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Lebbink CA, Links TP, Czarniecka A, Dias RP, Elisei R, Izatt L, Krude H, Lorenz K, Luster M, Newbold K, Piccardo A, Sobrinho-Simões M, Takano T, Paul van Trotsenburg AS, Verburg FA, van Santen HM. 2022 European Thyroid Association Guidelines for the management of pediatric thyroid nodules and differentiated thyroid carcinoma. Eur Thyroid J 2022; 11:e220146. [PMID: 36228315 PMCID: PMC9716393 DOI: 10.1530/etj-22-0146] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/08/2022] Open
Abstract
At present, no European recommendations for the management of pediatric thyroid nodules and differentiated thyroid carcinoma (DTC) exist. Differences in clinical, molecular, and pathological characteristics between pediatric and adult DTC emphasize the need for specific recommendations for the pediatric population. An expert panel was instituted by the executive committee of the European Thyroid Association including an international community of experts from a variety of disciplines including pediatric and adult endocrinology, pathology, endocrine surgery, nuclear medicine, clinical genetics, and oncology. The 2015 American Thyroid Association Pediatric Guideline was used as framework for the present guideline. Areas of discordance were identified, and clinical questions were formulated. The expert panel members discussed the evidence and formulated recommendations based on the latest evidence and expert opinion. Children with a thyroid nodule or DTC require expert care in an experienced center. The present guideline provides guidance for healthcare professionals to make well-considered decisions together with patients and parents regarding diagnosis, treatment, and follow-up of pediatric thyroid nodules and DTC.
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Affiliation(s)
- Chantal A Lebbink
- Wilhelmina Children’s Hospital and Princess Máxima Center, Utrecht, The Netherlands
| | - Thera P Links
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Agnieszka Czarniecka
- The Oncologic and Reconstructive Surgery Clinic, M. Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Renuka P Dias
- Department of Paediatric Endocrinology and Diabetes, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Rossella Elisei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Louise Izatt
- Department of Clinical Genetics, Guy's and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Heiko Krude
- Institute of Experimental Pediatric Endocrinology, Charité - Universitätsmedizin, Berlin, Germany
| | - Kerstin Lorenz
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Markus Luster
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Kate Newbold
- Thyroid Therapy Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Arnoldo Piccardo
- Department of Nuclear Medicine, EO Ospedali Galliera, Genoa, Italy
| | - Manuel Sobrinho-Simões
- University Hospital of São João, Medical Faculty and Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - Toru Takano
- Thyroid Center, Rinku General Medical Center, Osaka, Japan
| | - A S Paul van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Frederik A Verburg
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hanneke M van Santen
- Wilhelmina Children’s Hospital and Princess Máxima Center, Utrecht, The Netherlands
- Correspondence should be addressed to H M van Santen;
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Hii B, Maher D, Yeung M, Paul E, Serpell JW, Lee JC. Thyroidectomy Then and Now: A 50-Year Australian Perspective. World J Surg 2018; 43:1022-1028. [PMID: 30536022 DOI: 10.1007/s00268-018-04885-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Since the mid-1800s, thyroidectomy has transformed from a procedure associated with high to near-zero mortality. Nonetheless, surgeons must continue to strive to improve patient care. Using historical records and contemporary data, this study compares the practice and outcomes of thyroid surgery at a tertiary institution during two periods, 50 years apart. METHODS 'The Alfred Hospital Clinical Reports' recorded all cases of surgically managed thyroid disease from 1946 to 1959. These historical cases were compared to contemporary thyroidectomy cases at the Alfred Hospital from 2007 to 2016. Cases were compared for surgical indication and post-operative outcomes. RESULTS There were 746 patients in the historical group (mean age 53 years; 87% female) and 787 patients in the contemporary group (mean age 52 years; 80% female). The most common indication for thyroidectomy in both groups was non-toxic nodular goitre. A greater proportion of the contemporary group were diagnosed with thyroid malignancy (27% vs. 8%; p < 0.001). The contemporary group recorded significantly fewer cases of thyrotoxic crisis (2.1% vs. 0%; p = 0.001), permanent nerve palsy (4.6% vs. 0.4%; p < 0.001) and bilateral nerve palsy (1.2% vs. 0%; p = 0.01). There were no mortalities in the contemporary group, while the historical data recorded three deaths (0.44%). CONCLUSIONS This study compared thyroid surgery in two cohorts separated by a 50-year period. While it is not surprising that outcomes of thyroidectomy have improved, this study uniquely demonstrates trends of thyroid surgery over time and areas in which further improvements may be made.
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Affiliation(s)
- Belinda Hii
- Department of General Surgery, Monash University Endocrine Surgery Unit, The Alfred Hospital, 55 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Dominic Maher
- Department of General Surgery, Monash University Endocrine Surgery Unit, The Alfred Hospital, 55 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Meei Yeung
- Department of General Surgery, Monash University Endocrine Surgery Unit, The Alfred Hospital, 55 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Eldho Paul
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Clinical Haematology Department, Alfred Hospital, Melbourne, VIC, Australia
| | - Jonathan W Serpell
- Department of General Surgery, Monash University Endocrine Surgery Unit, The Alfred Hospital, 55 Commercial Rd, Melbourne, VIC, 3004, Australia
- Department of Surgery, Monash University, Melbourne, VIC, 3004, Australia
| | - James C Lee
- Department of General Surgery, Monash University Endocrine Surgery Unit, The Alfred Hospital, 55 Commercial Rd, Melbourne, VIC, 3004, Australia.
- Department of Surgery, Monash University, Melbourne, VIC, 3004, Australia.
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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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Saber A, Rifaat M, Ellabban GM, Gad MA. Total thyroidectomy by loupe magnification: a comparative study. Eur Surg 2011. [DOI: 10.1007/s10353-011-0591-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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What would be left behind if subtotal thyroidectomy were preferred instead of total thyroidectomy? Am J Surg 2010; 199:765-9. [PMID: 20226438 DOI: 10.1016/j.amjsurg.2009.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Revised: 02/16/2009] [Accepted: 02/16/2009] [Indexed: 12/27/2022]
Abstract
BACKGROUND The choice between subtotal thyroidectomy (STT) and total thyroidectomy (TT) for multinodular goiter (MNG) remains controversial. METHODS Thyroid tissue samples of 34 patients who underwent TT for multinodular disease between October 2005 and June 2007 in Pamukkale University Hospital, Department of General Surgery were evaluated. Thyroid tissues weighing 2 g each from either side were separated from the main specimen to simulate the tissues that would be left behind if a subtotal resection were performed instead of a total resection. Ki-67 staining was performed. RESULTS The mean age of subjects was 49.3 +/- 12 years and 25 (73.5%) were females. Papillary microcarcinomas were found in 4 patients, 1 of which was in a residual thyroid specimen (RTS). Micronodule formations were found in 73.5% of specimens simulating residual thyroid. While Ki-67 indexes of residual thyroid tissues were 4.65% in nodules and 1.91% in normal areas (P < .05), they were 5.42% and 2.84%, respectively, for nodular and normal areas in the main specimens (P < .05). CONCLUSION Remnant thyroid tissues, following STT, have a high percentage of micronodule formation with a remarkable cellular proliferative activity.
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Raval MV, Browne M, Chin AC, Zimmerman D, Angelos P, Reynolds M. Total thyroidectomy for benign disease in the pediatric patient--feasible and safe. J Pediatr Surg 2009; 44:1529-33. [PMID: 19635300 DOI: 10.1016/j.jpedsurg.2008.11.032] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Revised: 11/04/2008] [Accepted: 11/05/2008] [Indexed: 11/30/2022]
Abstract
PURPOSE Total thyroidectomy (TT) is a safe and efficacious treatment of malignant thyroid disease in children. The role of TT in benign thyroid disease is less well-defined. The goal of this study was to compare the safety of TT performed for benign and malignant disease. METHODS The medical records of 31 patients undergoing TT from January 2000 to June 2007 at a single center were reviewed. The benign cohort totaled 15 patients consisting of 12 with Graves' disease, 2 with hyperthyroidism, and 1 with large and symptomatic multinodular goiter. The malignant cohort totaled 16 patients consisting of 9 with malignant disease, 4 with a nodule and history of cancer or radiation exposure, and 3 with RET proto-oncogene mutations. RESULTS The most common complication was transient hypocalcemia observed in 7 (46%) of 15 patients with benign disease and 9 (56%) of 16 patients with malignancy (P = .72). Permanent hypocalcemia, defined as need for calcium supplement 6 months postprocedure, was observed in 1 patient with benign disease (6.67%) and 1 patient with malignancy (6.25%; P = 1.0). A single parathyroid gland was reimplanted in 2 patients with malignancy and 2 patients with benign disease (P = 1.0). One case of keloid scar was noted, and no cases of recurrent laryngeal nerve palsy, nerve paralysis, tracheal injury, tracheostomy, or wound infection were encountered in either cohort. There were no cases of relapse hyperthyroidism in the benign cohort. CONCLUSIONS Similar rates of postoperative complications can be expected with TT for benign thyroid disease as compared to TT for malignant disease. Total thyroidectomy is a safe treatment option for benign thyroid disease in children.
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Affiliation(s)
- Mehul V Raval
- Division of Pediatric Surgery, Children's Memorial Hospital, Northwestern University School of Medicine, Chicago, IL 60614, USA
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Snook KL, Stalberg PLH, Sidhu SB, Sywak MS, Edhouse P, Delbridge L. Recurrence after total thyroidectomy for benign multinodular goiter. World J Surg 2007; 31:593-8; discussion 599-600. [PMID: 17308855 DOI: 10.1007/s00268-006-0135-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Total thyroidectomy is now the preferred option for the management of benign multinodular goiter (BMNG), and it ought not be associated with recurrent disease. The aim of the present study was to examine the efficacy of total thyroidectomy for BMNG and to review reasons for recurrence. MATERIAL AND METHODS The study group comprised all patients from January 1980 to December 2005 who underwent a definitive procedure to remove all thyroid tissue for BMNG, and who were subsequently identified as having developed a recurrence. Included were patients who underwent primary total thyroidectomy at our unit, or a two or more stage procedure where a definitive secondary total thyroidectomy was performed at our unit. RESULTS There were 3,044 total or secondary total thyroidectomies performed for BMNG during the study period. Ten patients were identified as having developed recurrent BMNG requiring reoperation despite previous complete "total" thyroidectomy. There were 11 sites of recurrence in 10 patients. Only one was a true local recurrence in the thyroid bed. Another 9 recurrences related to the embryology of the thyroid gland, 4 in the pyramidal tract and 5 in the thyrothymic tract. There was one recurrence at another site (submandibular) in a patient with presumed metastatic thyroid cancer despite benign histology. There were no complications in any of the 10 patients. CONCLUSIONS Total thyroidectomy for BMNG is not only a safe procedure but is efficacious in preventing recurrent disease. Failure to remove embryological remnants such as thyrothymic residue or pyramidal remnants during total thyroidectomy is the major cause of recurrence.
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Affiliation(s)
- Kylie L Snook
- Department of Endocrine and Oncology Surgery, University of Sydney Endocrine Surgical Unit, Royal North Shore Hospital, St Leonards, 2065, Sydney, NSW, Australia
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Ozbas S, Kocak S, Aydintug S, Cakmak A, Demirkiran MA, Wishart GC. Comparison of the complications of subtotal, near total and total thyroidectomy in the surgical management of multinodular goitre. Endocr J 2005; 52:199-205. [PMID: 15863948 DOI: 10.1507/endocrj.52.199] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose of the study is to compare complication rates of bilateral subtotal (BST), near total (NTT) and total thyroidectomy (TT) in a cohort of patients undergoing surgery for benign multinodular goitre (MNG). Seven hundred and fifty patients undergoing surgery for MNG were studied with a median follow-up of 53 months (range 18-102). There was no operative mortality in this group and no patients required urgent re-exploration for haematoma. After BST 14 patients (14/170 - 8.2%) developed transient hypocalcaemia and 4 patients (4/170 - 2.4%) had transient and one permanent (1/170 - 0.6%) recurrent laryngeal nerve (RLN) palsy. In NTT group 39 patients (39/320 - 12.2%) developed transient hypocalcaemia and 2 patients (0.6%) transient voice disturbances. None of the patients in this group experienced permanent complications. However, in TT group 78 patients had (78/260 - 30%) transient hypocalcaemia whereas only one patient (1/260 - 0.4%) suffered permanent hypoparathyroidism and 5 patients (5/260 - 1.9%) had temporary RLN injury but none of them remained permanent. There are only 2 (2/170 - 1.2%) recurrences and those patients are in BST group. All of the patients in BST group required at least 100 microg of thyroxine supplementation following the operation. These results demonstrate low permanent complication rates following thyroid surgery. Although the incidence of transient hypoparathyroidism increases with the extent of the resection, permanent complication rates are similar for all three surgical procedures. Even with short follow-up, there is a risk of recurrence with BST and therefore NTT or TT may be the operation of choice for MNG.
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Affiliation(s)
- Serdar Ozbas
- Department of General Surgery, Adnan Menderes University, Aydin, Turkey
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Petrakis IE, Kogerakis NE, Lasithiotakis KG, Vrachassotakis N, Chalkiadakis GE. LigaSure versus clamp-and-tie thyroidectomy for benign nodular disease. Head Neck 2004; 26:903-9. [PMID: 15390199 DOI: 10.1002/hed.20073] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND LigaSure is an alternative bipolar diathermy system (BDS) combining vessel sealing with reduced thermal spread, which has been successfully used in many abdominal operations; however, there is a little experience in open thyroidectomy. This study compares the efficacy and the advantages of the LigaSure BDS when used for total thyroidectomy for benign thyroid disease with the conventional clamp-and-tie technique. METHODS Between May 1998 and October 2002, 517 patients underwent total thyroidectomy for benign thyroid multinodular goiter. Among them, from May 1998 until May 2000, 247 patients (group I) were operated on with the conventional clamp-and-tie technique, whereas from May 2000 until October 2003, 270 patients (group II) underwent total thyroidectomy for benign multinodular goiter with LigaSure BDS through a 4-cm transverse suprasternal incision. Demographics, pathologic characteristics, gland mass, operative time, blood loss, and complications were assessed. RESULTS There were no intraoperative complications. Thyroid mass was similar in both groups, but the operative time was shorter in group II than in group I (mean +/- standard deviation, 71 +/- 14 minutes vs 86 +/- 22 minutes; p < .01). Intraoperative total blood loss was similar between the two groups, but postoperative drain volume was less in group II than in group I (21 +/- 15 mL; p < .01). Major post-thyroidectomy complications (ie, laryngeal nerve palsy, hematoma, and hypocalcemia) occurred less frequently in the LigaSure group than in the clamp-and-tie group (0.7%, 0.4%, 1.1% vs 4%, 2%, 4.8%, respectively; p < .05). The mean +/- standard deviation postoperative hospital stay was significantly less for the patients in group II than for those in group I (2.3 +/- 1.7 days vs 2.8 +/- 1.3 days; p < .05). CONCLUSIONS The use of the LigaSure vessel sealer for thyroid surgery is an effective and safe alternative that reduces the overall operative time and could be successfully applied through a narrow surgical incision.
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Affiliation(s)
- Ioannis E Petrakis
- Department of General Surgery, University General Hospital of Heraklion, University of Crete, 114 Akadimias Avenue, GR-71305, Heraklion Crete, Greece.
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Bellantone R, Lombardi CP, Bossola M, Boscherini M, De Crea C, Alesina P, Traini E, Princi P, Raffaelli M. Total thyroidectomy for management of benign thyroid disease: review of 526 cases. World J Surg 2002; 26:1468-71. [PMID: 12360381 DOI: 10.1007/s00268-002-6426-1] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Total thyroidectomy is not frequently performed in cases of benign disease because of the associated risk of postoperative hypoparathyroidism and recurrent laryngeal nerve (RLN) damage. We chose a series of patients who had undergone total thyroidectomy (TT) for benign thyroid tumors to evaluate the safety of this approach and its role in the treatment of nonmalignant lesions of the thyroid. We considered only patients with a minimum follow-up of 24 months. Records of 526 patients who underwent TT were carefully reviewed, assessing for perioperative complications and late sequelae. The mean age was 44 +/- 15.7 years; 109 patients (20.7%) were male and 417 (79.3%) were female. Altogether, 65 patients (12.3%) were operated on for toxic goiter, 429 (81.6%) for bilateral nodular goiter, and 32 (6.1%) for thyroiditis. Postoperative hemorrhage requiring reoperation occurred in 8 cases (1.5%). The incidences of permanent RLN palsy (considered as a percentage of the nerves at risk) and permanent hypocalcemia were 0.4% and 3.4%, respectively. A trend toward a decrease in the complication rate was observed during the last 5 years. There were no disease recurrences during a mean follow-up of 44 months. The results of our series show that TT can be performed safely in patients, with a low incidence of lifetime disabilities. TT has the advantage of reducing/avoiding the risk of disease recurrence and reoperation and should therefore be considered a valuable option for treating benign thyroid diseases.
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Affiliation(s)
- Rocco Bellantone
- Divisione di Endocrinochirurgia, Dipartimento di Scienze Chirurgiche, Università Cattolica del Sacro Cuore, L go A Gemelli 8, 00168 Rome, Italy
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Mishra A, Agarwal G, Agarwal A, Mishra SK. Safety and efficacy of total thyroidectomy in hands of endocrine surgery trainees. Am J Surg 1999; 178:377-80. [PMID: 10612531 DOI: 10.1016/s0002-9610(99)00196-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Fear of a high complication rate of total thyroidectomy, especially in the hands of less experienced surgeons, limits its routine use. The results of total thyroidectomy in the hands of endocrine surgery trainees and consultants were compared to know whether this procedure can be performed effectively and safely by trainees. METHODS Medical records of 232 patients who underwent total thyroidectomy from 1990 to 1997 were reviewed. Patients were put into groups A (operated by consultants) and B (trainees). Safety (postoperative hypoparathyroidism, recurrent laryngeal nerve palsy, and hemorrhage) and efficacy (postoperative radioactive iodine uptake) in the two groups were compared. RESULTS There were 127 patients in group A and 105 in group B. Rates of occurrence of permanent hypoparathyroidism and recurrent laryngeal nerve palsy were comparable in the two groups. Postoperative radioactive iodine uptake in the two groups was not significantly different. CONCLUSIONS Total thyroidectomy can be safely and effectively performed by endocrine surgical trainees.
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Affiliation(s)
- A Mishra
- Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Affiliation(s)
- M H Wheeler
- Department of Endocrine Surgery, University Hospital of Wales, Cardiff, UK
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Abstract
What operation to perform in the case of a patient with thyroid cancer is a controversial issue, because there are few trials of treatments on which to base decisions. Small papillary tumours in young patients can be adequately treated by less than total thyroidectomy as can some variants of follicular carcinoma, but outwith these settings total thyroidectomy is recommended.
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Affiliation(s)
- T W Lennard
- Department of Surgery, Medical School, Framlington Place, Newcastle upon Tyne, UK
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Crowe PJ, Chetty R, Dent DM. Thyroid frozen section: flawed but helpful. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1993; 63:275-8. [PMID: 8311812 DOI: 10.1111/j.1445-2197.1993.tb00382.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The role of frozen section (FS) thyroid histology is controversial, some finding it helpful and others finding it inaccurate and of little assistance. The FS and subsequent permanent histology diagnosis were analysed retrospectively in 241 patients, 23 of whom were subsequently shown to have carcinoma. FS correctly identified five (22%) of these, deferred the diagnosis in three (13%) and made an incorrect benign diagnosis in 15 (65%). This impaired accuracy was attributed to the high proportion (13/23) of follicular neoplasms, which are difficult to categorize on FS. No false positive diagnoses were made in the 218 patients with benign disease. The possibility of a benign FS diagnosis being converted to malignant was 6.2%. The result of the FS affected management in that all five patients with the diagnosis of cancer underwent immediate contralateral surgery, but only seven of 18 in the negative FS group had further surgery when permanent histology demonstrated carcinoma, despite equivalent risk factors for poor prognosis in each group. This study suggests that the interpretation of FS and risk factors, in particular the tendency to interpret most follicular neoplasms as benign rather than defer decision, may be improved if pathologists and surgeons interested in thyroid disease are involved in the management of patients with thyroid nodules. Although FS remains flawed it is helpful in a small proportion of cases where it allows immediate contralateral surgery.
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Affiliation(s)
- P J Crowe
- Department of Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
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