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1.
Pan Afr Med J ; 35: 9, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32117524

RESUMO

Lesions of the inferior laryngeal nerve are the most devastating complications of thyroid surgery. Identifying the inferior laryngeal nerve is all the more difficult when its path is atypical. We report a case of right non-recurrent inferior laryngeal nerve detected during thyroidectomy.


Assuntos
Complicações Pós-Operatórias/diagnóstico , Traumatismos do Nervo Laríngeo Recorrente/diagnóstico , Tireoidectomia/efeitos adversos , Adulto , Feminino , Humanos , Glândula Tireoide/cirurgia , Tireoidectomia/métodos
3.
Am Surg ; 86(2): 121-126, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32167046

RESUMO

We performed a retrospective study of our large patient cohort aiming to examine the ability to predict postthyroidectomy hypocalcemia. A retrospective review of patients who underwent total or near-total thyroidectomy at our institution between 2008 and 2018 was performed. Postoperative hypocalcemia was defined as Ca level <8.0 mg/dL (reference range: 8.9-10.1 mg/dL) within 30 days of operation. Logistic regression was used to develop models for prediction of the occurrence of postoperative hypocalcemia. Inclusion criteria were met by 1463 patients. Hypocalcemia was documented in 223 patients (15%). Models based on parathyroid hormone (PTH) levels alone had an associated receiver operator characteristic with an areas under the curve (AUC) of 0.79. There was an inverse relationship between time of measurement and PTH levels within the first two hours after thyroidectomy (P < 0.01). When measured two to six hours after closure, the predictive ability of PTH compared favorably (AUC = 0.82) with either earlier (within the first two hours after closure, AUC = 0.79) or later measurement (6-24 hours after closure, AUC = 0.77). When measured between two and six hours postoperatively, PTH < 19 pg/mL had a sensitivity of 90 per cent and negative predictive value of 96 per cent for postoperative hypocalcemia. The model that included the PTH level, concurrently measured total blood calcium level, and time of measurement had an improved predictive ability with an AUC of 0.87. PTH level of 19 pg/mL measured two to six hours after thyroidectomy had a sensitivity of 90 per cent and a negative predictive value of 96 per cent in our cohort. The model including postoperative PTH level, calcium level, and time of measurement may further improve the ability to predict postthyroidectomy hypocalcemia.


Assuntos
Hipocalcemia/etiologia , Hormônio Paratireóideo/sangue , Complicações Pós-Operatórias , Tireoidectomia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Biomarcadores/sangue , Cálcio/sangue , Feminino , Humanos , Hipocalcemia/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Fatores de Tempo , Adulto Jovem
4.
BMC Surg ; 20(1): 6, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31914981

RESUMO

BACKGROUND: Head and neck surgeries can perturb normal structures of neck muscles and nerve innervations, which are supposed to function in harmony to allow complicated process like swallowing. It is still likely that cricopharyngal dysfunction emerges years after the head and neck surgeries. CASE PRESENTATION: We report a case with history of left unilateral vocal cord immobility and development of dysphagia and aspiration 2 years after radical thyroidectomy with neck lymph nodes dissection and medialization thyroplasty. Cricopharyngeal dysfunction was impressed and was confirmed with visualization of cricopharyngeal narrowing segment in radiographic contrast swallow examination. The patient was treated successfully by cricopharyngeal myotomy, achieving long-term relief in our 4 years of follow up. CONCLUSIONS: Our case of delayed cricopharyngal dysfunction after radical thyroidectomy and medialization thyroplasty shows that it is important to follow up swallowing functions after patients with UVCI undergo medialization thyroplasty. In the event of delayed manifestation of cricopharyngeal function, it can still be treated successfully by cricoharyngeal myotomy, achieving long term relief of dysphagia.


Assuntos
Transtornos de Deglutição/cirurgia , Traumatismos do Nervo Laríngeo/complicações , Miotomia/métodos , Esvaziamento Cervical/efeitos adversos , Músculos Faríngeos/cirurgia , Complicações Pós-Operatórias/cirurgia , Tireoidectomia/efeitos adversos , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Feminino , Humanos , Traumatismos do Nervo Laríngeo/fisiopatologia , Traumatismos do Nervo Laríngeo/cirurgia , Pessoa de Meia-Idade , Músculos Faríngeos/inervação , Músculos Faríngeos/fisiopatologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia
5.
J Surg Res ; 245: 64-71, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31401249

RESUMO

BACKGROUND: The American Thyroid Association (ATA) issued specific preoperative preparatory guidelines for patients undergoing thyroidectomy for treatment of Graves' disease. Our goal is to determine if compliance with these guidelines is associated with better outcomes. METHODS: A retrospective review of a prospectively maintained database identified 228 patients with Graves' disease who underwent total thyroidectomy between August 2007 and May 2015. Patients treated in compliance with ATA guidelines were compared with those not in full compliance with the current preparatory guidelines. RESULTS: At the time of surgery, 52% of all patients followed ATA guidelines. Patients who were prepped per ATA guidelines had fewer episodes of intraoperative tachycardia (0.3 versus 4.5, P = 0.04) but had no difference in peak systolic blood pressure or in number of episodes of systolic blood pressure > 180 mmHg. ATA prepped and nonprepped patients had similar mean operating room time and length of stay. ATA prepped and nonprepped patients had similar complication rates, including transient hypocalcemia (30.4% versus 25.5%, P = 0.45), prolonged hypoparathyroidism (0.98% versus 4.3%, P = 0.15), hoarse voice (10.8% versus 7.5%, P = 0.42), permanent recurrent laryngeal nerve paralysis (2.9% versus 2.1%, P = 0.71), and hematoma (2.9% versus 0%, P = 0.09). CONCLUSIONS: Our data suggest that compliance with ATA guidelines for thyroidectomy preparation is not essential for a successful surgical outcome. Although preparation per the guidelines decreased the frequency of intraoperative tachycardia, it did not impact intraoperative hypertension, operating room time, or postoperative complications.


Assuntos
Doença de Graves/cirurgia , Fidelidade a Diretrizes/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Guias de Prática Clínica como Assunto , Cuidados Pré-Operatórios/normas , Tireoidectomia/normas , Adulto , Bases de Dados Factuais/estatística & dados numéricos , Endocrinologia/normas , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Estudos Retrospectivos , Sociedades Médicas/normas , Tireoidectomia/efeitos adversos , Estados Unidos/epidemiologia , Adulto Jovem
6.
J Surg Res ; 245: 107-114, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31415931

RESUMO

BACKGROUND: To help control opioid overprescription, we conducted a large institutional, 3-site initiative to provide discharge prescribing guidelines for different procedures. Our aim is to refine institutional guidelines for parathyroidectomy. METHODS: Patients undergoing parathyroidectomy completed a 28-question survey about opioid consumption. Discharge opioid prescription amounts were converted into morphine milligram equivalents (MMEs) and reported as median and interquartile range (IQR). Consumption was dichotomized into top quartile MME users (Q4) versus standard users (Q1, Q3). Univariate analysis compared opioid consumption. RESULTS: A total of 91 patients were included; 90% were opioid-naive. While the median prescribed was 75 (IQR 75, 150) MME, the median consumed was 0 (IQR 0, 20). Top users reported higher pain scores [median (IQR): 2 (2, 4)] compared to standard users [1 (0, 3), P = 0.01]. However, there was no difference in opioid consumption between unilateral neck exploration, bilateral exploration, or thyroidectomy and parathyroidectomy, P = 0.11. There was no difference in opioid consumption by age, sex, or BMI (all P > 0.05). Of those receiving a prescription, 94.6% had left-over opioids at the time of survey, resulting in 82% of prescribed opioids being unused. CONCLUSIONS: Over half of patients undergoing parathyroidectomy did not consume any opioid, and very few needed more than 2 d of opioid. Moreover, most patients did not dispose the unused opioids, which put these pills at risk of diversion and misuse. Surgical approach did not change consumption, illustrating that these guidelines are applicable to thyroidectomy given the similarity between techniques. We recommend prescribing nonopioid analgesics for patients undergoing parathyroidectomy.


Assuntos
Analgésicos não Entorpecentes/efeitos adversos , Analgésicos Opioides/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Paratireoidectomia/efeitos adversos , Padrões de Prática Médica/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Prescrições de Medicamentos/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , /prevenção & controle , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Guias de Prática Clínica como Assunto , Uso Indevido de Medicamentos sob Prescrição/prevenção & controle , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Estudos Retrospectivos , Tireoidectomia/efeitos adversos
7.
Medicine (Baltimore) ; 98(51): e18309, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860980

RESUMO

This study aimed to investigate the application of the healthcare failure mode and effect analysis (HFMEA) to reduce the incidence of posture syndrome of thyroid surgery (PSTS).Subjects before (n = 78, July 2017-December 2017) and after (n = 114, January 2018-June 2018) HFMEA implementation (The Second Hospital of Nanjing, Nanjing University of Chinese Medicine) were selected. The training for PSTS was optimized using HFMEA.The occurrence of PSTS was reduced from 59% to 18% after HFMEA (P < .001). Symptoms of pain and nausea and vomiting were also decreased after HFMEA (all P < .001). The critical thinking ability of 34 medical personnel to evaluate the reduction of thyroid postoperative posture syndrome increased from 246 ±â€Š19 to 301 ±â€Š14 (P < .001) after HFMEA.HFMEA was used to create preoperative posture training procedures for PSTS, bedside cards for training, innovative preoperative posture training equipment, and a diversified preoperative posture training health education model.


Assuntos
Análise do Modo e do Efeito de Falhas na Assistência à Saúde , Posicionamento do Paciente/métodos , Complicações Pós-Operatórias/prevenção & controle , Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversos , Adolescente , Adulto , Idoso , Análise do Modo e do Efeito de Falhas na Assistência à Saúde/métodos , Humanos , Incidência , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Melhoria de Qualidade , Síndrome , Neoplasias da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/cirurgia , Tireoidectomia/educação , Tireoidectomia/métodos , Adulto Jovem
9.
Chirurgia (Bucur) ; 114(5): 564-570, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31670631

RESUMO

The complications of thyroidectomy vary from hypocalcemia and recurrent laryngeal nerve lesions to injury of vocal folds, local hematoma, cysts, granuloma. Post-operative hypocalcemia has an incidence of 1.2-40%. Permanent hyoparathyroidism is registered in 3% of cases. This is a brief narrative review focusing on the levels of calcium after performing a thyroidectomy and the need of calcium supplements under these circumstances. This complication, even it seems rather harmless at first, in fact it represents an important contributor to hospitalization delay and, especially for severe forms, to poor quality of life, including the risk of life threatening episodes. Devascularisation of parathyroid glands in addition to injury or dissection causes hypoparathyroidism. Hypocalcemia risk differs with sex (females have a higher risk), lymph node dissection (it increases the risk), it differs with type of thyroidectomy (larger dissections have a higher risk; also the intervention for recurrent goitre and second intervention for post-operatory bleeding increase the risk of hypocalcemia; while Basedow disease is probably at higher risk than multinodular goitre among benign conditions) and the duration of procedure. Pre-operatory low calcium, parathormon (PTH), 25-hydroxivitamin D increases the risk. The calcium drop rate matters as well: a decrease of 1 mg/dL calcium over 12 hours after surgery is independently correlated with the risk of symptomatic hypocalcemia. Early post-operatory PTH and calcium are best predictors for the need of oral calcium supplements. Routine post-operatory calcium and vitamin D supplementation statistically significant decreases the risk of developing transitory hypocalcemia and acute complications compare to calcium alone supplements or no supplements. In cases of hypoparathyroidism calcitriol is preferred.


Assuntos
Hipocalcemia/terapia , Tireoidectomia/efeitos adversos , Cálcio/sangue , Humanos , Hipocalcemia/sangue , Hipocalcemia/etiologia , Hipoparatireoidismo/sangue , Hipoparatireoidismo/tratamento farmacológico , Hipoparatireoidismo/etiologia , Hormônio Paratireóideo/sangue , Qualidade de Vida , Fatores de Risco , Resultado do Tratamento
10.
Chirurgia (Bucur) ; 114(5): 579-585, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31670633

RESUMO

The current concept of complete resection of thyroid parenchyma shifted the practice from subtotal thyroidectomy to total thyroidectomy for a wide range of benign and malignant thyroid affliction and brought the tubercle of Zuckerkandl once again into attention. This embryological remnant has been shown to have a constant relationship with the recurrent laryngeal nerve and the superior parathyroid gland and may be used as a landmark for safe dissection. In order to assess if the presence of the tubercle of Zukerkandl has an impact on the most important complications of thyroid surgery, we have prospectively studied 128 patients diagnosed with nodular goiter who underwent total thyroidectomy. Grade 0 or the absence of the tubercle of Zuckerkandl, according to Pellizo et al, was noted in 42 cases (32.8%). During surgery, we identified 38 grade 1 tubercles (29.7%), 31 grade 2 tubercles (24.2%) and 16 grade 3 tubercles (12.5%). Out of 11 bilateral tubercles, 4 were measured as grade 3.Of all 47 patients with grade 2 and 3 tubercles, 18 (38.3%) developed transient postoperative hypocalcemia (p 0.0001, r=0.47) and 10 (21.3%) transient postoperative nerve palsy (p=0.004, r=0.25). All patients fully recovered during follow-up. The tubercle of Zuckerkandl, when present and of significant macroscopic size is associated with increased rates of transient postoperative hypocalcemia and recurrent laryngeal nerve palsy.


Assuntos
Bócio Nodular/cirurgia , Hipocalcemia/etiologia , Traumatismos do Nervo Laríngeo Recorrente/etiologia , Glândula Tireoide , Tireoidectomia/efeitos adversos , Paralisia das Pregas Vocais/etiologia , Humanos , Nervo Laríngeo Recorrente/anatomia & histologia , Glândula Tireoide/anatomia & histologia , Glândula Tireoide/embriologia , Tireoidectomia/métodos
11.
Chirurgia (Bucur) ; 114(5): 602-610, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31670636

RESUMO

Background: Post-surgical hypoparathyroidism (PoSH) is a common long-term complication after thyroid surgery. The reported median (range) incidence rates of temporary and permanent PoSH was 27% (19 - 38%) and 1% (0 - 3%) respectively. Material and Methods: We retrospectively analyzed the files of 552 patients who underwent thyroidectomy in our surgery department between 2015- 2017 with the aim to assess the prevalence of PoSH and to identify patient and disease related factors associated with postoperative hypocalcemia. Results: 171 (30.97%) patients developed PoSH, 88.37% transient, 11.63% permanent. The median (IQR) duration of postoperative hypocalcemia was 60 (67.5) days. Preoperative biological parameters were similar in PoSH and the control group, except median (IQR) serum magnesium level that was significantly higher in PoSH group [2.04 (0.17) vs. 1.89 (0.28) mg/dl, p=0.005]. In the subgroup of patients with thyroid carcinoma the surgery duration was longer in PoSH patients compared to the control group [135 (60) vs. 110 (43) minutes, p=0.020]. In patients with PoSH, median post-operative serum calcium was significantly higher in patients with reported difficult surgery [8.2 (0.2) vs. 7.9 (0.6) mg/dl, p=0.043] and the mean serum calcium decrease was higher in patients with cervical neck dissection and lymphadenectomy (1.94 +-0.59 vs. 1.68 +-0.56 mg/dl, p=0.033). Conclusions: Our data show a high prevalence of PoSH that is likely to increase given the rising number of thyroid surgeries being performed. Further research is needed in order to better define this condition, to establish appropriate treatment and preventive measures.


Assuntos
Hipoparatireoidismo/etiologia , Tireoidectomia/efeitos adversos , Humanos , Hipocalcemia/sangue , Hipoparatireoidismo/sangue , Estudos Retrospectivos , Tireoidectomia/métodos
12.
Surg Technol Int ; 35: 101-106, 2019 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-31687788

RESUMO

Transoral endoscopic thyroidectomy by vestibular approach (TOETVA) represents an innovative and scarless technique for thyroid surgery. The procedure is conducted via a three-port technique at the oral vestibule using a 10mm port for the 30° endoscope and two additional 5mm ports for the dissecting and coagulating instruments. Patients meeting the following criteria can be considered as candidates for TOETVA: (a) an ultrasonographically (US) estimated thyroid diameter =10cm; (b) US-estimated gland volume =45mL; (c) nodule size =50mm; (d) presence of a benign tumor, such as a thyroid cyst or a single- or multinodular goiter; (e) Bethesda 3 and/or 4 categories, and (f) papillary microcar-cinoma without the evidence of metastasis. Beyond the classic complications of thyroid surgery, namely cervical hematoma, recurrent laryngeal nerve injury and hypoparathyroidism, novel consequences can occur as mental nerve (MN) injury. In this paper, leading experts in the field report on their current clinical experience with the TOETVA approach for thyroid gland surgery, with emphasis given to tips and tricks to avoid and manage MN injury.


Assuntos
Tireoidectomia , Endoscopia , Humanos , /prevenção & controle , Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversos
13.
Plast Reconstr Surg ; 144(4): 659e-668e, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31568312

RESUMO

BACKGROUND: Botulinum toxin type A (BTxA) injection is effective for surgical scar prevention. Although some studies have aimed to confirm the efficacy of BTxA injection at different time points, none has been conducted to determine the most appropriate timing of injection for scar management. The authors predicted that the injection of BTxA at different times during the wound healing process would cause differing scar quality improvement and clarify unknown molecular mechanisms. METHODS: The study included adults who underwent thyroidectomy. All patients received paralesional BTxA injections on the day of the surgery on either the right or left side of the operative site. The same dose was injected on the noninjected side by means of the same method after 2 weeks. At 2, 4, 12, and 24 weeks postoperatively, the modified Stony Brook Scar Evaluation Scale, visual analogue scale, and erythema index were used for objective, subjective, and quantitative evaluations of the scar. At week 24 postoperatively, a quantitative scar assessment was performed with respect to the erythema index, skin elasticity, melanin index, and friction. RESULTS: On objective evaluation of the scar and patient satisfaction at 24 weeks postoperatively, the operation-day injection side showed better outcomes than the 2-week-postoperative injection side. These differences were significant from postoperative week 4. In the final quantitative scar assessment at postoperative week 24, significant improvements were observed in the erythema index and skin elasticity. CONCLUSION: These results suggest that immediate postoperative BTxA injection is more effective for thyroidectomy scar management in terms of erythema, skin elasticity, and patient satisfaction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Cicatriz/etiologia , Cicatriz/prevenção & controle , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Tireoidectomia/efeitos adversos , Cicatrização/efeitos dos fármacos , Adulto , Idoso , Feminino , Humanos , Injeções Intralesionais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo
14.
BMJ Case Rep ; 12(10)2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31604721

RESUMO

A 39-year-old man was admitted to our hospital with the diagnosis of thyroid storm due to Graves' disease. Near-total thyroidectomy was performed after 1 month's pharmacological treatment, and he presented with tetany next morning. Serum corrected calcium value was 5.7 mg/dL. Procollagen type 1 N-terminal propeptide increased considerably, while tartrate-resistant acid phosphatase 5b decreased. These changes indicated that bone formation exceeded bone resorption in reverse after thyroidectomy. Calcium gluconate was administered intravenously for 14 days, before the patient was discharged. Oral administration of calcium and active forms of vitamin D was continued for 4 months. Rapid skeletal uptake of calcium from blood caused severe and persistent hypocalcaemia, which is called hungry bone syndrome. When patients with Graves' disease have severe thyrotoxicosis, high serum alkaline phosphatase levels and low bone mineral densities, they are at high risk for hungry bone syndrome after thyroidectomy, and should be educated for the symptoms of hypocalcaemia.


Assuntos
Doenças Ósseas Metabólicas/etiologia , Doença de Graves/complicações , Hipocalcemia/etiologia , Tireoidectomia/efeitos adversos , Tireotoxicose/complicações , Adulto , Doenças Ósseas Metabólicas/tratamento farmacológico , Cálcio/uso terapêutico , Doença de Graves/cirurgia , Humanos , Hipocalcemia/tratamento farmacológico , Masculino , Tireotoxicose/cirurgia , Vitamina D/uso terapêutico
15.
Acta otorrinolaringol. esp ; 70(5): 301-305, sept.-oct. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-186374

RESUMO

El hipoparatiroidismo es la complicación más frecuente tras la tiroidectomía total. Se define por la presencia de hipocalcemia con unos niveles de hormona paratiroidea (PTH) bajos o inadecuadamente normales. La hipocalcemia aguda es una complicación potencialmente grave. Su tratamiento se basa, según la gravedad del cuadro, en la administración de calcio por vía oral o intravenosa, pudiendo requerir asimismo calcitriol oral. El riesgo de hipocalcemia sintomática tras una tiroidectomía es muy bajo si la PTH postoperatoria desciende menos del 80% respecto de la preoperatoria. Estos pacientes podrían ser dados de alta sin tratamiento, aunque los umbrales son variables entre laboratorios y recomendamos extremar la vigilancia en los casos de riesgo aumentado (enfermedad de Graves, grandes bocios, reintervenciones o constancia de la extirpación de alguna paratiroides). El tratamiento a largo plazo busca controlar los síntomas manteniendo la calcemia en el límite bajo de la normalidad, vigilando el producto calcio-fósforo y la aparición de hipercalciuria


Hypoparathyroidism is the most common complication after total or completion thyroidectomy. It is defined as the presence of hypocalcemia accompanied by low or inappropriately normal parathyroid hormone (PTH) levels. Acute hypocalcemia is a potential lethal complication. Hypocalcemia treatment is based on endovenous or oral calcium supplements as well as oral calcitriol, depending on the severity of the symptoms. The risk of clinical hypocalcemia after bilateral thyroidectomy is considered very low if postoperative intact PTH decrease less than 80% with respect to preoperative levels. These patients could be discharged home without treatment, although this threshold may vary between institutions, and we recommend close surveillance in cases with increased risk (Graves disease, large goiters, reinterventions or evidence of parathyroid gland removal). Long-term treatment objectives are to control the symptoms and to keep serum calcium levels at the lower limit of the normal range, while preserving the calcium phosphate product and avoiding hypercalciuria


Assuntos
Humanos , Hipoparatireoidismo/etiologia , Tireoidectomia/efeitos adversos , Calcitriol/uso terapêutico , Cálcio/sangue , Cálcio/uso terapêutico , Doença de Graves/cirurgia , Hipercalciúria/prevenção & controle , Hipercalciúria/terapia , Hiperfosfatemia/tratamento farmacológico , Hiperfosfatemia/etiologia , Hipocalcemia/etiologia , Hipoparatireoidismo/tratamento farmacológico , Hipoparatireoidismo/prevenção & controle , Cuidados Intraoperatórios , Glândulas Paratireoides/cirurgia , Glândulas Paratireoides/transplante , Hormônio Paratireóideo/sangue , Cuidados Pós-Operatórios , Reimplante
16.
Best Pract Res Clin Endocrinol Metab ; 33(4): 101319, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31530446

RESUMO

Graves' disease is an autoimmune disorder caused by thyroid stimulating auto-antibodies directed against the thyrotropin receptor on thyroid follicular cells. It is the most common cause of hyperthyroidism and is associated with cardiovascular, ophthalmologic and other systemic manifestations. Three treatment options are available for Graves' disease: anti-thyroid drugs, radioactive iodine and thyroidectomy. While thyroidectomy is the least common option used for treatment of Graves' disease, it is preferentially indicated for patients with a large goiter causing compressive symptoms, suspicious or malignant thyroid nodules or significant ophthalmopathy. The best operation for Graves' disease has been a matter of debate. The standard operation was a subtotal thyroidectomy for much of the twentieth century, however, over the past 20 years total thyroidectomy has been increasingly performed. Herein, we provide a historical perspective and review the current literature, including randomized controlled trials, systematic reviews and meta-analyses and conclude that total thyroidectomy is the preferred option for the surgical treatment of Graves' disease, with a nearly 0% recurrence rate, predictable postoperative hypothyroidism and a low complication rate comparable to subtotal thyroidectomy when performed by high-volume thyroid surgeons.


Assuntos
Doença de Graves/cirurgia , Traumatismos do Nervo Laríngeo/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Tireoidectomia/métodos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Tireoidectomia/efeitos adversos , Tireoidectomia/normas , Tireoidectomia/estatística & dados numéricos
17.
Khirurgiia (Mosk) ; (9): 44-51, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31532166

RESUMO

OBJECTIVE: To determine validity and adequacy of the assessment of experience acquisition in video-assisted hemithyroidectomy, to compare surgical outcomes at the learning stage and in delayed period. MATERIAL AND METHODS: Experience acquisition was studied via assessment of the duration of video-assisted hemithyroidectomy in 67 patients who were operated by the same surgeon. Time of surgery was analyzed through between-group comparison of surgical outcomes. These groups were defined arbitrarily, in exponential fashion, using the logarithm method and moving average. Risks of failure regarding duration of surgery and postoperative complications were investigated using CUSUM analysis. RESULTS: Minimum period of experience accumulation in video-assisted hemithyroidectomy (26 procedures) was determined using logarithmic analysis, maximum period (66 interventions) - using CUSUM analysis. Other approaches also showed sharp nature of the learning curve.CUSUM analysis of failures at the learning stage showed 2-fold decrease of their probability after 66 operations. However, even experience acquisitiondoes not exclude risk of failures in hemithyroidectomy. CONCLUSION: Arbitrary division of the cohort of patients seems to be unreasonable because clear number of operations necessary to achieve sustainable results does not follow it.Mathematical methods adequately reflect experience accumulation and allow determining the required number of interventions for stable results and minimum complication rate.


Assuntos
Curva de Aprendizado , Doenças da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Cirurgia Vídeoassistida/métodos , Estudos de Coortes , Humanos , Tireoidectomia/efeitos adversos , Tireoidectomia/estatística & dados numéricos , Cirurgia Vídeoassistida/efeitos adversos , Cirurgia Vídeoassistida/estatística & dados numéricos
18.
Best Pract Res Clin Endocrinol Metab ; 33(4): 101317, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31526606

RESUMO

The available evidence concerning the relationship between volume and outcome for thyroid surgery is assessed in this article. Morbidity forms the principal surrogate marker of thyroid surgery quality for which postoperative hypocalcaemia and recurrent laryngeal nerve injuries are most commonly reported upon. Whilst there is an abundance of published data for these outcomes, interpretation to recommend annual volume thresholds is challenging. This is due to a lack of consensus on definitions not only for outcomes but high and low volume surgeons. The evidence reviewed in this article supports the notion that high volume surgeons achieve superior outcomes in thyroid surgery quality though it is not possible to recommend minimal annual volumes on the basis of this evidence alone. Every thyroid surgeon should know their own outcomes and how they compare with their peers and engagement in thyroid surgery registries can facilitate this.


Assuntos
Traumatismos do Nervo Laríngeo/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Sistema de Registros/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Tireoidectomia/efeitos adversos , Humanos , Traumatismos do Nervo Laríngeo/etiologia , Complicações Pós-Operatórias/etiologia , Cirurgiões/normas , Tireoidectomia/normas , Tireoidectomia/estatística & dados numéricos
19.
Int J Pediatr Otorhinolaryngol ; 127: 109673, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31546062

RESUMO

INTRODUCTION: Thyroid cancer in children is a hot topic because of the large clinical heterogeneity and the risk of severe complications. We aimed to study 1. The frequency, 2. Etiology, and 3. Risk factors of post-surgery complications of thyroid cancer. MATERIAL AND METHODS: A retrospective analysis including risk factors for post-surgery complications of patients treated for thyroid malignancies in years 2006-2018 was performed. RESULTS: Over a period of 12 years 22 patients with thyroid malignancy (68% female; 12.6 ±â€¯4.0 years of age, median follow-up 6 years) were identified. Histologically, 12 (55%) patients had papillary carcinoma. Six patients (27.3%) had multiple endocrine neoplasia type 2 (MEN2) syndrome, 3 (13.7%) patients had medullary carcinoma and 1 patient had follicular carcinoma. Neck lymph node metastases were diagnosed in 8 (36.4%), distant metastases in 6 (27.3%), and both locations were involved in 4 (18.2%) patients. Six (27.3%) children had surgical complications: 1 child had unilateral vocal cord paralysis and transient hypoparathyroidism and 5 had transient hypoparathyroidism. The higher risk of surgery complications in forward stepwise logistic regression was associated in with distant metastases (R2 = 0.584, OR 52.63, p = 0.010). CONCLUSIONS: Postoperative complications were significantly associated with presence of distant metastases. Favorable results were observed in with children with MEN2 syndrome.


Assuntos
Adenocarcinoma Folicular/cirurgia , Carcinoma Neuroendócrino/cirurgia , Carcinoma Papilar/cirurgia , Neoplasia Endócrina Múltipla/cirurgia , Complicações Pós-Operatórias/etiologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversos , Adolescente , Criança , Feminino , Humanos , Hipoparatireoidismo/etiologia , Metástase Linfática , Masculino , Pescoço , Esvaziamento Cervical/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia/métodos , Paralisia das Pregas Vocais/etiologia
20.
Best Pract Res Clin Endocrinol Metab ; 33(4): 101312, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31477522

RESUMO

Surgery for substernal goiters can be technically demanding. Extensive mediastinal extension brings the thyroid gland into close quarters with vital intrathoracic structures. Proper preoperative planning is required to determine the potential need for an extracervical approach. Assessing the risk of requiring an extracervical approach is typically based on findings from cross-sectional imaging of the neck and chest. This article addresses the important anatomical considerations when resecting a large substernal goiter and also reviews various extracervical approaches.


Assuntos
Bócio Subesternal/cirurgia , Complicações Pós-Operatórias/etiologia , Tireoidectomia/métodos , Bócio Subesternal/diagnóstico por imagem , Bócio Subesternal/patologia , Humanos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Tireoidectomia/efeitos adversos
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