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1.
Zhonghua Wai Ke Za Zhi ; 58(11): 870-875, 2020 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-33120451

RESUMO

Objective: To examine the feasibility of small drain in transoral endoscopic thyroidectomy vestibular approach (TOETVA). Methods: A prospective research was performed in Department of Oncology Plastic Surgery/Head and Neck Surgery, Hunan Cancer Hospital, from October 2018 to March 2019. Totally 103 patients who met the inclusion and exclusion criteria, signed the operation agreement of TOETVA, had their surgery completed and followed-up over 6 months, were enrolled in analysis. A central venous catheter was used as a drain tube in all cases (outer diameter 1.7 mm, inner diameter 1.0 mm). Visual analogue scale (VAS) was applied for assessing pain scores during the first 24 hours after the operation. Vancouver scar scale (VSS) was used for assessing the scar left by the drainage. The drainage volume (minimum scale:10 ml, approximate read: 1 ml) was recorded every 2 hours during the first postoperative 12 hours, every 4 hours during 12 to 24 hours, every 8 hours during 24 to 48 hours, and once from 48 hours until extubation. The volume of drainage, the cumulative volume and the percentage of cumulative volume accounting for the total volume were calculated. The data of residual volume (subtract the cumulative volume from the total volume) in the postoperative 24, 32 and 40 hours were analyzed, and their upper one-side P(95) was calculated by percentile method. Results: There were 12 males and 91 females. The age was (36.6±9.7) years (range: 18 to 58 years). The intraoperative tube-inserting time was (10.1±2.6) minutes (range: 6 to 18 minutes). The pain score on the first day was 2.7±1.1 (range: 1 to 5). The extubation time was (2.7±0.5) days (range: 2 to 4 days). VSS scores in the postoperative 1(st) month and 6(th) month were 2.9±1.3 (range: 0 to 7) and 0(2)(M(Q(R))), respectively. The size of the scar was 0 (2.5) mm in the postoperative 6(th) month. Sixty-four patients had no visible scars. There were 5 patients who had postoperative drain-related complications (1 for air leakage, 1 for tube blockage, 3 for subcutaneous hydrop, 2 for regional infection), who were all cured after proper treatment. The total volume of drainage for 98 patients without postoperative drain-related complications was (80.1±12.2) ml (range: 58 to 131 ml). The cumulative drainage within 8 hours accounted for (53.8±4.2)% (range: 41.0% to 62.9%) of the total drainage. The volume of residual fluids in the postoperative 32 hours was estimated to (5.8±2.7) ml (range: 0 to 12 ml,P(95)=10.0 ml). Conclusions: The small drain tubecan be applied in TOETVA, providing a satisfied cosmetic appearance and a reliable drainage. The main exudation period of the wound is within 8 hours after the operation. If a residual volume less than 10 ml is considered to be self-absorbable, the shortest safe extubation point for 95% patients without drain-related complications should be 32 hours after the operation.


Assuntos
Drenagem/instrumentação , Endoscopia , Doenças da Glândula Tireoide/cirurgia , Tireoidectomia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia Endoscópica por Orifício Natural , Esvaziamento Cervical , Estudos Prospectivos , Tireoidectomia/métodos , Adulto Jovem
2.
Radiol Clin North Am ; 58(6): 1059-1070, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33040848

RESUMO

Over the past several years, there has been an increase in the discovery of thyroid cancers, likely because of the marked increased utilization of computed tomography (CT) and MR imaging. Despite the increase in number of thyroid cancers, the overall mortality remains unchanged because most of these cancers are the differentiated type and have a more indolent behavior. CT and MR imaging are important in the preoperative evaluation of thyroid goiters and thyroid cancer. This article discusses the imaging characteristics of benign and malignant thyroid diseases, and the important information that needs to be relayed to the surgeon.


Assuntos
Imagem por Ressonância Magnética/métodos , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Biópsia por Agulha , Diagnóstico Diferencial , Feminino , Humanos , Imuno-Histoquímica , Incidência , Masculino , Medição de Risco , Doenças da Glândula Tireoide/diagnóstico por imagem , Doenças da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/epidemiologia , Nódulo da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Resultado do Tratamento
3.
Medicine (Baltimore) ; 99(38): e22338, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957404

RESUMO

The ability to identify patients with aggressive papillary thyroid microcarcinoma (PTMC) from the low-risk patients is critical to planning proper management of PTMC. Lymph node metastases showed association with recurrence and low survival rate, especially in patients with >5 or ≥2 mm metastatic lymph nodes. Therefore, this study aimed to investigate the preoperatively predictive factors of non-small-volume (metastatic lymph nodes >5 or ≥2 mm in size) central lymph node metastases (NSVCLNM) in PTMC patients. A total of 420 patients with clinically node-negative (cN0) PTMC without extrathyroidal extension underwent thyroidectomy plus central neck dissection (CND) between January 2013 and December 2015, were retrospectively analyzed. Of the 420 patients, 33 (7.9%) had NSVCLNM. The 5-year recurrence-free survival was significantly less in cN0 PTMC patients with NSVCLNM, when compared with patients without NSVCLNM (80.8% vs 100%, P < .001). Multivariate logistic regression revealed age ≤36 years (P < .001), male sex (P = .002), ultrasonic tumor sizes of >0.65 cm (P < .001), and ultrasonic multifocality (P = .039) were independent predictive factors of NSVCLNM. A prediction equation (Y = 1.714 × age + 1.361 × sex + 1.639 × tumor size + 0.842 × multifocality -5.196) was developed, with a sensitivity (69.7%) and a specificity (84.0%), respectively, at an optimal cutoff point of -2.418. In conclusion, if the predictive value was >-2.418 according to the equation, immediate surgery including CND rather than active surveillance might be considered for cN0 PTMC patients.


Assuntos
Carcinoma Papilar/patologia , Metástase Linfática/patologia , Neoplasias da Glândula Tireoide/patologia , Adulto , Carcinoma Papilar/mortalidade , Carcinoma Papilar/cirurgia , Feminino , Humanos , Metástase Linfática/diagnóstico , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Melhoria de Qualidade , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Neoplasias da Glândula Tireoide/mortalidade , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adulto Jovem
4.
J Clin Endocrinol Metab ; 105(12)2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-32929476

RESUMO

CONTEXT: Invited update on the management of systemic autoimmune Graves disease (GD) and associated Graves orbitopathy (GO). EVIDENCE ACQUISITION: Guidelines, pertinent original articles, systemic reviews, and meta-analyses. EVIDENCE SYNTHESIS: Thyrotropin receptor antibodies (TSH-R-Abs), foremost the stimulatory TSH-R-Abs, are a specific biomarker for GD. Their measurement assists in the differential diagnosis of hyperthyroidism and offers accurate and rapid diagnosis of GD. Thyroid ultrasound is a sensitive imaging tool for GD. Worldwide, thionamides are the favored treatment (12-18 months) of newly diagnosed GD, with methimazole (MMI) as the preferred drug. Patients with persistently high TSH-R-Abs and/or persistent hyperthyroidism at 18 months, or with a relapse after completing a course of MMI, can opt for a definitive therapy with radioactive iodine (RAI) or total thyroidectomy (TX). Continued long-term, low-dose MMI administration is a valuable and safe alternative. Patient choice, both at initial presentation of GD and at recurrence, should be emphasized. Propylthiouracil is preferred to MMI during the first trimester of pregnancy. TX is best performed by a high-volume thyroid surgeon. RAI should be avoided in GD patients with active GO, especially in smokers. Recently, a promising therapy with an anti-insulin-like growth factor-1 monoclonal antibody for patients with active/severe GO was approved by the Food and Drug Administration. COVID-19 infection is a risk factor for poorly controlled hyperthyroidism, which contributes to the infection-related mortality risk. If GO is not severe, systemic steroid treatment should be postponed during COVID-19 while local treatment and preventive measures are offered. CONCLUSIONS: A clear trend towards serological diagnosis and medical treatment of GD has emerged.


Assuntos
Gerenciamento Clínico , Doença de Graves/diagnóstico , Oftalmopatia de Graves/diagnóstico , Hipertireoidismo/diagnóstico , Imunoglobulinas Glândula Tireoide-Estimulantes/sangue , Antitireóideos/uso terapêutico , Biomarcadores/sangue , Diagnóstico Diferencial , Feminino , Doença de Graves/complicações , Doença de Graves/terapia , Oftalmopatia de Graves/etiologia , Oftalmopatia de Graves/terapia , Humanos , Hipertireoidismo/complicações , Hipertireoidismo/terapia , Imunoglobulinas Glândula Tireoide-Estimulantes/imunologia , Radioisótopos do Iodo/uso terapêutico , Masculino , Metimazol/uso terapêutico , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/terapia , Receptores da Tireotropina/imunologia , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/imunologia , Tireoidectomia/métodos , Ultrassonografia
5.
Medicine (Baltimore) ; 99(36): e22133, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899100

RESUMO

The importance of bedside assistants has been well established in various robotic procedures. However, the effect of assistants on the surgical outcomes of thyroid surgery remains unclear. We investigated the effects of a dedicated robot assistant (DRA) in robotic thyroidectomy. We also evaluated the learning curve of the DRA.Between January 2016 and December 2019, 191 patients underwent robotic total thyroidectomy, all of which were performed by a single surgeon. The DRA participated in 93 cases, while non-dedicated assistants (NRAs) helped with 98 cases. Demographic data, pathologic data, operative times, and postoperative complications were recorded and analyzed.Robotic thyroidectomy was successful in all 191 patients, and none required conversion to the conventional open procedure. Mean operative time was shorter in the DRA group than in the NRA group (183.2 ±â€Š33.6 minutes vs 203.1 ±â€Š37.9 minutes; P < .001). There were no significant differences in terms of sex distribution, age, preoperative serum thyroid stimulating hormone level, or pathologic characteristics between the groups. Cumulative summation analysis showed that it took 36 cases for the DRA to significantly reduce operative time. Mean operative time decreased significantly in the subgroup including the 37th to the 93rd DRA cases compared with the subgroup including only the first 36 DRA cases (199.7 ±â€Š37.3 minutes vs 172.8 ±â€Š26.4 minutes; P < .001). NRA group showed no definite decrease of operation time, which indicated that the NRAs did not significantly deviate from the mean performance.Increased experience of the bedside assistant reduced operative times in the robotic thyroidectomy. Assistant training should be considered as a component of robotic surgery training programs.


Assuntos
Internato e Residência/organização & administração , Procedimentos Cirúrgicos Robóticos/métodos , Tireoidectomia/métodos , Fatores Etários , Estudos de Casos e Controles , Feminino , Humanos , Curva de Aprendizado , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Sexuais , Fatores Socioeconômicos
6.
Tokai J Exp Clin Med ; 45(3): 144-147, 2020 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-32901904

RESUMO

A 14 year-old girl with a previous medical history of cholecystic polyps was referred to our department with throat discomfort during swallowing. The cervical ultrasound and magnetic resonance imaging revealed a massive polycystic formation with a diameter of 45 × 24 × 31 mm consistent with a right lobe goiter. However, there were no findings for suspected malignancy. Hemithyroidectomy was performed and the specimen was sent for histopathological assessment. Hematoxylin-eosin staining of the right lower nodule showed variably-sized follicles consistent with adenomatous goiter. The right upper nodule showed a growth of relatively compact sized follicles with a thick fibrous capsule. A satellite nodule lying outside of the tumor capsule was consistent with minimally invasive follicular thyroid microcarcinoma. We observed her without any additional treatment and no recurrence is seen at present.


Assuntos
Carcinoma/patologia , Bócio/patologia , Bócio/cirurgia , Achados Incidentais , Neoplasias da Glândula Tireoide/patologia , Adolescente , Feminino , Bócio/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Microscopia Acústica , Tireoidectomia/métodos
7.
Acta Med Indones ; 52(2): 163-171, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32778631

RESUMO

Global widespread of current coronavirus disease 2019 (COVID-19) pandemic has emerged huge predicament to healthcare systems globally. This disease caused by a new beta-type coronavirus, known as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), may lead to systemic multiorgan dysfunction syndrome and subsequently cause death due to abundant angiotensin converting enzyme 2 as its functional receptors throughout body. Oncology patients even have a worse prognosis with greater infection susceptibility because they are in a state of suppression of the systemic immune system due to malignancy and anticancer therapy. This problem makes adequate and appropriate treatment urgently needed. Through randomized clinical trials, various drugs were known to have good responses in COVID-19 patients. Here, we reported a-49-year-old-woman that was confirmed for COVID-19 by clinical manifestation, radiology profile, high procalcitonin concentration, and positive polymerase chain reaction (PCR) test. The patient also had breast and thyroid cancers history and had undergone various therapeutic modalities such as chemotherapy, thyroid surgery, and breast surgery. She was undergoing hormone therapy but experiencing disease progression after achieving complete remission based on PET-CT scan 4 months before. The patient was treated with various antibiotics but showed a significant clinical improvement by administering moxifloxacin.


Assuntos
Antineoplásicos/uso terapêutico , Betacoronavirus/isolamento & purificação , Neoplasias da Mama , Infecções por Coronavirus , Moxifloxacina/administração & dosagem , Pandemias , Pneumonia Viral , Pró-Calcitonina/sangue , Neoplasias da Glândula Tireoide , Anti-Infecciosos/administração & dosagem , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Técnicas de Laboratório Clínico/métodos , Comorbidade , Infecções por Coronavirus/sangue , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Feminino , Humanos , Mastectomia/métodos , Pessoa de Meia-Idade , Pneumonia Viral/sangue , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Radiografia Torácica/métodos , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/terapia , Tireoidectomia/métodos , Resultado do Tratamento
8.
Ann R Coll Surg Engl ; 102(9): 737-743, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32820638

RESUMO

INTRODUCTION: Open thyroidectomy is the most common approach to thyroid surgery. However, 'scarless' (in the neck) endoscopic thyroidectomy, consisting of endoscopic and robotic surgery, is progressively being adopted for its perceived cosmetic benefits. This study aims to determine the patient's preferred surgical approach and to identify the factors that influence their decision. MATERIALS AND METHODS: A pilot study consisting of 100 patients with a surgical thyroid disorder were prospectively recruited from a single tertiary centre. An interviewer-administered survey was conducted. Demographic, socioeconomic status, scar perception and an adapted body image scale were evaluated to identify factors that shaped the patient's perception of the surgical approach. RESULTS: The mean age of participants was 54.5 ± 13.0 years; 72% were women and 87% Chinese. Of the 100 patients, 75 patients considered scarless endoscopic thyroidectomy as their preferred surgical approach while 25 patients opted for open thyroid surgery. Improvement in scar perception score between scarless endoscopic thyroidectomy and open thyroid surgery is associated with an increased willingness to choose scarless endoscopic thyroidectomy. The mean body image scale score was 6.9 ± 2.8, indicating no statistical difference between the surgical approaches. On multivariate analysis, improvement in scar perception score (odds ratio 3.38, 95% confidence interval 1.11-10.29) and having surgeon recommendation (odds ratio 6.38, 95% confidence interval 1.80-22.63) were independently associated with interest in scarless endoscopic thyroidectomy. CONCLUSION: Patients interest in undergoing scarless endoscopic thyroidectomy is driven by improved scar perception and surgeon's recommendation compared with open thyroid surgery.


Assuntos
Cicatriz/etiologia , Endoscopia/efeitos adversos , Preferência do Paciente/estatística & dados numéricos , Tireoidectomia/efeitos adversos , Atitude Frente a Saúde , Cicatriz/prevenção & controle , Cicatriz/psicologia , Estudos Transversais , Endoscopia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Preferência do Paciente/psicologia , Projetos Piloto , Estudos Prospectivos , Inquéritos e Questionários , Doenças da Glândula Tireoide/cirurgia , Tireoidectomia/métodos
9.
Am Surg ; 86(9): 1148-1152, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32853031

RESUMO

BACKGROUND: The 2015 American Thyroid Association Management Guidelines for patients with thyroid nodules recommended a comprehensive sonographic evaluation of thyroid nodules' characteristics and the presence of any suspicious cervical lymph nodes (LNs) in the central and lateral compartments. This detailed sonographic assessment is still not routinely performed. We hypothesized that an endocrine surgeon-performed ultrasound (SUS) significantly enhances the management of thyroid cancer patients when compared with referral ultrasound (RUS). METHODS: We conducted a retrospective review of 267 consecutive thyroid surgery patients who were diagnosed with thyroid cancer on final pathology. All patients had undergone a SUS, but only 130 cohorts with both RUS and SUS were included. Features of thyroid nodules and LN and changes in the management plan were recorded. RESULTS: Based on SUS assessment, 26 patients (20%) were noted to have suspicious thyroid nodules which warranted a fine-needle aspiration (FNA) and were missed in RUS. On FNA, there were 12 patients with Bethesda categories III/IV and 14 patients with Bethesda V/VI. Those 26 patients were found to have a malignancy in the final pathology assessment. Thirty-eight patients (29.2%) were noted to have suspicious central/lateral neck findings on SUS but were not reported in RUS. Additionally, 8 patients (6.1%) were found to have a parathyroid adenoma by SUS and required concurrent parathyroidectomy. DISCUSSION: A comprehensive neck ultrasound in thyroid cancer patients, performed by their endocrine surgeon, could enhance management planning and outcomes. This finding highlights the critical need for education and improvement of routine neck ultrasonographic examination performed in the community.


Assuntos
Estadiamento de Neoplasias/métodos , Cirurgiões , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Ultrassonografia/métodos , Humanos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/diagnóstico , Resultado do Tratamento
11.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(6): 364-373, jun.-jul. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-193361

RESUMO

Hay controversia sobre la realización de laringoscopia preoperatoria (LP) en cirugía de tiroides. Las recomendaciones, basadas en estudios observacionales, varían entre unas publicaciones y otras. El objetivo del estudio es conocer la prevalencia de parálisis laríngea hallada en LP de pacientes a los que se realizó tiroidectomía en enfermedad benigna y maligna. Se realizó la revisión sistemática con 29 artículos incluidos para el estudio cualitativo y metaanálisis de 13 artículos en los que pudieron obtenerse los datos para evaluar el mismo efecto (LP realizada en todos los pacientes incluidos; se recoge a los pacientes con parálisis laríngea preoperatoria, figura el número total de pacientes y pueden asignarse las parálisis preoperatorias a los grupos de histología posoperatoria maligna o benigna). La prevalencia agrupada de parálisis preoperatoria en enfermedad benigna fue del 1,1% (IC del 95%, 0,7 a 1,7%; I2 71%) y en enfermedad maligna 6,3% (IC del 95%, 3,8 a 9,4%; I2 85%). La prevalencia es significativamente superior entre pacientes con enfermedad maligna con un efecto estimado RR 5,66, IC del 95%, 2,48, 12,88. Los estudios analizados presentan sesgos que será necesario corregir en investigaciones futuras, eliminando los sesgos de cegamiento en la selección y asignación de pacientes o en la técnica de laringoscopia empleada. La LP en cirugía de tiroides evalúa posibles trastornos de motilidad laríngea. La prevalencia de la parálisis laríngea en enfermedad de tiroides hallada en la LP en pacientes con diagnóstico posoperatorio de enfermedad maligna es más elevada que en el grupo de enfermedad benigna. Esta información es necesaria para interpretar la señal de neuromonitorización intraoperatoria y tomar decisiones


There is controversy regarding the performance of preoperative laryngoscopy (LP) in thyroid surgery, with different recommendations being made, based on observational studies, in various publications. The aim of the study was to know the prevalence of laryngeal paralysis found in the LPs of patients who underwent thyroidectomy in benign and malignant pathology. A systematic review was carried out with 29 articles included for the qualitative study and a meta-analysis of 13 articles in which the data could be obtained to evaluate the same effect (in all patients in which an LP was carried out, those with preoperative laryngeal paralysis were included, and assigned to malignant or benign postoperative histology groups). The pooled prevalence of preoperative paralysis in benign pathology was 1.1% (95% CI 0.7 to 1.7%, 71% I2) and in 6.3% malignant pathology (95% CI 3.8 to 9.4%; I2 85%). The prevalence was significantly higher among patients with malignant pathology with an estimated effect RR 5.66, 95% CI, 2.48, 12.88. The studies analyzed present biases that will need to be corrected in future research, eliminating blinding biases in the selection and allocation of patients or in the laryngoscopy technique used. The LP in thyroid surgery evaluates possible disorders of laryngeal motility. The prevalence of laryngeal paralysis in thyroid pathology found in LPs in patients with a postoperative diagnosis of malignant pathology was higher than in the benign pathology group. This information is necessary for interpreting the intraoperative neuromonitoring signal and for making informed decisions


Assuntos
Humanos , Paralisia das Pregas Vocais/diagnóstico por imagem , Paralisia das Pregas Vocais/epidemiologia , Tireoidectomia/métodos , Estatísticas não Paramétricas , Viés
12.
Medicine (Baltimore) ; 99(29): e21060, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702848

RESUMO

BACKGROUND: Postoperative sore throat (POST) is an important concern in surgical patients undergoing endotracheal intubation. Its prevalence after thyroidectomy is up to 80%. The current study aimed to assess the effect of dexmedetomidine and remifentanil on postoperative sore throat. METHODS: Seventy-four patients who underwent thyroidectomy were randomized to receive either dexmedetomidine (group D) or remifentanil (group R). At anesthesia induction, group D received dexmedetomidine 1 µg/kg over 10 minutes, followed by continuous dexmedetomidine infusion at 0.3 to 0.6 µg/kg/hour during surgery. Group R received remifentanil of 3 to 4 ng/ml during induction, followed by 1.5 to 2.5 ng/ml remifentanil infusion during surgery. POST at rest and swallowing was assessed during the first 24 hours in serial time periods (0-1, 1-6, and 6-24 hours). Hoarseness and postoperative pain score were also assessed. RESULTS: POST incidence at rest (0-1, 1-6, and 6-24 hours) and swallowing (1-6 and 6-24 hours) was lower in group D than in group R. POST severity was significantly lower in group D than in group R during each time period. The incidence of postoperative hoarseness was also lower in group D than in group R at 1 to 6 and 6 to 24 hours. The postoperative pain score was lower in group D than in group R during each time period. CONCLUSION: Intraoperative dexmedetomidine infusion reduced the incidence and severity of POST for 24 hours after thyroidectomy.


Assuntos
Dexmedetomidina/uso terapêutico , Faringite/tratamento farmacológico , Faringite/etiologia , Período Pós-Operatório , Remifentanil/uso terapêutico , Tireoidectomia/efeitos adversos , Adulto , Analgésicos não Entorpecentes/normas , Analgésicos não Entorpecentes/uso terapêutico , Analgésicos Opioides/normas , Analgésicos Opioides/uso terapêutico , Dexmedetomidina/normas , Feminino , Humanos , Intubação Intratraqueal/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/tratamento farmacológico , Remifentanil/normas , Tireoidectomia/métodos
13.
Zhonghua Wai Ke Za Zhi ; 58(8): 626-630, 2020 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-32727195

RESUMO

Objective: To examine the value serum calcium and intact parathyroid hormone (iPTH) levels measured on the first day after total thyroidectomy on prediction for permanent hypoparathyroidism. Methods: Totally 546 patients with thyroid cancer and benign thyroid lesions who underwent total thyroidectomy at Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University from February 2008 to December 2018 were analyzed retrospectively. There were 158 males and 388 females aging (50.9±13.2) years (range: 19.0 to 79.2 years). Serum calcium and iPTH levels were collected before surgery, on the first day and 6 months after surgery. Logistic regression was used to analyze the correlation between each data and the occurrence of permanent hypoparathyroidism after surgery.The area under the receiver operating characteristic curve was used to evaluate the predictive power of iPTH for postoperative occurrence of permanent hypoparathyroidism. Results: Among the 546 cases of total thyroidectomy, 22 cases of permanent hypoparathyroidism occurred, with an incidence of 4.0% (22/546). Multivariate analysis showed that iPTH levels on the first day after total thyroidectomy (OR=2.932, 95%CI: 1.129 to 7.616, P=0.027) and serum calcium levels (OR=2.584, 95%CI: 1.017 to 6.567, P=0.046) were independent prognosis factors for postoperative permanent hypoparathyroidism. When the threshold value of iPTH at 24 hours after total thyroidectomy was 5.51 ng/L, the AUC was 0.956 (95%CI: 0.936 to 0.972, P=0.000), sensitivity was 100%, specificity was 85.1%, positive predictive value was 22%, negative predictive value was 100%. When the threshold value of serum calcium at 24 hours after total thyroidectomy was 1.93 mmol/L, the AUC was 0.733 (95%CI: 0.694 to 0.770, P=0.000), sensitivity was 63.6%, specificity was 78.1%, positive predictive value of 10.8% and negative predictive value of 98.1%. Conclusions: Serum iPTH and calcium levels on the first day after total thyroidectomy were related to the occurrence of permanent hypoparathyroidism postoperatively. The predictive value of iPTH level is higher than that of serum calcium level.


Assuntos
Cálcio/sangue , Hipoparatireoidismo/sangue , Hormônio Paratireóideo/sangue , Doenças da Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversos , Adulto , Idoso , Feminino , Humanos , Hipoparatireoidismo/etiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Doenças da Glândula Tireoide/sangue , Tireoidectomia/métodos , Adulto Jovem
14.
Am J Otolaryngol ; 41(4): 102543, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32474327

RESUMO

PURPOSE: The purpose of this study is to assess the efficacy of ultrasonography in the differentiation of a bilateral and a unilateral WDTC to help physicians decide on performing a total or a partial thyroidectomy. MATERIALS AND METHODS: Retrospective chart review of all patients diagnosed with papillary thyroid carcinoma following a total thyroidectomy or a complete thyroidectomy between January 2013 and December 2015 at the Department of Otorhinolaryngology and Head and Neck Surgery in Soroka University Medical Center in southern Israel. The preoperative ultrasound images of the thyroid were compared to the final pathology in the contralateral lobe. RESULTS: Seventy seven patients (77) were included in this study, There was no correlation between the sonography in the contralateral lobe and the malignancy on that side (p = 0.479). US had a 39% false negative rate and 69% false positive rate. CONCLUSION: The patients with a well-differentiated carcinoma of the thyroid, a benign nodule detected sonographically in the contralateral lobe should not bear a high weight in decision making regarding the extent of surgery.


Assuntos
Tomada de Decisão Clínica/métodos , Câncer Papilífero da Tireoide/diagnóstico por imagem , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Ultrassonografia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia
15.
Rev. argent. cir ; 112(2): 185-188, ilus
Artigo em Inglês, Espanhol | LILACS | ID: biblio-1125800

RESUMO

La cirugía endoscópica transluminal a través de orificios naturales (NOTES) ha sido aplicada por primera vez por K. Witzel en el año 2008, introduciendo el abordaje transoral para la patología tiroidea en cadáveres y puercos. En el año 2016, A. Anuwong publicó la primera serie de casos en seres humanos por abordaje vestibular. Referimos en esta ocasión el caso de una paciente de 37 años, quien acudió a la consulta por presentar una tumoración cervical anterior de dos meses de evolución. Ecografía tiroidea con bocio polinodular. Punción aspiración con aguja fina: lesión con hiperplasia folicular en lóbulo derecho e izquierdo. Se decide realizar tiroidectomía transoral endoscópica por abordaje vestibular. La duración de la intervención fue de 180 minutos, la pérdida sanguínea fue de 20 mL. El dolor, escaso y el tiempo de internación, 36 horas. En el presente trabajo se propone el desarrollo de esta técnica y la experiencia en nuestro primer caso de tiroidectomía total en patología tiroidea benigna.


Natural orifice transluminal endoscopic surgery (NOTES) was applied for the first time by K. Witzel in 2008, introducing the transoral endoscopic resection of the thyroid gland in human cadavers and living pigs. In 2016, A. Anuwong published the first case series using the vestibular approach in humans. We report the case of a 37-year-old female patient with a mass in the anterior aspect of the neck which appeared two months before consultation. The thyroid ultrasound reported multinodular goiter. The fine-needle aspiration (FNA) biopsy reported hyperplastic follicular nodule in both lobes. The patient underwent transoral endoscopic thyroidectomy by vestibular approach. Operative time was 180 minutes and blood loss was 20 mL. Pain was minimal and hospital stay was 36 hours. We report our first experience with total thyroidectomy in a patient with benign thyroid nodules.


Assuntos
Humanos , Feminino , Adulto , Tireoidectomia/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Glândula Tireoide , Neoplasias da Glândula Tireoide/patologia
16.
Rev Assoc Med Bras (1992) ; 66(2): 109-111, 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32428142

RESUMO

Goiter is a localized or generalized thyroid hypertrophy. It can remain within the cervical region or grow down until it invades the mediastinum. The signs and symptoms depend on the size and location of the goiter. Although drugs and radioactive iodine are often used to treat thyroid disease, the presence of symptomatic substernal goiter is a clear indication for surgery. Death or postoperative complications rarely occur. We present a case of a 71-year-old man with recurrent thyroid pathology in the form of substernal goiter and hyperthyroidism even after partial thyroidectomy. The importance of this relates to the clinical evolution, volume, and location of the goiter as well as the surgical and pharmacological approach.


Assuntos
Bócio Subesternal/patologia , Bócio Subesternal/cirurgia , Tireoidectomia/métodos , Idoso , Bócio Subesternal/diagnóstico por imagem , Humanos , Masculino , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
17.
Medicine (Baltimore) ; 99(19): e20138, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384495

RESUMO

BACKGROUND: More surgeons have known the importance of parathyroid grand and recurrent laryngeal nerve protection in the surgery, but there is still plenty of scope to improve the surgical techniques. This study aims at investigating whether the improved method of finding recurrent laryngeal nerve (RLN) can protect parathyroid grand and RLN. METHODS: One hundred fifty-eight patients were enrolled and divided randomly into the test and control group according to different methods of finding RLN in the surgery. In the experimental group the author could quickly find the laryngeal recurrent nerve in the lower part of the neck and separate along the surface of the recurrent laryngeal nerve to the point where the recurrent laryngeal nerve gets into the larynx close to the thyroid gland named lateral approach, while in the control group the author severed the middle and lower thyroid vein and raised the lower thyroid pole to look for the RLN near the trachea by the blunt separation. RESULTS: The author identified 152 and 159 parathyroid glands in the test and control group, respectively and there were a lower ratio of auto-transplantation and less operative time in the test group compared with that in the control group. The author also found that the parathyroid hormone level (1 day and 2 months) in the test group was higher than that in the control group. There were no differences in metastatic LN and recurrent laryngeal nerve palsy in the 2 groups. CONCLUSION: The improved method of finding RLN is a simple, efficient and safe way, and easy to implement.


Assuntos
Nervo Laríngeo Recorrente/anatomia & histologia , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adulto , China , Feminino , Humanos , Hipoparatireoidismo/tratamento farmacológico , Hipoparatireoidismo/etiologia , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Glândulas Paratireoides/anatomia & histologia , Complicações Pós-Operatórias/epidemiologia , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia
18.
Am Surg ; 86(3): 245-249, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32223805

RESUMO

The frequency, pattern, and predictive factors for skip LN metastasis in patients with papillary thyroid carcinoma (PTC) remain controversial. In this study, we evaluated predictive factors of skip LN metastasis in these patients. We reviewed the medical records of 68 PTC patients who underwent total thyroidectomy, central neck dissection, and lateral neck dissection at the initial operation. The relationships between skip LN metastasis and clinicopathologic factors were analyzed. After careful examination of electronic medical records of patients, 19 patients were excluded from the study. Of the remaining 49 patients, 9 (18.4%) had skip LN metastasis. Multivariate analysis showed that tumor size <1 cm was an independent risk factor for the presence of skip metastasis (P = 0.035, odds ratio: 3.78, 95% confidence interval: 1.09-13.15). The rate of positive LN was relatively higher in micro-PTC patients than PTC patients. This finding is clinically significant and should be considered in routine clinical practice.


Assuntos
Linfonodos/patologia , Câncer Papilífero da Tireoide/patologia , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adulto , Idoso , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Humanos , Excisão de Linfonodo/métodos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Esvaziamento Cervical/métodos , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Razão de Chances , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Câncer Papilífero da Tireoide/mortalidade , Neoplasias da Glândula Tireoide/mortalidade , Resultado do Tratamento
19.
Medicine (Baltimore) ; 99(15): e19795, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282744

RESUMO

In the 7th edition of AJCC staging system, cervical lymph node metastases (LNM) in papillary thyroid carcinoma (PTC) is considered as a poorer prognostic indicator only in patients aged 45 years or older, but as a low-risk factor in patients younger than 45 years. The objective of this study is to investigate the influence of cervical LNM on prognostic outcomes of young patients (<45 years' old) with PTC.We carried out a retrospective analysis of 1896 PTC patients younger than 45 years' old at diagnosis, who were firstly treated in our department between January 2005 and December 2014. Clinicopathologic features, recurrences, disease-free survival (DFS) were recorded and analyzed.A total of 1896 consecutive patients were identified, comprising of 426 males and 1470 females after a median follow-up period of 40 months (3-129 months) from initial surgery to disease recurrence or to the end of follow-up. The rate of recurrence was 2.16% (n = 41). The DFS rates for a 1-year, 3-year, or 5-year team were 99.1%, 97.8%, or 97.4%, respectively. Univariate analysis showed that diagnosed age ≤30 years, tumor size >1.0 cm, extrathyroidal extension, multifocal lesions, lesions in bilateral lobes, central neck LNM, and lateral neck LNM were associated with a worse DFS. Multivariate analysis showed that only central neck LNM and lateral neck LNM were significant independent prognostic factors for DFS (P < .001). For patients with papillary thyroid microcarcinoma, cervical LNM were also identified as independent risk factors for DFS (P < .001).LNM have prognostic significance for DFS in PTC patients younger than 45 years. It indicated that PTC patients (<45 years old) with LNM, especially lateral neck LNM, were understaged by the 7th edition of AJCC staging system. Thus, radical resection of primary tumor and metastatic lymph nodes, frequent follow-up, and strict TSH suppression should be taken for young patients with PTC.


Assuntos
Linfonodos/patologia , Metástase Linfática/patologia , Receptores da Tireotropina/antagonistas & inibidores , Câncer Papilífero da Tireoide/patologia , Adulto , Carcinoma Papilar/mortalidade , Carcinoma Papilar/patologia , Intervalo Livre de Doença , Feminino , Humanos , Linfonodos/diagnóstico por imagem , Linfonodos/cirurgia , Masculino , Margens de Excisão , Pescoço/patologia , Recidiva Local de Neoplasia/epidemiologia , Estadiamento de Neoplasias/métodos , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Câncer Papilífero da Tireoide/mortalidade , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/mortalidade , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia/métodos
20.
Medicine (Baltimore) ; 99(16): e19840, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32312007

RESUMO

To determine the levels of parathyroid hormone (PTH) in the fluids of various tissues for identification of parathyroid glands during thyroidectomy.Our study comprised 31 patients with thyroid cancer who underwent lobectomy with central compartment dissection at our hospital from October 2014 to February 2015. A total of 186 tissue samples, including 28 from parathyroid glands and 158 from non-parathyroid tissues, were obtained during the operations. Tissue fluids were collected via fine-needle aspiration to measure PTH levels; the tissue was punctured 3 times with a 26-gauge syringe needle and washed with 0.5 mL normal saline. Tissues were also prepared for pathological examination.PTH concentrations were significantly higher in parathyroid tissues than non-parathyroid tissues. None of the patients had irremediable parathyroid dysfunction after surgical resection.Use of fine-needle aspiration for quantification of PTH levels in tissue fluids rapidly, safely, and effectively identifies the parathyroid glands during thyroidectomy.


Assuntos
Biópsia por Agulha Fina/métodos , Glândulas Paratireoides/cirurgia , Hormônio Paratireóideo/análise , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adulto , Idoso , Feminino , Humanos , Hipotireoidismo/epidemiologia , Hipotireoidismo/prevenção & controle , Excisão de Linfonodo/métodos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/normas , Doenças das Paratireoides/diagnóstico , Doenças das Paratireoides/fisiopatologia , Glândulas Paratireoides/patologia , Período Pós-Operatório , Sensibilidade e Especificidade , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia/efeitos adversos
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