Bocio multinodular ectópico submandibular: a propósito de un caso y revisión de la literatura / Submandibular ectopic multinodular goiter: case report and literature review

Resumen El tiroides ectópico es una alteración congénita infrecuente que presenta una prevalencia entre 1/100.000-1/300.000. En el 90% de los casos se encuentra en la línea media cervical, siendo los casos de tiroides ectópico cervical lateral muy infrecuentes. Presentamos el caso de una paciente de 44 años que consultó por presentar una tumoración submandibular izquierda de más de seis meses de evolución. Las pruebas de imagen (ecografía, tomografía computarizada y gammagrafía) sugirieron un bocio ectópico multinodular; la punción aspiración con aguja fina (PAAF) informó de tejido tiroideo sin atipias (Bethesda II) y el estudio sanguíneo de hormonas tiroideas fue normal, orientando finalmente el caso como un bocio multinodular ectópico submandibular eutiroideo. Ante la ausencia de síntomas y signos sugerentes de malignidad, en conjunto con una PAAF con características de benignidad, se decidió realizar seguimiento. En el momento que presentó clínica por efecto masa se decidió realizar la exéresis de la lesión, que confirmó el diagnóstico de bocio multinodular ectópico. Los casos descritos en la literatura de bocio multinodular ectópico submandibular como único tejido tiroideo funcionante son excepcionales. El tiroides ectópico se debe considerar en el diagnóstico diferencial de una masa submandibular. Aunque actualmente no existe un consenso en relación con el manejo de dicha patología, el crecimiento de la masa puede contribuir a la decisión de una exéresis completa del tiroides ectópico, aun tratándose del único tejido tiroideo funcionante.

Abstract Ectopic thyroid is an uncommon congenital disorder with a prevalence between 1/100,000-1/300,000. In 90% of cases, it is placed in cervical midline, being the cases of lateral cervical ectopic thyroid very infrequent. We present the case of a 44-year-old female patient who had a left submandibular mass during more than six months. Imaging tests (ultrasound, computed tomography and scintigraphy) suggested a multinodular ectopic goiter; fine needle aspiration (FNA) reported thyroid tissue without atypia (Bethesda II) and the thyroid hormone blood tests were normal, finally orienting the case as a euthyroid submandibular ectopic multinodular goiter. In the absence of symptoms and signs suggestive of malignancy, together with an FNA with benign characteristics, it was decided to follow up. When the patient presented clinical symptoms due to mass effect, it was decided to perform excision of the lesion, which confirmed the diagnosis of ectopic multinodular goiter. There are very few cases described in the literature of submandibular ectopic multinodular goiter as the only functioning thyroid tissue. Ectopic thyroid should be considered in the differential diagnosis of a submandibular mass. Although there is currently no consensus on the management of this pathology, the growth of the mass may contribute to the decision of a complete excision of the ectopic thyroid, even if it is the only functioning thyroid tissue.

Bocio Intratorácico / Intrathoracic goiter

El bocio intratorácico se define como aquel bocio que se encuentra parcial o totalmente en el mediastino; su incidencia está en relación con el bocio multinodular. Es asintomático entre el 20­30%. Su diagnóstico se hace por pruebas de imagen; su Gold estándar es la tomografía axial computarizada. El tratamiento más efectivo y recomendado es la cirugía, sobre todo para pacientes con síntomas opresivos o con sospecha de malignidad y bocios hiperfuncionantes en quienes el tratamiento farmacológico no fue exitoso. Se detalla el caso de una paciente de 59 años de edad, quien, con síntomas opresivos esternales, a quien se le diagnostica masa mediastínica, la cual se resuelve con indicación quirúrgica, siendo resolutiva para la paciente, con mejoras en la sintomatología y diagnostico de benignidad. (AU)

Intrathoracic goiter is defined as partially or totally in the mediastinum; its incidence is related to multinodular goiter. It is asymptomatic in 20-30%. Its diagnosis is made by imaging tests; the gold standard is computerized axial tomography. Treatment can be pharmacological with risk of recurrence; the most effective and recommended is surgery, especially for patients with oppressive symptoms or with suspected malignancy. We present the case of a 59-year-old patient with sternal oppressive symptoms, who is diagnosed with a mediastinal mass, which resolved by surgery, with improvements in symptoms and a diagnosis of benignity. (AU)

Cirugía mayor ambulatoria de la glándula tiroides y paratiroides: resultados tras 6 años de experiencia / Major outpatient surgery of the thyroid and parathyroid glands: results after 6 years experience

Objetivo: La cirugía mayor ambulatoria (CMA) y con estancia inferior a 24 horas (overnight stay) se ha consolidado en muchas patologías aunque en cirugía tiroidea y paratiroidea resulta controvertido. El objetivo es valorar nuestros resultados en cirugía del tiroides y paratiroides en régimen de CMA durante un periodo de 6 años. Material y Métodos: Estudio observacional prospectivo de pacientes con indicación de hemitiroidectomía o paratiroidectomía enfocada en régimen CMA entre enero de 2011 y diciembre de 2016. Los pacientes cumplían criterios de CMA. En los primeros años se excluyeron los nodulos tiroideos mayores de 3 cm y los pacientes ASA III. Los pacientes ingresaron la mañana de la intervención, tras el acto quirúrgico pasaron a la Unidad de Recuperación Posquirúrgica y posteriormente a sala de hospitalización. Tras 8 h, si cumplían criterios, fueron dados de alta. Resultados: Se intervinieron 270 pacientes, la tasa de aplicabilidad global fue del 59%, la tasa de aceptabilidad global del 83,6% y el índice de sustitución del 49,2%. El índice de ingresos no deseados fue del 10,4% para la paratiroidectomía y del 17,6% en la cirugía del tiroides. Ningún paciente presentó complicaciones mayores en su domicilio. El grado de satisfacción fue alto o muy alto en el 94% de los pacientes. Conclusiones: La paratiroidectomía enfocada y la hemitiroidectomía realizada por cirujanos expertos en pacientes seleccionados, es segura y efectiva en régimen ambulatorio. Es posible mejorar el índice de sustitución ambulatorio aumentando la tasa de aplicabilidad y aceptabilidad.

Objetive: Ambulatory or overnight stay surgery have been consolidated in many different procedures. However, its use in thyroid and parathyroid surgery is still controversial. The aim of this report is to present the results of 6 years of ambulatory patients undergoing surgery of the thyroid or parathyroid glands. Material and Methods: Prospective observational study of patients who underwent hemithyroidectomy or selective parathyroidectomy in the ambulatory program from January 2011 to December 2016. All patients included met the general criteria of ambulatory surgery. During the first years nodules bigger than 3 cm and patients classified as ASA III were excluded. Patients arrive at hospital the morning of surgery. After the operation, patients pass to the post-anesthesia care unit and then to the hospitalization room. 8 hours after surgery patients are discharged home if they meet the criteria. Results: 270 patients were operated, 159 of them met the inclusion criteria. The overall applicability rate was 59%. The acceptance rate was 83.6% and the substitution index was 49.2%. The unwanted hospital admission was 10.4% for the parathyroidectomy and 17.6% for the hemithyroidectomy. Any patient presented major complications at home. The satisfaction rate was high or very high for 94% of the patients. Conclusion: Selective parathyroidectomy and hemithyroidectomy performed by experienced surgeons in selected patients can be safely and effectively carried out in ambulatory surgery (outpatient). It would be possible to improve the substitution index by increasing the application and acceptability ratios.

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 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.

Tiroidectomía total en el bocio multinodular benigno / [Total thyroidectomy treatment of bening multinodular goiter].

INTRODUCTION: The treatment of benign multinodular goiter (BMNB) is a matter of ongoing debate in recent decades despite evidence that total thyroidectomy (TT) is associated with a significant reduction in disease recurrence and minimal morbidity in trained hands. OBJECTIVE: Determine BMNB recurrence after 10 years in 100 patients treated with TT and evaluate the technique-related complications. DESIGN: Prospective non randomized. MATERIAL AND METHODS: From March 1999 to March 2001, one hundred patients, 95 female, with an average age of 42.4 years (range 23-67) underwent TT for having a BMNB, which was confirmed by cervical ultrasound, which also served as a guide to perform fine-needle aspiration (FNA). In all cases, laryngoscopy was performed before and after post-surgical bitstream. RESULTS: Mean operative time was 49 minutes (range 35-58). Recurrencial recorded paralysis (1

) and five hypoparathyroidism (5

), both transient and no definitive case. All patients were discharged within 24 hours of surgery. We did not record any recurrence BMNB a follow-up period of more than 10 years. CONCLUSION: The TT is the treatment choice of BMNB, being an effective, safe, with low rates of complications and to avoid or significantly reduce the recurrence of this disease.

Evaluation of incidental thyroid cancer in patients with thyroidectomy / Evaluación incidental del cáncer de tiroides en pacientes con tiroidectomía

OBJECTIVE: The present study aimed to emphasize the necessity and significance of thyroidectomy by determining the prevalence of incidental thyroid cancer in the cases that underwent surgical intervention for the treatment of benign thyroid disease. SUBJECTS AND METHOD: Thyroidectomy was performed in 443 cases including those with benign multinodular goitre (BMNG) or toxic adenoma or toxic multinodular goitre. Diagnosis was made based on routine physical examination, laboratory analyses, imaging methods and postoperative histopathological findings of the cases. RESULTS: The mean age of the cases was 45.5 (19-68) years and 72.5% (n = 321) were female. The most common clinical diagnosis prior to the surgery was BMNG (n = 428, 96.6%). While BMNG was determined to be the most common histopathological diagnosis after thyroidectomy at a rate of 81.7% (n = 362), the rate of thyroid cancer was found to be 14% (n = 81). The prevalence ofpapillary cancer was 84% (n = 56), whereas it was 4% (n = 4), 1% (n = 1) and 0.0% (n = 0) for medullary, follicular and anaplastic cancers, respectively. Papillary cancer was also the most common type of thyroid cancer between genders. As compared to gender, there was no statistically significant difference in terms of distribution of age among general, benign and malignant types of thyroid cancer (p > 0.05). CONCLUSION: It is appropriate to prefer thyroidectomy for the treatment of benign thyroid diseases due to the high prevalence ofincidental thyroid cancer after thyroidectomy in such cases.

OBJETIVO: El presente estudio tiene por objeto destacar la necesidad e importancia de la tiroidectomía mediante la determinación de la prevalencia del cáncer de tiroides incidental en los casos sometidos a intervención quirúrgica para el tratamiento de enfermedades tiroideas benignas. SUJETOS Y MÉTODO: Se practicó la tiroidectomía en 443 casos incluyendo aquellos con bocio multinodular benigno (BMNG) o adenoma tóxico o bocio multinodular tóxico. El diagnóstico se realizó a partir de un examen físico de rutina, análisis de laboratorio, métodos de imaginología, y resultados histopatológicos postoperatorios de los casos. RESULTADOS: La edad promedio de los casos fue 45.5 años (19-68) y 73% (n = 321) eran mujeres. El diagnóstico clínico más común antes de la cirugía fue BMNG (n = 428, 96,6%). Si bien se determinó que BMNG era el diagnóstico histopatológico más frecuente después de la tiroidectomía con una tasa de 81.7% (n = 362), se halló que la tasa de cáncer de tiroides era 14% (n = 81). La prevalencia de cáncer papilar fue de 84% (n = 56), mientras que para el cáncer medular, folicular y anaplásico, fue de 4% (n = 4), 1% (n = 1) y 0.0% (n = 0) respectivamente. El cáncer papilar también fue el tipo más común de cáncer de tiroides entre los géneros. En comparación con el género, no hubo ninguna diferencia estadísticamente significativa en cuanto a la distribución por edad entre los tipos generales, benignos y malignos de cáncer de tiroides (p > 0.05). CONCLUSIÓN: Es apropiado preferir la tiroidectomía para el tratamiento de las enfermedades tiroideas benignas debido a la alta prevalencia de cáncer tiroideo incidental después de la tiroidectomía en tales casos.

Total thyroidectomy in benign multinodular goitre

Total thyroidectomy is the standard surgical procedure for thyroid malignancy. Many surgeons do not perform total thyroidectomy in cases of Benign Multinodular Goitre [BMNG] owing to the fear of recurrent laryngeal nerve [RLN] damage and postoperative risk of hypoparathyroidism. Long term thyroxin therapy with its side effects is an additional factor. We conducted this study to assess total thyroidectomy as a safe option for managing BMNG. Surgical Unit-I and Surgical Unit-Ill, Allied Hospital, a tertiary care hospital affiliated with Punjab Medical College, Faisalabad. Duration of study was two years from January 2008 to January 2010. A total number of 196 consecutive patients undergoing total thyroidectomy [TT] for BMNG were included in this study. Patients with thyroid malignancy or suspicion of malignancy were excluded. Preoperative assessment included baseline biochemical workup and thyroid function tests. Preoperative serum calcium and indirect laryngoscopy [IDL] was performed in all the patients. Postoperative assessment included serum calcium estimation after 24 hrs and 07 days of TT. IDL was considered in any patient with suspected RLN palsy. Drain output was recorded at 24 hrs after TT. Total number of 196 patients were included with 49 male and 147 female [male to female ratio of 1:3]. Age ranged from 14-60 yrs [mean:37 yrs]. One thirty six patients undergoing TT had non-toxic MNG while 60 patients had toxic MNG controlled on antithyroid drugs. Drain output ranged from 10-100 ml in 24 hrs. No patient developed permanent RLN palsy. Seven patients [3.5%] had temporary unilateral RLN palsy. Fifty six patients [28.5%] developed temporary hypocalcemia. None of the patients developed permanent hypocalcemia. Two patients developed seroma formation which was aspirated with wide bored needle. Two patients got superficial wound infection which recovered with oral antibiotics. Postoperative hemorrhage requiring re-exploration did not occur in any patient. Postoperative stay ranged from 2-4 days. Most of the patients were discharged 48 hrs after surgery. There was no postoperative mortality. Total Thyroidectomy is a safe method for treating Benign Multinodular Goitre in experienced hands with low postoperative complications and morbidity

Total versus sub-total thyroidectomy for multinodular goiter

The aim of the study was to compare total and subtotal thyroidectomy [STT] for benign bilateral multinodular goiter [BBMNG] in terms of the proportion of hypoparathy-roidism and recurrent laryngeal nerve paralysis [RLNP]. Quasi experimental Place and duration of study: Department of Surgery, Khyber Teaching Hospital Peshawar, from 1st October 2007 to 30th September 2008. A total of 60 patients with bilateral multinodular goiter, were divided in to two groups A and B [30 patients in each group]. Group A patients were subjected to IT while group patients to STT. Sample technique used was non-probability purposive. Demographic details, biochemical findings, indications for operation, operating time and complications under study were noted for either group. There was no significant difference in the age, gender, hormonal status or duration of goiter between the two groups [P=0.123, P=0.74, P=0.509 and P=0.6, respectively]. The mean operating time was longer [138 +/- 30 min versus 112 +/- 33 min, P=0.046] for TT vs STT. Either temporary RLNP or HPT occurred in 3 [9.9%] or 6 [20%] of the patients undergoing total compared with 2 [6.6%] or 3 [9.9%] of the patients undergoing SIT [P=0.64 and P=0.278, respectively]. Permanent RLNP was observed in none and HPT in one patient only in TT group compared with none of either complication in STT group [P=0.313 for permanent HPT]. The present study shows that TT can be performed without increasing risk of complications, and it is an acceptable alternative for benign MNG, especially in endemic regions, where patients present with a huge multinodular goiter

Total thyroidectomy in treatment of non-malignant goiter: is it worthwhile?

Total thyroidectomy is increasingly being accepted as a treatment of choice for differentiated thyroid cancer. However, because of presumed increased morbidity associated with this procedure, it is still not considered a viable option for management of benign thyroid disorders. To assess the safety and efficacy of total thyroidectomy for management of benign thyroid disorders, we analyzed our data from 100 total thyroidectomies performed for benign thyroid disorders. Demographic details, biochemical findings, indications for operation, specimen weight, and complications were noted. Among these patients, 35 had a toxic goiter and 65 had a non toxic goiter. The mean duration of goiters was 3.8 +/- 3.06 years [3 - 8 years], and the mean weight of the specimens was 85 gm +/- 180 gm. The incidence of permanent hypothyroidism and permanent recurrent laryngeal nerve plasy were 1% in both. According to this study, we can conclude that: total thyroidectomy should be considered as the treatment of choice for multinodular goiter and Graves' disease in a setting of palpable nodule[s] or ophthalmopathy [or both] because reoperation for recurrent goiter in such a setting would be hazardous with distressing complications

Post thyroidectomy hypocalcemia - does arterial ligation play a significant role?

The aim of this study was to determine if bilateral inferior thyroid artery [ITA] ligation is a causal factor for the occurrence of postoperative hypocalcaemia after subtotal thyroidectomy. Quasi experimental trial. One year study from Jan 2005 to Dec 2005 conducted at surgical department of Rawalpindi General Hospital [UNIT-I]. One hundred patients were included in the study who underwent subtotal thyroidectomy with and without truncal ligation of inferior thyroid artery and were prospectively analyzed comparing postoperative and late serum calcium levels A significant incidence of postoperative hypocalcaemia occurred: more in Group A [48%] as compared to Group B [22%]. This difference was statistically significant shown by the P value < 0.5 on the 1st postoperative day in patients with ligation of inferior thyroid artery. The ligation of the ITA tends to produce hypocalcaemia in patients undergoing subtotal Thyroidectomy

Rationale for near total thyroidectomy in patients with multinodular goitre

To prove that Near total Thyroidectomy [NTT] with minimal residual tissue is the procedure of choice in patients with Multi-Nodular Goitre [MNG]. Retrospective study from February 2002 to December 2006. Surgical Ward-II, Jinnah Postgraduate Medical Centre [JPMC], Karachi. A total of 521 consecutive patients, operated for simple or toxic MNG were included in this study. Apart from detailed clinical work-up, investigations including thyroid function tests and thyroid scans were carried out in all cases. All patients underwent near total thyroidectomy with preservation of recurrent laryngeal nerves and parathyroid glands. Out of 521 cases, 73 [14%] had carcinoma on histopathological examination of the removed glands; 47 [64%] underwent completion thyroidectomy which was uneventful, while 22 had radioiodine ablation with decreased dosage for provision of minimal residual tissue and four declined further treatment. Near total thyroidectomy is a versatile surgical procedure for patients with MNG, keeping in view the risk of associated occult malignancy. Furthermore, the risk of damage to recurrent laryngeal nerve [RLN] and parathyroids is low in patients undergoing completion thyroidectomy. Hence, a more radical procedure should be adopted for surgical treatment in MNG

Fresh thyroid auto-transplantation after thyroidectomy for multi-nodular goiter: An alternative to life long thyroxine replacement

Surgery for simple multi-nodular goiter affecting both thyroid lobes usually necessitate near total thyroidectomy to avoid recurrence, but this leads to inevitable postoperative hypothyrosdism requiring thyroxine replacement therapy which not only life long but also not without morbidity. The aim of this study is to evaluate the ability of fresh thyroid auto-transplant after thyroidectomy for muiti-nodular goiter to survive, grow and restore normal thyroid function as an alternative to life long thyroxine replacement. This study includes 25 patients complaining of bilateral simple multi-nodular goiter whom undergo near total thyroidectomy [NTT] with intra-sternomastoid muscle auto-transplantation of about 1 cm of fresh thyroid tissue which was proved normal clinically and by intra-operative frozen section with further post-operative paraffin section examination of all specimens. All patients were followed post-operatively by thyroid function tests and [99]mTc-pertchnetate thyroid scanning. The transplanted fresh thyroid tissue was surviving and growing in all patients but with variable functions. Euthyroid state was obtained in 23 patients within the first 6 months with 2 patients remain in hypothyroid state requiring thyroxine replacement therapy in variable doses. With further follow-up for another 6 months, one patient from euthyroid group developed hypothyroidism necessitated starting thyroxine replacement therapy. The auto-transplanted fresh thyroid tissue is able to survive and grow with the ability to restore normal thyroid function with variable degree making this technique a magic alternative to life long thyroxine therapy in most cases

Função tireóidea após lobectomia total por bócio não tóxico / Thyroid function after total lobectomy for non-toxic goiter

INTRODUÇÃO: A sofisticação dos métodos de diagnóstico por imagem, em especial o ultra-som, contribuiu para que nódulos cada vez menores fossem diagnosticados com maior frequência. Nódulos tireóideos são encontrados ao exame ultra-sonográfico, em até 17% das mulheres adultas. A lobectomia total é considerada procedimento adequado para o tratamento dos nódulos benignos laterais da tireóide. O hipotireoidismo pode ocorrer em 5% a 35% dos doentes, após esse procedimento e está relacionado tanto com a quantidade de tecido glandular remanescente, quanto com a sua qualidade funcional. Neste estudo avaliou-se a ocorrência do hipotireoidismo após lobectomia total, visando identificar os indivíduos com maior risco de desenvolver essa doença. MÉTODOS: No período de março de 1996 a julho de 2005, foram selecionados 228 indivíduos eutireóideos submetidos à lobectomia total da tireóide por bócio não tóxico, do Departamento de Cirurgia de Cabeça e Pescoço do Instituto Brasileiro de Controle do Câncer e da clínica privada do autor. Realizou-se estudo retrospectivo com 186 indivíduos passíveis de análise, considerando os níveis séricos de tireotrofina (TSH) pré e pós-operatórios e a dosagem de anticorpos antitireóideos. O volume do coto tireóideo remanescente foi determinado por exame ultrasonográfico. Os exames anatomopatológicos foram revistos e quantificaram, por meio da análise semiquantitativa, os agregados linfocitários e os folículos linfóides: graduados de 0 a IV e de 0 a III, respectivamente. O hipotireoidismo foi diagnosticado quando TSH = 5,5 mU/L em até oito semanas após a operação. RESULTADOS: Houve predomínio do sexo feminino neste estudo (88%), com a idade variando de 16 a 72 anos e com média de 45 anos...

INTRODUCTION: Thyroid nodules, recently, have their diagnosis increased because of the improvement of imaging methods, especially ultrasound. Around 17% of these nodules may be identified in adult women by ultrasound. Total lobectomy is considered an appropriate procedure for benign thyroid nodules. Hypothyroidism may occur in 5% to 35% patients after total lobectomy and it is related to the volume of the remnant thyroid tissue and its functional quality. This study was designed to evaluate the incidence of postoperative hypothyroidism and to determine patients with high risk for this disease. METHODS: From March 1996 to July 2005, 228 euthyroid patients, from the Department of Head and Neck Surgery of the Brazilian Institute for Cancer Control (IBCC) and from the author?s private office, had a total lobectomy due to non-toxic goiter. Out of these patients, 186 were selected for this retrospectively study. Thyrotrophin (TSH) levels, antithyroid antibodies, volume of the remnant thyroid by ultrasound and a semiquantitatively review of the histological specimens considering lymphocytic infiltration were studied. Hypothyroidism was defined for TSH = 5,5 mU/L up to eight weeks postoperative. RESULTS: Women were predominant (88%) with ages varying from 16 to 72 years old and the median age of 45 years old. The average time of follow-up was 29 months, ranging from six months to nine years. TSH ³ 5,5 mU/L occurred in 61 patients (32,8%). Adenomatous goiter was the principal diagnosis in 82% of the hypothyroids patients and 80,7% of the euthyroids...

Surgery versus pharmacotherapy of benign thyroid diseases

Surgical management of benign thyroid diseases [BTDs] has been a topic of interest and confusion for many years. Almost 80% of thyroidectomies at an average endocrine surgical unit are carried out for BTDs. Resistance to surgical intervention in BTDs has been based on the belief that increased complication rate is inherent in its use, this is despite the potential advantages in terms of confirming the benign nature of the lesion, controlling the disease, and relieving local symptoms of large neck mass. Benign thyroid diseases are more likely to occur in middle-aged women living in iodine deficient areas, or have a family history of goiter, or in patients taking iodine-containing drugs, like amoidarone, or in patients with previous history of x-ray exposure. However, the physician must be careful in making the diagnosis of BTDs in patients at the extremes of age or in the presence of positive history of radiation, or in patients with family history of thyroid or colon cancer. In this article we will review the etiology, epidemiology, diagnostic methodologies and the recent trends in the surgical and medical management of BTDs

Surgical management of thyroid diseases--a study on 78 cases.

A total of 78 cases with thyroid diseases were treated surgically in the Department of ENTD, Mymensingh Medical College Hospital during the period from 2000-2001. The different types of surgery were done according to the diagnosis being presented here. Out of 78 cases, 60 (76.9%) were female and 18 (23.1%) were male having female to male ratio of 3.3:1. The highest number, 47 cases (60.3%) belongs to 21-40 year age group. The study revealed the incidence of thyroid diseases as follows: 53 (67.9%) Benign cold single nodular goitre. 17(21.8%) Benign cold multinodular goitre and 08 (10.3%) Papillary carcinoma of thyroid. Regarding surgical management 40 (51.3%) patients underwent hemithyroidectomy. Lobectomy were done for 13 (16.7%), subtotal thyroidectomy for 15 (19.2%), total thyroidectomy for 5 (6.4%) patients and total thyroidectomy with functional neck dissection were performed for 5 (6.4%) patients. The study showed that females were the mostly affected group having benign single cold nodular goitre who were treated surgically by hemithyroidectomy.

Aspectos clínicos del cáncer de tiroides en la IX Región / Clinical aspects of the thyroid cancer in IX Región

Estudio retrospectivo descriptivo de 96 pacientes operados en el servicio de cirugía del Hospital Regional de Temuco, con diagnóstico de cáncer de tiroides en un período de 13 años, desde enero de 1985 a diciembre de 1997. La forma de presentación más frecuente fue la de bocio uninodular en 43,6 por ciento, la punción citológica tuvo un alto porcentaje de falsos negativos (44 por ciento). En 48 pacientes (50 por ciento) se constató en el intraoperatorio compromiso extratiroideo. El procedimiento quirúrgico de elección fue la tiroidectomía total en 56 casos; el tipo histológico más frecuente fue el cáncer papilar en el 76,6 por ciento de los casos. Tratamiento complementario con yodo 131 se realizó en 54 pacientes, existió seguimiento en el 79 por ciento de los pacientes. La mortalidad total es de 9 pacientes