Thyroid gland injury after blunt neck trauma: a case report.

Soft-tissue injuries are relatively common after blunt neck trauma. Due to neck content, several vital structures can be compromised. Isolated trauma to the thyroid is highly uncommon, and few cases are reported in the literature. A 61-year-old otherwise healthy woman sustained blunt trauma to the left frontal half of the neck caused by seatbelt injury in a motor vehicle accident. She presented with a painful anterior neck swelling associated with dyspnea. Computed tomography showed the left thyroid lobe lacerations with features suggestive of thyroid gland active bleeding. She underwent surgical exploration with left thyroidectomy and recovered un-eventfully. Isolated thyroid gland injury is infrequent and is present in about 1-2% of the cases, and in most reported cases, there is an underlining pathology within the gland. Patients can be present with neck swelling, pain, respiratory distress, and dysphagia. Patients who sustained blunt neck trauma should be assessed and stabilized according to the ATLS® principles. Injury to vital structures should be ruled out first. Although these cases are rare, physicians should consider the possibility of thyroid injury after blunt neck trauma or neck swelling is noted.

A Rare Case of Traumatic Thyroid Gland Hypoperfusion/Devascularization After a Gunshot Wound Through the Neck: Computed Tomography Findings.

BACKGROUND The thyroid gland is rarely injured in cases of penetrating neck trauma. Computed tomography (CT) plays a central role in prompt evaluation of the extent of penetrating neck trauma and can demonstrate thyroid gland injury. The current literature on thyroid gland injury is limited mostly to blunt trauma, with little emphasis on findings seen on CT imaging. In the present case report, we focus on CT imaging findings of thyroid gland hypoperfusion/devascularization in a patient who had a gunshot wound injury through the base of his neck. CASE REPORT A 26-year-old man was transferred to our trauma center after experiencing multiple gunshot wounds, including one through the base of the neck. The bullet path through his neck was associated with enlargement/edema involving the right thyroid lobe, with an asymmetric decrease in enhancement involving the mid and superior aspects of the right thyroid lobe. Maximum-intensity-projection angiographic images of the vascular supply of the thyroid gland suggested an abrupt decrease in caliber close to the origin of the posterior glandular branch of the right superior thyroid artery. The findings favored vasospasm rather than an arterial injury, which led to hypoperfusion/devascularization of the upper pole of the right thyroid lobe. CONCLUSIONS Thyroid gland hypoperfusion/devascularization after a penetrating neck injury is rare. Recognition of CT imaging findings that favor post-traumatic organ hypoperfusion/devascularization is crucial for prompt management and to decrease morbidity in such cases.

Shattered thyroid gland from blunt neck trauma in a child.

Thyroid gland rupture in a child secondary to blunt trauma is an extremely rare occurrence. The number of published cases of thyroid gland injuries in children is very limited in the research literature. A case report of shattered thyroid gland in a child is presented. This case highlights potential life-threatening complications and reviews management of thyroid gland injuries. Based on this case and other published pediatric case reports, conservative management may be a reasonable approach in thyroid gland injuries from blunt neck trauma in children.

Ligadura segregada de la arteria tiroidea superior. Minimizar la lesión posterior a la tiroidectomía en el rama externa del nervio laríngeo superior. Un nuevo enfoque práctico / Segregated ligation of the superior thyroid artery minimize post-thyroidectomy injury to the external branch of superior laryngeal nerve, a novel practical approach

External division of the superior laryngeal nerve supplies the crico-thyroid muscle to excite length and thickness of the vocal fold. Thus, increasing voice tone. The vicinity with the superior thyroid vessels sets the external branch of the superior laryngeal nerve in danger every time the superior end of the thyroid is dissected. Thus, the aim of present study is to assess the rate and complication of external branch of the superior laryngeal nerve injury post- thyroidectomy when segregated ligation of superior thyroid vessels closes to thyroid capsule without prior nerve identification and without nerve stimulator or intraoperative neuro-monitoring. The presented study is a prospective, non- randomized clinical study included 1450 patients who underwent thyroidectomy which either (total thyroidectomies, near total thyroidectomies or lobectomy and isthmectomy) in the Department of Surgery/AL-Diawania Teaching Hospital in Diawania City, Iraq, between January 2000 and February 2018. All patients underwent thyroidectomy through segregated ligation of superior thyroid artery very closely to thyroid capsule without prior nerve identification and without nerve stimulator or intraoperative neuromonitoring. Postoperative indirect laryngoscopy vocal cord examination with long term follow up through physical examination and clinical history to evaluate nerve integrity. In present study, the total cases with EBSLN injury were 38 (2.6%), in which the transient EBSLN injury occurred in 28 (1.9%) of patients and permanent injury occurred in 10 (0.7%) of patients and majority of cases with EBSLN injury were occur in patients with large size goiter 29 (2%) more than small size goiter 9 (0.6%) And these differences were statistically significant differences, (P<0.005). In addition to, the majority of cases with EBSLN injury were occur in male {25(1.7%)} more than female patients {13(0.9%)} And these differences were statistically significant differences, (P<0.005). Segregated ligation of superior thyroid artery is a safe technical option, cost effective, time preserved and need surgical skills to minimized risk of injury to the external laryngeal nerve

Espina de pescado alojada en la glándula tiroides / Fishbone lodged in the thyroid gland

Los cuerpos extraños alojados en la vía aéreodigestiva superior son un motivo de consulta frecuente para el otorrinolaringólogo. Uno de los más frecuentes son las espinas de pescado. En raras ocasiones, éstas migran hacia tejidos adyacentes y generan complicaciones importantes. Presentamos el caso de una paciente que tras la ingesta de pescado manifiesta sensación de cuerpo extraño faríngeo, odinofagia y dolor látero cervical derecho. Dada la ausencia de hallazgos a la exploración física y laringoscópica se realiza una tomografia computarizada cervical, visualizando un cuerpo extraño alojado en la glándula tiroidea. Se interviene mediante cervicotomía media, realizando la extracción de la espina sin complicaciones. El diagnóstico precoz y manejo adecuado es determinante para prevenir complicaciones en estos casos.

Foreign bodies in the aerodigestive tract are commonly confronted in otolaryngology practice. The most frequent are the fish bones. In rare cases they can move and cause numerous complications. We report the case of a patient that manifest the sensation of pharyngeal foreign body, after fish ingestion. She also referred odynophagia and right cervical pain. Physical and laryngoscopic examination were normal. A cervical CT was performed, where a foreign body lodged in the thyroid gland was visualized, median cervicotomy was done and the foreign body was extracted. Early diagnosis and adequate management are crucial to prevent complications in these cases.

Model-based calculation of thyroid gland normal tissue complication probability in head and neck cancer patients after radiation therapy.

AIM: Primary hypothyroidism is one of the late complications that can occur after radiation therapy for malignant tumors in the head and neck region. The aim of this retrospective study was to show the validity of the Lyman-Kutcher-Burman (LKB) normal tissue complication model for thyroid gland based on clinical results. METHODS: Thyroid function was evaluated by measuring thyroid-stimulating hormone and free thyroxine serum levels before radiation therapy, 3 months after the beginning of radiation therapy, and afterwards at each follow-up visit. Cumulative incidence was calculated using the Kaplan-Meier method. Dose-volume histogram, total dose, fractionation schedule, total duration of the treatment, and other parameters were used for normal tissue complication probability calculation based on the LKB model. The model was evaluated after fitting with the three sets of parameters for grade 2 hypothyroidism: 1) "Emami," where n = 0.22; m = 0.26, and D50 = 80 Gy; 2) "mean dose," where n = 1; m = 0.27, and D50 = 60 Gy; and 3) "Lyman EUD," where n = 0.49; m = 0.24, and D50 = 60 Gy. A value 3.0 Gy was used for α/ß ratio RESULTS: Eighty-three patients treated with volumetric modulated arc therapy for head and neck cancers at the University Hospital Martin, Slovakia, from January 2014 to July 2017, were included in the retrospective study. Median follow-up was 1.2 years. Cumulative incidence of hypothyroidism grade 2 or higher after 12 and 24 months was 9.6 and 22.0%, respectively. Normal tissue complication probability values calculated with mean dose and Lyman EUD parameters showed the best correlation with our clinical findings. CONCLUSION: Empirically based modelling of normal tissue complication probability was valid for our cohort of patients. With carefully chosen parameters, the LKB model can be used for predicting the normal tissue complication probability value.

A surgical case of mediastinal hematoma caused by a minor traffic injury.

BACKGROUND: Mediastinal hematoma rarely occurs after a minor traffic injury. CASE PRESENTATION: A woman in her forties was transferred to the emergency room by ambulance due to a traffic accident. Computed tomography (CT) revealed no abnormal findings, and she went home. Two days after the accident, the contrast-enhanced CT was repeated, which revealed cervical and mediastinal hematomas. Because it was possible that there was active bleeding from the right inferior thyroid artery, embolization of the right inferior thyroid artery was performed; however, her condition further deteriorated, so we performed emergency surgery to achieve hemostasis and remove the hematoma. Because of oozing from the right thyroid lobe, we performed right hemithyroidectomy and drainage of mediastinal space and right thoracic cavity. Since there was no bleeding site in the mediastinum, we thought that the mediastinal hematoma was due to bleeding from the thyroid gland. Her postoperative course was uneventful, and she is doing well at 9 months of follow-up after surgery. CONCLUSIONS: It is possible that mediastinal hematoma might be caused by a minor traffic injury.

Animals in Iodine Deficiency or Sulfadimethoxine Models of Thyroid Damage Are Differently Affected by the Consumption of Brassica Sprouts.

The study was primarily aimed at investigating the effect of brassica sprout consumption, namely rutabaga (Brassica napus L. var. napobrassica) sprouts (R) generally recognized as antithyroid agent due to its goitrogenic substance content, on hematological, biochemical, and immunological parameters in rats. Sprouts were tested alone and in a combination with other antithyroid factors, such as iodine deficiency (RDI) and sulfadimethoxine (RS). The expression of the heme oxygenase-1 (HO-1) gene in the thyroid as a stress-inducible protein was determined. The thermographic analysis was also estimated. The intake of rutabaga sprouts by healthy rats did not reveal any significant, harmful effect on the thyroid function. Both body temperature and expression of HO-1 remained unchanged in response to the consumed sprouts. In animals with hypothyroidism, rutabaga sprouts enhanced the negative effect of iodine deficiency or sulfadimethoxine ingestion on the organism by increasing the WBC (RDI), TNF-α (RS), creatinine (RS), and triglyceride (RDI and RS) levels, as well as decreasing PLT (RS) level. Moreover, rutabaga sprout consumption by rats with iodine deficiency and sulfadimethoxine decreased their body temperature. Additionally, the concomitant administration of sprouts and iodine depletion significantly reduced the expression of HO-1 in the thyroid. The results may prove useful in confirming rutabaga sprout consumption to be safe, though the seeds of this vegetable provide a well-known antithyroid agent. Our results have shown that rutabaga sprout consumption may be also a factor that enhances the negative clinical features only when combined with iodine deficiency and sulfadimethoxine ingestion.

Revisiting Rupture of Benign Thyroid Nodules after Radiofrequency Ablation: Various Types and Imaging Features.

BACKGROUND: To evaluate the imaging features, clinical manifestations, and prognosis of patients with thyroid nodule rupture after radiofrequency ablation (RFA). METHODS: The records of 12 patients who experienced thyroid nodule rupture after RFA at four Korean thyroid centers between March 2010 and July 2017 were retrospectively reviewed. Clinical data evaluated included baseline patient characteristics, treatment methods, initial presenting symptoms, imaging features, treatment, and prognosis. RESULTS: The most common symptoms of post-RFA nodule rupture were sudden neck bulging and pain. Based on imaging features, the localization of nodule rupture was classified into three types: anterior, posterolateral, and medial types. The anterior type is the most often, followed by posterolateral and medial type. Eight patients recovered completely after conservative treatment. Four patients who did not improve with conservative management required invasive procedures, including incision and drainage or aspiration. CONCLUSION: Thyroid nodule rupture after RFA can be classified into three types based on its localization: anterior, posterolateral, and medial types. Because majority of thyroid nodule ruptures after RFA can be managed conservatively, familiarity with these imaging features is essential in avoiding unnecessary imaging workup or invasive procedures.

Thyroid Trauma-A National Analysis of Incidence, Mortality, and Concomitant Injury.

BACKGROUND: Traumatic injury to the thyroid is rare with no large national studies in the literature. We sought to describe the incidence of traumatic thyroid injury and to compare injury characteristics, operative interventions, and outcomes of isolated thyroid versus thyroid and concomitant neck injury. METHODS: The National Trauma Data Bank (2007-2015) was used to identify patients with thyroid injury. Concomitant injury to surrounding neck structures included the trachea, esophagus, carotid arteries, cervical spine vertebrae, or vertebral arteries. A multivariable logistic regression analysis was performed. RESULTS: The incidence of thyroid injury was <0.1%. Of these, 59.7% of patients had isolated thyroid injury and 40.3% had thyroid and concomitant neck injury. Most patients in both groups had a penetrating mechanism (75.8% and 85.6%). Thyroid operative intervention was rare in both groups (isolated thyroid injury 19.3%, thyroid and concomitant neck injury 22.1%). Direct thyroid repair was the most common type of surgical intervention performed (isolated thyroid 13.1% versus thyroid and concomitant neck injury 15.1%; P = 0.280), whereas total thyroidectomy was only performed in a single patient. Mortality was decreased for patients with isolated thyroid injury compared with thyroid and concomitant neck injury (8.9% versus 19%; P < 0.001). CONCLUSIONS: Thyroid injury in trauma patients is extremely rare and occurs more frequently with penetrating trauma. Isolated thyroid trauma is associated with a lower risk of mortality, compared to thyroid trauma with concomitant neck injury. Most thyroid injury is treated nonoperatively, and when operative intervention is required, direct thyroid repair is most commonly performed.

[Effects of endoplasmic reticulum stress-induced apoptosis in thyroid injury caused by fluoride in rat].

Objective: To explore the effects of endoplasmic reticulum stress-induced apoptosis in thyroid injury of rats caused by excessive fluoride intake. Methods: All 40 Wistar rats were randomly divided into four groups, control group, low fluoride group, medium fluoride group and high fluoride group. The rats in control group were fed with tap water (fluoride concentration=0.344 mg/L) and the experimental rats were fed with the water contaminated fluoride with the dose of 5, 10 and 20 mg/L. 10 rats (female: male=1∶1) in each group were sacrificed after 8 months of exposure through drinking water. The contents of urine fluoride were detected by fluorine ion selective electrode method. Morphology of thyroid was observed through light microscope and apoptosis in thyroid were detected by the terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay. The mRNA and protein expressions of glucose-regulated protein 78 (GRP78) and C/EBP homologous protein (CHOP) were analyzed by RT-PCR and immunohistochemistry respectively, and results were compared among groups. Results: The contents of urine fluoride in all fluoride treated groups were separately (4.74±1.88), (7.70±2.82) and (10.50±2.92) mg/L, which were gradually higher than that of control group (2.23±0.54) mg/L (P<0.05). Morphological changes were found in thyroid tissues of fluoride treated groups, thyroid follicular hyperplasia or even no cavity cell clusters were observed. Apoptosis in thyroid were notably increased in fluoride treated groups. The mRNA expression levels of GRP78 in all fluoride treated groups were separately 1.30±0.42, 1.39±0.29 and 1.50±0.27, which were significantly higher than that of control group (0.93±0.24) (P<0.05). And the mRNA expression levels of CHOP in medium and high fluoride groups were separately 1.17±0.29 and 1.30±0.26, which were significantly higher than that of control group (0.91±0.20) (P<0.05). The protein expression levels of GRP78 and CHOP in medium and high fluoride groups were respectively 29.68±4.04, 29.90±3.74 and 4.05±1.62, 4.44±1.81, which were significantly higher than those in the control group (separately 23.80±6.36, 2.27±0.89) (P<0.05). Conclusion: Excessive-fluoride intake can induce thyroid injury, and endoplasmic reticulum stress-induced apoptosis might be involved in the injury.

Efficacy of Drainless Total Thyroidectomy in Intrathyroidal Lesions of Thyroid

Abstract Introduction There is difference of opinion about the placement of the drain in thyroid surgeries, and, to the best of our knowledge, the efficacy of drainless total thyroidectomy regarding various parameters of thyroid lesions has not been well-established. Objective To report our experience with drainless total thyroidectomy, and to define an appropriate patient population for its performance. Methods This is a retrospective case analysis of the patients who underwent total thyroidectomy for intrathyroidal lesions with or without central neck dissection in a tertiary referral hospital (number = 74). The patients, who had undergone total thyroidectomy without any drain insertion, were analyzed, and the relationships among various parameters of thyroid lesions were noted in relation to seroma and hematoma formation. Results Seroma formation was noted only in 5 out of 74 patents (6.75%). All of the seromas that occurred were observed in patients with thyroid lesions < 4 cm, and 4 out of 5 seromas were observed in patients with a malignant pathology. There was no statistically significant difference in seroma formation between patients younger or older than 50 years of age. The nature of the lesion, whether benign or malignant, did not affect the formation of seroma. Of interest is the fact that none of the 10 patients who had central neck dissection performed as part of their treatment developed seroma. Conclusions Drainless total thyroidectomy is safe across all age groups for patients harboring either benign or malignant thyroid pathologies. However, caution is to be observed in opting for drainless total thyroidectomy in patients with large lesions (> 5 cm)

Orbitopatía asociada al tiroides en edades pediátricas / Thyroid-associated orbinopathy at pediatric ages

La enfermedad de Graves es rara en los niños y adolescentes, y aunque cursa con una clínica bastante florida, no siempre se piensa en este diagnóstico, y en no pocas ocasiones llegan a la consulta de Endocrinología remitidos de servicios de Psicología y/o Psiquiatría por un predominio de alteraciones conductuales (hiperquinesia, irritabilidad). La afección ocular puede aparecer en relación o no con los estados de hipertiroidismo, y se presenta en muchos casos con el paciente eutiroideo, por lo que se nombra actualmente orbitopatía asociada al tiroides. Es una enfermedad autoinmune y autolimitada que afecta el tejido conectivo, y su evolución es menos grave que en el adulto. El tratamiento de esta entidad es muy particularizado en las edades pediátricas, debido a que las modalidades terapéuticas por sí mismas no cumplen todos los criterios de efectividad y seguridad. Teniendo en cuenta el grado y la severidad de la orbitopatía se establecen los protocolos de atención. Es válido señalar que en estas edades -por lo general- se presentan formas leves o moderadas. Existen tres líneas de tratamiento: el medicamentoso, con antitiroideos de síntesis; el iodo radiactivo solo, o combinado con terapia esteroidea; o la extirpación quirúrgica de la glándula tiroides. En niños es muy raro que se llegue a la cirugía orbitaria. Con el objetivo de reagrupar información actualizada sobre este tema se presenta esta revisión(AU)

Graves´ disease is rare in children and adolescents, and although it develops with a fairly abundant clinic, this diagnosis is not always taken into account and in many occasions, the patients are referred to the endocrinology service from the psychology and /or psychiatry service because of predominant behavioral alterations (hyperkinesia, irritability). This eye disease may appear, either associated or not, to the conditions of hyperthyroidism, and it occurs many times in the euthyroid patient, so it is presently called thyroid-associated orbinopathy. It is an autoimmune, autolimited disease affecting the connective tissue and its progression is less severe than in the adult. The treatment is very particularized at pediatric ages because the therapeutic modalities as such do not meet all the required effectiveness and safety criteria. Taking into account the degree and the severity of orbinopathy, the respective care protocols are set. Generally speaking, it is worthwhile to point out that at these ages; there are moderate or slight forms of disease. There are also three lines of treatment: medication with synthesis anti-thyroid; the radioiodine therapy alone or in combination with steroidal therapy; and the surgical excision of the thyroid gland. It is very uncommon that a child undergoes orbital surgery. The objective of this review was to reorganize updated information about this topic(AU)

Bilateral recurrent laryngeal nerve injury in a specialized thyroid surgery unit: would routine intraoperative neuromonitoring alter outcomes?

BACKGROUND: Bilateral recurrent laryngeal nerve (RLN) palsy following total thyroidectomy is a rare complication, however, poses significant morbidity to the patient when it does occur. The purpose of this paper was to determine the incidence of bilateral RLN palsy in a specialized thyroid unit and determine whether the routine use of intraoperative nerve monitoring (IONM) would alter the outcome. METHODS: This is a retrospective review of prospectively gathered data. A total of 7406 patients underwent total thyroidectomy at the University of Sydney Endocrine Surgical Unit between January 1990 and February 2014. IONM was utilized on a selective basis and we sought to assess whether IONM would have altered outcome in those patients who developed bilateral RLN palsy. RESULTS: Of the 7406 patients who underwent total thyroidectomy, seven patients (0.09%) developed bilateral RLN palsy during the study period. There was one permanent RLN palsy (0.01%) and routine IONM may have prevented one death and altered the outcome in two of the seven patients. CONCLUSION: Bilateral RLN palsy is a rare entity occurring in one out of 1000 cases in a specialized thyroid unit. IONM may facilitate the decision to pursue delayed surgery where the signal is lost on the first surgical side and has the potential to avoid bilateral RLN palsy following total thyroidectomy.

Towards automated spectroscopic tissue classification in thyroid and parathyroid surgery.

BACKGROUND: In (para-)thyroid surgery iatrogenic parathyroid injury should be prevented. To aid the surgeons' eye, a camera system enabling parathyroid-specific image enhancement would be useful. Hyperspectral camera technology might work, provided that the spectral signature of parathyroid tissue offers enough specific features to be reliably and automatically distinguished from surrounding tissues. As a first step to investigate this, we examined the feasibility of wide band diffuse reflectance spectroscopy (DRS) for automated spectroscopic tissue classification, using silicon (Si) and indium-gallium-arsenide (InGaAs) sensors. METHODS: DRS (350-1830 nm) was performed during (para-)thyroid resections. From the acquired spectra 36 features at predefined wavelengths were extracted. The best features for classification of parathyroid from adipose or thyroid were assessed by binary logistic regression for Si- and InGaAs-sensor ranges. Classification performance was evaluated by leave-one-out cross-validation. RESULTS: In 19 patients 299 spectra were recorded (62 tissue sites: thyroid = 23, parathyroid = 21, adipose = 18). Classification accuracy of parathyroid-adipose was, respectively, 79% (Si), 82% (InGaAs) and 97% (Si/InGaAs combined). Parathyroid-thyroid classification accuracies were 80% (Si), 75% (InGaAs), 82% (Si/InGaAs combined). CONCLUSIONS: Si and InGaAs sensors are fairly accurate for automated spectroscopic classification of parathyroid, adipose and thyroid tissues. Combination of both sensor technologies improves accuracy. Follow-up research, aimed towards hyperspectral imaging seems justified. Copyright © 2016 John Wiley & Sons, Ltd.

Complicaciones derivadas de la tiroidectomía en el Hospital General "Calixto García" / Thyroidectomy complications observed in ¨Calixto Garcia¨ general hospital

Introducción: el tiroides es una glándula donde se asienta con frecuencia la enfermedad nodular tanto benigna como maligna. En muchas ocasiones, se presenta con criterio de intervención quirúrgica. De ella se derivan complicaciones tales como el hipoparatiroidismo posoperatorio, la lesión de los nervios laríngeos superiores, y recurrentes, así como hematoma del sitio operatorio todo lo cual nos motivó a realizar el presente trabajo. Objetivos: identificar las complicaciones derivadas de las tiroidectomías y relacionarlas con las variantes anatómicas y la extensión de la tiroidectomía. Método: se estudiaron un total de 234 intervenciones realizadas sobre el tiroides en nuestro centro desde febrero de 2012 hasta octubre de 2015. Se aplicó el método de porcientos para el cálculo de todas las variables. Se obtuvo la información existente en las historias clínicas y los informes operatorios. Resultados: la mayoría de las tiroidectomías realizadas en nuestro centro son las de afecciones benignas. Las variantes anatómicas anómalas del laríngeo recurrente se evidenciaron en algunos casos. Hubo una lesión recurrencial temporal y otra permanente para un 0,42 por ciento respectivamente. Se apreciaron tres hipoparatiroidismo temporales, con 1,28 por ciento, y una lesión vascular de arteria tiroidea media anterior anómala. Conclusiones: las afecciones benignas aún son las más frecuentes en el tiroides. El conocimiento de la anatomía del tiroides y sus variantes son vitales para realizar tiroidectomías. Las complicaciones como el hipoparatiroidismo y la lesión recurrencial se relacionan con la extensión de esta(AU)

Introduction: The thyroid gland is the frequent location of the nodular illness either benign or malignant. In many occasions, the surgical procedure is the main criterion to treat the disease. Some of the complications associated to surgery are postoperative hypoparatyroidism, upper laryngeal nerve injure, mostly outer branch; recurrent laryngeal nerve, and hematoma in the surgical site. Objectives: To identify the most frequently illnesses affecting the thyroid. Method: A total of 234 surgeries performed in the thyroid in our center from February 2012 to October 2015 were studied. The percentage method was used to estimate all the variables. Required information was taken from the medical histories and the surgery reports. Results: Most of the thyroidectomies performed in our center were on benign lesions. The anomalous anatomical variants of the recurrent laryngeal nerve were evident in some cases. There was one temporary recurrent lesion and one permanent, accounting for 0.42%, respectively. Three cases of temporary hypoparathyroidism for 1.28% and a vascular lesion in the anomalous anterior medial thyroid artery were reported. Conclusions: Benign illnesses are still the most frequent ones in the thyroid gland. The knowledge about the thyroid anatomy and its variants are vital to perform thyroidectomies. Hypoparathyroidism and recurrent laryngeal lesion are the complications related to the extension of thyroidectomy(AU)

Thyroid gland rupture caused by blunt trauma to the neck.

BACKGROUND: Thyroid rupture following blunt trauma is extremely rare, and neck pain without swelling may be the only presenting symptom. However, hemorrhage and hematoma subsequently causes severe tracheal compression and respiratory distress. CASE PRESENTATION: A 71-year-old Japanese woman visited our emergency room with a complaint of increasing right-sided neck pain at the thyroid cartilage level after she tripped and accidentally hit her neck against a pole 3 h back. On admission, her vital signs were stable. There was no swelling or subcutaneous emphysema. Laryngeal endoscopy revealed mild laryngeal edema, although there was no impairment in vocal fold mobility on either side. Contrast-enhanced computed tomography (CT) revealed rupture of the right lobe of the thyroid gland accompanied by a large hematoma extending from the neck to the mediastinum. Under general anesthesia, the right lobe was resected and the hematoma was evacuated. CONCLUSION: Only a few isolated cases of thyroid rupture caused by blunt neck trauma have been reported in patients with normal thyroid glands and neck pain without swelling may be the only presenting symptom. When suspected, CT should be performed to confirm the diagnosis determine the optimal treatment.

[Parathyreoidectomy in Rats Using Microsurgery and Medical Adhesive Sulfacrylate].

BACKGROUND: One of the main difficulties in assessing the effectiveness of etiologic treatment of hypoparathyroidism is absence of its standardized model. OBJECTIVE: The aim of the study was to develop a method of hypoparathyroidism modeling. METHODS: Controlled nonrandomized study was performed on female Wistar rats aged 10 month. Group 1 (n =14) was performed with destruction of parathyroid glands with electrocoagulation; group 2 (n =12)--parathyroidectomy by the developed method. In 3 and 14 days after the surgery the levels of ionized calcium, parathyroid hormone, number of white blood cells, blood leukocyte formula, indicators of immunological tests, histological examination of organs in the area of operations were performed. Statistical analysis was performed using the nonparametric Mann-Whitney-Wilcoxon test. RESULTS: Selection of animals by sex and age criteria, angular skin incision, use of the operating microscope, microsurgical techniques, extirpation of parathyroid glands via resection of thyroid gland with the closure of the wound defect glue appeared to be the distinctive features of the developed method. In 14 days the group 2 showed decrease in ionized calcium (p = 0.016), PTH (p = 0.094), leucocytes (p = 0.004), PI (p = 0.003), spontaneous NBT test (p = 0.004), induced NBT test (p = 0.003) compared with group 1. Histological examination in the group 2 revealed no changes in thyroid gland, thin connective tissue capsule, cavity with a small amount of glue, however, there were determined foci of necrosis with perifocal inflammation in the group 1. CONCLUSION: Combination of several techniques allowed to simulate metabolic disorders with persistent hypocalcemia as well as lack of mortality in early postoperative period.

Two cases of thyroid rupture after blunt cervical trauma.

The consequences of thyroid gland rupture following blunt cervical trauma can be quite grave. Almost all of these cases are associated with preexisting thyroid lesions; the traumatic rupture of a previously normal thyroid gland is very rare. Both surgical and nonsurgical management techniques have been advocated for thyroid injuries, but there is still no consensus on treatment. We report cases of thyroid gland rupture following blunt cervical trauma in 2 patients: a 24-year-old man with a previously normal thyroid and an 8-year-old boy with a preexisting thyroid nodule. The man was treated surgically and the boy was treated conservatively. Based on our experience with these cases and our review of the literature, we propose treatment guidelines for thyroid injuries.