Epidemiology and results of surgical treatment of euthyroid and toxic goiter depending on the peculiarities of clinical course, tracheal compression and comorbidity

BACKGROUND: At the time of seeking medical help, some patients have nodular/multinodular goiter of large and gigantic sizes, which leads to compression of the neck organs. In the structure of benign diseases, neck compression is diagnosed in 10% of cases, and tracheal narrowing is found in 84% of patients in this group. It was experimentally established that narrowing of the trachea leads to the development of hypertension in the pulmonary circulation. Patients with nodular/multinodular goiter with compression of the neck organs belong to the age group of 50 years and older, the peculiarity of which is comorbidity of varying severity. Cardiopulmonary syndromes may mask compression of the organs of the neck by the thyroid gland. As a rule, patients come and/or go to a cardiologist, pulmonologist, gastroenterologist and other specialists, as a result of which the timelines for timely surgical treatment are missed. Often, patients are delivered to the endocrine surgeon urgently due to the development of asphyxiation. The symptoms of impaired external respiration and the initial manifestations of pulmonary hypertension, as a result of compression syndrome, preceding this condition are evaluated only retrospectively. AIMS: To study the frequency of tracheal compression and symptoms of chronic hypoxia in the structure of benign thyroid diseases requiring surgical treatment, as well as an assessment of the nature of comorbid pathology and the results of surgical treatment. METHODS: A retrospective analysis of the results of surgical treatment of benign thyroid diseases for the period from March to August 2019 was carried out (100 observations). RESULTS: Toxic goiter prevailed in the structure of benign thyroid diseases (74%). Tracheal compression was observed in 69% of cases. When trachea was compressed, arterial hypertension statistically significantly prevailed (2, p0.01). The appearance of wheezing on inhalation/exhalation and an increase in its frequency were detected when the trachea narrowed to the thyroid gland to 10 mm or less in 10 cases (10%) with a statistically significant prevalence of pulmonary hypertension (2, p0.01). Thyroidectomy prevailed in the structure of operations (80%). There was no statistically significant increase in surgical complications depending on the severity of tracheal compression, age, and concomitant pathology. There were no fatal outcomes. CONCLUSIONS: Surgical treatment of patients with benign thyroid diseases complicated by compression of the neck organs is also shown safely regardless of age and associated pathology.

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Evaluation of Total Thyroidectomy for Treatment of Benign Diseases of Thyroid Gland

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.3929 ◽

2020 ◽

Vol 8 (B) ◽

pp. 166-170

Author(s):

Risto Cholancheski ◽

Natasha Tolevska ◽

Ardit Qafjani ◽

Ilir Vela ◽

Borislav Kondov ◽

...

Keyword(s):

Thyroid Gland ◽

Total Thyroidectomy ◽

Nerve Palsy ◽

Laryngeal Nerve ◽

Thyroid Diseases ◽

Recurrent Nerve ◽

Recurrent Nerve Palsy ◽

Laryngeal Nerve Palsy ◽

Toxic Goiter ◽

Benign Thyroid

BACKGROUND: The controversy of using total thyroidectomy (TT) in treatment of benign thyroid diseases still remains controversial over the rates of complication, mostly recurrence nerve palsy and hypocalcemia, compared to non-total thyroidectomies. The latest reports in this field of research showed that that the number of complications of TT is decreasing as the skills of surgeons increase. AIM: In this study, we reviewed 209 cases of total thyroidectomies for benign thyroid diseases where such surgery was indicated. The results were evaluated whether they support the previous reports that TT is save method of treatment of diffuse multinodular goiters, Graves’ disease thyroid adenomas with diffuse goiters and thyroiditis. METHODS: Two hundred and nine patients, 36 males and 173 females, medium age 47 (17–77) operated with TT between 2016 and 2018 were included in the evaluation study. We evaluated the: Diagnosis, indications for operation, pre-operative medication administration, laryngeal recurrent nerve palsy, hypocalcemia, hypoparathyroidism, and patohistology findings. The follow-up for hypocalcemia and laryngeal nerve palsy was performed 1 year postoperatively. RESULTS: The age of the patients was between 17 and 77 years, medium-range 47 years old. Of 209 patients, 173 (83%) were female and 36 (17%) male with a gender ratio of 1:4.8 males to females. Diagnoses before surgery were established as follows: Multinodular euthyroid goiter (MNEG) n = 106 (48.80%), multinodular toxic goiter n = 12 (5.74%), Graves’s disease n = 6 (2.87%), adenoma with multinodular goiter n = 73 (34.92%), and n = 16 (7.65%) patients with thyroiditis. Recurrence laryngeal nerve palsy (RLNP) occurred in 6 patients (2.87%), temporary within 3 months after the operation in 4 patients (1.92%) and permanent palsy within 6 months and more after an operation in 2 patients (0.95%). Voice hoarseness immediately and within 1 month after the operation was registered in 32 patients (15.3%). RLNP and hoarseness were registered mostly in patients with pre-operative problems, mostly with extra big MNEG. One of the permanent injuries of RLN was bilateral and all others were one sided. All patients were operated with normal pre-operative vocal cord movement findings. Post-operative hypocalcemia was registered in 35 patients (16.74%). Temporary nonsignificant hypocalcemia in 10 (4.78%), temporary significant hypocalcemia in 17 (8.13%), temporary severe hypocalcemia in 6 patients (2.87%), and permanent hypocalcemia in 2 patients (0.95%). CONCLUSION: Many studies have shown that the rate of complications is almost even for TT and NTT done for benign and malignant diseases of thyroid gland. Our data have shown that the risk of post-operative complications with TT is proportional to the number of complicated pre-operative findings of benign thyroid glands.

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PROBABILITY OF CANCER DETECTION DURING REPEATED OPERATIONS IN PATIENTS WITH BENIGN THYROID DISEASES

Vestnik of Russian military medical Academy ◽

10.17816/brmma13056 ◽

2019 ◽

Vol 21 (1) ◽

pp. 94-98

Author(s):

A F Romanchishen ◽

A V Gostimsky ◽

A L Akinchev ◽

I V Karpatsky

Keyword(s):

Malignant Lesion ◽

Needle Aspiration ◽

Thyroid Diseases ◽

Endocrine Surgery ◽

Thyroid Remnant ◽

Recurrent Goiter ◽

Surgical Tactics ◽

Toxic Goiter ◽

Probability Of Cancer ◽

Benign Thyroid

Introduction. Suspected malignant growth in patients with recurrent goiter is one of the main causes of repeated operations. Focuses of carcinoma can be detected in patients operated on for multinodular goiter with compression of the organs of the neck, recurrent diffuse toxic goiter. Objective of investigation is to assess the risk of a malignant lesion of the thyroid remnant in patients with recurrent goiter, to justify the surgical tactics in this group of patients. Material and methods. In the St. Petersburg Center of Endocrine Surgery and Oncology 28138 patients with various thyroid diseases were operated on for the period from 1973 till 2016. Results. In a retrospective analysis of the group consisting of 1106 patients with recurrent goiter, a new thyroid disease was detected in 156 (14.1%) cases. Thyroid cancer in thyroid remnant was detected in 57 (36.5%) cases or 5.2% of all the patients with recurrent goiter. The work describes the risk of malignant lesion of the thyroid remnant in patients with recurrent goiter and surgical tactics in this group of patients. Conclusion. Cancer of the thyroid gland, as a new disease of the thyroid remnant, in patients previously operated on for benign thyroid pathology, is found in 5.2% of observations. The possibilities of fine-needle aspiration biopsy in this group are reduced. Active surgical tactics in cases of multinodular transformation of the thyroid remnant is justified. The operation of choice is reresection up to thyroidectomy. Careful intraoperative study of removed tissue and close cooperation with the morphological service helps to reduce the number of diagnostic and tactical errors in patients with both recurrent and ordinary multi-node goiter.

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Treatment of diffuse toxic goiter with lithium electrophoresis

Kazan medical journal ◽

10.17816/kazmj70586 ◽

1986 ◽

Vol 67 (5) ◽

pp. 333-335

Author(s):

N. M. Petrov

Keyword(s):

Thyroid Gland ◽

Thyroid Diseases ◽

Antithyroid Therapy ◽

Diffuse Goiter ◽

Toxic Goiter

The purpose of this work was to clinically evaluate the efficacy of lithium electrophoresis in some thyroid diseases. We examined 28 patients with primary toxic diffuse goiter aged from 20 to 54 years (2 men and 26 women). Seventeen patients had mild thyrotoxicosis, nine had moderate, and two had severe thyrotoxicosis. Diffuse increase of thyroid gland of I-II degree was found in 22 patients, III - in 6 patients. thyrogenic ophthalmopathy of I-II degree was observed in 6 patients. Conservative antithyroid therapy was required in 23 patients, and 5 patients underwent strumulectomy.

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Incidental thyroid microcarcinoma in benign thyroid diseases: can it encourage total thyroidectomy as the first choice of surgical treatment? (A retrospective study)

Endocrine Abstracts ◽

10.1530/endoabs.56.p1132 ◽

2018 ◽

Author(s):

Dimitrios Askitis ◽

Eleni I Efremidou ◽

Alexandra Giatromanolaki ◽

Agis Esebidis ◽

Vasiliki Vamvakerou ◽

...

Keyword(s):

Retrospective Study ◽

Surgical Treatment ◽

Total Thyroidectomy ◽

Thyroid Diseases ◽

Thyroid Microcarcinoma ◽

First Choice ◽

Benign Thyroid

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A Giant Euthyroid Endemic Multinodular Goiter with No Obstructive or Compressive Symptoms

Case Reports in Medicine ◽

10.1155/2011/620480 ◽

2011 ◽

Vol 2011 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Ahmed Nada ◽

Ashraf Mohamed Ahmed ◽

Ramon Vilallonga ◽

Manuel Armengol ◽

Ibrahim Moustafa

Keyword(s):

Surgical Treatment ◽

Thyroid Gland ◽

Multinodular Goiter ◽

Histopathological Examination ◽

Surgical Excision ◽

Laryngeal Nerve ◽

Multinodular Goitre ◽

Thyroid Glands ◽

High Level ◽

Multiple Cysts

Diffusely enlarged thyroid glands (goitres) are becoming increasingly infrequent. However, in some geographical areas they are still relatively common and can cause compressive symptoms involving the trachea, oesophagus, and recurrent laryngeal nerve. Surgical treatment of diffusely enlarged thyroid glands requires a high level of expertise and may lead to severe complications. Here we present a case report of surgical treatment of an extremely enlarged thyroid gland, found in a 61-year-old female patient. The patient underwent surgery, and a thyroidectomy was performed. The resulting specimen weighed 4.7 kg (10.4 lbs). Histopathological examination revealed a multinodular goitre with multiple cysts and areas of haemorrhage and necrosis. Surgical excision can immediately resolve local symptoms and is often recommended when substernal extension is evident. To the best of our knowledge, this is the largest thyroid gland ever reported in the literature. Only experienced surgeons should treat large thyroid goitres. Ideally, large thyroid goitres should be treated before they reach a substernal component, otherwise any sudden growth in gland size could seriously compromise respiration.

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Radioiodine Therapy of Benign Thyroid Diseases: Graves’ Disease, Plummer’s Disease, Non-toxic Goiter and Nodules

Nuclear Medicine Therapy ◽

10.1007/978-1-4614-4021-5_17 ◽

2012 ◽

pp. 281-314

Author(s):

Cumali Aktolun ◽

Muammer Urhan

Keyword(s):

Radioiodine Therapy ◽

Thyroid Diseases ◽

Graves Disease ◽

Plummer's Disease ◽

Toxic Goiter ◽

Plummer’S Disease ◽

Benign Thyroid

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Safety and Effectiveness of Total Thyroidectomy for Benign Multinodular Goitre

AL-MUKHTAR JOURNAL OF SCIENCES ◽

10.54172/mjsc.v34i4.171 ◽

2019 ◽

Vol 34 (4) ◽

pp. 243-247

Author(s):

Naser Musbah ◽

Hasan I. Fadel Saad ◽

Salma Saleh Mohamed

Keyword(s):

Total Thyroidectomy ◽

Multinodular Goiter ◽

Thyroid Tissue ◽

Surgical Techniques ◽

Thyroid Diseases ◽

Complication Rates ◽

Multinodular Goitre ◽

Thyroid Malignancy ◽

Surgery Department ◽

Benign Thyroid

Total thyroidectomy is considered the best choice for thyroids carcinoma. However, it is still controversial for benign thyroid diseases because of higher complication rates. But meticulous surgical techniques by expert surgeons can avoid most of the complications and thereby avoid the risk of reoperation for any recurrences. The objective of the study was to evaluate and justify the use of total thyroidectomy in benign thyroid diseases especially in multinodular goiter and Grave’s disease. We have carried out an ongoing prospective study of thyroidectomy cases for different indications over a span of 5 years, from 2012 to 2016; in the Surgery department, Al-Thowra teaching hospital, Al-Beida. The total number of operated cases was 353. Cases were distributed according to age, sex, diagnosis and operative procedures. Various complications encountered were enlisted. Total thyroidectomy was performed in 247 cases for MNG and Thyroid malignancy. Hemi-thyroidectomy or lobectomy was done in 82 cases for solitary nodules. Enucleation of cysts was done in 6 cases. Operations were done for recurrent nodules in 18 cases. Overall complications were few and only minor. We recommend total thyroidectomy for all cases of MNG; which will reduce the risk of recurrence and development of malignancy in residual thyroid tissue. It also can prevent secondary thyrotoxicosis.

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Guideline for radioiodine therapy for benign thyroid diseases (version 3)

Nuklearmedizin ◽

10.1055/s-0038-1623919 ◽

2004 ◽

Vol 43 (06) ◽

pp. 217-220 ◽

Cited By ~ 8

Author(s):

J. Dressler ◽

F. Grünwald ◽

B. Leisner ◽

E. Moser ◽

Chr. Reiners ◽

...

Keyword(s):

Radioiodine Therapy ◽

Thyroid Volume ◽

Thyroid Diseases ◽

Antithyroid Drugs ◽

Graves Disease ◽

Co Morbidity ◽

History Of ◽

Individual Decisions ◽

Prophylactic Use ◽

Benign Thyroid

SummaryThe version 3 of the guideline for radioiodine therapy for benign thyroid diseases presents first of all a revision of the version 2. The chapter indication for radioiodine therapy, surgical treatment or antithyroid drugs bases on an interdisciplinary consensus. The manifold criteria for decision making consider the entity of thyroid disease (autonomy, Graves’ disease, goitre, goitre recurrence), the thyroid volume, suspicion of malignancy, cystic nodules, risk of surgery and co-morbidity, history of subtotal thyroidectomy, persistent or recurrent thyrotoxicosis caused by Graves’ disease including known risk factors for relapse, compression of the trachea caused by goitre, requirement of direct therapeutic effect as well as the patient’s preference. Because often some of these criteria are relevant, the guideline offers the necessary flexibility for individual decisions. Further topics are patients’ preparation, counseling, dosage concepts, procedural details, results, side effects and follow-up care. The prophylactic use of glucocorticoids during radioiodine therapy in patients without preexisting ophthalmopathy as well as dosage and duration of glucocorticoid medication in patients with preexisting ophthalmopathy need to be clarified in further studies. The pragmatic recommendations for the combined use of radioiodine and glucocorticoids remained unchanged in the 3rd version.

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