RESUMEN
BACKGROUND: Transient hypocalcemia due to parathyroid gland or vessel manipulation is a common complication following thyroidectomy. Considering the role of 25-hydroxyvitamin D (25(OH)D) in calcium hemostasis, this study aimed to evaluate the effect of preoperative vitamin D supplementation on hypocalcemia incidence in thyroidectomy patients. METHODS: In this randomized clinical trial, 100 patients scheduled for total thyroidectomy and suffering from preoperative moderate or severe vitamin D deficiency were enrolled. Patients were randomly allocated to either study or control groups using the sealed envelope method. Patients in the study group received vitamin D3 50,000-unit pearl weekly for 4 weeks prior to the operation. The control group received placebo. Total and ionized serum calcium levels were checked before surgery, the day after surgery, and 2 weeks postoperatively. RESULTS: No significant difference was observed in terms of demographic data. During serial total calcium checks (5 episodes), total calcium levels changed significantly in patients who had received vitamin D supplements compared to the control group (P = 0.043). Symptomatic hypocalcemia incidence was significantly lower in patients supplemented with 25-hydroxyvitamin D (25(OH)D) (P = 0.04). Also, the requirement for intravenous calcium administration in order to treat the hypocalcemia symptoms was significantly lower in the study in comparison to the control group (P = 0.03). CONCLUSIONS: Vitamin D supplementation in patients with vitamin D deficiency might lead to a lower incidence of early-onset symptomatic hypocalcemia; hence, requiring less calcium supplementation for the management of hypocalcemia.
Asunto(s)
Colecalciferol/uso terapéutico , Hipocalcemia/epidemiología , Complicaciones Posoperatorias/epidemiología , Cuidados Preoperatorios/métodos , Enfermedades de la Tiroides/cirugía , Tiroidectomía , Deficiencia de Vitamina D/tratamiento farmacológico , Vitaminas/uso terapéutico , Adenocarcinoma Folicular/cirugía , Adulto , Calcio/sangre , Femenino , Bocio Nodular/cirugía , Humanos , Hipocalcemia/sangre , Hipocalcemia/fisiopatología , Masculino , Complicaciones Posoperatorias/fisiopatología , Cáncer Papilar Tiroideo/cirugía , Neoplasias de la Tiroides/cirugía , Vitamina D/análogos & derivados , Vitamina D/sangre , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/diagnósticoRESUMEN
Surgery - is it any good for goiter? In patients with goiter the benefits of thyroid surgery have previously rarely been investigated, as only few alternatives existed. However, the increasing evidence of the advantages with non-surgical substitutes with lower costs and preferable risk profiles prompted us to investi-gate the evidence base for thyroid surgery thoroughly. This thesis consists of three published studies investigating the impact of thyroidectomy on: 1) changes in disease-specific quality of life, 2) swallowing symptoms and esophageal motility, and 3) tracheal anatomy and airflow, in a cohort of patients with benign nodular goiter.
Asunto(s)
Trastornos de Deglución/etiología , Trastornos de la Motilidad Esofágica/etiología , Bocio Nodular/cirugía , Complicaciones Posoperatorias/etiología , Calidad de Vida , Tiroidectomía/efectos adversos , Enfermedades de la Tráquea/etiología , Trastornos de Deglución/diagnóstico por imagen , Dinamarca , Trastornos de la Motilidad Esofágica/diagnóstico por imagen , Femenino , Bocio Nodular/clasificación , Bocio Nodular/complicaciones , Humanos , Yodo/sangre , Imagen por Resonancia Magnética , Masculino , Complicaciones Posoperatorias/diagnóstico por imagen , Ensayos Clínicos Controlados Aleatorios como Asunto , Recurrencia , Encuestas y Cuestionarios , Glándula Tiroides/diagnóstico por imagen , Glándula Tiroides/cirugía , Tiroidectomía/métodos , Tomografía Computarizada por Rayos X , Tráquea/anatomía & histología , Enfermedades de la Tráquea/diagnóstico por imagen , Resultado del TratamientoRESUMEN
INTRODUCTION: Thyroidectomy is a common surgery performed especially in treatment of multinodular goitre. The most common post-thyroidectomy complication is a postoperative hypocalcaemia, and the percentage of postoperative hypoparathyroidism could reach even 50%. Tested group and methods: A forward-looking, randomized testing was done on a group of 113 women being subject to multinodular goitre surgery. In this article, we wish to present an analysis of the results obtained in the control group, focusing on the predicative factors which determine the development of postoperative hypocalcaemia. Obtained results: The rate of postoperative biochemical hypocalcaemia development was significantly higher in the group of patients, where the preoperative calcium concentration was lower than 2,4 mmol/l. In that group, the development of biochemical hypocalcaemia was observed in 93,7% of cases (30 out of 32 patients), in comparison with 65,3% (17 out of 26) in the group of higher preoperative concentration of calcium. The highest risk of occurrence of postoperative hypocalcaemia was borne by the total thyroidectomy, while the lowest one by the subtotal thyroid lobectomy of one lobe only. CONCLUSIONS: A higher preoperative concentration of calcium in blood serum is related to the lower rate of occurrence of postoperative biochemical hypocalcaemia. However, no such correlation was revealed in the case of postoperative symptomatic hypocalcaemia. Lack of correlation was determined between the preoperative concentration of TSH and FT4 in blood serum and the rate of occurrence of postoperative hypocalcaemia, both symptomatic and asymptomatic. The performed statistics did not reveal a relation between the postoperative hypocalcaemia and the duration of the surgery, but a significant correlation was stated with the scope of the performed surgery. Revealing a relation between the rate of occurrence of postoperative hypocalcaemia and the experience of the surgeon performing the surgery was not successful.
Asunto(s)
Calcitriol/administración & dosificación , Bocio Nodular/cirugía , Hipocalcemia/prevención & control , Complicaciones Posoperatorias/prevención & control , Vitaminas/administración & dosificación , Adulto , Biomarcadores/sangre , Suplementos Dietéticos , Femenino , Humanos , Hipocalcemia/etiología , Tiroidectomía/efectos adversos , Resultado del TratamientoRESUMEN
In a patient with a differentiated thyroid cancer the standard treatment protocol to be followed is surgery, ablation of thyroid remnants with 131Iodine (131I), and TSH suppression. However, the treatment with 131I is not effective in some cases, and it no longer becomes a therapeutic option due to cell de-differentiation with loss of 131I uptake. Systemic treatment can be used as other options, although patients are not always responsive; thus, the disease may progress and therapeutic options may run out. Endocrine tumours may express somatostatin receptors,and this characteristic has been used, not only for diagnosis, but also for their treatment through somatostatin analogue labelling with radioactive isotopes. This was the case of a patient suffering from iodine-refractory follicular thyroid carcinoma, with somatostatin receptors expression, treated with 177Lu-DOTATATE, showing an excellent clinical and analytical response.
Asunto(s)
Adenocarcinoma Folicular/radioterapia , Neoplasias Óseas/radioterapia , Neoplasias Óseas/secundario , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/secundario , Lutecio/uso terapéutico , Octreótido/análogos & derivados , Compuestos Organometálicos/uso terapéutico , Radioisótopos/uso terapéutico , Radiofármacos/uso terapéutico , Neoplasias de la Tiroides/radioterapia , Adenocarcinoma Folicular/sangre , Adenocarcinoma Folicular/tratamiento farmacológico , Adenocarcinoma Folicular/cirugía , Anciano , Antibióticos Antineoplásicos/uso terapéutico , Biomarcadores de Tumor/sangre , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/tratamiento farmacológico , Terapia Combinada , Doxorrubicina/uso terapéutico , Everolimus/uso terapéutico , Femenino , Bocio Nodular/complicaciones , Bocio Nodular/cirugía , Humanos , Indazoles , Radioisótopos de Yodo/uso terapéutico , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/tratamiento farmacológico , Niacinamida/análogos & derivados , Niacinamida/uso terapéutico , Octreótido/uso terapéutico , Cuidados Paliativos , Compuestos de Fenilurea/uso terapéutico , Tomografía Computarizada por Tomografía de Emisión de Positrones , Pirimidinas/uso terapéutico , Sorafenib , Sulfonamidas/uso terapéutico , Tiroglobulina/sangre , Neoplasias de la Tiroides/sangre , Neoplasias de la Tiroides/cirugía , TiroidectomíaRESUMEN
CONTEXT: There are no studies evaluating teriparatide for prevention of post-thyroidectomy hypocalcemia. OBJECTIVE: Our objective was to evaluate whether teriparatide can prevent postsurgical hypocalcemia and shorten the hospitalization in subjects at high risk of hypocalcemia following thyroid surgery. DESIGN: This was a prospective phase II randomized open-label trial. SETTING: This trial was set on a surgical ward. PATIENTS: Twenty-six subjects (six males, 20 females) with intact PTH lower than10 pg/ml 4 hours after thyroidectomy were included. INTERVENTION: Subjects were randomized (1:1) to receive SC administration of 20 mcg of teriparatide every 12 hours until the discharge (treatment group) or to follow standard clinical care (control group). MAIN OUTCOME MEASURE: Adjusted serum calcium, duration of hospitalization, and calcium/calcitriol supplementation were measured. RESULTS: Overall, the incidence of hypocalcemia was 3/13 in treatment group and 11/13 in the control group (P = .006). Treated patients had a lower risk of hypocalcemia than controls (relative risk, 0.26 [95% confidence interval, 0.09-0.723)]). The median duration of hospitalization was 3 days (interquartile range, 1) in control subjects and 2 days (interquartile range, 0) in treated subjects (P = .012). One month after discharge, 10/13 subjects in the treatment group had stopped calcium carbonate supplements, while only 5/13 in the control group had discontinued calcium. The ANOVA for repeated measures showed a significant difference in calcium supplements between groups at 1-month visit (P = .04) as well as a significant difference between discharge and 1-month visit in the treatment group (P for interaction time group = .04) Conclusions: Teriparatide may prevent postsurgical hypocalcemia, shorten the duration of hospitalization, and reduce the need for calcium and vitamin D supplementation after discharge in high risk subjects after thyroid surgery.
Asunto(s)
Terapia de Reemplazo de Hormonas , Hipocalcemia/prevención & control , Complicaciones Posoperatorias/prevención & control , Teriparatido/uso terapéutico , Tiroidectomía/efectos adversos , Calcitriol/uso terapéutico , Calcio de la Dieta/uso terapéutico , Suplementos Dietéticos , Esquema de Medicación , Femenino , Bocio Nodular/cirugía , Enfermedad de Graves/cirugía , Terapia de Reemplazo de Hormonas/efectos adversos , Hospitales Universitarios , Humanos , Hipocalcemia/sangre , Hipocalcemia/epidemiología , Hipocalcemia/etiología , Incidencia , Inyecciones Subcutáneas , Italia/epidemiología , Tiempo de Internación , Masculino , Persona de Mediana Edad , Hormona Paratiroidea/sangre , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Riesgo , Teriparatido/administración & dosificación , Teriparatido/efectos adversos , Neoplasias de la Tiroides/cirugíaRESUMEN
BACKGROUND: Radiofrequency ablation (RFA) is a relatively novel procedure in the management of benign nodular goiter. This study was conducted to evaluate the safety and efficacy of ultrasound (US)-guided percutaneous RFA for benign symptomatic thyroid nodules as an alternative to surgery. METHODS: The study involved patients for whom a fine needle aspiration biopsy had proved a diagnosis of benign nodular goiter and had nodule-related symptoms such as dysphagia, cosmetic problems, sensation of foreign body in the neck, hyperthyroidism due to autonomous nodules or fear of malignancy. Percutaneous RFA was performed as an outpatient procedure under local anesthesia. The primary outcome was an evaluation of the changes in symptom scores (0-10) for pain, dysphagia and foreign body sensation at the 1st, 3rd, and 6th months after the RFA procedure. Secondary outcomes were assessing volume changes in nodules, complication rates, and changes in thyroid function status. RESULTS: A total of 33 patients (24% female, 76% male) and a total of 65 nodules were included into the study. More than one nodule was treated in 63.6% of the patients. We found a statistically significant improvement from baseline to values at the 1st, 3rd, and 6th months, respectively, as follows: pain scores (2.9 ± 2.7, 2.3 ± 2.01, 1.8 ± 1.7, and 1.5 ± 1.2, p 0.005), dysphagia scores (3.9 ± 2.7, 2.6 ± 1.9; 1.7 ± 1.6, and 1.1 ± 0.3, p 0.032), and foreign body sensation scores 3.6 ± 3, 2.5 ± 2.2; 1.6 ± 1.5, and 1.1 ± 0.4, p 0.002).The mean pre-treatment nodule volume was 7.3 ± 8.3 mL. There was a statistically significant size reduction in the nodules at the 1st, 3rd, and 6th months after RFA (3.5 ± 3.8, 2.7 ± 3.4, and 1.2 ± 1.7 mL, p 0.002). The volume reduction was found to be 74% at 6th months following the RFA (p 0.005). 8 patients had autonomously functioning nodules in the pre-treatment period, 50% (n: 4) became euthyroid at the 6th month after RFA. There were no complaints other than pain (12%). CONCLUSION: RFA can be an alternative treatment modality in the management of benign symptomatic thyroid nodules. The results showed that it is a safe and effective procedure.
Asunto(s)
Ablación por Catéter , Bocio Nodular/cirugía , Anestesia Local , Ablación por Catéter/efectos adversos , Trastornos de Deglución/etiología , Femenino , Estudios de Seguimiento , Bocio Nodular/complicaciones , Bocio Nodular/patología , Humanos , Hipertiroidismo/etiología , Masculino , Dolor/etiología , Estudios Prospectivos , Sensación , Resultado del Tratamiento , Ultrasonografía IntervencionalAsunto(s)
Displasia Ventricular Derecha Arritmogénica/diagnóstico , Displasia Ventricular Derecha Arritmogénica/fisiopatología , Hipocalcemia/fisiopatología , Hipoparatiroidismo/diagnóstico , Hipoparatiroidismo/fisiopatología , Artes Marciales/fisiología , Síncope/diagnóstico , Síncope/fisiopatología , Adulto , Biopsia , Diagnóstico Diferencial , Electrocardiografía , Endocardio/patología , Femenino , Bocio Nodular/cirugía , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/fisiopatología , Ventrículos Cardíacos/patología , Ventrículos Cardíacos/fisiopatología , Humanos , Hipocalcemia/diagnóstico , Imagen por Resonancia Magnética , Miocardio/patología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/fisiopatología , Pronóstico , Procesamiento de Señales Asistido por Computador , TiroidectomíaRESUMEN
CONTEXT: Calcitonin (CT) measurement is crucial to the early diagnosis and the follow-up of medullary thyroid cancer (MTC). If the evaluation of stimulated CT levels is required, a provocative test can be performed, being the high-dose Ca test recently reintroduced in clinical practice. OBJECTIVE: Our objective was to identify gender-specific thresholds for MTC diagnosis in a large series of patients who underwent the Ca test. PATIENTS AND METHODS: A total of 91 patients (49 females and 42 males) underwent the Ca test (calcium gluconate, 25 mg/kg) before thyroidectomy and both basal CT (bCT) and stimulated CT (sCT) were compared with histological results by receiver operating characteristic plot analyses. To evaluate possible side effects of Ca administration, cardiac function has been extensively studied. RESULTS: bCT levels were found to harbor the same accuracy as sCT in the preoperative diagnosis of MTC. The best Ca thresholds for the identification of MTC were >26 and >68 for bCT and >79 and >544 pg/mL for sCT in females and males, respectively. The high tolerability and safety of the Ca test was demonstrated and advice offered to be followed before and during the test. CONCLUSIONS: Gender-specific bCT and sCT cutoffs for the identification of C-cell hyperplasia and/or MTC have been defined. The bCT and sCT were found to have a similar accuracy, indicating that serum CT assays with improved functional sensitivity may likely decrease the relevance of the stimulation test in several conditions. Finally, systematic cardiac monitoring confirms the safety of the Ca test.
Asunto(s)
Calcitonina/sangre , Gluconato de Calcio , Carcinoma Medular/diagnóstico , Bocio Nodular/diagnóstico , Neoplasias de la Tiroides/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/sangre , Carcinoma Medular/sangre , Carcinoma Medular/cirugía , Niño , Diagnóstico Diferencial , Femenino , Bocio Nodular/sangre , Bocio Nodular/cirugía , Humanos , Masculino , Persona de Mediana Edad , Glándula Tiroides/patología , Glándula Tiroides/cirugía , Neoplasias de la Tiroides/sangre , Neoplasias de la Tiroides/cirugía , TiroidectomíaRESUMEN
BACKGROUND: The most common complication which occurs after thyroidectomy is postoperative hypocalcemia due to parathyroid gland damage. It usually appears 24-48 hours postoperatively, but there are clinical and biochemical factors which may contribute to its earlier diagnosis. OBJECTIVES: The aim of this study was to assess clinical and biochemical factors which can influence postoperative hypocalcemia after near-total thyroidectomy. MATERIAL AND METHODS: The material consisted of 103 patients with benign nodular goiter. In all patients the blood samples were taken 4 times and levels of total calcium, magnesium, inorganic phosphorus, parathormone and thyroid-stimulating hormone were measured. One day before surgery and during the first three days postoperatively patients were asked about symptoms of hypocalcemia and the presence or absence of a Trousseau sign was observed. RESULTS: There was no statistically significant connection between the symptoms of hypocalcemia and the age of patients and preoperative hyperthyroidism. Patients with symptomatic hypocalcemia had longer operating time, resected tissue weighed more and hospitalization time was longer than in patients without symptoms of hypocalcemia. Concomitant occurrence of hypocalcemia and hypomagnesemia postoperatively was found in 16% of patients. Changes in parathyroid hormone concentration measured 10 min after thyroid excision were more sensitive and specific for detecting patients with symptomatic hypocalcemia after surgery than total calcium concentration. CONCLUSIONS: Measurement of intraoperative parathormone level 10 min after thyroidectomy is a highly sensitive and specific factor for detecting postoperative hypocalcemia. If we connect this parameter with some other clinical features, it will be possible to predict postoperative hypocalcemia more accurately and introduce supplementation as early as possible.
Asunto(s)
Hipocalcemia/etiología , Complicaciones Posoperatorias/etiología , Tiroidectomía/efectos adversos , Adulto , Anciano , Femenino , Bocio Nodular/sangre , Bocio Nodular/cirugía , Humanos , Masculino , Persona de Mediana Edad , Hormona Paratiroidea/sangre , Curva ROCRESUMEN
OBJECTIVE: To investigate the use of hearing preservation cochlear implantation in children with partial deafness. PATIENTS AND METHODS: Five children with either drug-induced or congenital partial deafness were enrolled in a pilot study. The patients ranged in age from 13 months to 14 years. Implantation was performed using a hearing preservation technique. A Flex EAS electrode (MED-EL, Innsbruck, Austria) was used in all full insertions. RESULTS: Low frequency hearing was preserved in all patients with postoperative bone conduction within 10 dB of the preoperative hearing levels. These changes were preserved over the follow-up period of 12 months. There were significant improvements in speech perception. CONCLUSION: Hearing preservation cochlear implantation is a new effective modality in children with partial deafness.
Asunto(s)
Implantación Coclear/métodos , Implantes Cocleares , Sordera/inducido químicamente , Sordera/cirugía , Estimulación Acústica/métodos , Adenocarcinoma de Células Claras/tratamiento farmacológico , Adolescente , Antineoplásicos/efectos adversos , Neoplasias Cerebelosas/tratamiento farmacológico , Niño , Preescolar , Sordera/congénito , Femenino , Estudios de Seguimiento , Bocio Nodular/inducido químicamente , Bocio Nodular/congénito , Bocio Nodular/cirugía , Audición/fisiología , Pérdida Auditiva Sensorineural/inducido químicamente , Pérdida Auditiva Sensorineural/congénito , Pérdida Auditiva Sensorineural/cirugía , Humanos , Lactante , Neoplasias Renales/tratamiento farmacológico , Masculino , Platino (Metal)/toxicidad , Estudios ProspectivosRESUMEN
We report the case of a 24-year-old woman with familial adenomatous polyposis and diagnosed with cribriform-morular variant of papillary thyroid carcinoma. Neck ultrasound and computed tomography identified multiple nodules in the thyroid gland and neck lymph nodes. The cytological analysis was compatible with the diagnosis of papillary cancer of the thyroid. Total thyroidectomy with lymph node dissection was performed. The histological analysis established the diagnosis of cribriform-morular variant of papillary thyroid carcinoma. Despite preoperative findings suggesting an aggressive form of thyroid cancer with lymph node involvement, the final diagnosis was a variant of papillary thyroid carcinoma often associated with familial adenomatous polyposis and known to have a good prognosis.
Asunto(s)
Carcinoma Papilar/patología , Neoplasia Endocrina Múltiple/patología , Neoplasias de la Tiroides/patología , Antineoplásicos Hormonales/uso terapéutico , Carcinoma Papilar/clasificación , Carcinoma Papilar/diagnóstico por imagen , Carcinoma Papilar/genética , Carcinoma Papilar/radioterapia , Carcinoma Papilar/secundario , Carcinoma Papilar/cirugía , Terapia Combinada , Estrógenos , Femenino , Genes APC , Bocio Nodular/etiología , Bocio Nodular/cirugía , Humanos , Radioisótopos de Yodo/uso terapéutico , Linfadenitis/patología , Linfadenitis/cirugía , Neoplasia Endocrina Múltiple/genética , Disección del Cuello , Neoplasias Hormono-Dependientes/diagnóstico por imagen , Neoplasias Hormono-Dependientes/genética , Neoplasias Hormono-Dependientes/patología , Neoplasias Hormono-Dependientes/terapia , Progesterona , Pronóstico , Radiografía , Radioterapia Adyuvante , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/genética , Neoplasias de la Tiroides/radioterapia , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Ultrasonografía , Adulto JovenRESUMEN
PURPOSE: Postoperative hematoma remains an uncommon but potentially life-threaten complication of thyroid surgery. The aim of this study is to assess the efficacy of Ankaferd Blood Stopper (ABS) in comparison to hemostasis by conventional technique (HCT) for the controlling of oozing-type bleeding following total thyroidectomy. METHODS: We randomized 61 patients with benign euthyroid multinodular goiter who underwent total thyroidectomy subject to one of the two different hemostasis techniques. There were 31 patients in the HCT group and 30 patients in the ABS group. The study was designed prospectively to compare ABS and HCT groups in terms of operation time, postoperative drainage, duration of postoperative stay, and complications. RESULTS: Mean postoperative drainage from the closed suction drains at first 24 hr were 24.6 ± 8.6 ml and 12.0 ± 9.2 ml (p = .001) and mean total postoperative drainage were 38.5 ± 13.2 ml and 20.6 ± 12.2 ml (p = .001) in the HCT and ABS groups, respectively, indicating statistically significant differences. CONCLUSIONS: On the basis of the results of this trial, the use of ABS seems to be more effective than HCT to control hemorrhage following total thyroidectomy.
Asunto(s)
Hemostasis Quirúrgica/métodos , Extractos Vegetales/uso terapéutico , Adulto , Anciano , Femenino , Bocio Nodular/cirugía , Hematoma/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/prevención & control , Hemorragia Posoperatoria/prevención & control , Tiroidectomía/métodosRESUMEN
BACKGROUND: No consensus exists on optimal treatment for Graves' disease once anti-thyroid medication fails to induce remission. Total thyroidectomy is a more cost-effective treatment than radioactive iodine or life-long anti-thyroid medication, but hypocalcaemia is an important complication, leading to longer hospital admissions and increased prescription costs. This study aimed to compare the relative risk of hypocalcaemia requiring medical treatment for patients with Graves' disease. METHODS: Prospective cohort study of patients undergoing total thyroidectomy for Graves' disease and for multinodular goitre, calculating serum calcium levels 24-hours post-operatively and prescription rates. RESULTS: Mean corrected calcium concentrations 24 hours post-operatively were 2.05 mmol/l for Graves' disease patients and 2.14 mmol/l for multinodular goitre patients (p = 0.003). Biochemical hypocalcaemia developed in 92 per cent (n = 34) of Graves' disease patients and 71 per cent (n = 43) of multinodular goitre patients (p = 0.012). Graves' disease patients were more likely to be prescribed calcium supplementation pre-discharge (p = 0.037). CONCLUSION: Total thyroidectomy for Graves' disease carries an increased risk of hypocalcaemia at 24 hours, and of calcium supplementation pre-discharge. Graves' disease patients should be informed of the increased risk of hypocalcaemia associated with total thyroidectomy, and this risk must be factored into future cost-effectiveness analysis.
Asunto(s)
Bocio Nodular/cirugía , Enfermedad de Graves/cirugía , Hipocalcemia/etiología , Tiroidectomía/efectos adversos , Adulto , Calcio de la Dieta , Análisis Costo-Beneficio , Femenino , Bocio Nodular/sangre , Bocio Nodular/complicaciones , Enfermedad de Graves/sangre , Enfermedad de Graves/complicaciones , Humanos , Hipocalcemia/sangre , Hipocalcemia/epidemiología , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Estudios Prospectivos , Factores de Riesgo , Tiroidectomía/economía , Factores de Tiempo , Resultado del TratamientoRESUMEN
Nodular goiter encompasses a spectrum of diseases from the incidental asyntomatic small solitary nodule to the large intrathoracic goiter causing pressure symptoms as well as functional complaints. The mainstay in the diagnostic evaluation is related to functional and morphological characterization with serum thyroid-stimulating hormone (TSH), ultrasound (US) and other imaging procedures and cytology by fine needle aspiration (FNA) on the basis of the different diseases. A clinical classification considering solitary cyst, adenomatous functioning nodule, follicular lesion and multinodular goiter may be proposed to consider the alternative therapies other than surgery as TSH suppressive or thyrostatic treatment, 131I therapy, percutaneous ethanol injection therapy (PEIT) or the only clinical exam in benignant lesions. Surgery should be advocated for the treatment of thyroid nodules whenever a patient presents with either pressure symptoms, hyperthyroidism or follicular/indeterminate cytology. Surgical approach, intraoperatory strategy and the extension of surgical treatment are correlated to the different clinical categories. At surgery the frozen section analysis in case of hemithyroidectomy is of aid to rule out malignancy and to prevent the reoperation. The surgical treatment of choice in case of uninodular goiter is lobectomy, total thyroidectomy or near total thyroidectomy is the correct treatment of multinodular bilateral goiter. The choice of the treatment must be condivided with the patient.
Asunto(s)
Bocio Nodular/cirugía , Glándula Tiroides/cirugía , Bocio Nodular/patología , Humanos , Glándula Tiroides/patología , Tiroidectomía , Cirugía Asistida por VideoRESUMEN
BACKGROUND: The aim of this study was to assess the impact of the neuromonitoring of the external branch of the superior laryngeal nerve (EBSLN) on the voice quality after mini-incision thyroidectomy under local/regional anesthesia and intravenous sedation. METHODS: Patients undergoing mini-incision thyroidectomy under local anesthesia were prospectively randomized for either nerve monitoring of the EBSLN (group 1) or no nerve monitoring (group 2). Voice and swallowing assessment were obtained by using the Voice Handicap Index-10 (VHI-10) and the Reflux Symptom Index questionnaires (RSI) before surgery and at 3 weeks and 3 months after surgery. RESULTS: Recruitment led to 22 patients in group 1 and 25 patients in group 2. The rate of visualized EBSLN was higher in group 1 (66% vs 21%; P = .003). Contrary to group 1, in group 2, the median total VHI-10 score was significantly higher 3 months after surgery (P = .034) compared with preoperatively, indicating a subjective voice handicap. In both groups, there was no difference in median total RSI score before surgery or at 3 weeks and 3 months after surgery. CONCLUSION: Nerve monitoring aids in the visualization of the EBSLN during mini-incision thyroidectomy under local/regional anesthesia and leads to an improvement in patient-assessed voice quality after surgery but does not impact swallowing.
Asunto(s)
Traumatismos del Nervio Laríngeo , Nervios Laríngeos/fisiopatología , Monitoreo Intraoperatorio/métodos , Tiroidectomía/métodos , Anestesia de Conducción , Anestesia Local , Sedación Consciente , Trastornos de Deglución/etiología , Trastornos de Deglución/fisiopatología , Trastornos de Deglución/prevención & control , Femenino , Bocio Nodular/cirugía , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos , Neoplasias de la Tiroides/cirugía , Tiroidectomía/efectos adversos , Factores de Tiempo , Trastornos de la Voz/etiología , Trastornos de la Voz/fisiopatología , Trastornos de la Voz/prevención & control , Calidad de la VozRESUMEN
Total Thyroidectomy (TT) is a gold standard for benign bilateral pathologies and malignant pathologies of the thyroid. TT has numerous advantages over less radical approaches, such as the resolution of the thyroid pathology, avoidance of recurrences, and improved response to life-long substitutive organotherapy. TT has a negligible rate of recurrence. Near Total Thyroidectomy (NTT) is associated with a low rate of recurrence. Subtotal Thyroidectomy (ST), in which a portion of the thyroid gland is deliberately left in the thyroid lodge, has a considerably higher rate of recurrence. The incidence of complications with TT is similar to that with other techniques of thyroid exeresis. However, despite the radical intent of surgeons, a real TT is not always carried out. The complete removal of all the thyroid tissue employing TT is not the norm and micro/macroscopic remnants almost always remain. The literature on these tissue remnants is often based on techniques that are not very accurate in terms of determining the diameters of the tissue remaining. In our study, conducted by colour echo-doppler of the thyroid lodge in 102 patients who had undergone TT for benign thyroid pathologies, we demonstrated significant thyroid tissue remnants after TT in 34 cases of 102 (33,3%). Therefore, out of a total of 102 so-called "total thyroidectomies", only 68 (66,7%) were really total, whereas 12 patients (11,76%) had near total thyroidectomy, leaving tissue remnants < 1 cm, and 22 patients (21,57%) had subtotal thyroidectomy, with tissue remnants > or = 1 cm.
Asunto(s)
Enfermedades de la Tiroides/cirugía , Glándula Tiroides/patología , Tiroidectomía/efectos adversos , Tiroidectomía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Bocio Nodular/cirugía , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Enfermedades de la Tiroides/complicaciones , Enfermedades de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/cirugía , Resultado del Tratamiento , UltrasonografíaRESUMEN
The treatment of benign multinodular goitre (MNG) is controversial, but surgery is recommended in large compressive goitres. While some patients decline surgery others may have contraindications due to comorbidity, since MNG is prevalent in the elderly. Therefore, non-surgical treatment alternatives are needed. Until recently, levothyroxine therapy was the preferred non-surgical alternative, but due to low efficacy and potential side-effects, it is not recommended for routine use in recent international guidelines. Conventional radioiodine ((131)I) therapy has been used for two decades as an effective and safe alternative to surgery in the treatment of symptomatic non-toxic MNG. Since much higher activities of (131)I are employed when treating non-toxic rather than toxic MNG, there has been reluctance in many countries to use this treatment modality. Frequently, the (131)I -uptake in a non-toxic MNG is low, which makes (131)I therapy less feasible. Another challenge is the negative correlation between the initial goitre size and goitre volume reduction (GVR). With its ability to more than double the thyroid (131)I-uptake, recombinant human TSH (rhTSH) increases the absorbed radiation dose and thus enhances the GVR by 35-56% at the expense of up to fivefold higher rate of permanent hypothyroidism. An alternative strategy is to reduce the administered (131)I-activity with a factor corresponding to the rhTSH induced increase in (131)I-uptake. Hereby, the extrathyroidal irradiation can be reduced without compromising efficacy. Thus, although in its infancy, and still experimental, rhTSH-augmented (131)I therapy may profoundly alter the non-surgical treatment of benign non-toxic MNG.
Asunto(s)
Bocio Nodular/terapia , Radioisótopos de Yodo/uso terapéutico , Tirotropina/uso terapéutico , Animales , Terapia Combinada , Suplementos Dietéticos , Bocio Nodular/tratamiento farmacológico , Bocio Nodular/radioterapia , Bocio Nodular/cirugía , Humanos , Yodo/uso terapéutico , Proteínas Recombinantes/uso terapéutico , Tiroxina/uso terapéuticoRESUMEN
Reoperative thyroid surgery is a technical challenge with a high incidence of complications and recurrent disease. It requires a thorough understanding of the anatomy and biology of the disease process, expertise in surgical technique, and avoidance of complications related to recurrent laryngeal nerve and parathyroid glands. Preoperative evaluation includes review of previous surgical procedures and pathology reports and evaluation of the extent of the disease with appropriate imaging studies. Preoperative evaluation of the vocal cord and vocal cord function is vitally important. Postoperative adjuvant treatment with radioactive iodine or external radiation therapy should be considered in selected individuals. Proper histologic evaluation of the recurrent thyroid tumor is important, to rule out poorly differentiated thyroid carcinoma. Despite good surgical resection, the incidence of local recurrence in the central compartment is high in patients undergoing reoperative thyroid surgery.
Asunto(s)
Enfermedades de la Tiroides/cirugía , Tiroidectomía , Calcitonina , Drenaje , Bocio Nodular/cirugía , Enfermedad de Graves/cirugía , Humanos , Metástasis Linfática , Pronóstico , Recurrencia , Reoperación , Tiroglobulina/sangre , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/cirugía , Tiroidectomía/métodos , UltrasonografíaRESUMEN
A 65-year old patient presented with newly diagnosed hypercalcemia and elevated parathyroid hormone levels. Exploration of parathyroid glands was performed under the diagnosis of primary hyperparathyroidism and was combined with thyreoidectomy due to concomittant multinodular goiter. However, no parathyroid adenoma was identified despite careful exploration. Therefore, the operation was terminated and an ectopic adenoma was suspected. A (99m)Tc-sestamibi scintigraphy with SPECT, neck ultrasound, neck CT scan with contrast media and selective venous sampling were performed for further localization of the adenoma. A single adenoma localized in the submandibular area of the left jaw was suspected and confirmed during surgical reexploration. Postoperatively, parathyroid hormone levels were below detection level and the patient required short-term calcium supplementation for symptomatic hypocalcemia.
Asunto(s)
Adenoma/diagnóstico , Coristoma/diagnóstico , Hipercalcemia/etiología , Hiperparatiroidismo Primario/diagnóstico , Neoplasias de las Paratiroides/diagnóstico , Enfermedades de la Glándula Submandibular/diagnóstico , Adenoma/patología , Adenoma/cirugía , Anciano , Coristoma/patología , Coristoma/cirugía , Diagnóstico Diferencial , Femenino , Bocio Nodular/diagnóstico , Bocio Nodular/patología , Bocio Nodular/cirugía , Humanos , Hiperparatiroidismo Primario/patología , Hiperparatiroidismo Primario/cirugía , Glándulas Paratiroides/patología , Neoplasias de las Paratiroides/patología , Neoplasias de las Paratiroides/cirugía , Paratiroidectomía , Reoperación , Enfermedades de la Glándula Submandibular/patología , Enfermedades de la Glándula Submandibular/cirugía , Glándula Tiroides/patología , TiroidectomíaRESUMEN
BACKGROUND: The most common significant complication of total thyroidectomy is hypoparathyroidism. Intraoperative prediction of which patients are likely to be affected would allow both intraoperative and postoperative interventions to be utilised in these patients. Selection of these patients is essential if we are to be successful at discharging total thyroidectomy patients on the first postoperative day. We investigated the utility of intraoperative parathormone measurement from the internal jugular vein at predicting postoperative hypocalcaemia. MATERIALS AND METHODS: Prospective collection of data was done on 45 consecutive total thyroidectomy patients. Preoperative calcium, intraoperative parathormone and postoperative calcium and parathormone were collected. The accuracy of intraoperative parathormone in predicting those with postoperative hypocalcaemia was assessed. RESULTS: Intraoperative parathormone of less than 2 pmol l(-1) had a sensitivity of 100% and a specificity of 95% in predicting those with postoperative hypocalcaemia. An intraoperative sample less than 2 pmol l(-1) was a highly significant predictor (p < 0.0001) of postoperative hypocalcaemia. CONCLUSION: Intraoperative assessment of parathormone is an accurate predictor of those patients who will become hypoparathyroid in the postoperative period. Intraoperative prediction allows for targeted autotransplantation of glands in those at risk and selected early institution of postoperative supplementation in these patients. Patients not identified as at risk can be safely discharged.