scholarly journals Management of hypocalcemia after modified bilateral radical neck dissection followed with total thyroidectomy: a case report

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
I Made Arimbawa ◽  
Ayu Diah Perdana Paramita ◽  
I Gde Ardika Nuaba ◽  
Herman Saputra
Keyword(s):  
Total Thyroidectomy ◽  
Neck Dissection ◽  
Radical Neck Dissection ◽  
Hypovitaminosis D ◽  
High Dose ◽  
Post Surgery ◽  
Node Metastases ◽  
Surgery Center ◽  
Intravenous Calcium ◽  
Elemental Calcium

Hypocalcemia is a common complication after total thyroidectomy due to acute hypoparathyroidsm post-surgery. The incident varies from 7%-69% depends on the surgery center. The management is divided based on the onset and symptoms. Carpal-pedal spasm, seizure, bronchospasms are the emergency symptoms of hypocalcemia that require administration of   intravenous calcium. However the management of asymptomatic hypocalcemia with oral calcium, vitamin D and hydrochlorothiazide can be difficult due to wide fluctuations of serum calcium and the risks of complication. Hereby we report a 14-year-old girl with hypocalcemia due to hypoparathyroidsm post modified  bilateral radical neck dissection and total thyroidectomy. She had papillary thyroid carcinoma and lymph node metastases. After surgery, she developed classic sign of hypocalcemia,  numbness in extremities which progressed to cramps. Physical examination revealed chvostek’s sign. Laboratory examination showed critical value of hypocalcemia with normal level of albumin, hypoparathyroidsm and hypovitaminosis D. The initial treatment was started by giving  intravenous calcium gluconate 10% and calcitriol. Monitoring level of calcium and phosphate were performed regularly. Calcium level was maintained by giving high dose of elemental calcium, vitamin D3 and hydrochlorothiazide followed.

Evaluation of High Dose Preoperative Activated Vitamin D to Prevent Post Total Thyroidectomy Hypocalcemia

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mahmoud Ahmed Mohamed El-Shafaei ◽  
Hesham Mohamed Ali Omran ◽  
Ehab Mohammed Ali Fadl ◽  
Abanoub Magdy Abd El-Malak Ter Elbar
Keyword(s):  
Vitamin D ◽  
Total Thyroidectomy ◽  
Hypovitaminosis D ◽  
High Dose ◽  
Postoperative Hypocalcemia ◽  
Specialized Hospital ◽  
Egyptian Patients ◽  
Group 2 ◽  
Surgery Department ◽  
Vitamin D3 Deficiency

Abstract Background With increase in the number of thyroidectomies, the incidence of postoperative hypocalcemia has seen a rise as well. Deficiency of vitamin D has long been debated as a risk factor for post thyroidectomy hypocalcemia. The advantage of using vitamin D as a predictor for postoperative hypocalcemia may be (i) easy to estimate (ii) any deficiency can be easily corrected. Objective To determine the effectiveness of preoperative high dose calcitriol supplementation in reducing hypocalcemia following total thyroidectomy. Patients and Methods to assess the effect of preoperative vitamin D3 deficiency on post thyroidectomy hypocalcemia. For that purpose, 40 Egyptian patients for whom total thyroidectomy was performed in general surgery department at El-demerdash and Ain Shams University Specialized Hospital form March 2020 to September 2020. Patients were divided into 2 Groups; Group 1 included patients receiving preoperative single oral dose of active vit D(300000 IU) and Group 2 included patients receiving placebo instead of vit D. The incidence of postoperative hypocalcemia was investigated in all patients. Results Preoperative vitamin D measurements revealed a deficiency prevalence of 66.7% and a mean Vitamin D level of 17.09 ± 6.01. The main findings of the current study as regards to calcium was that the mean preoperative level of calcium was 9.61 ± 0.48 mg/dl, the lowest level of postoperative calcium was detected after 48 hours and 72 hours. With respect to relation between calcium and preoperative vitamin D, the results showed that there is no big difference between two groups (hypocalcemia occurred in 30% from patients in vit D group and 35% in placebo group) and no patients with normal preoperative vitamin D had a postoperative hypocalcemia 24, 48 or 72 hours after the operation. Conclusion Giving of single preoperative high dose vitamin D doesn’t reduce the overall rate of hypocalcemia after total thyroidectomy. Postoperative hypocalcemia is closely related to the preoperative vitamin D level and patients with hypovitaminosis D are more labile to develop hypocalcemia.

Robotic Total Thyroidectomy with Modified Radical Neck Dissection via Unilateral Retroauricular Approach

2014 ◽  
Vol 21 (12) ◽  
pp. 3872-3875 ◽  
Author(s):  
Hyung Kwon Byeon ◽  
F. Christopher Holsinger ◽  
Ralph P. Tufano ◽  
Hyo Jin Chung ◽  
Won Shik Kim ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Neck Dissection ◽  
Radical Neck Dissection ◽  
Modified Radical Neck Dissection ◽  
Retroauricular Approach

Clinico-statistical Considerations on Thyroid Cancer in the Youth

1966 ◽  
Vol 52 (3) ◽  
pp. 201-229 ◽  
Author(s):  
Umberto Ballarati ◽  
Ugo Marinoni ◽  
Gianpeglio Puricelli ◽  
Gianluigi Spreafico
Keyword(s):  
Thyroid Cancer ◽  
Lymph Nodes ◽  
Thyroid Nodule ◽  
Total Thyroidectomy ◽  
Neck Dissection ◽  
Radical Neck Dissection ◽  
Papillary Adenocarcinoma ◽  
Cervical Lymph Nodes ◽  
Solid Carcinoma ◽  
Diagnosis Of Thyroid Cancer

On a series of 220 patients with carcinoma of the thyroid, 17 (10 females and 7 males) were under the 24th year of age. In four cases the tumor was diagnosed between the 5th and the 14th year of age and in 13 cases between the 15th and the 24th year; there were 13 cases of papillary adenocarcinoma, 2 cases of follicular adenocarcinoma, and 2 cases of solid carcinoma. In 7 cases the tumor was preceded by the appearance of goiter; only one patient had been previously irradiated. The first clinical sign of disease was a thyroid nodule in 10 cases, metastases to cervical lymph nodes in 7 cases; in 3 of these last cases primary neoplasia of the thyroid remained clinically occult. Scanning with I181 was used in 13 cases for the diagnosis of thyroid cancer. Surgical and radiological therapies were associated in all cases; the enucleation of the tumor was performed in one case, emithyroidectomy in 7 cases, total thyroidectomy in 6 cases. Surgery was limited to dissection of the neck in 3 cases. In addition, thyroidectomy was associated to radical neck dissection in 9 cases with metastases. In all cases I181 was administered; in 7 cases it was associated to X-therapy and in 8 cases to telecobaltotherapy. One patient is alive 3 months after the beginning of the treatment, 6 patients from 1 to 3 years, 3 patients from 5 to 6 years, 2 patients after 8 years and 5 patients from 10 to 15 years.

scholarly journals Postoperative Chylothorax after Modified Radical Neck Dissection for Thyroid Carcinoma: A Missable Rare Complication of Thyroid Surgery

Medicina ◽  
2020 ◽  
Vol 56 (9) ◽  
pp. 481
Author(s):  
Junghyun Lee ◽  
In Eui Bae ◽  
Jin Yoon ◽  
Keunchul Lee ◽  
Hyeong Won Yu ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Total Thyroidectomy ◽  
Neck Dissection ◽  
Respiratory Symptoms ◽  
Rare Complication ◽  
Radical Neck Dissection ◽  
Papillary Thyroid ◽  
Asymptomatic Group ◽  
Modified Radical Neck Dissection ◽  
Drain Removal

Background and objectives: Currently, few studies have been conducted on postoperative chylothorax, specifically in total thyroidectomy with modified radical neck dissection (MRND) in papillary thyroid carcinoma patients. This study provides the actual incidence, etiology, and clinical features of postoperative chylothorax and reports the clinical outcomes after treatment, which were dependent upon the severity of the complications. Materials and Methods: The medical charts of 111 papillary thyroid cancer (PTC) patients who underwent total thyroidectomy with modified radical neck dissection from January 2016 to December 2018 were reviewed retrospectively. The results were compared in three groups: the no chylothorax group, the subclinical (asymptomatic) group, and the clinical (symptomatic) group. Results: Chylothorax occurred in 23 patients (20.7%, 23/111). Nineteen (82.6%, 19/23) were subclinical chylothorax cases, which implies a small amount of chyle leakage with no respiratory symptoms. Four (17.4%, 4/23) were clinical, meaning they had either respiratory symptoms, such as dyspnea, desaturation, or a large amount of chylothorax in the images. The incidence was significantly higher in patients who underwent left modified radical neck dissection, and this corresponds to the side in which chylothorax occurred. There were also statistical differences in the drainage color, peak amount, or drain removal time. Conclusions: Postoperative chylothorax is a rare complication following neck dissection. However, it can be fatal if the condition progresses. Therefore, patients who undergo total thyroidectomy with modified radical neck dissection, especially on the left side, should be monitored for respiratory symptoms, and serial chest x-ray images obtained.

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