Large goiters and postoperative complications: does it really matter?

Hemithyroidectomy, does the indication influence the outcome?

PURPOSE

Hemithyroidectomies are mainly performed for two indications, either therapeutically to relieve compression symptoms or diagnostically for suspicious nodule(s). In case of the latter, one could consider the approach to be rather extensive since the majority of patients have no symptoms and will have benign disease. The aim of this study is to investigate the complication rates of diagnostic hemithyroidectomy and to compare it with the complication rates of compressive symptoms hemithyroidectomy.

METHODS

Data from patients who had undergone hemithyroidectomy either for compression symptoms or for excluding malignancy were extracted from a well-established Scandinavian quality register (SQRTPA). The following complications were analyzed: bleedings, wound infections, and paresis of the recurrent laryngeal nerve (RLN). Risk factors for these complications were examined by univariable and multivariable logistic regression.

RESULTS

A total of 9677 patients were included, 3871 (40%) underwent surgery to exclude malignancy and 5806 (60%) due to compression symptoms. In the multivariable analysis, the totally excised thyroid weight was an independent risk factor for bleeding. Permanent (6-12 months after the operation) RLN paresis were less common in the excluding malignancy group (p = 0.03).

CONCLUSION

A range of factors interfere and contribute to bleeding, wound infections, and RLN paresis after hemithyroidectomy. In this observational study based on a Scandinavian quality register, the indication "excluding malignancy" for hemithyroidectomy is associated with less permanent RLN paresis than the indication "compression symptoms." Thus, patients undergoing diagnostic hemithyroidectomy can be reassured that this procedure is a safe surgical procedure and does not entail an unjustified risk.

Unveiling the Accuracy of Ultrasonographic Assessment of Thyroid Volume: A Comparative Analysis of Ultrasonographic Measurements and Specimen Volumes

In endocrine surgery, a precise ultrasonographic measurement of thyroid volume is crucial. However, there is limited comparative research between ultrasonographic and specimen volumes, which has left this issue open to debate. This study aims to assess the accuracy of recommended formulas for ultrasonographic thyroid volume measurement by comparing them to specimen volumes and analyzing the influencing variables. From the data of 120 eligible patients, different formulas, including ultrasonographic thyroid volume (US-TV) based on the ellipsoid formula, lower correction factor thyroid volume (LCF-TV), and calculated ultrasonographic (derived formula) thyroid volume (CU-TV), were used to estimate the thyroid volume based on measurements taken prior to surgery. These measurements were compared with the intraoperative specimen volume (IO-TV) derived using Archimedes' principle. According to our findings, the mean values for US-TV and LCF-TV were significantly lower, whereas CU-TV was higher than IO-TV. Deviations were more significant in patients who had surgery for benign indications or compressive symptoms and in those with suppressed thyroid-stimulating hormone levels. Although the ellipsoid formula tends to underestimate the actual thyroid volume, it remains the most accurate method for measuring ultrasonographic thyroid volume. The deviation is greater for larger volumes.