Assessing national trends in indications for pediatric total thyroidectomy.

PURPOSE: The most common indications for total thyroidectomy (TT) in children are malignancy and thyrotoxicosis due to Graves' disease (GD). However, the incidence of patients with GD among patients undergoing TT is unknown. This study aims to examine trends in pediatric TT. MATERIALS AND METHODS: The US Agency for Health Research and Quality Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) was queried to identify patients who underwent TT between 1997 and 2019. Weighted national estimates were obtained. Statistical analysis was completed using univariate logistic regression and one-sided Mann-Kendall Test. RESULTS: An estimated 4803 pediatric patients underwent TT within the study years. GD was the indication in 25 % of cases. Mann-Kendall testing showed a trend toward an increasing proportion of TT for GD without reaching statistical significance (z = 1.3609, S = 12, p = 0.0688). Statistically significant univariate associations were found among those who underwent thyroidectomy for GD compared to other indications, as they were more likely to be female (ß = 0.286, 95 % CI [0.058, 0.514], p = 0.014), Black, or Hispanic (ß = 1.392 [1.064, 1.721], p < 0.001; and ß = 0.562 [0.311, 0.814], p < 0.001, respectively). Additionally, they were less likely to have private insurance (ß = -0.308 [-1.076, -0.753], p = 0.002) and more likely to live in a ZIP code associated with a median household income below the 50th percentile (ß = 0.190 [0.012, 0.369], p = 0.036). The associations with the female sex, Black race, and Hispanic race persisted in multivariate analysis. CONCLUSION: GD appears to be an increasingly prevalent indication for TT. Patient characteristics differ from those who undergo TT for other diagnoses.

Investigating potential disparities by exploring time to surgical thyroid cancer treatment.

(1) Delays in initial treatment have been a frequently used metric for assessing disparities in medicine; however, there has been sparse literature on treatment delays in thyroid cancer. We therefore aimed to assess disparities by investigating the association between race/ethnicity, insurance type, and socioeconomic status and time to surgical treatment of thyroid cancer. (2) A retrospective chart review was conducted to collect demographic and clinical data from 443 surgical thyroid cancer patients at Mount Sinai Hospital in 2018-2019. We investigated the time between thyroid cancer diagnosis and surgery by race/ethnicity, insurance, and income groups. (3) Univariate analysis showed that race/ethnicity, insurance type, and SES alone were not statistically significant predictors of earlier time to treatment (p = 0.766, 0.339, 0.435, respectively). On multivariable linear regression, time between diagnosis and surgical treatment was not significantly different for racial minorities compared to non-Hispanic White patients, patients with Medicare/Medicaid compared to private insurance, and patients with lowest income quartile (<$54,585) compared to those with the highest (≥$116,560). (4) Present study showed no significant delays in treatment for different racial/ethnic, insurance, and income groups.

Evolution in the management of thyroid surgery over a period of 15 years in a Belgian center.

BACKGROUND: Guidelines for thyroid surgery have evolved to reflect advances in medical knowledge and decrease the overdiagnosis of low-risk thyroid cancer. Our goal was to analyze the change made in operative thyroid management and the impact on thyroid cancer diagnosis. BACKGROUND: Guidelines for thyroid surgery have evolved to reflect advances in medical knowledge and decrease overdiagnosis of low risk thyroid cancer. Our goal was to study the evolution, over a long period, of pre- and postoperative management and the influence on histological cancer diagnosis and, more particularly, microcancer. METHODS: In this retrospective cohort study, we included 891 consecutive patients who underwent thyroid surgery between 2007 and 2020. RESULTS: Respectively 305, 290 and 266 patients underwent surgery over the 3 periods of 2007-2010, 2011-2015 and 2016-2020. In all three periods, women represented approximately 70% of the population, and the mean age was 54 years old (range: 67). Most surgeries (90%) involved total thyroidectomies. Over the study period, the proportion of preoperative fine needle aspiration (FNA) increased from 13 to 55%, p < 0,01. Cancer was found in a total of 116 patients: 35 (11%) patients between 2007 and 2010, 50 (17%) between 2011 and 2015 and 32 (12%) between 2016 and 2020 (p = 0.08). For all 3 periods, papillary thyroid cancer (PTC) was the most prevalent, at approximately 80%. The proportion of thyroid cancer > T1a increased significantly from 37% (2011-2015 period) to 81% (2016-2020 period), p = 0.001. Patients treated with radioiodine remained relatively stable (approximately 60%) but were more frequently treated with a low dose of radioiodine (p < 0.01) and recombinant human TSH (p < 0.01). Operative thyroid weight decreased over time in all but the low-risk T1a PTC cases. CONCLUSIONS: Over a period of 15 years and according to the evolution of recommendations, the care of patients who underwent thyroid surgery changed with the increased use of preoperative FNA. This change came with a decrease in low-risk T1a PTC.

Association of Medicaid expansion with access to thyroidectomy for benign disease at high-volume centers.

BACKGROUND: Insurance-based disparities in access to thyroidectomy are well established. Patients undergoing thyroidectomy by high-volume surgeons have fewer complications and better postoperative outcomes. The aim of this study was to evaluate the association of Medicaid expansion with access to high-volume centers for thyroidectomy for benign disease. METHODS: The Vizient Clinical Data Base was queried for adult operations for benign thyroid disease from 2010 to 2019. Centers were sorted by volume into quartiles. Difference-in-difference analysis evaluated changes in insurance populations in expansion and non-expansion states after Medicaid expansion. Odds of patients undergoing operations in the 4 volume quartiles after stratifying by insurance and Medicaid expansion status were calculated. RESULTS: A total of 82,602 patients underwent operations at 364 centers. Expansion states increased Medicaid coverage in all volume quartiles compared to non-expansion states after Medicaid expansion (Q1, +4.87%, Q2, +5.35%, Q3, +8.57%, Q4, +4.62%, P < .002 for all). After Medicaid expansion, Medicaid patients had higher odds of undergoing operation at lower volume hospitals compared to the highest volume centers in both expansion states (Q1, ref, Q2, 1.82, Q3, 1.76, Q4, 1.67, P < .001) and non-expansion states (Q1, ref, Q2, 1.54, Q3, 2.04, Q4, 1.44, P < .001). Privately insured patients were most likely to undergo their operation at the highest volume centers in all states (E: Q1, ref, Q2, 0.78, Q3, 0.74, Q4, 0.66, P < .001; NE: Q1, ref, Q2, 0.89, Q3, 0.58, Q4, 0.85, P < .001). CONCLUSION: Medicaid expansion increased Medicaid coverage in expansion states, but Medicaid patients in both expansion and non-expansion states were less likely to be operated on at the highest volume centers compared to privately insured patients. Persistent barriers to accessing high-volume care still exists for Medicaid patients.

Factors affecting the rates of incidental parathyroidectomy during thyroidectomy.

BACKGROUND: The most important factors affecting the development of postoperative hypocalcaemia (PH) include intraoperative trauma to the parathyroid glands, incidental parathyroidectomy (IP), and the surgeon's experience. In this study, we aimed to determine the incidence of IP, evaluate its effect on postoperative calcium levels and investigate the effect of surgeon experience and volume on IP incidence and postoperative calcium levels. METHODS: This retrospective study included 645 patients who underwent thyroid surgery at the Department of General Surgery, Kütahya Health Sciences University between September 2016 and March 2020. All patients underwent surgery at a single clinic by general surgeons experienced in thyroid surgery and their residents (3-5 years). RESULTS: Normal parathyroid glands were reported in 58 (8.9%) of 645 patients. In 5 (8.6%) of 58 patients the parathyroid gland was detected in the intrathyroidal region. PH developed in ten patients (17.2%) with incidental removal of the parathyroid glands. A statistically significant difference was found between the number of incidentally removed parathyroid glands and the development of hypocalcaemia (p<0.05). Normal parathyroid glands were reported in the pathology of 37 (7.9%) patients operated on by general surgeons and 22 (12.6%) patients operated on by their residents. PH developed in 39 (8.2%) patients operated on by general surgeons and in 8 (4.5%) patients operated on by their residents. CONCLUSIONS: We found that the complication rate during the resident training process was the same as that of experienced general surgeons. A thyroidectomy can be safely performed by senior residents during residential training.

Racial implications of time to surgery in disparities in thyroid cancer survival.

INTRODUCTION: The influence of time to surgery on racial/ethnic disparities in papillary thyroid carcinoma (PTC) survival remains unstudied. MATERIALS AND METHODS: The National Cancer Database (2004-2017) was queried for patients with localized PTC. Survival data was compared by time to surgery, patient demographics, and multivariable Cox regression was performed. RESULTS: Of 126,708 patients included, 5% were Black, 10% Hispanic. Of all patients, 85% had no comorbidities. Non-Hispanic White (NHW) patients had a shorter median time to surgery than Black and Hispanic patients (36 vs. 43 vs. 42 days, respectively p â€‹< â€‹0.001). In multivariable analysis, longer time to surgery (>90 days vs â€‹< â€‹30 days) and Black race vs NHW, were associated with worse survival (HR: 1.56, (95%CI, 1.43-1.70), p â€‹< â€‹0.001 and HR: 1.21, (1.08-1.36), p â€‹= â€‹0.001), respectively. CONCLUSION: Delaying surgery for thyroid cancer is associated with worse survival. However, independent of time to surgery and other confounders, there remains a disparity as black patients have poorer outcomes.

Sex differences and racial/ethnic disparities in the presentation and treatment of medullary thyroid cancer.

BACKGROUND: This study assessed for disparities in the presentation and management of medullary thyroid cancer (MTC). METHODS: Patients with MTC (2010-2020) were identified from the National Cancer Database. Differences in disease presentation and likelihood of guideline-concordant surgical management (total thyroidectomy and resection of ≥1 lymph node) were assessed by sex and race/ethnicity. RESULTS: Of 6154 patients, 68.2% underwent guideline-concordant surgery. Tumors >4 â€‹cm were more likely in men (vs. women: OR 2.47, p â€‹< â€‹0.001) and Hispanic patients (vs. White patients: OR 1.52, p â€‹= â€‹0.001). Non-White patients were more likely to have distant metastases (Black: OR 1.63, p â€‹= â€‹0.002; Hispanic: OR 1.44, p â€‹= â€‹0.038) and experienced longer time to surgery (Black: HR 0.66, p â€‹< â€‹0.001; Hispanic: HR 0.71, p â€‹< â€‹0.001). Black patients were less likely to undergo guideline-concordant surgery (OR 0.70, p â€‹= â€‹0.022). CONCLUSIONS: Male and non-White patients with MTC more frequently present with advanced disease, and Black patients are less likely to undergo guideline-concordant surgery.

Perfil epidemiológico de pacientes com diagnóstico de carcinoma diferenciado de tireoide em seguimento em ambulatório de endocrinologia / Epidemiological profile of patients diagnosed with differentiated thyroid carcinoma followed in an outpatient clinic of endocrinology

Objetivo: Avaliar o perfil epidemiológico de pacientes com diagnóstico de carcinoma diferenciado de tireoide. Métodos: Estudo analítico descritivo, realizado por meio da análise e da coleta de dados de 34 prontuários de pacientes em seguimento em um ambulatório de endocrinologia de um hospital público em São Paulo. Foram incluídos todos os pacientes em acompanhamento no ambulatório com diagnóstico de tumores diferenciados; foram excluídos os menores de 18 anos e/ou com diagnóstico de outras neoplasias de tireoide (que não tumores diferenciados). Resultados: A idade dos pacientes variou de 25 a 84 anos ao diagnóstico, com média de 51 anos, tendo sido representados por 32 mulheres (94,11%) e 2 homens (5,88%). A maioria dos tumores (41,17%) possuía tamanho entre 1 e 2cm. A maior parte dos pacientes tinha baixo risco de recorrência, e todos foram tratados cirurgicamente. Conclusão: O tumor diferenciado mais frequente é o subtipo papilífero. Sua prevalência se dá em mulheres, com média de idade ao diagnóstico de 51 anos. (AU)

Objective: To evaluate the epidemiological profile of patients with differentiated thyroid carcinoma. Methods: Th is i s a d escriptive, analytical study performed through the analysis and collection of data from 34 medical records of patients being followed in an endocrinology clinic of a public hospital in the city of São Paulo. All patients being followed at the outpatients' department with a diagnosis of differentiated thyroid carcinoma were included, and those under 18 and/or with diagnosis of other cancer of the thyroid (other than differentiated tumors) were excluded. Results: the patients' ages ranged from 25 to 84 years at diagnosis, an average of 51 years represented by 32 women (94.11%) and 2 men (5.88%). Most tumors (41.17 %) were between 1 and 2cm. Most patients showed low risk of recurrence, and all were surgically treated. Conclusion: The most frequent differentiated tumor was the papillary one. Its prevalence was on women, with an average age at diagnosis of 51 years. There were only two patients with recurrent disease, and one with metastasis to the lung that died. (AU)

Preoperatively undiagnosed papillary thyroid carcinoma in patients thyroidectomized for benign multinodular goiter

ABSTRACT Objective Incidental thyroid cancers (ITCs) are often microcarcinomas; among them, the most frequent histotype is the papillary one. The purpose of this study was to evaluate the rate of papillary thyroid cancer (PTC) in patients thyroidectomized for benign multinodular goiter. Subject and methods We retrospectively evaluated the histological incidence of PTC in 207 consecutive patients who, in a 1-year period, underwent thyroidectomy for benign multinodular goiter. All patients came from an iodine-deficient area (Orleans, France) with three nuclear power stations located in the neighboring areas of the county town. Results Overall, 25 thyroids (12.1%) harbored 37 PTC, of which 31 were microcarcinomas. In these 25 PTC patients, mean age was 55 ± 10 years (range 30-75), female:male ratio 20:5 (4:1). In 10 patients (40% of 25 and 4.8% of 207), PTCs were bilateral, and in 7 (2 with microPTCs) the thyroid capsule was infiltrated. These 7 patients underwent central and lateral cervical lymph node dissections, which revealed lymph node metastases in one and two cases, respectively. Radioiodine treatment was performed in 7 cases. Neither mortality nor transient and permanent nerve injuries were observed. Four (16%) transient hypocalcaemias occurred as early complications. At last follow-up visit (mean length of follow-up 17.2 ± 3.4 months), all patients were doing well and free of any clinical local recurrence or distant metastases. Conclusion With a 12% risk that multinodular goiter harbors preoperatively unsuspected PTCs, which can have already infiltrated the capsule and that can be accompanied by PTC foci contralaterally, an adequate surgical approach has to be considered.

Thyroid cancer burden and economic impact on the Brazilian public health system

ABSTRACT Objective: Recent data indicates an increasing incidence of thyroid cancer not accompanied by a proportional increase in mortality, suggesting overdiagnosis, which may represent a big public health problem, particularly where resources are scarce. This article aims to describe and evaluate the procedures related to investigation of thyroid nodules and treatment and follow-up of thyroid cancer and the costs for the Brazilian public health system between 2008 and 2015. Materials and methods: Data on procedures related to investigation of thyroid nodules and treatment/follow-up of thyroid cancer between 2008 and 2015 in Brazil were collected from the Department of Informatics of the Brazilian Unified Health System (Datasus) website. Results: A statistically significant increase in the use of procedures related to thyroid nodules investigation and thyroid cancer treatment and follow-up was observed in Brazil, though a reduction was noted for procedures related to the treatment of more aggressive thyroid cancer, such as total thyroidectomy with neck dissection and higher radioiodine activities such as 200 and 250 milicuries (mCi). The procedures related to thyroid nodules investigation costs increased by 91% for thyroid ultrasound (p = 0.0003) and 128% in thyroid nodule biopsy (p < 0.001). Costs related to treatment and follow-up related-procedures increased by 120%. Conclusion: The increase in the incidence of thyroid cancer in Brazil is directly associated with an increased use of diagnostic tools for thyroid nodules, which leads to an upsurge in thyroid cancer treatment and followup-related procedures. These data suggest that substantial resources are being used for diagnosis, treatment and follow-up of a potentially indolent condition.

Experiencia clínica en tiroidectomía total del Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello Hospital Guillermo Grant Benavente / Clinical experience in total thyroidectomy of the Department of Otolaryngology and Head and Neck Surgery of Guillermo Grant Benavente Hospital

Introducción: La tiroidectomía es una de las cirugías más frecuentes realizadas en cabeza y cuello. Existen escasos reportes de experiencia en tiroidectomías en servicios de otorrinolaringología en Chile. Objetivo: Analizar la experiencia clínica con las tiroidectomías totales realizadas en el Servicio de ORL y Cirugía de Cabeza y Cuello de nuestro hospital. Material y método: Estudio descriptivo retrospectivo. Revisión de fichas clínicas de pacientes sometidos a tiroidectomías totales (TT) entre los años 2010 y 2014 en nuestro servicio. Resultados: Se realizaron 271 tiroidectomías totales. La indicación más frecuente fue por tamaño (51%). Los diagnósticos más frecuentes fueron carcinomas papilares (46%) e hiperplasia folicularcoloidea (37%). Se presentaron lesiones transitorias del nervio laríngeo recurrente en 2,9%, y lesiones persistentes en 2,5%. Hipocalcemia transitoria se presentó en el 25% de los pacientes. Discusión: Nuestra serie presenta resultados concordantes con la literatura, presenta una baja tasa de complicaciones, las cuales se observan principalmente en pacientes con vaciamiento cervical y/o en que se observaron 2 o menos paratiroides. Conclusiones: La tiroidectomía total es una técnica quirúrgica segura y nuestra experiencia presenta resultados concordantes a los publicados en la literatura internacional.

Introduction: Thyroidectomy is one of the most common surgeries performed in head and neck. There are few reports of experience in thyroidectomy in otolaryngology services in Chile. Aim: To analyze the clinical experience with total thyroidectomy performed in the service of ENT and Head and Neck Surgery of our hospital. Material and method: Retrospective descriptive study. Review of medical records of patients undergoing total thyroidectomy (TT) between 2010 and 2014 in our service records. Results: A total of 271 thyroidectomy were performed. The most frequent indication was size (51%). The most frequent diagnoses were papillary carcinomas (46%) and follicular colloid hyperplasia (37%). We found 2.5% of transient recurrent laryngeal nerve injury and 2.9% had persistent lesions. Transient hypocalcemia occurred in 25% of patients. Discussion: Our series shows good agreement with literature, it has a low rate of complications, which are mainly seen in patients with neck dissection and/or observed 2 or less parathyroid during surgery. Conclusions: Total thyroidectomy is a safe surgical technique, and our experience shows consistent results to those reported in international literature.

Analysis of pattern of occurrence of thyroid carcinoma between 2001 and 2010 / Análise do padrão de ocorrência do carcinoma de tireoide entre 2000-2010

ABSTRACT INTRODUCTION: An ongoing discussion is found in medical literature about the reasons for changes in thyroid carcinoma incidence patterns over the last decades. OBJECTIVE: To analyze the clinical and pathological characteristics of thyroid carcinoma cases over a decade. METHODS: Cross-sectional study over an historical cohort. Medical records of 628 thyroid cancer cases in a single center were reviewed. 597 patients were included. Microcarcinoma cases were selected for a qualitative analysis phase, in which medical records were reviewed for better understanding of thyroid nodule and thyroid cancer diagnosis process. RESULTS: An increase in the proportion of cases with thyroid cancer diagnosis was observed throughout the decade; new cases were predominantly tumors of less than 2 cm, with histopathological signs of low aggressiveness. There was an increase in proportion of cases with malignant cytological results among microcarcinomas. CONCLUSION: There is a trend for increase in thyroidectomies due to cancer in this institution, with proportional increment of cases with histopathological characteristics indicative of early disease. Among microcarcinomas, there is an increasing group represented by cancer cases that were not incidentally diagnosed, related to an enhancement in preoperative diagnostic methods.

RESUMO Introdução: Persiste uma discussão na literatura sobre as razões para as mudanças no padrão de incidência do carcinoma de tireoide nas últimas décadas. Objetivo: Analisar as características clinicopatológicas dos casos de carcinoma de tireoide ao longo de uma década. Método: Estudo transversal sobre uma coorte histórica. Os registros médicos de 628 casos de câncer de tireoide de um único centro foram revisados. Foram incluídos 597 pacientes. Os casos de microcarcinoma foram selecionados para uma fase de análise qualitativa, na qual os registros médicos foram revisados para melhor entendimento do processo de diagnóstico do nódulo e do câncer. Resultados: Observamos um aumento na proporção de casos com diagnóstico de câncer de tireoide ao longo da década; os novos casos foram predominantemente de tumores < 2 cm, com sinais histopatológicos de baixa agressividade. Houve aumento na proporção de casos com resultado citológico maligno entre os microcarcinomas. Conclusão: Há uma tendência de crescimento nas tireoidectomias por câncer na nossa instituição, com incremento proporcional de casos com características histopatológicas indicativas de doença precoce. Entre os microcarcinomas, há um grupo em ascensão representado por casos com diagnóstico não-ocasional de câncer, relacionados à melhora dos métodos diagnósticos pré-operatórios.

Thyroid surgery performed on an overnight basis: a 17 years of experience

Objective This study aimed to evaluate the results of thyroid surgeries with hospitalization periods shorter than 18 hours performed in a surgical endocrinology service, correlating these results with type of procedure, the definitive diagnosis and complications associated with the procedure.Subjects and methods The procedures performed, complications associated, hospitalization period, and relationships among these variables were assessed in consecutive patients subjected to different types of thyroid surgeries from January 1997 to March 2014 by the same group of surgeons. Data were analyzed by frequency, and the associations between the hospitalization period and other variables were analyzed using the Pearson chi-square test and Fisher’s exact test, using a multiple comparisons test with Bonferroni correction.Results Among the 3,411 surgeries performed, 799 of them were malignant neoplasia, 2,505 were benign tumors and 107 were Graves’ disease. The following procedures were performed: total thyroidectomy (1597 patients); total thyroidectomy with neck exploration (369 patients); lobectomy plus isthmectomy (1084 patients); total thyroidectomy complementation (145 patients); total thyroidectomy with neck dissection (84 patients); modified radical total thyroidectomy (13 patients); nodulectomy (11 patients); unresectable (9 patients); central neck dissection (48 patients); lateral neck dissection (38 patients); and others (13 patients). The following surgical complications, characteristic of the procedure: hemorrhage in 41 (1.2%) patients, hypoparathyroidism in 10 (0.3%) patients and recurrent laryngeal nerve (RLN) injury in 23 (0.7%) patients. Hospitalization shorter than 18 hours was observed in 97% of patients.Conclusion Thyroid surgery can be safely performed in virtually all patients on an overnight basis in specialized services.

Tasa de tiroidectomías por cáncer y por enfermedades benignas tiroídeas y su posible relación con un déficit de selenio ambiental / Rate of thyroidectomy by cancer and benign thyroid diseases and its possible relation with a deficit of selenium environmental

Recientemente hemos reportado el déficit de selenio ambiental, y el estatus alterado de selenio medido como actividad de Glutatión Peroxidasa en población beneficiaria del Servicio de Salud de Osorno. Estos déficits se asocian a alteraciones funcionales y estructurales del tiroides que se correlacionan con la aparición de enfermedades tiroídeas benignas y cáncer tiroídeo. El objetivo de este trabajo es mostrar la tasa de tiroidectomías por cáncer y por enfermedades benignas que se presentan en las comunas que habitan la población beneficiaria del Servicio de Salud Osorno y llamar la atención sobre su posible asociación con el estatus alterado de selenio y la menor actividad de Glutatión Peroxidasa descrita previamente.

We have recently reported the lack of environmental selenium and the altered selenium status measured as deficient glutathione peroxidase (GPx) activity in the population affiliated to the Osorno Health Service. These deficits are associated to functional and structural abnormalities of the thyroid gland that correlates with the appearance of benign thyroid pathologies and thyroid cancer. The aim of this investigation is to show the rate of thyroidectomy associated with malign and benign disease in the communities associated to the Osorno Health Service and warn about their possible link with the poor amount of selenium in the environment and the altered function of the GPx enzyme, previously described.

Experiencia clínica en tiroidectomía total / Clinical experience in total thyroidectomy

Introducción: La tiroidectomía total es una de las cirugías más frecuentes en cabeza y cuello. La experiencia en servicios de ORL es escasa en Chile. Objetivo: Analizar la experiencia clínica en tiroidectomía total en el Servicio de ORL del Hospital Guillermo Grant Benavente. Material y método: Estudio descriptivo prospectivo. Evaluación de los aspectos clínicos, la técnica quirúrgica y el porcentaje de complicaciones de los pacientes sometidos a tiroidectomía total durante el año 2009. Resultados: Se realizaron 34 tiroidectomías totales. La indicación más frecuente fue bocio multinodular (82,3 por ciento). Los diagnósticos más frecuentes fueron hiperplasia folicular (44 por ciento) y carcinoma papilar (32 por ciento). Se presentó lesión del nervio laríngeo recurrente transitoria en 8,8 por ciento, no se presentaron lesiones permanentes. Se presentó hipocalcemia transitoria en 29 por ciento y permanente en sólo un paciente (2,9 por ciento). Conclusiones: Nuestra experiencia presenta resultados en relación a indicaciones, diagnósticos y complicaciones concordantes con los estándares aceptados por la literatura mundial.

Introduction: Total thyroidectomy is one of the most frequent surgeries in head and neck. Experience in ENT services is scarce in Chile. Aim: To analyze clinical experience in total thyroidectomy in the ENT service of Guillermo Grant Benavente Hospital. Material and method: Prospective descriptive study. Evaluation of clinical aspects, surgical technique and percentage of complications of patients submitted to total thyroidectomy during the year 2009. Results: There were done 34 total thyroidectomies. The most frequent indication was multinodular goiter. The most frequent diagnoses were follicular hyperplasia (44 percent) and papillary carcinoma (32 percent). Transitory injury to the recurrent laryngeal nerve was present in 8,8 percent. Permanent injuries did not happen. Transitory hypocalcemia was present in 29 percent and permanent in only one patient (2,9 percent). Conclusions: Our experience presents results in relation to indications, diagnosis and complications, in accordance with the standards of the world literature.

Cáncer de tiroides pediátrico: serie de casos / Retrospective review of pediatric patients with thyroid cancer

Background: In childhood, thyroid cancer is uncommon and has a different biological behaviour than in adults. Aim: To analyze the surgical experience in thyroid cancer in children. Material and Methods: Review of medical records of patients aged 15 years or less with a thyroid cancer, operated in a Regional hospital between 1980 and 2007. Results: Six females and 2 males, aged 9 to 15 years, were operated in the study period. Five had a family history of thyroid diseases. Four had involvement of cervical lymph nodes at the moment of operation but none had systemic dissemination. All were euthyroid. A total thyroidectomy was performed in four patients. Cervical lymph node dissection was also performed in four patients. No immediate complications were recorded. One patient had a local relapse. Five patients were also treated with radioiodine. At the end of the follow up ranging from 108 to 320 months, all patients are asymptomatic. The pathological study disclosed a papillary carcinoma in seven and medullary carcinoma in one patient. Conclusions: Thyroid cancer in childhood has low mortality rates and surgical treatment is safe and effective.

El cáncer de tiroides en edad pediátrica es extremadamente infrecuente y tiene un comportamiento biológico diferente al adulto. El objetivo de este estudio es analizar la experiencia quirúrgica local en los últimos 27 años. Estudio de serie de casos describiendo las características anatomoclínicas, quirúrgicas, resultados del tratamiento y condición actual de los pacientes analizados mediante estadística descriptiva, realizando curva de sobrevida con método de Kaplan-Meier. Se intervinieron quirúrgicamente 8 pacientes por cáncer tiroideo, 6 del sexo femenino y 2 del masculino, con edad promedio de 13 años (9 a 15 años). Cinco tenían antecedentes familiares de patología tiroidea. Cuatro presentaron al momento del diagnóstico linfoadenopatías metastáticas cervicales, ninguno evidenció diseminación sistémica. Todos presentaban estado eutiroideo. El diagnóstico histopatológico concluyó carcinoma papilar en 7 casos y medular en 1. Se realizó tiroidectomía total en 4 pacientes. En 4 se practicó linfadenectomía cervical. No hubo complicaciones postoperatorias inmediatas. En 5 se complementó con radioyodoterapia. Una paciente desarrolló recidiva regional. Al término del estudio 7 llevan vida normal. Una paciente con carcinoma medular esporádico falleció siete años después de la cirugía, a causa de metástasis pulmonares y hepáticas. El seguimiento promedio de los cánceres papilares fue de 165 meses (108 a 320 meses). El cáncer de tiroides en edad pediátrica se asocia a una supervivencia prolongada, incluso en etapas avanzadas. La extensión de cirugía en los carcinomas papilares debe considerar factores pronósticos como tamaño y extensión del tumor primario, presencia o ausencia de metástasis y ciertamente, experiencia y buen juicio del equipo quirúrgico.

Tiroidectomia sin ligaduras: evaluando Ligasure Precise® / Ligasure® for hemostasis during thyroidectomy

Introducción: En tiroidectomia total se están evaluando métodos de hemostasia distintos a la ligadura habitual. Objetivo: Presentar nuestra experiencia inicial en la tiroidectomia total sin ligaduras, al utilizar el método de sellado de vasos a través de Ligasure Precise®. Material y método: Se consignaron en forma prospectiva, los datos de 129 pacientes: Datos personales, fecha de operación, antecedentes mórbidos, síntomas, función tiroidea, examen físico, ecografía, punción con aguja fina, tipo de operación, cirujano, tiempo operatorio, estadía postoperatoria, débito de drenajes, biopsia intraoperatoria y definitiva, complicaciones. Se utilizó un p < 0.05 como significativo para los cálculos estadísticos. Resultados: Se realizaron 129 tiroidectomías entre Enero y Agosto del 2005. Se operaron 65 pacientes deforma tradicional y 64 con Ligasure. No hubo mortalidad operatoria. Edad promedio 42,7 y 46,9 para cada grupo (p >0.05). Biopsia definitiva informó carcinoma en 34 y 32 por ciento respectivamente. Hospitalización promedio de 2,63 días y 2,26 días (p 0.02). El débito de drenajes fue 78 ce para el grupo Ligasure y 63,2 ce para el grupo tradicional. Tiempo operatorio promedio de 94 minutos (grupo tradicional) y 92 minutos (Ligasure) (p= 0.6). Las complicaciones fueron hematoma (1 caso por grupo), Lesión de recurrente laríngeo (1 caso en el grupo de ligadura tradicional) e hipocalcemia transitoria (6 casos en el grupo Ligasure y 1 caso en el grupo control). Conclusión: La tiroidectomia con Ligasure Precise es un método cómodo para el cirujano y tan seguro como la tiroidectomia con ligaduras. Su aplicación, indicación y reales beneficios deben ser evaluados en el futuro con mayor número de casos.

Background: Traditionally, hemostasis during thyroidectomy is done using clamp ligation of vessels. There is a new hemostasis method based on thermal coagulation and pressure that be used in this type of surgery. Aim: To report the experience with Ligasure Precise® thermal hemostasis system. Material and methods: Prospective evaluation of patients subjected to thyroidectomy with or without the use of Ligasure®. The choice of patients for each type of hemostasis was not randomized. Operative time, surgical complications and postoperative evolution were assessed. Results: During the study period, 64 patients aged 43 + 15 years were operated using Ligasure® and 65, aged 47 + 12, were operated using traditional hemostasis. Among patients with and without use of Ligasure®, operative time was 92 and 94 minutes respectively (p=NS), wound drainage volume was 78 and 63 ml respectively (p=NS) and hospital stay was 2.6 and 2.3 days respectively (p = 0.02). One patient in each group had a hematoma, one patient operated with Ligasure® had a lesion of the recurrent laryngeal nerve. Six patients operated using Ligasure® and one operated without it, had transient hypocalcaemia. Conclusions: Ligasure® hemostasis system is safe in thyroidectomy.

Cáncer de tiroides / Thyroides neoplasm

El presente trabajo refiere la experiencia de 112 casos de cáncer tiroideo estudiados, tratados y evaluados en el Servicio de Cirugía de Cabeza y Cuello del Hospital Nacional Guillermo Almenara Irigoyen, durante un período de 20 años, desde 1965 hasta 1985. En este estudio se analizan las diferentes variedades del cáncer de la tiroides, demostrando la alta incidencia del cáncer bien diferenciado tiroideo, llegando a más del 80 por ciento. Con menor frecuencia se presentó el cáncer indiferenciado o anaplásico, y más raramente aún el cáncer medular. En la etapa inicial de la enfermedad, Estadío I, se presenta poco más del 21 por ciento. En el Estadío II se presentó el 37.5 por ciento de los casos; igual frecuencia en el Estadío III. En etapa diseminada de la enfermedad, Estadío IV se presentó el 3.57 por ciento. El tratamiento principalmente realizado fue la cirugía, desde la lobectomía total ampliada al itsmo, hasta una tiroidectomía sub-total y total. Para las metástasis cervicales se realizaron las disecciones radiales del cuello, de tipo estandar y con la cobaltoterapia, así mismo a las neoplasias que infiltraban la tráquea y los músculos pre-tiroideos. Es importante señalar que en el cáncer tiroideo en Estadío I bien diferenciado tanto papilar como folicular, la curación y sobrevida a 5, 10, 15 y más años, llegó al 100 por ciento, solamente con el tratamiento quirúrgico.

Carcinoma diferenciado de tiroides: experiencia del Hospital de Valdivia / Thyroid differential carcinoma: experience at Hospital de Valdivia

Entre enero de 1978 y diciembre de 1996 se tratáron portadores de cáncer diferenciado de tiroides, 98 del tipo papilar y 4 del folicular. El grupo incluyó 86 mujeres y 16 hombres, con promedio de edad de 46,3 años (margen 9 a 80 años). De acuerdo a la clasificación de Meissner y Warren, 2 pacientes se estadificaron en estadio 0 (1,9 por ciento), 45 (44,1 por ciento) en estadio I;31 (30 por ciento) en estadio II; 17 (16,7 por ciento) en estadio IIIa; 1 (1,0 por ciento) en estadio IIIb y 6 (5,9 por ciento) en estadio IV. De los 102 pacientes, 100 fueron sometidos a tratamiento quirúrgico considerando el estadio de la enfermedad, tamaño del tumor primario y tipo histológico del carcinoma, priviligiando la cirugía conservadora en los cánceres papilares intracapsulares y la tiroidectomía total en los papilares extracapsulares y en los foliculares. Las complicaciones postoperatorias inmediata fueron 3 hematomas cervicales, 3 lesiones de nervio recurrente, 2 hipoparatiroidismo y otras menores, la mayoría de ellas secundarias a tiroidectomía total o casi total. No hubo mortalidad perioperatoria. La serie tiene un promedio de seguimiento de 74,1 meses. La sobrevida global es de 83,9 por ciento a 5 años y de 81,8 por ciento a 10 años, porcentaje que se mantiene hasta 20 años. En el estadio I la sobrevida es de 97,7 por ciento a 20 años

Evaluación de los cambios de la voz post tiroidectomía total sin lesión recurrencial: experiencia preliminar / Voices changes after uncomplicated total thyroidectomy: initial experience

Las alteraciones de la voz luego de la tiroidectomía son causadas por la lesión del Nervio Recurrente o Laríngeo Superior. Estos cambios en la voz también pueden ser originados por la modificación temporaria de los músculos pretiroideos. Objetivo: describir por qué luego de la tiroidectomía, aparecen cambios en la voz en pacientes con buena movilidad de las cuerdas vocales en controles pre y postoperatorios. Lugar de aplicación: Servicio de Cirugía Oncológica. Diseño: estudio prospectivo no randomizado. Población: 25 pacientes a los que se les realizó tiroidectomía total. Método: 25 pacientes fueron estudiados entre marzo de 1997 y junio de 1998. La edad promedio fue de 43 años, 22 fueron mujeres y 11 fumadores. Nueve casos fueron bocios multinodular, 9 adenomas bilaterales y 7 carcinomas diferenciados. Todos los pacientes fueron sometidos a tiroidectomías totales según técnica, con identificación y preservación del nervio recurrente y laríngeo superior. Durante la cirugía, los músculos pretiroideos no fueron cortados. Se realizó una fibrolaringoscopía en el pre y postoperatorio para controlar la movilidad de las cuerdas vocales. El análisis acústico de la voz reveló que la intensidad de la voz (Shimmer) creció entre los 2 y 4 meses, y se normalizó a los 6 meses. El tono fundamental de la voz (Fo) disminuyó entre los 2 y 4 meses, pero no se normalizó a los 6 meses. Conclusiones: los cambios de la voz luego de la tiroidectomía total ocurren. Los valores del Shimmer se normalizaron a los 6 meses no así los del Fo. Esto es importanete para el conocimiento de los pacientes en el preoperatorio