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1.
G Chir ; 40(3): 234-237, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31484015

RESUMO

Papillary thyroid carcinoma (PTC) is the most common mali gnancy of the thyroid gland. In 21-90% of the patients occult lymph node metastases may occur. The case reported here describes a woman who underwent a total thyroidectomy for multinodular goiter and who presented an enlarged lymph node on the left side of the neck, which showed a metastasis from PTC. The patient underwent imaging investigation with CT and FNAB. The pathological examination diagnosed a papillary thyroid cancer metastases. The pT underwent a I131 total body scan, negative for secondary localization.


Assuntos
Carcinoma Papilar/diagnóstico por imagem , Carcinoma Papilar/secundário , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Carcinoma Papilar/complicações , Feminino , Bócio/cirurgia , Humanos , Achados Incidentais , Metástase Linfática , Pessoa de Meia-Idade , Neoplasias da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia
2.
Best Pract Res Clin Endocrinol Metab ; 33(4): 101285, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31221571

RESUMO

The advent of continuous vagus stimulation (CVS), eliminating lag time between nerve preparation with potential trauma and stimulation, has transformed the intraoperative surgical strategy in thyroid surgery. Continuous intraoperative nerve monitoring empowers the surgeon to be optimally aware of traction-related injury to the recurrent laryngeal nerve (RLN). Electromyographic precursor lesions, called combined events, prompt surgeons to cease harmful surgical maneuvers and release the nerve before damage to the nerve is established. Complete RLN recovery, defined as restitution of the nerve amplitude to ≥50% of baseline, assures the surgeon that it is safe to pursue completion surgery of the contralateral side in one procedure. If this restitution is incomplete or absent (<50% of amplitude baseline) immediate vocal cord paralysis is likely and it is advisable to delay completion surgery until the nerve has fully recovered. This review summarizes the tremendous progress made in this dynamic field, delineating the extent to which CVS has changed the landscape: tailoring intraoperative decision making to determine the safest course of action for patients with benign goiter.


Assuntos
Tomada de Decisão Clínica , Bócio/cirurgia , Monitorização Neurofisiológica Intraoperatória/métodos , Tireoidectomia/métodos , Estimulação do Nervo Vago/métodos , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Traumatismos do Nervo Laríngeo Recorrente/etiologia , Traumatismos do Nervo Laríngeo Recorrente/prevenção & controle , Tireoidectomia/efeitos adversos
3.
BMC Surg ; 18(Suppl 1): 20, 2019 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-31074402

RESUMO

BACKGROUND: About 10% of cervico-mediastinal goiter need to associate cervicotomy with a total or partial sternotomy to allow a safe removal of the goiter. Aim of this study is to identify preoperative predictors of sternotomy for mediastinal goiter. METHODS: Between January 2008 and December 2015, 586 patients were submitted to total thyroidectomy at Surgical Clinic of Brescia, Italy. Among these, patients with cervico-mediastinal goiter have been divided in two groups based on the necessity of an associated sternotomy in the operating field: Group 1 (n = 40 patients) did not need sternotomy and Group 2 (n = 4 patients) underwent cervicotomy associated with sternotomy. Clinical and pathological characteristics of patients were retrospectivelly recorded. RESULTS: Among study group, 44 patients had cervico-mediastinal goiter. Thoracic CT was performed in all patients: an extension above aortic arch was found in 41 patients (93.18%) while an extention below aortic arch was found in 3 patients (6.82%). The extension of the goiter below the aortic arch resulted as a predictive value in the choice of surgical treatment (p = 0.0001). The thyroiditis process was found to be a significant predictive of the extention to a sternotomic approach (p = 0.029). The years of goiter's presence were on average 8.40 years in Group 1 and 14.75 years in Group 2. These parameters proved to be predictive when choosing a cervicotomy with sternotomy. CONCLUSIONS: Our study, despite limitations posed by small sample and its retrospective analisys, highlights the role of goiter's extention (below the aortic arch), disease length (for more than 14.75 years) and flogistic process (positivity of Tg Ab and anti-TPO-Ab) in the choice of combined (cervicotomic and sternotomic) approach to goiter's removal.


Assuntos
Bócio Subesternal/cirurgia , Esternotomia/métodos , Tireoidectomia/métodos , Tireoidite/patologia , Adulto , Idoso , Feminino , Bócio/cirurgia , Humanos , Itália , Masculino , Mediastino , Pessoa de Meia-Idade , Estudos Retrospectivos
4.
J Coll Physicians Surg Pak ; 29(6): 574-576, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31133159

RESUMO

An enlarging thyroid normally extends into the mediastinum, resulting in a presternal or substernal goiter, depending on its migration anteriorly or posteriorly, respectively. The first one was a rare entity in medical literature, being previously reported in only 6 cases worldwide. The present case reports a 54-year woman with a presternal goiter. She had a history of partial thyroidectomy due to a colloid goiter in 2004. Her thyroid function revealed subclinical hypothyroidism. No other abnormalities were present in physical exam or in laboratory tests. A resection of the remaining thyroid tissue was made, with great postsurgical recovery. The anatomopathological study revealed a colloid goiter. Such case porpoise is to remember physicians that unusual presentations of ordinary diseases can occur. This report differs on literature, which demonstrated that papillary thyroid carcinoma is the most important cause of presternal goiter. Moreover, unlike previous reports with normal thyroid function, this case is the only one reported with subclinical hypothyroidism.


Assuntos
Bócio/cirurgia , Glândula Tireoide/diagnóstico por imagem , Tireoidectomia/métodos , Transtornos de Deglutição/etiologia , Dispneia/etiologia , Feminino , Humanos , Hipotireoidismo/complicações , Pessoa de Meia-Idade , Tireotropina/sangue , Tiroxina/sangue , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia
5.
World J Surg ; 43(9): 2228-2234, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31065775

RESUMO

BACKGROUND: The aim of this study was to determine the incidence, risk factors, and spontaneous recovery rate of vocal fold paresis (VFP) with routine laryngoscopy before and after thyroid surgery. METHODS: All consecutive patients undergoing primary or redo thyroid surgery between years 2011-2016 were prospectively registered in an electronic database, and scheduled for pre- and postoperative laryngoscopic vocal fold inspection by otolaryngologists independently of the surgical team. RESULTS: A total of 920 thyroid operations with 1296 nerves at risk were performed in 866 patients. Pre- and postoperative laryngoscopy was done in 95% and 98%, respectively. Preoperative VFP was detected in 24 (2.8%) patients. New postoperative VFP was found in 53 of 920 operations (5.8%) and in 55 of 1296 nerves at risk (4.2%). After 12 months, 14 had recovered full vocal fold function and eight had near-complete recovery. VFP was permanent after 29 operations (3.2%); two patients were lost to follow-up with uncertain outcome. Of the 1296 nerves at risk, injury was permanent in 30 (2.3%). In multivariate analysis, patients operated for recurrent goiter had nearly nine times higher risk of new VFP (23% rate), whereas patients with malignant histology had three times higher risk of postoperative VFP (up to 22% rate). CONCLUSION: VFP continues to be a serious complication of thyroid surgery, especially in operations for redo goiter and thyroid malignancy. The incidence of VFP may be underestimated unless laryngoscopic examinations are performed routinely.


Assuntos
Laringoscopia , Complicações Pós-Operatórias/epidemiologia , Glândula Tireoide/cirurgia , Paralisia das Pregas Vocais/epidemiologia , Adulto , Idoso , Feminino , Bócio/cirurgia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Período Pré-Operatório , Fatores de Risco , Neoplasias da Glândula Tireoide/cirurgia , Paralisia das Pregas Vocais/etiologia
8.
Endocr J ; 66(5): 423-430, 2019 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-30814438

RESUMO

T helper (Th) 17 cells and interleukin (IL)-17 play a significant role in the pathogenesis of autoimmune thyroid disease (AITD). However, it has recently become clear that Th17 cells are more heterogeneous and exhibit two different phenotypes, whereas IL-23 and IL-1ß are crucial for the generation of pathogenic Th17 lymphocytes. We aimed to investigate the association between IL-17 and Th17-promoting cytokines in AITD by studying the immunoexpression patterns of IL-17, IL-23, and IL-1ß in thyroid tissue. Following thyroidectomy, 29 patients with AITD (21 cases of Hashimoto's thyroiditis (HT) and 8 cases of Graves' disease (GD)) and 18 patients with colloid goiter, as controls, were enrolled in this study, and immunohistochemistry was performed. The expression level of IL-17 in thyrocytes was significantly higher in HT and GD patients than in colloid goiter patients. Immunopositivity for both IL-23 and IL-1ß was significantly increased in HT patients compared to GD and colloid goiter patients. However, no difference was found between IL-23 or IL-1ß expression in patients with GD and colloid goiter. A positive correlation between IL-17 and IL-23 as well as IL-17 and IL-1ß expression was observed in HT patients (r = 0.574, p = 0.007 and r = 0.461, p = 0.036, respectively). In the GD group, IL-17 was positively correlated with IL-1ß (r = 0.817, p = 0.013) but not with IL-23 expression. We found increased IL-23 and IL-1ß expression in the HT group but not in the GD group. Furthermore, both interleukins were correlated with IL-17 immunopositivity in thyroid tissue, suggesting that pathogenic Th17-promoting cytokines may play a role in HT pathogenesis.


Assuntos
Doença de Graves/metabolismo , Doença de Hashimoto/metabolismo , Interleucina-1beta/metabolismo , Interleucina-23/metabolismo , Células Th17/metabolismo , Adulto , Idoso , Feminino , Bócio/metabolismo , Bócio/cirurgia , Doença de Graves/cirurgia , Doença de Hashimoto/cirurgia , Humanos , Imuno-Histoquímica , Interleucina-17/metabolismo , Masculino , Pessoa de Meia-Idade , Células Epiteliais da Tireoide/metabolismo , Tireoidectomia
9.
Rev. esp. anestesiol. reanim ; 66(3): 163-166, mar. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-187381

RESUMO

La enfermedad de McArdle o glucogenosis de tipo V es una miopatía metabólica rara que consiste en pérdida muscular y debilidad. Los pacientes con esta enfermedad presentan riesgos asociados a la anestesia. Pueden presentar hipoglucemia, rabdomiólisis, fallo renal agudo, alteraciones iónicas y también se ha relacionado con una mayor incidencia de hipertermia maligna durante el procedimiento anestésico. La compresión intermitente debido a la medición de la presión no invasiva, las posturas en la mesa de quirófano que puedan provocar contracturas musculares o el temblor ocasionado por la hipotermia o por la misma anestesia pueden desencadenar rabdomiólisis en estos pacientes. En este artículo exponemos nuestra experiencia con una paciente con síndrome de McArdle bajo anestesia general para tiroidectomía total por bocio multinodular eutiroideo


McArdle disease or type V glycogenosis is a rare metabolic myopathy consisting of muscle loss and weakness. These patients have risks associated with anaesthesia. They can present with hypoglycaemia, rhabdomyolysis, acute renal failure, and electrolyte changes. It has also been associated with a higher incidence of malignant hyperthermia during the anaesthetic procedure. Intermittent compression due to the measurement of non-invasive pressure, postures on the operating table that may cause muscle contractures, or tremor caused by hypothermia or anaesthesia itself, may trigger rhabdomyolysis in these patients. In this article we present our experience in submitting a patient with McArdle's syndrome to general anaesthesia for total thyroidectomy due to multinodular euthyroid goitre


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Doença de Depósito de Glicogênio Tipo V/complicações , Bócio/cirurgia , Tireoidectomia/métodos , Remifentanil/administração & dosagem , Propofol/administração & dosagem , Rocurônio/administração & dosagem , Testes Genéticos/estatística & dados numéricos , Síndromes do Eutireóideo Doente/complicações , Anestesia/métodos , Hipertermia Maligna/prevenção & controle
10.
Horm Metab Res ; 51(2): 127-133, 2019 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-30759490

RESUMO

We have previously reported decreased thyroid function within the laboratory reference range and changes in mitochondrial function after hemithyroidectomy. Peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1α) and coactivator-1ß (PGC-1ß) are key regulators of mitochondrial biogenesis and function. The aim was to examine the influence of hemithyroidectomy on the longitudinal change in mRNA expression of these genes. In addition, we measured longitudinal changes in mRNA expressions of the mitochoncrial-related genes nuclear factor erythroid-derived 2-like 2 (NFE2L2), mitochondrial transcription factor A (TFAM), and sodium dismutase 2 (SOD2). Twenty-eight patients were examined before and 1, 3, 6, and 12 months after hemithyroidectomy for benign euthyroid goiter. Thyroid stimulating hormone (TSH) and thyroid hormones were measured, and whole blood gene expression of PGC-1α, PGC-1ß, NFE2L2, TFAM, and SOD2 was examined by reverse transcription quantitative Polymerase Chain Reaction. We used mixed effect regression models to investigate changes in gene expression with time. Averaged over all follow-up visits, TSH increased (p=0.001), tT3 declined (p=0.01), and fT4/tT3 ratio increased (p=0.03) over one-year follow-up, but fT4 remained unchanged. Averaged over all follow-up visits, whole blood PGC-1α levels (p<0.001) and SOD2 (p=0.009) levels declined, but PGC-1ß, TFAM, and NFE2L2 did not change over one-year follow-up. The study demonstrates significant downregulation of whole blood PGC-1α and SOD2 gene expressions in hemithyroidectomized patients with a concomitant increase in TSH concentration within the reference range. Thus, hemithyroidectomized patients may likely have impaired mitochondrial function.


Assuntos
Bócio/sangue , Coativador 1-alfa do Receptor gama Ativado por Proliferador de Peroxissomo/sangue , Hormônios Tireóideos/sangue , Tireoidectomia , Adulto , Feminino , Seguimentos , Bócio/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Superóxido Dismutase/sangue
11.
BMC Emerg Med ; 19(1): 18, 2019 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-30696398

RESUMO

BACKGROUND: Pregnancy constitutes a significant factor in thyroid hypertrophy and can rarely progress to respiratory distress. We describe case of pregnant woman with acute respiratory distress following a tracheal compression due to goiter, quickly resulting in respiratory arrest, requiring emergency orotracheal intubation and thyroidectomy. CASE PRESENTATION: A pregnant woman with a growing goiter was referred to the hospital with a respiratory difficulty. During the examination, we found a large homogeneous goiter. The patient showed signs of respiratory exhaustion with bradypnea and pulmonary auscultation revealing decreased ventilation of the two pulmonary fields. The evolution quick led to respiratory arrest. The patient was rapidly intubated, which saved her. A thoracic computed tomography was performed and revealed a large goiter, compressing the trachea in its thoracic area and oppressing the vascular structures. Obstetrical ultrasound was normal. Thyroidectomy was decided after the patient's preparation. After 24 h, the patient was successfully extubated without incident and the postoperative period was uneventful. CONCLUSION: Airway obstruction during pregnancy secondary to goiter is rare but can be fatal. Early diagnosis might have avoided the evolution towards the respiratory failure. Prevention requires early surgery preferably before pregnancy or in our case a surgery in the second trimester.


Assuntos
Bócio/complicações , Complicações na Gravidez/etiologia , Insuficiência Respiratória/etiologia , Doença Aguda , Adulto , Feminino , Bócio/cirurgia , Humanos , Intubação Intratraqueal , Gravidez , Complicações na Gravidez/terapia , Insuficiência Respiratória/terapia , Tireoidectomia
13.
Surgery ; 165(1): 75-79, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30415868

RESUMO

BACKGROUND: Few long-term studies define the appropriate extent of surgery and recurrence rates for unilateral multinodular goiter. We compared the rate and time to reoperation in patients with multinodular goiter who underwent lobectomy to that of patients with benign solitary nodule. METHODS: Retrospective study of a prospective database of all patients who underwent lobectomy for multinodular goiter or solitary nodule from 1991 to 2017. We analyzed reoperation rates and time to reoperation. Reoperation was defined as the need for completion thyroidectomy determined the following citeria: nodule greater than 3 cm, multiple nodules, nodule growth or suspicion for malignancy by ultrasound or fine-needle aspiration biopsy, or compressive symptoms. RESULTS: Included in the study were 2,675 lobectomies; 852 (31.85%) for multinodular goiter. In total, 394 patients (14.7%) underwent reoperation: 261 (30.6%) with a previous multinodular goiter and 133 (7.29%) with solitary nodule (P < .0001). A total of 80% of the patients with multinodular goiter and 67.66% with solitary nodule recurred as multinodular goiter; 3.5% of all recurrences were carcinomas. The mean time to reoperation was 14.8 years, without difference between groups (P = .5765). Patients without reoperation were younger (47 ± 15 vs 54 ± 13 years of age, P < .0001) and more likely to be male (P < .0001). CONCLUSION: Lobectomy for unilateral multinodular goiter is the procedure of choice given the length of time to reoperation. Patients and surgeons should be aware of the need for long-term surveillance.


Assuntos
Bócio Nodular/cirurgia , Bócio/cirurgia , Reoperação/estatística & dados numéricos , Tireoidectomia/estatística & dados numéricos , Carcinoma/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/patologia , Fatores de Tempo
14.
World J Surg ; 43(4): 1022-1028, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30536022

RESUMO

BACKGROUND: Since the mid-1800s, thyroidectomy has transformed from a procedure associated with high to near-zero mortality. Nonetheless, surgeons must continue to strive to improve patient care. Using historical records and contemporary data, this study compares the practice and outcomes of thyroid surgery at a tertiary institution during two periods, 50 years apart. METHODS: 'The Alfred Hospital Clinical Reports' recorded all cases of surgically managed thyroid disease from 1946 to 1959. These historical cases were compared to contemporary thyroidectomy cases at the Alfred Hospital from 2007 to 2016. Cases were compared for surgical indication and post-operative outcomes. RESULTS: There were 746 patients in the historical group (mean age 53 years; 87% female) and 787 patients in the contemporary group (mean age 52 years; 80% female). The most common indication for thyroidectomy in both groups was non-toxic nodular goitre. A greater proportion of the contemporary group were diagnosed with thyroid malignancy (27% vs. 8%; p < 0.001). The contemporary group recorded significantly fewer cases of thyrotoxic crisis (2.1% vs. 0%; p = 0.001), permanent nerve palsy (4.6% vs. 0.4%; p < 0.001) and bilateral nerve palsy (1.2% vs. 0%; p = 0.01). There were no mortalities in the contemporary group, while the historical data recorded three deaths (0.44%). CONCLUSIONS: This study compared thyroid surgery in two cohorts separated by a 50-year period. While it is not surprising that outcomes of thyroidectomy have improved, this study uniquely demonstrates trends of thyroid surgery over time and areas in which further improvements may be made.


Assuntos
Doenças da Glândula Tireoide/cirurgia , Tireoidectomia/tendências , Austrália/epidemiologia , Feminino , Bócio/história , Bócio/cirurgia , História do Século XX , História do Século XXI , Humanos , Laringoscopia/história , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/história , Doenças da Glândula Tireoide/epidemiologia , Doenças da Glândula Tireoide/história , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/história
15.
Gen Thorac Cardiovasc Surg ; 67(6): 561-565, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30141079

RESUMO

A 67-year-old woman was presented with a mediastinal tumor extending from the left lobe of the thyroid and passing through the posterior trachea, causing displacement of the esophagus to the left side of the patient and then descending into the right side of the mediastinum to below the carina. Surgery was performed under two-lung ventilation with the patient in a prone position; general anesthesia was performed with a single-lumen tube combined with artificial pneumothorax. In thoracoscopic surgery, we were able to confirm and preserve anatomical structures. After detachment of the tumor at the level of the left and right subclavian arteries, the patient was placed supine, a cervical incision was added, and the tumor was extracted. The tumor was diagnosed as a nonmalignant mediastinal goiter (MG). No such surgical report was found in the literature, and one would be useful for this new approach to MG removal.


Assuntos
Bócio/cirurgia , Neoplasias do Mediastino/cirurgia , Pneumotórax Artificial , Decúbito Ventral , Respiração Artificial/métodos , Toracoscopia/métodos , Idoso , Feminino , Humanos , Resultado do Tratamento
16.
Auris Nasus Larynx ; 46(4): 593-598, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30577987

RESUMO

OBJECTIVE: We evaluated the accuracy and feasibility of transcutaneous laryngeal ultrasonography as an alternative to videolaryngoscopy for assessing vocal cord mobility to rule out recurrent laryngeal nerve injury following thyroidectomy. METHODS: Forty-five adult patients scheduled to undergo elective thyroidectomy under general anesthesia were included. Preoperatively, indirect laryngoscopy and transcutaneous laryngeal ultrasonography was done for assessing vocal cord mobility. Intraoperatively, following induction, patients were intubated using videolaryngoscope. On completion of the surgical procedure, one anesthetist performed videolaryngoscopy so as to record vocal cord mobility while the patients were being extubated in deep plane of anesthesia. Simultaneously another anesthesiologist performed transcutaneous laryngeal ultrasonography.Vocal cord mobility, changes in hemodynamics and total time duration for the two procedures was recorded. Indirect laryngoscopic assessment and flexible fiberoptic laryngoscopy was done on postoperative day 1 and 7 respectively. RESULTS: Postoperative videolaryngoscopy picked up bilaterally mobile vocal cords in 88.8% cases. Transcutaneous laryngeal ultrasonography could correctly identify 39(86.6%) of these patients, with 1(2.5%) patient being misdiagnosed as having bilaterally immobile vocal cords. Further, videolaryngoscopy identified 5 patients of vocal cord palsy, of which transcutaneous laryngeal ultrasonography correctly identified 3 (60%) patients. Hence, in comparison to videolaryngoscopy, the sensitivity, specificity, positive predictive value, and negative predictive value of transcutaneous laryngeal ultrasonography for assessment of vocal cords was 75%, 95.1%, 60%, and 97.5% respectively. CONCLUSION: In patients undergoing thyroidectomy, transcutaneous laryngeal ultrasonography can serve as a non-invasive, bedside screening tool for assessing vocal cord palsy postoperatively.


Assuntos
Bócio/cirurgia , Laringoscopia/métodos , Traumatismos do Nervo Laríngeo Recorrente/diagnóstico , Neoplasias da Glândula Tireoide/cirurgia , Ultrassonografia/métodos , Paralisia das Pregas Vocais/diagnóstico , Prega Vocal/diagnóstico por imagem , Adulto , Feminino , Humanos , Laringe/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Traumatismos do Nervo Laríngeo Recorrente/etiologia , Sensibilidade e Especificidade , Tireoidectomia/efeitos adversos , Paralisia das Pregas Vocais/etiologia
17.
Auris Nasus Larynx ; 46(1): 129-134, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30017236

RESUMO

OBJECTIVE: Data pertaining to the outcomes of retrosternal goiter surgeries performed at secondary care centers, where thoracic surgery expertise is not readily available, is infrequently reported. Careful patient selection is crucial to avoid an unexpected need for a sternotomy during surgery. We sought to evaluate the surgical management of patients with retrosternal goiters treated at two secondary care centers. METHODS: Retrospective review of clinical records and computed tomographic (CT) scans of 557 patients who underwent thyroid surgery at the Departments of Otolaryngology, Head and Neck Surgery of Manukau Surgery Center and Whangarei Base Hospital. Inclusion criterion was extension of goiter below the plane of the thoracic inlet on CT scan. Clinicopathologic features and surgical outcomes were recorded. RESULTS: The prevalence of retrosternal goiter was 72 of 557 patients (12.9%). All patients in this series underwent thyroidectomy transcervically. Dyspnea was present in 48 patients (66.7%). On preoperative CT scans, the goiter was noted to extend beyond the aortic arch in seven patients (9.7%), tracheal bifurcation in five patients (6.9%) and posterior mediastinum in 15 patients (20.8%). Malignancy was diagnosed in eight patients (11.1%) histologically. Postoperatively, vocal cord paralysis was temporary in 5 patients (6.9%) and permanent in 1 patient (1.4%). Hypocalcaemia was transient in 10 patients (13.9%). No permanent hypocalcemia, tracheomalacia, postoperative hematoma or patient death was reported. During the study period, 4 patients were encountered in the outpatients setting whereby the evaluation of their CT imaging demonstrated features deemed to be at high risk of requiring a sternotomy: primary mediastinal goiter (n=2) and inferior extent of goiter to the level of right atrium (n=2). These patients were pre-emptively referred to a tertiary center where thoracic surgery service was available and their data was reported separately. CONCLUSION: With careful patient selection, the majority of retrosternal goiter can be resected transcervically with minimal morbidities. Preoperative CT scan yielded useful surgical information; in the presence of primary mediastinal goiter or inferior extent of goiter to the level of the right atrium, surgery should be planned in a tertiary center where thoracic surgeon is available.


Assuntos
Bócio Subesternal/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adulto , Idoso , Feminino , Bócio/cirurgia , Bócio Subesternal/diagnóstico por imagem , Bócio Subesternal/patologia , Humanos , Hipocalcemia/epidemiologia , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Complicações Pós-Operatórias/epidemiologia , Recuperação de Função Fisiológica , Encaminhamento e Consulta , Estudos Retrospectivos , Centros de Cuidados de Saúde Secundários , Esternotomia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Tomografia Computadorizada por Raios X , Paralisia das Pregas Vocais/epidemiologia
18.
J Ayub Med Coll Abbottabad ; 31(4): 481-484, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31933295

RESUMO

Background: Protection of parathyroid is very important in thyroid surgery. Our aim was to compare the effect of Focus Harmonic Scalpel and Conventional Haemostasis on parathyroid function in thyroid surgery. Methods: To analyse the clinical data of patients in our hospital from November 2011-December 2015 retrospectively. Operations have been performed with Focus Harmonic Scalpel in thyroid surgery since May 2013. Seventy-four patients with nodular goitre constituted Harmonic Scalpel group and Conventional Haemostasis group, and so did 139 patients with thyroid papillary carcinoma. Clinical data were compared such as age, gender, thyroid volume, operation procedure, preoperative parathyroid hormone and serum calcium concentration between the two groups. The differences between the two groups were observed in serum calcium concentration, parathyroid hormone concentration, incidence of transient hypocalcaemia and hypoparathyroidism after operation. Results: The preoperative data showed no significant difference between Harmonic Scalpel group and Conventional Haemostasis group. No significant difference existed in postoperative clinic data at six a.m. the first day after operation between the two groups for patients with nodular goitre. The incidence of transient hypoparathyroidism and hypocalcaemia in Harmonic Scalpel group were less than that in Conventional Haemostasis group in thyroid surgery. Significant differences existed in the mean of serum calcium concentration and incidence of transient hypocalcaemia between the two groups for thyroid papillary carcinoma statistically. Conclusion: Focus Harmonic Scalpel has certain advantages than conventional Haemostasis in protecting parathyroid glands, reducing the incidence of transient hypoparathyroidism and hypocalcaemia in thyroid surgery, especially for patients with thyroid cancer.


Assuntos
Hemostasia Cirúrgica/instrumentação , Glândulas Paratireoides/fisiologia , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/instrumentação , Adulto , Idoso , Cálcio/sangue , Feminino , Bócio/cirurgia , Hemostasia Cirúrgica/efeitos adversos , Hemostasia Cirúrgica/métodos , Humanos , Hipocalcemia/etiologia , Hipoparatireoidismo/etiologia , Masculino , Pessoa de Meia-Idade , Glândulas Paratireoides/lesões , Hormônio Paratireóideo/sangue , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Tireoidectomia/efeitos adversos
19.
Ethiop J Health Sci ; 28(2): 169-176, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29983514

RESUMO

Background: Airway management problems may arise when intubating patients with goitre scheduled for thyroidectomy. Goitres are not uncommon in sub-Saharan Africa, thyroidectomy being the main treatment. The aim of this study was to determine incidences of difficult intubation (DI), failed intubation (FI) and predictors of DI using a modified intubation difficulty score (IDS). Methods: One hundred and twenty-five consenting patients with goitre scheduled for thyroidectomy were recruited. Goitre-related factors (GRF) of duration of illness, diagnosis, neck circumference, tracheal deviation and narrowing and retrosternal extension were recorded as well as Mallampati classification and BMI. At intubation, modified IDS was determined for each patient. Patients with modified IDS ≤ 5 were categorized as easy intubation group (E), and those with modified IDS >5 were categorized as difficult intubation group (D). The GRF of all patients in group D were compared with matched patients in group E. Results: Incidence of DI was 13.6% with 2 (1.6%) cases of failed intubation. Comparing groups D and E, duration of illness was 4.28 ± 3.78 years in group D versus 7.44 ± 7.63 years group E, p = 0.1353. Neck circumference was 41.42 ±5.30 cm in group D versus 37.43±2.68 cm in group E, p = 0.0200. Tracheal deviation, narrowing and retrosternal extension, and surgical diagnosis were not significantly different among both groups. Conclusion: Incidence of DI was 13.6% and that of FI was 1.6%. Neck circumference was found to be a predictor of difficult intubation in goitre patients scheduled for thyroidectomy using the modified IDS.


Assuntos
Bócio/cirurgia , Intubação Intratraqueal , Tireoidectomia , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Feminino , Humanos , Incidência , Intubação Intratraqueal/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pescoço/anatomia & histologia , Nigéria , Traqueia , Adulto Jovem
20.
Am J Case Rep ; 19: 808-811, 2018 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-29987269

RESUMO

BACKGROUND Diffuse lipomatosis of the thyroid gland is a particularly rare histopathological condition characterized by diffuse fatty infiltration within the thyroid stroma. CASE REPORT We report a case of a 53-year-old woman who presented with a 2-year history of massive neck goiter and mild dysphagia. A computed tomography (CT) scan revealed heterogeneous enhancing of an enlarged thyroid gland with left lobe cranial extension and compression of the pharynx, and caudal bilateral retrosternal growth. The patient underwent total thyroidectomy and histopathological examination revealed mature fatty tissue diffusely distributed throughout the thyroid gland. Excision of the gland was somewhat challenging due to the very thin thyroid capsule and recurrent protrusion of fat from the capsule. CONCLUSIONS Diffuse thyroid lipomatosis is an extremely rare histopathological condition characterized by diffuse fatty infiltration in thyroid stroma. Despite its rarity, it should be considered in the differential diagnoses of a patient presenting with a goiter.


Assuntos
Bócio/diagnóstico , Lipomatose/diagnóstico , Doenças da Glândula Tireoide/diagnóstico , Diagnóstico Diferencial , Feminino , Bócio/cirurgia , Humanos , Lipomatose/cirurgia , Pessoa de Meia-Idade , Doenças da Glândula Tireoide/cirurgia , Tireoidectomia
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