carcinoma.

The importance of pathologic features of metastatic lymph nodes (LNs), such as size, number, and extranodal extension, has been recently emphasized in patients with papillary thyroid carcinoma (PTC). We evaluated the characteristics of metastatic LNs identified after prophylactic central neck dissection (CND) in patients with PTC. We performed a retrospective review of 1,046 patients who underwent unilateral or bilateral thyroidectomy with ipsilateral prophylactic CND. We reviewed the characteristics of the metastatic LNs and analyzed their correlation to the clinicopathologic characteristics of the primary tumor. Cervical LN metastasis after prophylactic CND was identified in 280 out of 1046 patients (26.8%). The size of metastatic foci (≥2mm) was independently correlated with primary tumor size (≥1cm) (p=0.016, OR=1.88). Primary tumor size (≥1cm) was also correlated to the number of metastatic LNs (≥5) (p=0.004, OR=3.14) and extranodal extension (p=0.021, OR=2.41) in univariate analysis. The size of the primary tumor affects pathologic features of subclinical LN metastasis in patients with PTC. Patients with primary tumors ≥1cm have an increased risk of larger LN metastases (≥2mm), an increased number of LN metastases (≥5), and a higher incidence of ENE, which should be considered in decision for prophylactic CND.

PTH and ionized calcium evaluation in unilateral thyroidectomized cats

The aim of this study was to measure ionized calcium and intact parathormone concentrations after unilateral thyroidectomy with parathyroid autotransplantation in hyperthyroid cats. Hiperthyroid cats may have calcium homeostasis disorder and have decreased calcium concentration. Calcium levels decrease after thyroidectomy and their levels must be measured before thyroidectomy. Seventeen hyperthyroid cats with palpable nodules were submitted to clinical and laboratorial examination and they were prepared to surgery. Unilateral thyroidectomy with parathyroid gland autotransplantation was performed. Concentrations of serum urea, creatinine, alkaline phosphatase, alanine aminotransferase, phosphorus, potassium, total thyroxine and hematologic profile were determined before and seven days after surgery. Blood samples for serum ionized calcium concentration were collected before and after surgery on days 1, 2, 7, 15, 21. Serum calcium concentration fell significantly in all cats within 24 hours after surgery. Hypocalcemia occurred in two cats without clinical signs. The iPTH concentration measurements for samples throughout the study were uniformly low, with no patterns or trends identified. There wasn’t correlation between serum calcium levels and iPTH levels in any moment before and after surgery. iPTH couldn’t indicate parathyroid gland function after thyroidectomy in cats. The results of this study suggest that calcium concentration of all thyroidectomized cats must be measured before surgery even if they are submitted to unilateral thyroidectomy. iPTH concentration doens’t evaluate patathyroid gland function.

Single-port unilateral transaxillary totally endoscopic thyroidectomy: A survival animal and cadaver feasibility study.

BACKGROUND:Single-port unilateral axillary thyroidectomy has great potential to become a valid alternative technique for thyroid surgery. We tested the technique in a study on live animals and cadavers to evaluate the feasibility and reproducibility of the procedure.MATERIALS AND METHODS:Institutional review board (IRB) approval was obtained in our university by the Council of Ethics for the study in surviving animals and cadavers. Subtotal thyroidectomy using unilateral axillary single port was performed in five dogs and five cadavers. Performing incision in the axillary fossa, a disposable single port was inserted. The dissection progressed for creating a subcutaneous tunnel to the subplatysmal region; after opening the platysma muscle and separation of the strap muscles, the thyroid gland was identified. After key anatomical landmarks were identified, the dissection was started at the upper pole towards the bottom, and to the isthmus. Specimens were extracted intact through the tunnel. Clinical and laboratorial observations of the experimental study in a 15-day follow-up and intraoperative data were documented.RESULTS:All surgeries were performed in five animals which survived 15 days without postoperative complications. In the surgeries successfully performed in five cadavers, anatomical landmarks were recognised and intraoperative dissection of recurrent nerves and parathyroid glands was performed. Mean operative time was 64 min (46-85 min) in animals and 123 min (110-140 min) in cadavers, with a good cosmetic outcome since the incision was situated in the axillary fold.CONCLUSION:The technique of single-port axillary unilateral thyroidectomy was feasible and reproducible in the cadavers and animal survival study, suggesting the procedure as an alternative to minimally invasive surgery of the neck.