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Saidou A, Djafarou AB, Alfari AA, Zabeirou Oudou A, Ide K, Bakou OG, Younssa H, James Didier L, Sani R. Results of thyroidectomies according to general surgeons and otolaryngologist and cervico faciale surgeons at the general Hospital of Reference of Niamey, what differences in the protocols of management? BMC Surg 2024; 24:28. [PMID: 38238721 PMCID: PMC10795351 DOI: 10.1186/s12893-023-02305-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 12/27/2023] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVE To evaluate the surgical management of thyroid pathologies at the Reference General Hospital. METHODS This was a retro-prospective study over 4 years 6 months carried out in the departments of General and Digestive Surgery (GDS) and Otorhinolaryngology and Cervico Facial Surgery (ORL/FCS). It involved 182 patients who underwent thyroid surgery. RESULTS A frequency of thyroidectomy of 9.46% was found. Females predominated with a sex ratio of 0.1. The average age of patients was 42.85 years, a standard deviation 12.80. 84.06% of patients had consulted for anterior cervical mass. EU-TIRADS score 3 represented 7,14% of cases. Heteromultinodular goiter was the main indication for thyroid surgery (59.34%). Total thyroidectomy was the most commonly performed gesture in general surgery in 88,23% (n = 105), in Otorhinolaryngology, it was in the same proportion as lobo-isthmectomy at 47.61% (n = 30). The first route was video-assisted thyroidectomy 2.2% (n = 4). The recurrent laryngeal nerve was dissected and seen in 159 cases (87.36%) and parathyroid glands were also seen and preserved in 58.24% of cases (n = 106). In immediate postoperative surgery, the main complications were unilateral recurrent paralysis with dysphonia in 3.3% (n = 6) and compressive hematoma in 2.2% (n = 4). No deaths had been recorded. CONCLUSION Total thyroidectomy was the most performed procedure in department of General and Digestive Surgery. Routine oral calcium and vitamin D supplementation in the general surgery ward, reduces the occurrence of hypocalcemia after total thyroidectomy and allows a safe and early exit. Standardizing protocols will further reduce complications.
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Affiliation(s)
- A Saidou
- Department of General and Digestive Surgery, Reference General Hospital, 12 674, Niamey, BP, Niger.
| | - A B Djafarou
- Department of Otolaryngology and Cervico Facial Surgery, Reference General Hospital, 12 674, Niamey, BP, Niger
| | - A A Alfari
- Department of Physical Medicine and Functional Rehabilitation, Reference General Hospital, 12 674, Niamey, BP, Niger
| | - A Zabeirou Oudou
- Department of General and Digestive Surgery, Reference General Hospital, 12 674, Niamey, BP, Niger
| | - K Ide
- Department of General and Digestive Surgery, National Hospital, 238, Niamey, BP, Niger
| | - O G Bakou
- Department of General and Digestive Surgery, Reference General Hospital, 12 674, Niamey, BP, Niger
| | - H Younssa
- Department of General and Digestive Surgery, Amirou Boubacar Diallo Hospital, 10146, Niamey, BP, Niger
| | - L James Didier
- Department of General and Digestive Surgery, Reference Hospital, Maradi, Niger
| | - R Sani
- Department of General and Digestive Surgery, National Hospital, 238, Niamey, BP, Niger
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Boggiano V, Barnhouse K, Rodriguez TG, Kim L. Recurrent multinodular goitre and primary hyperparathyroidism due to adenoma arising in a parathyroid autotransplant more than 20 years after near-total thyroidectomy. BMJ Case Rep 2023; 16:e256177. [PMID: 37977844 PMCID: PMC10660904 DOI: 10.1136/bcr-2023-256177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
The patient is a female in her 60s with a remote history of a near-total thyroidectomy in 1997 for multinodular goitre. At the initial operation, she sustained a left recurrent laryngeal nerve injury. A devascularised parathyroid gland was autotransplanted into the right sternocleidomastoid muscle. She had been off of thyroid hormone for long periods, and her most recent levothyroxine requirement had fallen to only 25 mcg daily. The patient presented more than 20 years after her thyroidectomy with hoarseness, fatigue and dyspnoea. Laboratory studies suggested primary hyperparathyroidism. Imaging demonstrated bilateral pulmonary emboli and bulky thyroid tissue extending into her mediastinum. She underwent a completion thyroidectomy with the removal of a parathyroid adenoma arising in the autotransplanted parathyroid. This case illustrates the possibility of regrowth of benign thyroid tissue after thyroidectomy. In addition, to our knowledge, this is the first case report of a parathyroid adenoma arising from autotransplantation of a normal parathyroid.
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Affiliation(s)
- Victoria Boggiano
- Department of Family Medicine, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kathleen Barnhouse
- Department of Family Medicine, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Lawrence Kim
- Division of Surgical Oncology, UNC, Hillsborough, North Carolina, USA
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Elhassan MMA, Gismalla MDA, Mohamed SAH, Faggad A. Clinicopathological profile and management of thyroid carcinoma: a Sub-Saharan country experience. Thyroid Res 2023; 16:35. [PMID: 37626413 PMCID: PMC10463320 DOI: 10.1186/s13044-023-00173-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 07/18/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND In Sudan, there is limited knowledge on the epidemiology, clinical characteristics and pathological patterns of thyroid cancer. To address this shortcoming, we studied the clinical, pathological and treatment patterns of thyroid cancer at the National Cancer Institute ‒ University of Gezira (NCI-UG), Sudan. METHODS We performed a retrospective health facility-based study of patients with thyroid cancer who were treated at NCI-UG from January 2009 to December 2017. RESULTS A total of 139 patients with thyroid cancer were identified during the study period. Tumors were more common among women (69%). Goiter was the main presenting symptom (85%). The most common type of thyroid cancer was follicular carcinoma (41%), followed by papillary carcinoma (24%), then anaplastic carcinoma (20%). The mean age of the women was 56.3 years (SD ± 14.7), compared to 52.5 years (SD ± 16.6) for the men. The frequencies of stage I, II, III, and IV were 17%, 22%, 16%, and 45%, respectively. Different types of thyroidectomies were performed in 79% of the cases, lobectomy in 4%, and no surgery in 17%. Only 28% of the cases received radioactive iodine. Palliative chemotherapy and radiotherapy were prescribed to 17% and 37% of the cases, respectively. CONCLUSION Thyroid cancer is more prevalent among women and most patients present at later stages. The dominance of follicular type suggests that the majority of this population is iodine-deficient.
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Affiliation(s)
| | | | | | - Areeg Faggad
- Department of Molecular Biology, National Cancer Institute - University of Gezira, Wad Medani, Sudan
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Bharath S, Yadav SK, Sharma D, Jha CK, Mishra A, Mishra SK, Shekhar S. Total vs less than total thyroidectomy for benign multinodular non-toxic goiter: an updated systematic review and meta-analysis. Langenbecks Arch Surg 2023; 408:200. [PMID: 37204607 DOI: 10.1007/s00423-023-02941-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/14/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND We have performed an updated meta-analysis of randomized controlled trials (RCT) comparing total thyroidectomy (TT) with less than total thyroidectomy (LTT) for benign multinodular non-toxic goiter (BMNG). OBJECTIVES The objective was to evaluate the effects and outcomes of TT as compared to LTT. METHODS Eligibility criteria: RCTs comparing TT vs LTT. INFORMATION SOURCES PubMed, Embase, Cochrane Library and online registers were searched for articles comparing TT with LTT. Risk of bias: Articles were assessed for risk of bias using the Cochrane's revised tool to assess risk of bias in randomized trials (RoB 2 tool). SYNTHESIS OF RESULTS The main summary measures were risk difference using a random effects model. RESULTS Five randomized controlled trials were included in the meta-analysis. Recurrence rate was lower for TT compared to LTT. Adverse events like temporary or permanent recurrent laryngeal nerve (RLN) palsy and permanent hypoparathyroidism were similar in both groups except for the rate of temporary hypoparathyroidism which was lower in the LTT group. DISCUSSION All studies had unclear risk of bias for blinding of the participants and personnel and high risk of bias for certain selective reporting. This meta-analysis did not show any clear benefit or harm of either procedure (TT vs LTT) for goiter recurrence and re-operation rates (for both recurrence and incidental thyroid cancer). However, re-operation for goiter recurrence was significantly higher in the LTT group based on a single RCT. Evidence suggests increased rates of temporary hypoparathyroidism with TT but there was no difference in the rate of RLN palsy and permanent hypoparathyroidism between the two methods. The overall quality of evidence was low to moderate.
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Affiliation(s)
- S Bharath
- Department of Surgery, NSCB Medical College, Jabalpur, India
| | - Sanjay Kumar Yadav
- Department of Surgery, NSCB Medical College, Jabalpur, India.
- Netaji Subhash Chandra Bose Medical College, Jabalpur, India.
| | | | | | - Anjali Mishra
- Department of Endocrine Surgery, SGPGIMS, Lucknow, India
| | - Saroj Kanta Mishra
- Gangwal School of Medical Science and Technology, Indian Institute of Technology, Kanpur, India
| | - Saket Shekhar
- Department of PSM and Biostatistics, Rama Medical College, Kanpur, India
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Unlu MT, Kostek M, Aygun N, Isgor A, Uludag M. Non-Toxic Multinodular Goiter: From Etiopathogenesis to Treatment. SISLI ETFAL HASTANESI TIP BULTENI 2022; 56:21-40. [PMID: 35515961 PMCID: PMC9040296 DOI: 10.14744/semb.2022.56514] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/27/2022] [Indexed: 06/14/2023]
Abstract
Goiter term is generally used for defining the enlargement of thyroid gland. Thyroid nodules are very common and some of these nodules may harbor malignancy. Multinodular goiter (MNG) disease without thyroid dysfunction is defined as non-toxic MNG. There are many factors in etiology for development of MNG. They can be classified as iodine dependent and non-iodine dependent factors basically. Beyond this basic classification, the effect of many environmental and acquired factors is also effective on the development of goiter. Many methods have described for diagnosis and treatment for non-toxic MNG. Biochemical tests, imagining methods, invasive and non-invasive methods have been used for diagnosis for many years. Each method has advantages and disadvantages, separately. Although the best method for diagnosis is still debatable, distinguishing malignant nodules from benign nodules is the first and most important step for MNG. Biochemical tests such as serum thyroid stimulating hormone (TSH) measurement, thyroid hormone measurement; and thyroid ultrasonography are used for diagnosis of MNG, traditionally. Nowadays, there are some new techniques were developed like ultrasound-elastography. Furthermore, thyroid scintigraphy may be used if there is abnormal TSH measurement. Fine-needle aspiration biopsy and some cross-sectional imaging methods (computed tomography, magnetic resonance imaging, and positron emission tomography) could be used, too. After a certain diagnosis is made, treatment options should be evaluated. Many treatment methods have been used for goiter from ancient times upon today. From non-invasive methods such as medical follow-up to invasive methods such as lobectomy or thyroidectomy are options for treatment. Patients with compression symptoms due to an enlarged thyroid gland are usually candidates for surgery. In this study, it is aimed to determine the most appropriate treatment for the patient by discussing the advantages and disadvantages of all these methods. The present review discusses definition of goiter term, etiology, epidemiology, pathogenesis, diagnostic methods, and treatment methods for nontoxic MNG.
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Affiliation(s)
- Mehmet Taner Unlu
- Division of Endocrine Surgery, Department of General Surgery, University of Health Sciences Turkey, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Kostek
- Division of Endocrine Surgery, Department of General Surgery, University of Health Sciences Turkey, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Nurcihan Aygun
- Division of Endocrine Surgery, Department of General Surgery, University of Health Sciences Turkey, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Adnan Isgor
- Department of General Surgery, Memorial Sisli Hospital, Istanbul, Turkey
| | - Mehmet Uludag
- Division of Endocrine Surgery, Department of General Surgery, University of Health Sciences Turkey, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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Bosset M, Bonjour M, Castellnou S, Hafdi-Nejjari Z, Bournaud-Salinas C, Decaussin-Petrucci M, Lifante JC, Perrin A, Peix JL, Moulin P, Sassolas G, Pugeat M, Borson-Chazot F. Long-Term Outcome of Lobectomy for Thyroid Cancer. Eur Thyroid J 2021; 10:486-494. [PMID: 34956920 PMCID: PMC8647111 DOI: 10.1159/000510620] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/01/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Recent guidelines of the American Thyroid Association (ATA) suggest that a lobectomy may be sufficient to treat low- to intermediate-risk patients with thyroid tumors ≤40 mm, without extrathyroidal extension or lymph node metastases. The present study aimed to evaluate long-term recurrence after lobectomy for differentiated thyroid cancer and to analyze factors associated with recurrence. METHODS In this retrospective cohort study, patients who underwent a lobectomy for thyroid cancer in a tertiary center between 1970 and 2010 were included. The outcome was the proportion of pathology-confirmed thyroid cancer recurrence, assessed in the whole cohort or in subgroups according to tumor size (≤ or >40 mm). RESULTS A total of 295 patients were included, and these were followed-up for a mean (standard deviation, SD) 19.1 (7.8) years (5,649 patient-years); 61 (20.7%) were male and the mean (SD) age at diagnosis was 39.7 (12) years. Histological subtype was papillary in 263 (89.2%) patients and mean cancer size was 22.9 (16.9) mm. According to the 2015 ATA guidelines, 271 (91.9%) cancers had a low risk of recurrence and 24 (8.1%) an intermediate risk. A reoperation was performed in 54 patients (18.3%) and recurrence was confirmed in 40 (13.6%), diagnosed for 55% of cases more than 10 years after their initial surgery. Among recurrent patients, 14 (4.8% of the cohort) were operated for a contralateral papillary thyroid microcarcinoma and 26 (8.8% of the cohort) for a locoregional or metastatic recurrence. Non-suspicious nodular recurrences were monitored without reoperation in 53 (18.0%) patients. At the end of follow-up, 282 (95.6%) patients were in remission. Tumors with locoregional or metastatic recurrence were more frequent among tumors with aggressive histology (19.2 vs. 4.1%, p = 0.015) and of intermediate risk category (28.6 vs. 7.1%, p = 0.018). Tumors >40 mm, which would have been treated by thyroidectomy according to the 2015 ATA guidelines criteria, were found in 34 (11.5%) patients and were associated with a higher frequency of recurrence (20.6 vs. 7.3%, p = 0.024) and less remission (85.3 vs. 96.9%, p = 0.001). CONCLUSION The outcome of thyroid cancer treated by lobectomy is very good, particularly for cancer ≤40 mm. A prolonged follow-up is required due to the risk of late recurrence.
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Affiliation(s)
- Matthieu Bosset
- Fédération d'Endocrinologie, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France
| | - Maxime Bonjour
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France
| | - Solène Castellnou
- Fédération d'Endocrinologie, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France
- *Solène Castellnou, Fédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, FR–69500 Bron (France),
| | - Zakia Hafdi-Nejjari
- Registre des Cancers Thyroïdiens du Département du Rhône, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France
| | - Claire Bournaud-Salinas
- Centre de Médecine Nucléaire, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France
| | - Myriam Decaussin-Petrucci
- Service d'Anatomie-Pathologique, Hospices Civils de Lyon, Groupement Hospitalier Lyon-Sud, Pierre Bénite, France
| | - Jean Christophe Lifante
- Service de Chirurgie Endocrinienne, Hospices Civils de Lyon, Groupement Hospitalier Lyon-Sud, Pierre Bénite, France
- Laboratoire Health Services and Performance Research (EA 7425 HESPER), Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Agnès Perrin
- Fédération d'Endocrinologie, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France
| | - Jean-Louis Peix
- Service de Chirurgie Endocrinienne, Hospices Civils de Lyon, Groupement Hospitalier Lyon-Sud, Pierre Bénite, France
| | - Philippe Moulin
- Fédération d'Endocrinologie, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France
- CarMeN Laboratory, Université Claude-Bernard Lyon 1, Inserm U1060, INRA U1397, INSA Lyon, IMBL, Villeurbanne, France
| | - Geneviève Sassolas
- Registre des Cancers Thyroïdiens du Département du Rhône, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France
| | - Michel Pugeat
- Fédération d'Endocrinologie, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France
| | - Françoise Borson-Chazot
- Fédération d'Endocrinologie, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France
- Registre des Cancers Thyroïdiens du Département du Rhône, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France
- Laboratoire Health Services and Performance Research (EA 7425 HESPER), Université Claude Bernard Lyon 1, Villeurbanne, France
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Mu L, Ren C, Xu J, Guo C, Huang J, Ding K. Total versus near-total thyroidectomy in Graves' disease: a systematic review and meta-analysis of comparative studies. Gland Surg 2021; 10:729-738. [PMID: 33708555 DOI: 10.21037/gs-20-757] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Total thyroidectomy (TT), near-total thyroidectomy (NT), and subtotal thyroidectomy (ST) are three surgical procedures for Graves' disease (GD) patients, but most previous studies have only evaluated the complications of TT versus ST or TT/NT versus ST; there is not a meta-analysis of NT versus TT, so whether NT is superior to TT for GD patients still unclear. Methods We comprehensively searched PubMed, Embase, Web of Science, and the Cochrane Library, without restriction to region, publication type, or language, on 10 June, 2020. We conducted this systematic review and meta-analysis of all included studies assessing the two surgical procedures. Results In total, 528 cases were identified from two randomized controlled trials (RCTs) and three retrospective studies. The incidence of permanent hypoparathyroidism after NT was lower than with TT [odds ratio (OR), 0.22; 95% confidence interval (CI), 0.06-0.80; P=0.02], and there was no statistical difference in the recurrence of hyperthyroidism (OR, 0.33; 95% CI, 0.01-8.12; P=0.50) and other postoperative complications (P>0.05). Conclusions NT for GD was superior to TT regarding permanent hypoparathyroidism, but there was no significant difference in preventing recurrent hyperthyroidism, as well as the other postoperative complications.
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Affiliation(s)
- Lan Mu
- Department of Thyroid Surgery, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Chutong Ren
- Department of Thyroid Surgery, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Jiangyue Xu
- Department of Thyroid Surgery, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Can Guo
- Department of Thyroid Surgery, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Jiangsheng Huang
- Department of Thyroid Surgery, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Ke Ding
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
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Gualniera P, Scurria S, Mondello C, Asmundo A, Sapienza D, Gianlorenzo D. Narrative review of proving the causal link of recurrent laryngeal nerve injury and thyroidectomy: a medico legal appraisal. Gland Surg 2020; 9:1564-1572. [PMID: 33224832 PMCID: PMC7667053 DOI: 10.21037/gs-20-203] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 09/10/2020] [Indexed: 11/06/2022]
Abstract
The recurrent laryngeal nerve (RLN) injuries are frequent complications related to thyroid surgery determining patient complaints and malpractice litigations. In the present work, the authors provide a brief review on the peculiarities of RLN injuries associated with thyroidectomy to highlight the various aspects of medicolegal assessment of causal link between surgery and nerve damage. The characteristics of thyroid disease, the anatomical peculiarities of surgery site and the nerve identification and preservation are factors that mostly influence the liability admission or rejection. In this context, the clinical records are fundamental, representing the most important probative tool. The possibility of having a set of information collected by clinical records, which allows for analysis and comparison to be made regarding the adherence to standards for thyroid surgery, is essential to set any medico-legal deliberation. However, the medicolegal evaluation can be very difficult. The practitioners involved in the medicolegal analysis of patient complaints related to this thyroidectomy complication need an in-depth knowledge of surgical technique, damage prevention activities and related clinical picture. To this must be added an adequate competence in the evaluation of the causal link (relation between the event and the injury and between that injury and the temporary/permanent impairment) based on the rigorous application of the medicolegal method.
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Affiliation(s)
- Patrizia Gualniera
- Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Serena Scurria
- Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Cristina Mondello
- Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Alessio Asmundo
- Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Daniela Sapienza
- Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Dionigi Gianlorenzo
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
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Boutzios G, Tsourouflis G, Garoufalia Z, Alexandraki K, Kouraklis G. Long-term sequelae of the less than total thyroidectomy procedures for benign thyroid nodular disease. Endocrine 2019; 63:247-251. [PMID: 30302663 DOI: 10.1007/s12020-018-1778-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/01/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Nodular goiter is the most common disorder of the thyroid gland. Less than total thyroidectomy procedures are considered the gold standard in the surgical management of nodular thyroid disease despite its propensity for recurrence. The aim of the study was to assess long-term sequelae of the less than total thyroidectomy procedures. MATERIAL AND METHODS In this single-center retrospective study, records of 154 patients that underwent less than total thyroidectomy, for nodular disease and/or hyperthyroidism between 1998 and 2013, were reviewed. Patients with malignant findings in the histology report and a follow-up of less than 5 years were excluded. RESULTS The mean age of the recorded patients was 65.1 ± 12.91 years of which 132 were females. Subtotal thyroidectomy was performed in 45.5% of the study population, 22.1% underwent partial thyroidectomy, while the remaining 32.5% underwent lobectomy. Long-term thyroxine supplementation was administered in 138 patients (89.6%). Recurrence of clinically important nodules (>1 cm) was observed in 68.2% of patients but only 11% of the population underwent completion thyroidectomy. In the univariate analysis, the duration of follow-up (p = 0.00005, C.I.: 0.903-0.965) as well as the type of operation (p = 0.035, C.I.: 1.031-2.348) appeared to have a significant correlation with nodular recurrence. The multivariate analysis identified the duration of follow-up (p = 0.0005, C.I.: 0.908-0.973) as the only significant predictive factor of nodular recurrence. CONCLUSION This is the first study with such a long duration of post-operative follow-up. The high rate of nodular recurrence in less than total thyroidectomy procedures along with the lifelong need for thyroxine supplementation suggest that a more conservative surgical approach is needed. When surgery is recommended, we suggest total thyroidectomy as the treatment of choice to avoid the recurrence of disease, the high cost associated with frequent follow-ups by means of sonography as well as thyroxine replacement therapy.
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Affiliation(s)
- Georgios Boutzios
- Department of Pathophysiology, Laiko University Hospital, Medical School, University of Athens, Athens, Greece.
| | - Gerasimos Tsourouflis
- Second Department of Propaedeutic Surgery, Laiko University Hospital, Medical School, University of Athens, Athens, Greece
| | - Zoe Garoufalia
- Second Department of Propaedeutic Surgery, Laiko University Hospital, Medical School, University of Athens, Athens, Greece
| | - Krystallenia Alexandraki
- Department of Pathophysiology, Laiko University Hospital, Medical School, University of Athens, Athens, Greece
| | - Grigorios Kouraklis
- Second Department of Propaedeutic Surgery, Laiko University Hospital, Medical School, University of Athens, Athens, Greece
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10
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Author's Reply. North Clin Istanb 2019; 5:275-276. [PMID: 30688926 PMCID: PMC6323558 DOI: 10.14744/nci.2018.54775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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11
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Barczyński M, Konturek A, Hubalewska-Dydejczyk A, Gołkowski F, Nowak W. Ten-Year Follow-Up of a Randomized Clinical Trial of Total Thyroidectomy Versus Dunhill Operation Versus Bilateral Subtotal Thyroidectomy for Multinodular Non-toxic Goiter. World J Surg 2018; 42:384-392. [PMID: 28942461 PMCID: PMC5762805 DOI: 10.1007/s00268-017-4230-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background The aim of this study was to validate in a 10-year follow-up the initial outcomes of various thyroid resection methods for multinodular non-toxic goiter (MNG) reported in World J Surg 2010;34:1203–13. Materials and methods Six hundred consenting patients with MNG were randomized to three groups of 200 patients each: total thyroidectomy (TT), Dunhill operation (DO), bilateral subtotal thyroidectomy (BST). Obligatory follow-up period of 60 months was extended up to 120 months for all the consenting patients. The primary outcome measure was the prevalence of recurrent goiter and need for revision thyroid surgery. The secondary outcome measure was the cumulative postoperative and post-revision morbidity rate. Results The primary outcomes were twice as inferior at 10 years when compared to 5-year results for DO and BST, but not for TT. Recurrent goiter was found at 10 years in 1 (0.6%) TT versus 15 (8.6%) DO versus 39 (22.4%) BST (p < 0.001), and revision thyroidectomy was necessary in 1 (0.6%) TT versus 5 (2.8%) DO versus 14 (8.0%) BST patients (p < 0.001). Any permanent morbidity at 10 years was present in 5 (2.8%) TT patients following initial surgery versus 7 (4.0%) DO and 10 (5.7%) BST patients following initial and revision thyroidectomy (nonsignificant differences). At 10 years, 23 (11.5%) TT versus 25 (12.5%) DO versus 26 (13.0%) BST patients were lost to follow-up. Conclusions Total thyroidectomy can be considered the preferred surgical approach for patients with MNG, as it abolishes the risk of goiter recurrence and need for future revision thyroidectomy when compared to more limited thyroid resections, whereas the prevalence of permanent morbidity is not increased at experienced hands. Registration number: NCT00946894 (http://www.clinicaltrials.gov).
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Affiliation(s)
- Marcin Barczyński
- Department of Endocrine Surgery, Third Chair of General Surgery, Faculty of Medicine, Jagiellonian University Medical College, 37 Prądnicka Street, 31-202, Kraków, Poland.
| | - Aleksander Konturek
- Department of Endocrine Surgery, Third Chair of General Surgery, Faculty of Medicine, Jagiellonian University Medical College, 37 Prądnicka Street, 31-202, Kraków, Poland
| | - Alicja Hubalewska-Dydejczyk
- Chair and Department of Endocrinology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Filip Gołkowski
- Department of Endocrinology and Internal Medicine, Faculty of Medicine, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
| | - Wojciech Nowak
- Department of Endocrine Surgery, Third Chair of General Surgery, Faculty of Medicine, Jagiellonian University Medical College, 37 Prądnicka Street, 31-202, Kraków, Poland
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Kaliszewski K, Wojtczak B, Grzegrzółka J, Bronowicki J, Saeid S, Knychalski B, Forkasiewicz Z. Nontoxic Multinodular Goitre and Incidental Thyroid Cancer: What Is the Best Surgical Strategy?-A Retrospective Study of 2032 Patients. Int J Endocrinol 2018; 2018:4735436. [PMID: 29887888 PMCID: PMC5977011 DOI: 10.1155/2018/4735436] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 04/23/2018] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES A discussion with regard to the most optimal surgical procedure in nontoxic multinodular goitre (NTMNG). We assessed and compared three main types of operations in 2032 patients with NTMNG. METHODS This is a retrospective study of 2032 patients operated on in one center due to NTMNG. The observation period was 48 to 120 months (mean and SD: 87 ± 20). RESULTS The early complications included uni- and bilateral recurrent laryngeal nerve paralysis (URLNP, BRLNP), overt tetany (OT), and postoperative bleeding (POB). We observed after TT, STT, and DO URLNP: 15 (1.73%), 3 (0.64%), and 2 (0.28%), respectively (p < 0.05); BRLNP: 3 (0.34%), 2 (0.43%), and 0 (0.0%), respectively (p = 0.25); OT: 42 (4.84%), 6 (1.29%), and 9 (1.28%), respectively (p < 0.0001); and POB: 11 (1.26%), 4 (0.86%), and 3 (0.42%), respectively (p = 0.209). Persistent complications we observed after TT, STT, and DO are the following: URLNP: 9 (1.03%), 3 (0.64%), and 1 (0.14%), respectively (p = 0.086); BRLNP: 1 (0.11%), 1 (0.21%), and 0 (0.0%), respectively (p = 0.51); and OT: 11 (1.26%), 2 (0.43%), and 2 (0.28%), respectively (p = 0.052). Incidental thyroid cancer (ITC) was recognized after TT, STT, and DO in 18 (2.07%), 21 (4.52%), and 11 (1.56%), respectively (p = 0.039). Recurrent goitre (RG) was observed in 1 (0.11%) after TT, 3 (0.64%) after STT, and 2 (0.28%) after DO (p = 0.234). CONCLUSIONS Performing less radical surgery in NTMNG is associated with a significantly lower risk of early and late URLNP and OT. In the case of BRLNP (early and persistent) and POB, no statistically significant differences are seen. The occurrence of ITC is higher following more radical surgeries. Less radical surgery is connected with a higher risk of RG.
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Affiliation(s)
- Krzysztof Kaliszewski
- First Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Maria Sklodowska-Curie Street 66, 50-369 Wroclaw, Poland
| | - Beata Wojtczak
- First Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Maria Sklodowska-Curie Street 66, 50-369 Wroclaw, Poland
| | - Jędrzej Grzegrzółka
- Department of Human Morphology and Embryology, Division of Histology and Embryology, Medical University, Chalubinskiego Street 6a, 50-368 Wroclaw, Poland
| | - Jacob Bronowicki
- Students' Scientific Club of the First Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Sawsan Saeid
- Students' Scientific Club of the First Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Bartłomiej Knychalski
- First Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Maria Sklodowska-Curie Street 66, 50-369 Wroclaw, Poland
| | - Zdzisław Forkasiewicz
- First Department and Clinic of General, Gastroenterological and Endocrine Surgery, Wroclaw Medical University, Maria Sklodowska-Curie Street 66, 50-369 Wroclaw, Poland
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Abstract
Benign goiter is the most common endocrine disease that requires surgery, especially in endemic areas suffering from iodine-deficiency. Recent European and American guidelines recommended total thyroidectomy for the surgical treatment of multinodular goiter. Total thyroidectomy has now become the technique of choice and is widely considered the most reliable approach in preventing recurrence. Nevertheless, total thyroidectomy carries a substantial risk in terms of hypoparathyroidism and the morbidity associated with injury to the inferior laryngeal nerve. In this context, partial/less-than-total thyroidectomy is being considered once again as a viable alternative. This review will discuss the extent of thyroid surgery for benign disease and the impact of the surgical protocol on the patient- and surgeon-specific risk factors for specific complication rates.
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Affiliation(s)
- Özer Makay
- Division of Endocrine Surgery, Department of General Surgery, Ege University Hospital, Izmir, Turkey
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Grebennikova TA, Belaya ZE, Melnichenko GA. Hypoparathyroidism: disease update and new methods of treatment. ENDOCRINE SURGERY 2017. [DOI: 10.14341/serg2017270-80] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Гипопаратиреоз характеризуется гипокальциемией при нормальном или низком уровне паратиреоидного гормона (ПТГ). ПТГ регулирует уровень кальция в крови, влияя на реабсорбцию кальция и фосфора в почках, а также витамин D-зависимое всасывание кальция из желудочно-кишечного тракта. Наиболее распространенной причиной гипопаратиреоза является повреждение околощитовидных желез в ходе хирургического вмешательства в области шеи, в основном по поводу заболеваний щитовидной железы. Стандартные методы лечения включают в себя назначение препаратов кальция и витамина D для поддержания уровня кальция на нижней границе референсного интервала с целью предупреждения гиперкальциурии. Однако в ряде случаев компенсация гипокальциемии требует использования высоких доз препаратов кальция и витамина D, что сопровождается выраженным колебанием уровня кальция крови, внескелетной кальцификацией и ухудшением функции почек. В настоящее время наиболее перспективным методом лечения гипопаратиреоза является заместительная терапия рекомбинантным человеческим ПТГ(1-84), который представляет собой полноразмерный ПТГ. ПТГ(1-84) способствует поддержанию стойкой нормокальциемии, улучшая качество жизни пациентов. Однако влияние ПТГ(1-84) на функцию почек, костный обмен и профилактику других осложнений гипопаратиреоза требует дальнейшего изучения.
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15
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Aboelnaga MM, Elshafei MM, Elsayed E. Vitamin D status in Egyptian euthyroid multinodular non-toxic goiter patients and its correlation with TSH levels. ACTA ACUST UNITED AC 2016; 63:380-6. [PMID: 27552913 DOI: 10.1016/j.endonu.2016.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/07/2016] [Accepted: 06/24/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM Although the prevalence of MNG is widespread throughout the world, its pathogenesis is poorly understood, and the complex interactions of both genetic predisposition and the individuals' environment are likely. However, to the best of our knowledge, it remains unknown whether there is a relationship between vitamin D status and prevalence or pathogenesis of euthyroid MNG. Therefore, the goal of the present study was determination of vitamin D status in euthyroid MNG as well as exploration of the correlation between vitamin D status & TSH levels. METHODS A total of 77 patients diagnosed with euthyroid MNG and 50 subjects without goiter were matched according to age, weight and BMI as control group in this case control study. RESULTS We found that patients with euthyroid MNG had statistically significant lower mean of [25(OH)D] (24.21±8.68ng/mL) in comparison with its mean in control subjects (28.37±10.91ng/mL, P value=0.019). The 28 sufficient vitamin D MNG patients had statistically significant lower level of TSH than 49 insufficient vitamin D MNG patients. Vitamin D and TSH levels correlate with vitamin D levels in MNG patients in Pearson correlation. Also 25 OH vitamin D was a significant independent predictor for TSH levels among euthyroid MNG patients in regression analysis. CONCLUSIONS Patients with euthyroid MNG have lower levels of vitamin D and TSH levels correlate with vitamin D levels in euthyroid MNG patients. In addition, 25 OH vitamin D was a significant independent predictor for TSH levels among euthyroid MNG patients. We recommend hypovitaminosis D evaluation and correction in patients with MNG.
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Affiliation(s)
| | - Maha M Elshafei
- Endocrinology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Eman Elsayed
- Clinical Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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16
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Safety and Effectiveness of Total Thyroidectomy and Its Comparison with Subtotal Thyroidectomy and Other Thyroid Surgeries: A Systematic Review. J Thyroid Res 2016; 2016:7594615. [PMID: 27006857 PMCID: PMC4783568 DOI: 10.1155/2016/7594615] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/23/2016] [Accepted: 01/31/2016] [Indexed: 11/17/2022] Open
Abstract
Diseases associated with the thyroid gland are one of the most frequently seen endocrine disorders across the globe. Total thyroidectomy is currently the preferred treatment for many thyroid diseases. Controversies exist among surgeons regarding safety of total thyroidectomy due to the risk associated with it like postoperative hypoparathyroidism or recurrent laryngeal nerve damage. Since, in the recent years, the incidence of thyroidectomy is in increasing trend in south Indian population, this review aims to study the available data regarding the appropriateness and safety of total thyroidectomy and compares it with subtotal thyroidectomy and other thyroid surgeries. This is a retrospective comprehensive review of various articles and publications regarding total and partial thyroidectomy performed across the world. Many retrospective studies and few prospective studies suggest that the incidence of transient hypocalcemia is higher after total thyroidectomy than after subtotal thyroidectomy, but the incidence of other complications including recurrent laryngeal nerve palsy and postoperative hematoma is not significantly different between the two procedures. Hence in our review we found that total thyroidectomy is safe and cost effective with low complication rates and provides little significant advantage of being safer procedure compared to subtotal thyroidectomy.
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17
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Abstract
Hypoparathyroidism is a rare endocrine disorder in which parathyroid hormone (PTH) production is abnormally low or absent, resulting in low serum calcium and increased serum phosphorus. The most common cause of hypoparathyroidism is parathyroid gland injury or inadvertent removal during thyroid surgery. Current treatments include supplementation with calcium and active vitamin D, with goal albumin-corrected serum calcium level in the low-normal range of 8-9 mg/dl. Complications of the disease include renal dysfunction, nephrocalcinosis, kidney stones, extracellular calcifications of the basal ganglia, and posterior subcapsular cataracts, as well as low bone turnover and increased bone density. Until January 2015, hypoparathyroidism was the only classic endocrine disease without an available hormone replacement. Recombinant human PTH 1-84, full-length PTH, is now available for a selected group of patients with the disease who are not well controlled on the current standard therapy of calcium and active vitamin D. In addition, the role of PTH replacement on quality of life, intracerebral calcifications, cataracts, improving bone turnover, and reduction of renal complications of the disease remains to be further investigated.
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Affiliation(s)
- Ejigayehu G. Abate
- Division of Endocrinology and Metabolism, Mayo Clinic, Jacksonville, FL, USA
- *Correspondence: Ejigayehu G. Abate,
| | - Bart L. Clarke
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
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Knobel M. Which Is the Ideal Treatment for Benign Diffuse and Multinodular Non-Toxic Goiters? Front Endocrinol (Lausanne) 2016; 7:48. [PMID: 27242669 PMCID: PMC4876491 DOI: 10.3389/fendo.2016.00048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 05/11/2016] [Indexed: 11/30/2022] Open
Abstract
Patients with large benign goiters often present local compressive symptoms that require surgical treatment, including dysphagia, neck tightness, and airway obstruction. In contrast, patients with such goiters who remain asymptomatic may be observed after exclusion of malignancy. The use of levothyroxine (LT4) to reduce the volume of the goiter is still a controversial treatment for large goiters, and the optimal surgical procedure for multinodular goiter is still debatable. Radioiodine is a safe and effective treatment option when used alone or in combination with recombinant human TSH. This review discusses current therapeutic options to treat diffuse and multinodular non-toxic benign goiters.
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Affiliation(s)
- Meyer Knobel
- Thyroid Unit, Division of Endocrinology and Metabolism, University of São Paulo Medical School, Hospital das Clínicas, São Paulo, Brazil
- *Correspondence: Meyer Knobel,
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Surgical Management of Nontoxic Multinodular Goiter: Is the Jury Still Out? Indian J Surg 2015; 77:341-2. [PMID: 26702247 DOI: 10.1007/s12262-015-1310-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 06/19/2015] [Indexed: 10/23/2022] Open
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