Black pigmentation seen in thyroid surgery: an indication for total thyroidectomy?

2019 ◽  
Author(s):  
Nassim Sodagari ◽  
Seyed Mohsen Khoshniat Nikoo ◽  
Anoushiravan Hedayat ◽  
Hamidreza Aghayi
Keyword(s):  
Total Thyroidectomy ◽  
Thyroid Surgery ◽  
Black Pigmentation

Post-thyroidectomy bleeding: analysis of risk factors from a national registry

2021 ◽  
Author(s):  
H E Doran ◽  
S M Wiseman ◽  
F F Palazzo ◽  
D Chadwick ◽  
S Aspinall
Keyword(s):  
Risk Factors ◽  
Total Thyroidectomy ◽  
Thyroid Surgery ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Bleeding Risk ◽  
Redo Surgery ◽  
Day Case ◽  
Increased Risk ◽  
Male Sex

Abstract Background Post-thyroidectomy haemorrhage occurs in 1–2 per cent of patients, one-quarter requiring bedside clot evacuation. Owing to the risk of life-threatening haemorrhage, previous British Association of Endocrine and Thyroid Surgeons (BAETS) guidance has been that day-case thyroidectomy could not be endorsed. This study aimed to review the best currently available UK data to evaluate a recent change in this recommendation. Methods The UK Registry of Endocrine and Thyroid Surgery was analysed to determine the incidence of and risk factors for post-thyroidectomy haemorrhage from 2004 to 2018. Results Reoperation for bleeding occurred in 1.2 per cent (449 of 39 014) of all thyroidectomies. In multivariable analysis male sex, increasing age, redo surgery, retrosternal goitre and total thyroidectomy were significantly correlated with an increased risk of reoperation for bleeding, and surgeon monthly thyroidectomy rate correlated with a decreased risk. Estimation of variation in bleeding risk from these predictors gave low pseudo-R2 values, suggesting that bleeding is unpredictable. Reoperation for bleeding occurred in 0.9 per cent (217 of 24 700) of hemithyroidectomies, with male sex, increasing age, decreasing surgeon volume and redo surgery being risk factors. The mortality rate following thyroidectomy was 0.1 per cent (23 of 38 740). In a multivariable model including reoperation for bleeding node dissection and age were significant risk factors for mortality. Conclusion The highest risk for bleeding occurred following total thyroidectomy in men, but overall bleeding was unpredictable. In hemithyroidectomy increasing surgeon thyroidectomy volume reduces bleeding risk. This analysis supports the revised BAETS recommendation to restrict day-case thyroid surgery to hemithyroidectomy performed by high-volume surgeons, with caution in the elderly, men, patients with retrosternal goitres, and those undergoing redo surgery.

A Prospective Study on Post-Operative Complications Following Thyroid Surgery Conducted in a Tertiary Care Hospital in Tirupati

2021 ◽  
Vol 8 (31) ◽  
pp. 2900-2905
Author(s):  
Sadhu Nagamuneiah ◽  
Gandikota Venkata Prakash ◽  
Sabitha P ◽  
Karthik Periyasamy ◽  
Sanjay Raj Kumar Reddy Madduri ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Prospective Study ◽  
Total Thyroidectomy ◽  
General Hospital ◽  
Thyroid Surgery ◽  
Complication Rate ◽  
Wound Complication ◽  
Seroma Formation ◽  
Operative Complications ◽  
A Prospective Study

BACKGROUND Thyroidectomy is a surgical procedure which is commonly performed by surgeons worldwide, but the outcome and complication rates were mainly dependent on the surgeon’s skill and experience, indication and the extent of surgery and the number of thyroid surgeries performed at that particular centre. The aim of this study was to assess the frequency of the postoperative complications after thyroid surgery in Sri Venkateswara Ramnaraian Ruiya Government General Hospital, Tirupati. METHODS A prospective study conducted on 100 patients with thyroid swelling who attended the Sri Venkateshwara Ramnaraian Ruya Government General Hospital, Tirupati. Patient age, sex, rural/urban origin, history, diagnosis, type of surgery, laboratory investigation such as complete blood, serum calcium, thyroid function test, us culture and sensitivity test in wound infections and indirect laryngoscopy for all pre-operative patients and postoperative voice change patients. Outcomes recorded as a complication of thyroid surgery within one week. RESULTS Totally 100 patients were enrolled in the study. Thyroid enlargement was more common in females (F: M =5.6:1) presenting in 3rd and 4th decades mostly with the mean age and standard deviation were 42.92 years and 13.097 years respectively. Total thyroidectomy was the most common procedure performed (44 %) followed by hemithyroidectomy (31 %), subtotal thyroidectomies (29 %) and near total thyroidectomy (5 %). On histopathological examination most common finding was multinodular goiter (54 %) followed by nodular goiter (33 %) and malignancies (10 %). The overall postoperative complication rate was 47 %. The most common postoperative complications after thyroidectomies were seroma formation in wound complication (27 %), followed by hypocalcemia (11 %), recurrent laryngeal nerve (RLN) injury (3 %), and surgical site infection (2 %). Majority of these complications were found to be associated with total thyroidectomy, female population, and in patients with age more than 30 years. CONCLUSIONS Seroma formation in wound complication is the commonest post thyroidectomy complication. Female gender, old age, and extensive thyroid surgery were associated with increased complication rate. KEYWORDS Post-Operative Complications, Thyroid Surgery

Major post-operative complications of thyroid surgery: Preventable or not?

2009 ◽  
Vol 34 (3) ◽  
pp. 99-103 ◽  
Author(s):  
M.A. Majid ◽  
Md. Ibrahim Siddique
Keyword(s):  
Total Thyroidectomy ◽  
Vocal Cord ◽  
Thyroid Surgery ◽  
Multinodular Goiter ◽  
Vocal Cord Palsy ◽  
Subtotal Thyroidectomy ◽  
Permanent Hypoparathyroidism ◽  
Respiratory Obstruction ◽  
Operative Complications ◽  
Toxic Multinodular Goiter

Factors responsible for major complications following thyroid surgery in 598 patients were studied. Patients with non toxic multinodular goiter involving both lobes of thyroid constituted the maximum bulk subjected to thyroidectomy. The most frequent procedure was bilateral subtotal thyroidectomy. Reactionary hemorrhage occurred in 6 patients, all following bilateral procedures and among them 5 patients developed tension hematoma with respiratory obstruction despite the presence of a drain. Temporary vocal cord palsy was observed in 7 patients whereas one patient subjected to total thyroidectomy with neck dissection for papillary carcinoma of thyroid developed permanent right vocal cord palsy. Temporary parathyroid insufficiency was seen in 51 patients and one patient developed permanent hypoparathyroidism. Incidence of parathyroid insufficiency was higher in bilateral procedures as compared to unilateral ones. There was no operation related death in this series, but complications like hemorrhage, vocal cord palsy and parathyroid insufficiency following thyroid surgery are still a deep concern. Keywords: Complication; Post-operative; Thyroid surgeryOnline: 29-1-2009DOI: 10.3329/bmrcb.v34i3.1973     Bangladesh Med Res Counc Bull 2008; 34: 99-103. 

scholarly journals Simultaneous dysphagia and stridor: an unreported presentation of hypocalcaemia

2020 ◽  
Vol 2020 (9) ◽  
Author(s):  
Charlotte Thomas ◽  
Navdeep Bhamra ◽  
Adnan Darr ◽  
Aakash Amlani ◽  
John Murphy
Keyword(s):  
Total Thyroidectomy ◽  
Replacement Therapy ◽  
Thyroid Surgery

Abstract Hypocalcaemia is a well-recognized complication of total thyroidectomy surgery. Patients who develop post-operative hypocalcaemia often report symptoms of neuromuscular instability including peripheral numbness and/or tingling. In severe cases, larygospasm with stridor and bronchospasm can occur. We present the first reported case in the literature, to our knowledge, of a 58-year-old male presenting with intermittent exertional stridor, dysphonia and dysphagia following thyroid surgery 2 years previously. Clinical and radiological investigations were unremarkable. Pre-operative screening for a planned panendoscopy to investigate his symptoms highlighted a profound hypocalcaemia (adjusted calcium 1.42 mmol/l). Following calcium replacement therapy, his symptoms subsided. There is an absence of literature describing both dysphagia and stridor synchronously. We not only advocate regular routine follow-up and compliance assessments for such patients but also the consideration of hypocalcaemia as a differential in any patient presenting with such symptoms following any thyroid surgery.

Comparing Hematoma Incidence between Hemostatic Devices in Total Thyroidectomy: A Systematic Review and Meta-analysis

2019 ◽  
Vol 161 (5) ◽  
pp. 770-778 ◽  
Author(s):  
Nadia Hua ◽  
Alexandra Elizabeth Quimby ◽  
Stephanie Johnson-Obaseki
Keyword(s):  
Total Thyroidectomy ◽  
Thyroid Surgery ◽  
Alternative Energy ◽  
English Language ◽  
Meta Analysis ◽  
Cochrane Central Register ◽  
Energy Devices ◽  
Postoperative Hematoma ◽  
Significant Difference ◽  
Alternate Energy

Objective Alternative energy devices have become a popular alternative to conventional hemostasis in thyroid surgery. These devices have been shown to reduce operative time and thermal nerve injury. As hemostasis is paramount in thyroid surgery, we sought to examine the relative efficacy of 2 alternate energy devices compared to conventional hemostasis in preventing postoperative hematoma following total thyroidectomy. Data Sources Ovid MEDLINE, EMBASE, PubMed, and Cochrane Central Register of Controlled Trials. Review Methods A systematic literature search was performed for all relevant English-language studies published between 1946 and July 2018. Two authors independently extracted data and analyzed articles for quality using the National Institute of Health Quality Assessment Scale. Our primary outcome of interest was hematoma requiring reoperation. Results A total of 348 studies were screened, with 23 meeting the inclusion criteria. We found no significant difference in postoperative hematoma rates using alternate energy devices compared to conventional hemostasis ( P = .370, .317). Network meta-analysis echoed the results of conventional meta-analysis, demonstrating no significant difference in hematoma rates. Conclusions We found no significant difference in postoperative hematoma rates following total thyroidectomy for any indication with the use of alternate energy devices compared to conventional hemostatic techniques. This suggests that hematoma occurrence does not necessarily need to be considered when choosing between these hemostatic devices. This information may help guide surgeons’ decisions regarding choice of hemostatic technique during thyroid surgery.

scholarly journals Endoscopic Total Thyroidectomy: Report of Two Cases

1970 ◽  
Vol 26 (1) ◽  
pp. 46-49
Author(s):  
M Mohibul Aziz ◽  
MA Wohab Khan ◽  
Shamin Islam
Keyword(s):  
Total Thyroidectomy ◽  
Key Words ◽  
Vocal Cord ◽  
Thyroid Surgery ◽  
Harmonic Scalpel ◽  
Endoscopic Thyroidectomy ◽  
Vocal Cord Palsy ◽  
Experienced Hand ◽  
Thyroid Swelling ◽  
Medical University

Two patients (one male and one female) recently under went total thyroidectomies using a standard laparoscope at the department of surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. Three ports (one mid line and two laterals) were employed and a harmonic scalpel was used for the dissection. To the best of our knowledge, there was no report of endoscopic total thyroidectomy from Bangladesh. Both patients were fed on the first post operative day. They were discharged between the 3rd and 4th post operative days. There was no hypocalcaemia but one patient developed temporary unilateral vocal cord palsy. Endoscopic thyroidectomy appears to be a technically feasible patient friendly modality of treatment for the selected cases of thyroid swelling in an experienced hand with excellent out come. Key Words: Endoscopic; laparoscopic; thyroid surgery; total thyroidectomy. DOI: 10.3329/jbcps.v26i1.4233 J Bangladesh Coll Phys Surg 2008; 26: 46-49

scholarly journals Difficult Decision on Tyroid Surgery of Expert Witness: Complication or Malpractice

2017 ◽  
Vol 23 (2) ◽  
pp. 89-92
Author(s):  
Ali Rıza Tümer ◽  
Mahmut Şerif Yıldırım ◽  
Savaş Koçak
Keyword(s):  
Thyroid Carcinoma ◽  
Total Thyroidectomy ◽  
Cancer Patients ◽  
Thyroid Surgery ◽  
Expert Witness ◽  
Nodular Goiter ◽  
Laryngeal Nerve ◽  
Subtotal Thyroidectomy ◽  
Difficult Decision ◽  
Common Problems

Objective: Recurrent laryngeal nerve (RLN) paralysis and hypocalcemia following thyroid surgery have been designated as complication or malpractice. In this study, it was aimed to evaluate surgeons’ opinions towards RLN injury and hypocalcemia after bilateral subtotal thyroidectomy (BST) and total thyroidectomy (TT) in nodular goiter and thyroid carcinoma. Materials and Methods: We prepared a questionnaire to determine approaches of surgeons in such cases. We grouped the respondents according their thyroid surgery experiments and asked them to determine whether it is malpractice or complication in cases with unilateral or bilateral RLN paralysis and hypocalcemia after “bilateral subtotal thyroidectomy” and in cases with unilateral or bilateral RLN paralysis after “total thyroidectomy”. Results: In all groups describing bilateral RLN injury was more common. Problems which are defined as “complication” in cancer patients, were more likely defined as “malpractice” in benign cases. However, these differences were generally not statistically significant. Conclusion: There is no consensus about malpractice and complication discrimination among physicians. Every physician should evaluate every specific case in its own nature and conditions when asked to determine whether the case should be determined as complication or malpractice.

scholarly journals Postthyroidectomy Horner’s Syndrome

2012 ◽  
Vol 2012 ◽  
pp. 1-2 ◽  
Author(s):  
Ramon Vilallonga ◽  
José Manuel Fort ◽  
Alejandro Mazarro ◽  
Oscar Gonzalez ◽  
Enric Caubet ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Thyroid Surgery ◽  
Malignant Tumors ◽  
Rare Complication ◽  
Sympathetic Chain ◽  
Horner’S Syndrome ◽  
Horner's Syndrome ◽  
Cervical Sympathetic Chain ◽  
Cervical Sympathetic

Horner’s syndrome (HSd) results from an injury along the cervical sympathetic chain, producing ipsilateral miosis, ptosis, enophthalmos, and facial anhydrosis. Although more commonly associated to malignant tumors affecting the preganglionar segment of the sympathetic chain (especially in the lung apex), HSd has been described as a rare complication of thyroid surgery. We herein report a case of HSd after completing total thyroidectomy.

scholarly journals Comparing the Outcomes of Thyroid Surgical Procedures for Benign Diseases with Expertise of the Surgeon in a Tertiary Care Hospital in Rawalpindi, Pakistan

2021 ◽  
Vol 10 (2) ◽  
pp. 68-75
Author(s):  
Nadir Mehmood Mehmood ◽  
Liaquat Ali Bhatti ◽  
M. Idrees Anwar ◽  
M. Aslam Chaudhry ◽  
Malik Irfan Ahmed ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Surgical Procedures ◽  
Thyroid Surgery ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Subtotal Thyroidectomy ◽  
Care Hospital ◽  
Benign Diseases ◽  
Cross Sectional ◽  
Permanent Hypocalcemia

Background: There is a lack of standardized guidelines regarding selection of appropriate thyroid surgery for patients with benign diseases. As a result, an inexperienced surgeon may select a more aggressive surgical option, which may increase the complication rate. The objective of this study was to compare the outcomes of thyroid surgical procedures for benign diseases with the expertise of the surgeon.Material and Methods: A retrospective cross-sectional study from 1999 to 2018. The study setting is of a public sector tertiary care teaching hospital. Patients undergoing thyroid surgery (lobectomy with isthmusectomy, subtotal thyroidectomy (STT), near total thyroidectomy (NTT), or total thyroidectomy (TT)) were included. Expertise level 1, 2 and 3 (L1, L2, L3) of the surgeon was based on years of experience or number of thyroid surgeries to their credit. Postoperative complications (hypocalcemia, recurrent laryngeal nerve (RLN) damage, airway obstruction, hemorrhage and mortality) were measured against type of thyroid surgery and expertise of the surgeon.Results: A total of 833 thyroid surgeries were performed on 695 (83.43%) females and 138 (16.57%) males. About 502 (60.26%) STT, 228 (27.37%) TT, 61 (7.32%) NTT, 42 (5.04%) lobectomies with isthmusectomies were performed, with LI, 2, and 3 surgeons performing 21.25%, 45.74% and 33% of these procedures, respectively. Surgeons with L1, 2 and 3 levels of expertise caused 49.47%, 33.45% and 17.08% of adverse events, respectively. Permanent hypocalcemia, RLN damage and mortality were significantly more common in surgeries performed by L1 compared with L2 and L3 surgeons (P<.05). Transient and permanent hypocalcemia, transient and permanent RLN damage and mortality were significantly more common for total thyroidectomy compared to subtotal thyroidectomy (P<.01).Conclusions: Minimizing the occurrence of complications like permanent hypocalcemia, RLN damage and mortality, expertise of the surgeon and anticipated difficulty of the procedure needs to be taken into account while selecting a thyroid procedure.

scholarly journals A challenging TSH/GH co-secreting pituitary adenoma with concomitant thyroid cancer; a case report and literature review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jee Hee Yoon ◽  
Wonsuk Choi ◽  
Ji Yong Park ◽  
A Ram Hong ◽  
Sung Sun Kim ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Pituitary Adenoma ◽  
Total Thyroidectomy ◽  
Thyroid Surgery ◽  
Pituitary Tumor ◽  
Oral Glucose ◽  
Somatostatin Analogue ◽  
Papillary Thyroid ◽  
Α Subunit

Abstract Background Thyroid stimulating hormone (TSH) secreting pituitary adenoma (TSHoma) with coexisting thyroid cancer is extremely rare, and proper treatment of both diseases may pose a unique clinical challenge. When TSHoma has plurihormonality, particularly involving the co-secretion of growth hormone (GH), management can be more complicated. Herein, we present a difficult-to-manage case of papillary thyroid cancer with an incurable TSH/GH-secreting pituitary adenoma. Case presentation A 59-year-old man was referred to our hospital due to memory impairment and inappropriate TSH level. Sella magnetic resonance imaging revealed a huge pituitary mass extending to the suprasellar area. Clinical diagnosis of TSH/GH co-secreting pituitary adenoma was made based on elevated free T4, total T3, serum α-subunit, insulin-like growth factor-1 levels and non-suppressible GH levels after oral glucose loading. Rectal cancer and multifocal papillary thyroid microcarcinoma (PTMC) were diagnosed during initial screening for internal malignancy; lower anterior resection was performed and close observation was planned for PTMC. Long-acting octreotide therapy was commenced, which resulted in a dramatic reduction in TSHoma size and facilitated control of hormonal excess. Total thyroidectomy and radioactive iodine (RAI) therapy were needed during follow up due to the growth of PTMC. After the surgery, the pituitary adenoma represented resistance to somatostatin analogue therapy and the tumor size gradually increased despite the addition of dopamine agonist therapy. Furthermore, TSH suppressive therapy with levothyroxine was impossible and an adequate TSH level for RAI therapy was unmountable. Late debulking pituitary surgery was ineffective, and the patient gradually deteriorated and lost to follow up. Conclusion We report the first aggravated case of TSH/GH co-secreting pituitary tumor after total thyroidectomy for concomitant multifocal PTMC. Deferring of thyroid surgery until the TSHoma is well controlled may be the optimal therapeutic strategy in patients with TSHoma and coexistent thyroid cancer; ablative thyroid surgery may result in catastrophic pituitary tumor growth.

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