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1.
J Surg Res ; 281: 185-191, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36179596

RESUMO

INTRODUCTION: Total thyroidectomy (TT) has been shown to be a safe and effective treatment for Graves' disease. However, the time course for improvement of symptoms has not been defined. METHODS: With an institutional review board approval, we prospectively gathered survey data of all patients (n = 79) undergoing TT for Graves' disease at a single institution from 2019 to 2021. After informed consent was obtained, patients completed surveys preoperatively and at 2 wk followed by monthly postoperative visits/phone calls. Patient demographics and survey results were collected and analyzed. Symptom recovery time was evaluated using Kaplan-Meier analysis. RESULTS: A total of 50 patients completed the survey on postoperative follow-up (response rate 63%). Average age was 38 y (range 12-80 y) and 88% of patients were female. The most common preoperative symptoms were fatigue (90%) and heat/cold intolerance (88%). Tremor (median time to resolution: 1 wk; interquartile range [IQR] 1-3), diarrhea (median 1 wk [IQR 1-3]), and palpitations (median 1 wk [IQR 1-3]) resolved the most rapidly followed by eye symptoms (median 3 wk [IQR 1-6]), heat/cold intolerance (median 3 wk [IQR 3-30]), memory deficits (median 3 wk [IQR 1-undefined]), and fatigue (median: 3 wk [IQR 1-14]). There were no significant differences in time to resolution of symptoms by gender or age (less than versus 40 y and older). Those with uncontrolled Graves' had more severe symptoms but no difference in time to resolution from the euthyroid Graves' patients. CONCLUSIONS: Many Graves' disease symptoms improve rapidly following TT, with a median time to improvement of less than 1 mo.


Assuntos
Doença de Graves , Tireoidectomia , Humanos , Feminino , Adulto , Masculino , Tireoidectomia/efeitos adversos , Tireoidectomia/métodos , Doença de Graves/cirurgia , Resultado do Tratamento , Fadiga
2.
J Surg Res ; 281: 214-222, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36191377

RESUMO

INTRODUCTION: Little is known about nationwide practice patterns for the management medullary thyroid cancer (MTC) in relation to the 2015 American Thyroid Association guidelines and their impact on survival. METHODS: Using the Surveillance, Epidemiology, and End Results Program database (2000-2018), MTC treatment patterns were evaluated in terms of adherence to the 2015 American Thyroid Association guidelines across three time periods (2000-2009, 2010-2015, and 2016-2018). Outcomes of interest were guideline concordance, treatment utilization trends, disease-specific survival (DSS), and overall survival (OS). RESULTS: A total of 3332 patients with MTC were identified. Of which, 53.8%, 33.2%, and 11.4% of patients had localized, regional, and distant disease, respectively. In patients with locoregional disease, the rate of guideline-concordant surgery improved over time from 63.0% in 2000-2009 to 76.0% in 2016-2018 (P < 0.001). Guideline-concordant care was associated with increased OS (HR = 1.85, 95% CI: 1.42-2.43, P < 0.001) in patients with localized disease and increased DSS (HR = 1.65, 95% CI: 1.01-2.54, P < 0.001) and OS (HR = 1.89, 95% CI: 1.35-2.58, P < 0.001) in patients with regional disease. The median OS and DSS in patients with distant disease were 31 and 55 mo, respectively, and the rate of chemotherapy use rose from 21.6% to 39.2% (P = 0.003). CONCLUSIONS: The rate of guideline-concordant surgery for locoregional MTC increased after guideline publication in 2015, with an observed prolongment in OS and DSS. Chemotherapy use among patients with distant disease has increased over time, but their prognosis remains variable.


Assuntos
Neoplasias da Glândula Tireoide , Tireoidectomia , Humanos , Fidelidade a Diretrizes , Excisão de Linfonodo , Estadiamento de Neoplasias , Neoplasias da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/patologia , Prognóstico , Estudos Retrospectivos
3.
Ann Otol Rhinol Laryngol ; 132(1): 77-81, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35172629

RESUMO

OBJECTIVES: Opioid analgesia has been integral in post-operative pain control for decades. The over-prescription of opioids, commonly in the surgical patient, has contributed to the current opioid epidemic. Liposomal bupivacaine (LB), a long-acting analgesia formulation, has demonstrated decreased post-operative pain and opioid requirements in patients treated across multiple surgical subspecialties. The aims of this retrospective study are to assess post-operative pain and opioid use in patients who received LB at the time of thyroidectomy. METHODS: A cohort-matched retrospective review of patients who underwent thyroidectomy by 2 surgeons between January 2010 and December 2019 was performed. Patients were divided into those that received LB intraoperatively and those that did not. Statistical analyses were performed using the Chi-square or Fisher's exact test, and 2-sample T-test or Wilcoxon rank sum test. RESULTS: Of the 201 patients included in this study, 113 patients received LB and 88 did not. Patients who received LB had a lower median visual analog scale (VAS) pain score (2 vs 3, P = .2252), lower maximum VAS pain score (6 vs 7, P = .0898), were less likely to require opioid medications (73.5% vs 85.2%, P = .0434), and had a lower percentage of daily morphine milligram equivalent value ≥45 (89.8% vs 95.3%, P = .1581) during the post-operative period when compared to those that did not. CONCLUSION: This study suggests a role for incisional infiltration with LB for post-operative pain management in patients undergoing transcervical thyroidectomy. We report reduced post-operative pain scores and opioid analgesia requirements in patients who received LB.


Assuntos
Analgésicos Opioides , Bupivacaína , Humanos , Analgésicos Opioides/uso terapêutico , Bupivacaína/uso terapêutico , Anestésicos Locais/uso terapêutico , Estudos Retrospectivos , Tireoidectomia/efeitos adversos , Lipossomos/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico
4.
Bull Exp Biol Med ; 173(6): 794-800, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36322315

RESUMO

In this study we present 2 surgical models of hypothyroidism in male Wistar rats (n=80) based on total thyroidectomy. Animals weighing 180-200 g were randomly divided into sham-operated group and 2 experimental groups. Thyroidectomy was performed by 2 different methods: primary ligation of either thyroid artery (TE-I) or vein (TE-II). The success of the model was verified through general postoperative conditions, serum hormone levels, histological study, and neck ultrasound. Hypothyroidism was successfully reproduced in both TE-I and TE-II models. TE-I was characterized by lower intra- and post-operative mortality, while TE-II provided better surgical exposure to the key anatomical sites.


Assuntos
Hipotireoidismo , Ratos , Animais , Masculino , Ratos Wistar , Hipotireoidismo/patologia , Tireoidectomia
5.
J Med Life ; 15(10): 1283-1293, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36420298

RESUMO

Endoscopic thyroid surgery has gained popularity with the advances in laparoscopic and endoscopic instruments and techniques. Of all endoscopic approaches for thyroidectomy, the transoral endoscopic thyroidectomy vestibular approach (TOETVA) is the most promising procedure as it avoids neck scars and has less tissue dissection than other endoscopic techniques. This study aimed to present our first impression and initial experience with TOETVA in Erbil city. Twelve patients underwent surgery between November 2020 and April 2021, including eleven females and one male. Eleven total thyroidectomies and one lobectomy were performed. We found no significant postoperative complications. TOETVA is a safe and effective procedure, but it is challenging, needs good skills, and is a promising technique.


Assuntos
Laparoscopia , Tireoidectomia , Feminino , Humanos , Masculino , Tireoidectomia/efeitos adversos , Tireoidectomia/métodos , Iraque , Glândula Tireoide/cirurgia , Complicações Pós-Operatórias/etiologia
6.
Front Endocrinol (Lausanne) ; 13: 1041538, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36387905

RESUMO

Objective: To investigate the clinicopathological characteristics of papillary thyroid cancer (PTC) and identify risk factors for postoperative recurrence of PTC with recurrent laryngeal nerve (RLN) involvement. Methods: In total, 171 patients (112 women and 59 men, age: 18-80 years, and 65 patients aged ≥ 55) with T4a PTC with RLN involvement, treated at Beijing Tongren Hospital, Capital Medical University, from January 2006 to December 2020, were retrospectively examined. Clinicopathological characteristics, including voice analysis results, and survival outcomes were assessed. The Mann-Whitney U and Kruskal-Wallis H tests were used to analyze differences in acoustic parameters. The Kaplan-Meier method was used to calculate the overall survival (OS) and recurrence-free (RFS) rates. Univariate and multivariate Cox regression analyses were performed of the clinical data. Results: The postoperative follow-up period ranged from 12 to 196 months (mean: 66.18 months). Of the 171 patients, 16 had recurrence and 8 died of thyroid-related diseases. The 5-year OS rate was 95.22%. The 5-year RFS rate was 89.38%. Jitter and shimmer were higher and maximum phonation time was shorter in patients with preoperative vocal cord paralysis (VCP) than in those without RLN involvement, and in those with RLN involvement but without preoperative VCP. Acoustic parameters were similar in patients with no preoperative VCP and those without RLN involvement. Voice analysis results did not differ between cases with RLN adhesion and RLN invasion. Univariate analysis showed that age at onset ≥ 55 years, preoperative RLN palsy, and esophageal invasion were risk factors for postoperative recurrence of PTC with RLN involvement. Multivariate analysis showed that onset age ≥ 55 years (OR 4.52, 95% confidence interval: 1.44-14.19, P = 0.010) was an independent risk factor for recurrence. Conclusions: PTC patients with RLN invasion can achieve good outcomes. Preoperative voice analysis may offer insights into RLN function. Age of onset ≥ 55 years is an independent risk factor for postoperative recurrence in T4a PTC patients.


Assuntos
Doenças da Glândula Tireoide , Neoplasias da Glândula Tireoide , Paralisia das Pregas Vocais , Masculino , Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Nervo Laríngeo Recorrente/cirurgia , Nervo Laríngeo Recorrente/fisiologia , Câncer Papilífero da Tireoide/patologia , Estudos Retrospectivos , Tireoidectomia/métodos , Paralisia das Pregas Vocais/etiologia , Paralisia das Pregas Vocais/cirurgia , Doenças da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/patologia
7.
Front Endocrinol (Lausanne) ; 13: 1015319, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36339396

RESUMO

Purpose: Clinical guidelines presently recommend total thyroidectomy for the treatment of medullary thyroid cancer (MTC). This study was aimed to investigate whether lobectomy could be the initial treatment for stage I MTC patients. Methods: The retrospective study was based on data from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015. The risk factors of survival were estimated by the univariate and multivariate Cox proportional-hazards model. The effect of age on death risk was estimated using restricted cubic splines. Survival curves were constructed according to the Kaplan-Meier method. Results: A total of 988 stage I MTC patients was included in the study. Among them, 506 (51.2%) MTC patients received lobectomy and 482 (48.8%) received total thyroidectomy. The only independent prognostic factor for overall survival (OS) and disease-specific survival (DSS) was age, according to univariate and multivariate Cox regression analysis. The hazard ratio (HR) increased relatively slowly with age growing under the age of approximately 60 years. However, the death risk of MTC patients began to rise sharply with increasing age above 60 years. For patients under the age of 60, a significant survival difference for OS and DSS was observed between the lobectomy group and total thyroidectomy group (p < 0.05). However, for patients aged above 60, no significant survival difference was observed for OS or DSS (p > 0.05). Conclusion: Total thyroidectomy was an appropriate treatment for stage I MTC patients under the age of 60, which was consistent with the recommendation of the clinical guidelines. However, for those over the age of 60, lobectomy may be explored as a better surgical option. The findings may provide the evidence base for improving the clinical management of stage I MTC patients. Further prospective multicenter clinical studies are needed including information regarding RET status as well as calcitonin and CEA levels.


Assuntos
Carcinoma Neuroendócrino , Neoplasias da Glândula Tireoide , Humanos , Idoso , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/terapia , Carcinoma Neuroendócrino/cirurgia , Tireoidectomia/métodos
8.
Zhonghua Zhong Liu Za Zhi ; 44(11): 1214-1220, 2022 Nov 23.
Artigo em Chinês | MEDLINE | ID: mdl-36380671

RESUMO

Objective: To evaluate the effect of ultrasound diagnosis of thyroid micro-malignant nodules and accumulate practical experience for the management of active surveillance for them, so as to avoid overtreatment. Methods: A total of 949 patients who were diagnosed with thyroid malignant nodules using ultrasonography, with the nodules being less than 1 cm in size and without regional lymph node metastasis or distant metastasis, were included. They were treated by the same surgeon of the Department of Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Sciences from February 2014 to December 2020. 112 patients chose immediate surgery. The rest patients were asked to accept ultrasound examination every 6 months to 1 year. Follow-up endpoints: tumor size growth of 3 mm, tumor volume increase greater than 50%, lymph node metastasis or distant metastasis. Results: The median follow-up time was 19 months. 713 patients underwent surveillance for more than 6 months. Of the 713 patients, 570 (79.9%) were women, with mean age at 43.5 years old. Tumor progression was observed in 47 (6.6%) patients with a cumulative incidence of 2.7% (1 year), 7.2% (2 years) and 9.5% (3 years). In multivariate analysis, patient age [HR=0.508, 95%CI: 0.275-0.939, P=0.031], lesion number [HR=2.945, 95%CI: 1.593-5.444, P=0.001] and tumor size [HR=2.245, 95%CI: 1.202-4.192, P=0.011] at the beginning of observation were independent risk factors for tumor progression in patients with minimal thyroid malignant nodules during follow-up. During a median (range) active surveillance of 19 (6-80) months, 74 patients chose surgery during the surveillance. Among the 186 patients who underwent surgery, only 3 patients were diagnosed with fibrotic nodules in pathology, while the rest were papillary thyroid carcinoma. The ultrasound accuracy reached 98.4%(183/186). Conclusions: Ultrasonography is an effective method of diagnosing malignant thyroid nodules. Thyroid micro-malignant nodules progress slowly. As a result, it is safe to observe them instead of taking immediate surgery. Patient age, lesion number and tumor size at the beginning of observation are independent risk factors for the tumor progression of malignant nodules.


Assuntos
Carcinoma Papilar , Neoplasias da Glândula Tireoide , Nódulo da Glândula Tireoide , Humanos , Feminino , Adulto , Masculino , Nódulo da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/cirurgia , Carcinoma Papilar/cirurgia , Metástase Linfática , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Conduta Expectante , Ultrassonografia , Estudos Retrospectivos
9.
Medicina (Kaunas) ; 58(11)2022 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-36363517

RESUMO

Background and Objectives: Recurrent laryngeal nerve (RLN) paralysis is a fearful complication during thyroidectomy. Intraoperative neuromonitoring (IONM) and optical magnification (OM) facilitate RLN identification and dissection. The purpose of our study was to evaluate the influence of the two techniques on the incidence of RLN paralysis and determine correlations regarding common outcomes in thyroid surgery. Materials and Methods: Two equally sized groups of 50 patients who underwent total thyroidectomies were examined. In the first group (OM), only surgical binocular loupes (2.5×-4.5×) were used during surgery, while in the second group (IONM), the intermittent NIM was applied. Results: Both the operative time and the length of hospitalization were shorter in the OM group than in the IONM group (median 80 versus 100 min and median 2 versus 4 days, respectively) (p < 0.05). The male patients were found to have a five-fold higher risk of developing transient dysphonia than the females (adjusted OR 5.19, 95% IC 0.99-27.18, p = 0.05). The OM group reported a four-fold higher risk of developing transient hypocalcemia than the IONM group (OR 3.78, adjusted OR 4.11, p = 0.01). Despite two cases of temporary bilateral RLN paralysis in the IONM group versus none in the OM group, no statistically significant difference was found (p > 0.05). No permanent RLN paralysis or hypoparathyroidism have been reported. Conclusions: Despite some limitations, our study is the first to compare the use of IONM with OM alone in the prevention of RLN injuries. The risk of recurrent complications remains comparable and both techniques can be considered valid instruments, especially if applied simultaneously by surgeons.


Assuntos
Traumatismos do Nervo Laríngeo Recorrente , Paralisia das Pregas Vocais , Feminino , Humanos , Masculino , Traumatismos do Nervo Laríngeo Recorrente/epidemiologia , Traumatismos do Nervo Laríngeo Recorrente/etiologia , Traumatismos do Nervo Laríngeo Recorrente/prevenção & controle , Tireoidectomia/efeitos adversos , Tireoidectomia/métodos , Paralisia das Pregas Vocais/epidemiologia , Paralisia das Pregas Vocais/etiologia , Paralisia das Pregas Vocais/prevenção & controle , Glândula Tireoide/cirurgia , Duração da Cirurgia , Estudos Retrospectivos
10.
Georgian Med News ; (330): 59-64, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36427843

RESUMO

Cosmetic outcome is one of the essential objectives in the surgical management of thyroid diseases. To improve that; many new technologies has been proposed, among these; mini-invasive and natural orifice thyroidectomy. Transoral endoscopic thyroidectomy-vestibular approach (TOETVA) is the most recent natural orifice approach to the thyroid and parathyroid glands.; Aim - to report the learning curve for Transoral endoscopic thyroidectomy -vestibular approach (TOETVA) for a senior surgeon already had experience in conventional thyroid and minimal access surgery.; From December 2017 to October 2019, ten patients were included in the study and serially grouped into two groups; five in each. They were prospectively observed for the operative time, Intra- and postoperative complications, hospital stay and functional assessment. ; When compared with group (1); operative time saving in group (2) was about 35 minutes. No case was converted to conventional surgery. Accidental mucosal and skin lesions while introducing the surgical trocars were observed in the first two cases only.; Recurrent laryngeal nerve was identified in nine cases; even that, transient palsy was noticed in two cases of group (1) only. One patient from each group experiences lower paresthesia. Even if it is not routine; the use of drain decreased significantly in the last five cases.; All the patients developed post-operative subcutaneous emphysema and ecchymosis and resolved spontaneously on 1 and 10 days respectively.; After five Transoral endoscopic thyroidectomy-vestibular approach (TOETVA), a senior surgeon who had adequate basic experiences in conventional thyroidectomy and minimal access surgery can safely masters the technique of the surgery with satisfactory operative times, and a decreasing rate of intra- and postoperative complications. Exposure to more cases would reduce the learning curve.


Assuntos
Cirurgiões , Tireoidectomia , Humanos , Tireoidectomia/métodos , Curva de Aprendizado , Estudos Retrospectivos , Complicações Pós-Operatórias
11.
Medicine (Baltimore) ; 101(46): e29673, 2022 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-36401391

RESUMO

To compare the different techniques of managing the anterior cervical muscle group during endoscopic thyroidectomy via the trans-thoraco-areolar approach. A total of 90 patients with thyroid tumors less than 3 cm were evaluated. The time for each intraoperative step, total surgery duration, intraoperative blood loss volume, pathology results, number of lymph nodes dissected and patient satisfaction with esthetics were assessed. Intraoperative blood loss volume, drainage volume on the first postoperative day, number of lymph nodes dissected in the central region, postoperative hospitalization duration, number of transient laryngeal nerve palsy cases, and number of transient hypocalcemia cases were similar between the muscle transection (MT) and muscle retraction (MR) groups. The MT group had significantly higher postoperative pain scores after 12 hours, but pain scores at 48 hours postoperatively were not significantly different between the 2 groups. In the unilateral thyroidectomy subgroup, the durations of isthmus resection, freeing the lateral thyroid, exposing the laryngeal recurrent nerve, and management of the inferior pole were similar for both muscle management methods. The muscle dissection and suture time was significantly longer for the MT group than that for the MR group; in contrast, the upper pole management time of the muscle resection group was significantly shorter. In the bilateral resection subgroup, both muscle management methods required similar durations for managing the contralateral upper pole after ipsilateral thyroidectomy. However, intraoperative blood loss was significantly higher for MR than for MT, while postoperative pain was relatively mild. In the malignant tumor subgroup, duration of inferior thyroid pole management was significantly less for MT than for MR. There are significant differences between the 2 muscle management methods in handling and suturing muscles. Both methods have satisfactory postoperative outcomes for resection of thyroid nodules with diameters ≤3 cm. For tumors located in the upper pole, transection of the anterior cervical muscles confers higher feasibility of the thyroidectomy technique; however, suturing becomes difficult in such scenarios.


Assuntos
Neoplasias da Glândula Tireoide , Tireoidectomia , Humanos , Tireoidectomia/efeitos adversos , Tireoidectomia/métodos , Perda Sanguínea Cirúrgica , Endoscopia/métodos , Neoplasias da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/patologia , Dor Pós-Operatória/cirurgia
12.
Medicine (Baltimore) ; 101(43): e31393, 2022 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-36316835

RESUMO

BACKGROUND: Thyroidectomy is performed under general anesthesia using inhaled anesthetics such as sevoflurane or desflurane in many cases. The objective of this study was to investigate whether the incidence of postoperative pain and discomfort after thyroidectomy differed with the type of inhaled anesthetic. METHODS: Eighty-one female patients who underwent thyroidectomy were randomly assigned to the Sevo group (n = 42) or the Des group (n = 39). On the day of surgery and on the first, third, and seventh days after surgery, one registered nurse in charge of the entire questionnaire survey conducted the questionnaire assessment through face-to-face interviews or phone calls with the patients. The questionnaire evaluated the severity scores for seven items (sore throat, wound pain, nausea and vomiting, dizziness, occipital headache, posterior neck pain, and shoulder pain) regarding postoperative pain and discomfort experienced by patients and assessed which of these seven items caused the greatest discomfort to the patient on each day. RESULTS: Except for the severity score for dizziness on the day of surgery, the severity scores of postoperative pain and discomfort experienced by patients on the day of surgery and on the first, third, and seventh days after surgery showed no statistically significant differences between the two groups. In addition, on the day of surgery and on the first, third, and seventh days after surgery, patients reported that sore throat caused the greatest discomfort. CONCLUSION: In patients undergoing thyroidectomy under general anesthesia using sevoflurane or desflurane, except for dizziness on the day of surgery, no other manifestation of postoperative pain and discomfort was influenced by the type of inhaled anesthetic. Moreover, after thyroidectomy, postoperative sore throat caused the greatest discomfort to patients from the day of surgery to the seventh day after surgery.


Assuntos
Anestésicos Inalatórios , Isoflurano , Éteres Metílicos , Faringite , Humanos , Feminino , Sevoflurano , Desflurano , Anestésicos Inalatórios/efeitos adversos , Éteres Metílicos/efeitos adversos , Isoflurano/efeitos adversos , Tireoidectomia/efeitos adversos , Estudos Prospectivos , Tontura , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia
13.
BMC Surg ; 22(1): 374, 2022 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-36324095

RESUMO

BACKGROUND: While the most suitable approach for treating persistent/recurrent papillary thyroid carcinoma (PTC) remains controversial, reoperation may be considered an effective method. The efficacy of reoperation in patients with locoregional persistent/recurrent PTC, especially those with unsatisfactory radioactive iodine (RAI) ablation results, is still uncertain. This study aimed to clarify the clinical management strategies for locoregional persistent/recurrent PTC and to explore factors that may affect long-term patient outcomes after reoperation. METHODS: In total, 124 patients who initially underwent thyroidectomy and variable extents of RAI therapy and finally received reoperation for locoregionally persistent/recurrent PTC were included. The parameters associated with recurrence-free survival (RFS) were analysed using a Cox proportional hazards model. RESULTS: Overall, 124 patients presented with structural disease after initial therapy and underwent secondary surgical resection, of whom 32 patients developed further structural disease during follow-up after reoperation. At the time of reoperation, metastatic lymph nodes with extranodal extension (P = 0.023) and high unstimulated thyroglobulin (unstim-Tg) levels after reoperation (post-reop) (P = 0.001) were independent prognostic factors for RFS. Neither RAI avidity nor the frequency and dose of RAI therapies before reoperation affected RFS. CONCLUSIONS: Reoperation is an ideal clinical treatment strategy for structural locoregional persistent/recurrent PTC, and repeated empirical RAI therapies performed prior to reoperation may not contribute to the long-term outcomes of persistent/recurrent PTC patients. Metastatic lymph nodes with extranodal extension and post-reop unstim-Tg > 10.1 ng/mL may predict a poor prognosis.


Assuntos
Carcinoma Papilar , Neoplasias da Glândula Tireoide , Humanos , Câncer Papilífero da Tireoide/cirurgia , Radioisótopos do Iodo/uso terapêutico , Reoperação , Carcinoma Papilar/cirurgia , Carcinoma Papilar/patologia , Neoplasias da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/patologia , Prognóstico , Extensão Extranodal , Recidiva Local de Neoplasia/patologia , Estudos Retrospectivos , Tireoidectomia/efeitos adversos , Doença Crônica
14.
BJS Open ; 6(6)2022 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-36426588

RESUMO

BACKGROUND: The extent of thyroid surgery remains controversial for differentiated thyroid cancers (DTCs) that measure more than 1 cm but are not considered high risk. This study aimed to compare survival outcomes between hemithyroidectomy (HT) and total thyroidectomy (TT) in non-high-risk DTCs. METHODS: A population-based retrospective cohort of patients with non-high-risk DTCs more than 1 cm undergoing HT or TT between 1997 and 2017 in a territory with 41 public hospitals and clinics serving a population of 7 million was analysed. Multivariable Cox proportional hazards regression models adjusted for patient demographics and clinical parameters were used to compare the overall, disease-specific, and recurrence-free survival between TT and HT. Risks of postoperative complications were compared between the two groups. RESULTS: A total of 4771 patients (HT, 1368; TT, 3403) underwent thyroid surgery as a primary treatment. Median (range) follow-up was 117 (range: 72-179) months. Patients in the TT and HT groups had comparable risks of overall survival (HR 0.87; 95 per cent c.i. 0.73 to 1.04; P = 0.119) and disease-specific survival (HR 0.85; 95 per cent c.i. 0.52 to 1.40; P = 0.518). The TT group had better recurrence-free survival (HR 0.37; 95 per cent c.i. 0.26 to 0.52; P < 0.001) than the HT group. The temporary and permanent hypoparathyroidism rates in TT group were 14.96 per cent and 7.49 per cent respectively; none were reported in the HT group. CONCLUSIONS: Despite the comparable overall and disease-specific survivals, TT was associated with better recurrence-free survival than HT in a 10-year follow-up. This was at the expense of higher surgical morbidity rate in TT.


Assuntos
Adenocarcinoma , Hipoparatireoidismo , Neoplasias da Glândula Tireoide , Humanos , Tireoidectomia/efeitos adversos , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/cirurgia , Hipoparatireoidismo/epidemiologia , Adenocarcinoma/cirurgia
15.
Chirurgia (Bucur) ; 117(5): 556-562, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36318685

RESUMO

INTRODUCTION/OBJECTIVE: Thyroid carcinoma (TC) accounts for one percent of all carcinomas, with a higher incidence in women. Although there is controversy on the selection of the best surgical treatment for differentiated TC, total thyroidectomy (TT) and subtotal thyroidectomy (STT) are still the two main surgical procedures. The aim of the present study was to evaluate the early complication rates of thyroidectomy in patients undergoing thyroid surgery at a tertiary hospital in Greece. Methods: A total of 306 patients with differentiated TC who underwent thyroid surgery were enrolled retrospectively. Patients were divided into two groups. Group A included 214 patients undergoing TT, whereas 92 patients (group B) underwent STT. Demographic details of patients, operating time, and early complications (hypoparathyroidism, hematoma, infection, temporary recurrent laryngeal nerve palsy) were noted. Results: There was no significant difference in the sex, age, and mean operating time between the two groups (P=0.47, P=0.55, and P=0.09, respectively). Either hematoma or wound infection occurred in 3 (1.4%) or 4 (1.87%) of the patients undergoing TT compared to two (2.17%) or three (3.26%) of the patients undergoing STT (P=0.63 and P=0.46, respectively). In addition, either hypoparathyroidism or temporary recurrent laryngeal nerve palsy was observed in 34 (15.89%) or 13 (6.07%) of the patients undergoing TT compared with eleven (11.96%) or nine (9.78%) of the patients undergoing STT (P=0.37 and P=0.25, respectively). Conclusions: The current study demonstrates that total thyroidectomy can be safely performed in patients with differentiated thyroid carcinoma without increasing the risk of early complications.


Assuntos
Adenocarcinoma , Hipoparatireoidismo , Neoplasias da Glândula Tireoide , Paralisia das Pregas Vocais , Humanos , Feminino , Tireoidectomia/métodos , Estudos Retrospectivos , Paralisia das Pregas Vocais/etiologia , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Neoplasias da Glândula Tireoide/cirurgia , Hipoparatireoidismo/etiologia , Hematoma , Adenocarcinoma/cirurgia
16.
Front Endocrinol (Lausanne) ; 13: 1030007, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36325460

RESUMO

Background: Postoperative hypoparathyroidism remains the most frequent complication of neck endocrine surgery. In order to reduce the incidence of this feared complication, several systems for imaging of near infrared autofluorescence (NIRAF) have been invented to help surgeons identify parathyroid glands (PTGs) and evaluate their vascularization. We evaluated the efficacy of the EleVision IR system in thyroid and parathyroid surgery. Methods: We used the EleVision IR system in 25 patients who underwent thyroid/parathyroid surgery or both at our institution between December 2020 and July 2021. At various stages of the surgery, the surgeon first looked for PTGs with the naked eye and then completed the visual inspection with NIRAF imaging. We then compared both the naked eye and NIRAF-supported PTGs detection rates. At the end of surgery, we performed indocyanine green angiography of PTGs in 17 patients. Results: In total, we identified 80% of PTGs: 65% with the naked eye only and additional 15% with the assistance of the EleVision IR system. 14 of 17 patients evaluated by ICG angiography had at least one well-vascularized PTG. Only one of these patients (a case of subtotal parathyroidectomy for tertiary hyperparathyroidism) developed symptomatic postoperative hypocalcemia despite a normal parathormone level. The three other patients had at least one remaining moderately-vascularized PTG and only one patient developed transient postoperative hypoparathyroidism. Conclusion: We concluded that EleVision IR provides an efficient support for identification and evaluation of PTGs, and may be of great assistance in endocrine surgery. The images are easy to interpret even for less experienced surgeons thanks to the different types of color visualization and the possibility to measure the relative fluorescence intensity of PTGs and surrounding tissues.


Assuntos
Hipoparatireoidismo , Glândulas Paratireoides , Humanos , Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/cirurgia , Tireoidectomia/métodos , Hipoparatireoidismo/diagnóstico , Hipoparatireoidismo/etiologia , Paratireoidectomia/efeitos adversos , Paratireoidectomia/métodos , Perfusão/efeitos adversos
17.
Khirurgiia (Mosk) ; (10): 63-68, 2022.
Artigo em Russo | MEDLINE | ID: mdl-36223152

RESUMO

OBJECTIVE: To emphasize the main stages of safe endoscopic surgery on endocrine organs of the neck. MATERIAL AND METHODS: There were 79 patients with diseases of thyroid and parathyroid glands who underwent surgery between 2018 and 2021. Of these, 69 ones underwent transaxillary thyroidectomy, 10 patients underwent transaxillary parathyroidectomy. RESULTS: At initial stage of development of this technique, we obtained 2 intraoperative and 2 postoperative complications. Adverse events were completely cured. CONCLUSION: Endoscopic procedures on the endocrine organs of the neck are a safe alternative to traditional approaches. There are certain advantages of this approach. Compliance with surgical technique and focusing on dangerous stages minimize the risk of complications.


Assuntos
Endoscopia , Tireoidectomia , Endoscopia/efeitos adversos , Endoscopia/métodos , Humanos , Pescoço/cirurgia , Glândulas Paratireoides/cirurgia , Paratireoidectomia/efeitos adversos , Paratireoidectomia/métodos , Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversos , Tireoidectomia/métodos
18.
Rev Med Liege ; 77(10): 616-620, 2022 Oct.
Artigo em Francês | MEDLINE | ID: mdl-36226399

RESUMO

The clinician can access to a panel of therapeutic options to treat hyperthyroidism. Drugs, nuclear medicine and surgery can be used to take care of patients. Quite often, different options can be proposed to the same patient. The choice will be made based on each individual case : the presence of comorbidities, the urgency of the situation, the familial context and the patient's wishes. In this paper we will review the main therapeutic options. We will then discuss the key points that will allow to choose the most appropriate treatment.


Le traitement de l'hyperthyroïdie fait appel à un éventail de solutions allant des médicaments à la chirurgie en passant par la médecine nucléaire. Souvent, plusieurs options sont possibles dans une situation donnée. Le choix peut se faire en fonction de chaque contexte particulier : comorbidités, urgence, entourage familial et choix personnels. Dans cette vignette, nous passons en revue les grands axes thérapeutiques et leurs spécificités. Nous insistons ensuite sur les points qui permettent de décider du traitement.


Assuntos
Hipertireoidismo , Tireoidectomia , Humanos , Hipertireoidismo/diagnóstico , Hipertireoidismo/terapia
19.
BMJ Case Rep ; 15(10)2022 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-36207056

RESUMO

Several genetic and environmental factors contribute to the development of multinodular goitre. A transcervical surgical resection is recommended for larger goitres, though a minority of cases may require sternotomy or thoracotomy. We present a case of a posterior substernal goitre that was resected with combined transcervical and robotically assisted thoracic approaches. A woman in her 30s with an enlarging thyroid goitre elected to proceed with surgical resection. CT imaging demonstrated significant extension of the goitre into the posterior mediastinum and a staged approach was decided on. Both the initial transcervical thyroidectomy and the subsequent robotically assisted resection of the mediastinal portion were successful, without major complications. While most substernal goitres can be resected transcervically, certain rare anatomic features, such as extension into the posterior mediastinum, warrant consideration of a thoracic approach. Specifically, a robotic-assisted resection poses several advantages over traditional, more invasive approaches.


Assuntos
Bócio Subesternal , Procedimentos Cirúrgicos Robóticos , Feminino , Bócio Subesternal/diagnóstico por imagem , Bócio Subesternal/cirurgia , Humanos , Mediastino/cirurgia , Estudos Retrospectivos , Esternotomia , Tireoidectomia/métodos
20.
J Coll Physicians Surg Pak ; 32(10): 1326-1329, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36205279

RESUMO

OBJECTIVE: To determine the location of thyroid-related nerves by nerve monitoring and demonstrate the usefulness of Nerve Integrity Monitor in thyroid surgery. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of General Surgery, University of Health Sciences, Istanbul Training and Research Hospital, Turkey, from February 2017 to January 2020. METHODOLOGY: Patients, who underwent thyroid surgery, were evaluated for age, gender, preoperative diagnosis, type of surgery, histopathological result, postoperative hoarseness, and postoperative vocal cord examinations. The vagus nerve, recurrent laryngeal nerve (RLN), and superior laryngeal nerve (SLN) were mapped by nerve monitoring. RESULTS: A total of 328 patients were included in this study. On both sides, the vagus nerve was most often located in the posterior of the internal carotid artery and internal jugular vein and less frequently anterior to this vein. A total of 303 right RLNs and 305 left RLNs were verified. The SLN was visualised or motor activity was verified by nerve monitoring on the right side in 181 patients and on the left side in 179 patients. The SLN's location was classified most frequently as type I and least frequently as type IIb on the right and left sides. CONCLUSION: The reported variations, the experience of the surgeon, and these anatomical markers cannot be adequate in preventing nerve injuries. Furthermore, the variations can be identified more clearly peroperatively with the use of nerve monitoring. KEY WORDS: Laryngeal nerves, Nerve mapping, Nerve monitoring, Nervus vagus, Thyroid surgery, Zuckerkandl tubercles.


Assuntos
Traumatismos do Nervo Laríngeo Recorrente , Glândula Tireoide , Humanos , Nervos Laríngeos , Nervo Laríngeo Recorrente/fisiologia , Traumatismos do Nervo Laríngeo Recorrente/prevenção & controle , Traumatismos do Nervo Laríngeo Recorrente/cirurgia , Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversos , Nervo Vago/fisiologia
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