Outcome of Thyroid Surgeries at Patan Hospital

2018 ◽  
Vol 6 (1) ◽  
pp. 11-14
Author(s):  
Deepak Yadav ◽  
Bhawana Dangol ◽  
Anita GC ◽  
Namita Shrestha ◽  
Ishwor Raj Devkota ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Neck Dissection ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Central Compartment ◽  
Neck Surgery ◽  
Laryngeal Nerve ◽  
Completion Thyroidectomy ◽  
Lateral Neck ◽  
Lateral Neck Dissection

Objective: To assess the outcome of thyroid surgeries at Patan HospitalMaterials and Methods: It is a retrospective study of in-patient records of patients undergoing thyroid surgeries for various indications from April 2013 to January 2015 at Patan Hospital, Lalitpur.Results: During the period of 21 months, 75 patients underwent thyroid surgeries. Majority of patients underwent hemithyroidectomy (35) followed by total thyroidectomy (28), subtotal thyroidectomy (7) and completion thyroidectomy (5). Out of 28 patients undergoing total thyroidectomy (TT), 11 underwent central compartment clearance (CCC), 5 underwent CCC and lateral neck dissection. Among 5 patients undergoing completion thyroidectomy, CCC was performed in all cases and in one patient lateral neck dissection was also performed.  A total of 13 patients developed unilateral recurrent laryngeal nerve palsy (RLN), among them 5 had permanent palsy. Tracheostomy had to be done in immediate postoperative period for stridor following total thyroidectomy (TT) in one case. Temporary hypocalcaemia was observed in 10 (10/28) cases following TT, out of which 8 had undergone CCC. Permanent hypocalcaemia was observed in 7 (7/28) cases following TT out of which 3 had undergone CCC. Chylous leak occurred in one of the patient undergoing left level II-IV neck dissection which was managed conservatively. None of the patient had to be transfused postoperatively.Conclusion: Complications to thyroid surgery are not uncommon. Visualization of recurrent laryngeal nerve alone in our context is adequate in experienced hands. Identification of parathyroid during thyroidectomy is recommended to avoid hypocalcaemia. Meticulous dissection can reduce the complications.Nepalese Journal of ENT Head and Neck Surgery, Vol. 6, No. 1, 2015

scholarly journals Complications of Thyroid Surgery & Their Risk Factors: A Prospective Study at a Tertiary Care Center of Eastern Nepal

2019 ◽  
Vol 2 (1) ◽  
pp. 25-33
Author(s):  
Niranjan Panthi ◽  
S T Chettri ◽  
S P Shah ◽  
D Poudel ◽  
S Manandhar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Recurrent Laryngeal Nerve ◽  
Neck Dissection ◽  
Thyroid Surgery ◽  
Nerve Palsy ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Central Compartment ◽  
Laryngeal Nerve ◽  
Laryngeal Nerve Palsy

Background: Thyroid surgery is one of the commonest surgeries performed by otolaryngologists. Currently, the main postoperative complications are hypocalcemia and recurrent laryngeal nerve (RLN) palsy. Extent of surgery, lack of identification of RLN/ parathyroid glands, malignancy, central compartment neck dissection, lateral neck dissection, previous surgery and size of goiter are the risk factors for complications. The objectives of this study were to determine the frequency of postoperative complications after thyroid surgery and to analyze the risk factors of complications. Methods: It was a prospective study of 45 patients undergoing thyroid surgery in eastern Nepal from March 2014 to September 2015. The postoperative complications and the risk factors associated with these complications were evaluated. Results: There were total of 45 cases of thyroid surgery, with the mean age of 39.04 years. The main postoperative complications were: hypocalcaemia (6 or 13.33% cases) and vocal cord palsy due to recurrent laryngeal nerve injury (5 or 11.11% cases). Temporary hypocalcaemia was observed in 3(6.67%) cases while permanent hypocalcaemia developed in other 3 (6.67%) cases. Similarly, the temporary and permanent recurrent laryngeal nerve palsy occurred in 3 (6.67%) cases and 2 (4.44%)cases respectively. The risk factors associated with hypocalcaemia were: malignancy, repeat operation, central compartment neck dissection and non-identification of parathyroid glands during surgery. Similarly, recurrent laryngeal nerve palsy was observed in cases of malignancy and central compartment neck dissection. Conclusion: The major postoperative complications of thyroid surgery were hypocalcaemia and recurrent laryngeal nerve palsy. Malignancy and central compartment neck dissection had effect on incidence of complications. Sound knowledge of anatomy and meticulous surgical technique are needed to reduce the incidence of complications.

scholarly journals Safety and efficacy of microscope-assisted thyroidectomy

2020 ◽  
Vol 7 (3) ◽  
pp. 73-79
Author(s):  
Brihaspati Sigdel ◽  
Bhima Neupane ◽  
Tulika Dubey ◽  
Rajesh Maharjan ◽  
Kuseshwor Sah
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Neck Dissection ◽  
Parathyroid Gland ◽  
Recurrent Laryngeal Nerve Palsy ◽  
College Teaching ◽  
Laryngeal Nerve ◽  
Safe Procedure ◽  
Institutional Review ◽  
Ethical Approval

Introduction: Due to closely related structures like recurrent laryngeal nerve and parathyroid gland, thyroid surgery becomes challenging. Microscope assisted surgery has better visualization for dissection, and decreases the risk of injury to the nerve, parathyroid gland, and its vascular pedicle. Hence it decreases the operative complications. Method: This is a retrospective study of microscope-assisted thyroidectomy at Gandaki Medical College Teaching Hospital, Nepal from January 2017 to December 2019. Ethical approval was obtained from Institutional review committee. Types of surgery, postoperative hypocalcemia and recurrent laryngeal nerve function were analyzed descriptively. Result:  Out of total 48 microscope assisted thyroidectomy, 41 were female, 42(87.5%) benign pathology, 6(12.5.%) malignant. Hemithyroidectomy was done in 40(83.4%), total thyroidectomy 4 (8.2%), total thyroidectomy with neck dissection  3(6.3%), and completion thyroidectomy with neck dissection in 1(2.1%). Among total thyroidectomies, transient hypocalcemia occurred in 2(4.2%) and temporary recurrent laryngeal nerve palsy in 1(2.1%). No complication occurred in hemithyroidectomies. Conclusion: Microscope-assisted thyroidectomy is a safe procedure which leads to reduced complication of hypocalcemia and recurrent never palsy.

Importance of Identifying the Course of the Recurrent Laryngeal Nerve in Total and Near-Total Thyroid Lobectomies

2005 ◽  
Vol 71 (3) ◽  
pp. 225-227
Author(s):  
Zeki Acun ◽  
Fikret Cinar ◽  
Alper Cihan ◽  
Suat Can Ulukent ◽  
Lokman Uzun ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Nerve Injury ◽  
Nerve Palsy ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Thyroid Diseases ◽  
Thyroid Lobectomy ◽  
Laryngeal Nerve Injury

In our clinic, near-total thyroidectomy is the principal surgical procedure performed for benign thyroid diseases. We conducted a single-institution study on 176 consecutive patients who underwent near-total thyroidectomy due to various thyroid diseases. We compared the incidence of recurrent laryngeal nerve injury between total and near-total thyroid lobectomy sides in each patient. Our hypothesis was that the incidence of recurrent laryngeal nerve injury after total thyroid lobectomy would be similar to that of near-total thyroid lobectomy when the course of the recurrent laryngeal nerve was identified during surgery. The temporary recurrent laryngeal nerve palsy rates on the total and near-total thyroid lobectomy sides were 3.9 per cent (7 of 176 nerves) and 2.2 per cent (4 of 176 nerves), respectively. The difference was not statistically significant. Permanent recurrent laryngeal nerve palsy did not occur in any of our patients. In conclusion, the incidence of recurrent laryngeal nerve injury in total versus near-total thyroid lobectomy is not different when the course of the recurrent laryngeal nerve is identified during surgery.

Total thyroidectomy for safe and definitive management of Graves' disease

2013 ◽  
Vol 127 (7) ◽  
pp. 681-684 ◽  
Author(s):  
A Prasai ◽  
P A Nix ◽  
M Aye ◽  
S Atkin ◽  
R J England
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Nerve Palsy ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Laryngeal Nerve ◽  
Definitive Treatment ◽  
Royal Infirmary ◽  
Graves Disease ◽  
Laryngeal Nerve Palsy

AbstractBackground:The role of total thyroidectomy in the management of patients with Graves' disease remains controversial. However, there is increasing evidence to support the role of the procedure as a safe and definitive treatment for Graves' disease.Method:Patients were identified from a prospective thyroid database of the multidisciplinary thyroid clinic at Hull Royal Infirmary. All case notes were independently reviewed to confirm the data held on the database.Results:Over a 7-year period, the senior author has performed 206 total thyroidectomies for Graves' disease. The incidence of temporary recurrent laryngeal nerve palsy and hypoparathyroidism was 3.4 per cent and 24 per cent respectively. There was one case of permanent unilateral recurrent laryngeal nerve palsy, and 3.9 per cent of patients developed permanent hypoparathyroidism. There has been no relapse of thyrotoxicosis.Conclusion:In the context of a multidisciplinary thyroid clinic, total thyroidectomy should be offered as a safe and effective first-line treatment option for Graves' disease.

scholarly journals Recurrent laryngeal nerve injury in endoscopic surgery for thyroid cancer

2020 ◽  
Vol 10 (3) ◽  
Author(s):  
Hoàng Hiệp Phan ◽  
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Recurrent Laryngeal Nerve ◽  
Neck Dissection ◽  
Lymph Node Dissection ◽  
Differentiated Thyroid Cancer ◽  
Endoscopic Thyroidectomy ◽  
Central Compartment ◽  
Laryngeal Nerve ◽  
Node Dissection

Tóm tắt Đặt vấn đề: Tổn thương dây thần kinh thanh quản quặt ngược (TQQN) là một biến chứng hay gặp trong phẫu thuật ung thư tuyến giáp. Phẫu thuật nội soi mới được ứng dụng và biến chứng này cũng là một lo ngại với các phẫu thuật viên. Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả cắt ngang, theo dõi dọc. Người bệnh được chẩn đoán là ung thư tuyến giáp thể biệt hóa giai đoạn sớm, được điều trị phẫu thuật bằng mổ nội soi tại Bệnh viện Nội tiết trung ương từ tháng 01 năm 2013 đến tháng 9 năm 2016. Kết quả: 95 người bệnh (NB) được chẩn đoán là ung thư tuyến giáp thể biệt hóa giai đoạn sớm được phẫu thuật nội soi theo chỉ định. Tổn thương dây thần kinh TQQN không gặp khi cắt 1 thùy tuyến giáp. Tổn thương dây thần kinh TQQN tạm thời khi cắt toàn bộ tuyến giáp tổn thương là 4,8%, cắt toàn bộ tuyến giáp và nạo vét hạch 1 khoang, 2 khoang và 3 khoang lần lượt là 3,6%, 5,6% và 1/5, tính chung là 5,3%. Tổn thương dây thần kinh TQQN vĩnh viễn (sau mổ 6 tháng) có 1 người bệnh (1,1%), trường hợp này thường là có nhân nằm tại vị trí dây chằng Berry đi vào của dây thần kinh TQQN. Tổn thương dây thần kinh của nhóm nạo vét hạch khoang trung tâm (5,6%) cao hơn so với nạo vét hạch khoang bên (3,6%) sự khác biệt có ý nghĩa thống kê (p=0,015). Liệt dây thần kinh TQQN trong nhóm nạo vét hạch cổ tăng hơn gấp 1,27 lần ở nhóm không nạo vét hạch (p = 0,025). Kết luận: Tỉ lệ tổn thương dây thần kinh TQQN phụ thuộc vào phương pháp phẫu thuật tuyến giáp và có nạo vét hạch cổ hay không. Tỉ lệ này sẽ tăng khi nạo vét hạch, đặc biệt là nạo vét hạch khoang trung tâm. Abstract Background: Recurrent laryngeal nerve (RLN) injury is a common complication in thyroidectomy. Endoscopic thyroidectomy has just been applied for thyroid cancer and RLN injury is also a concern of the surgeons. Materials and Methods: It’s a cross-sectional with longitudinal study. Patients with early differentiated thyroid cancer were enrolled into this study underwent endoscopic thyroidectomy in National hospital of Endocrinology from January 2013 to September 2016. Results: 95 patients with early differentiated thyroid cancer underwent endoscopic thyroidectomy were included. No RLN injury occurred for one lobectomy. Transient RLN injury was 5,3% in total of which was 4,8% after total thyroidectomy (TT), TT with compartment neck dissection were 3,6%; 5,6% and 1/5, respectively. One patient with permanent RLN injury (1,1%) due to the node is located into Berry ligament of RLN. There was a significantly increased risk of RLN injury after TT with central compartment neck dissection compared to TT with lateral compartment neck dissection (5,6% vs 3,6%, p=0,015). RLN injury was significantly higher for TT with lymph node dissection is 1,27 than the group without lymph node dissection (p=0.025). Conclusions: RLN injury rate was significantly influenced by types of thyroidectomy and with/without lymph node dissection. The rate was increased after TT with lymph node dissection, especially central compartment neck dissection. Keywords: Early differentiated thyroid cancer, Endoscopic thyroidectomy.

Value of intra-operative neuromonitoring of the recurrent laryngeal nerve in total thyroidectomy for benign goitre

2015 ◽  
Vol 129 (6) ◽  
pp. 553-557 ◽  
Author(s):  
C Page ◽  
P Cuvelier ◽  
A Biet ◽  
V Strunski
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Nerve Palsy ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Laryngeal Nerve ◽  
Control Group ◽  
Laryngeal Nerve Palsy ◽  
Significant Difference ◽  
Patient Groups ◽  
The Impact

AbstractObjective:This study aimed to evaluate the impact of intra-operative neuromonitoring of the recurrent laryngeal nerve during total thyroidectomy for benign goitre.Methods:A single-centre retrospective study using historical controls was conducted for a 10-year period, comprising a series of 767 patients treated by total thyroidectomy for benign goitre. Of these, 306 had intra-operative neuromonitoring of the recurrent laryngeal nerve and 461 did not. Post-operative laryngeal mobility was assessed in all patients by direct laryngoscopy before hospital discharge and at post-operative follow-up visits.Results:In all, 6 out of 461 patients (1.30 per cent) in the control group and 6 out of 306 patients (1.96 per cent) in the intra-operative neuromonitoring group developed permanent recurrent laryngeal nerve palsy. No statistically significant difference was observed between the two patient groups.Conclusion:Intra-operative neuromonitoring does not appear to affect the post-operative recurrent laryngeal nerve palsy rate or to reliably predict post-operative recurrent laryngeal nerve palsy. However, it can accurately predict good nerve function after thyroidectomy.

scholarly journals The Importance of Lymph Node Dissection in Medullary Thyroid Carcinoma Management

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A901-A902
Author(s):  
Camila Alejandra Villavicencio ◽  
Alberto Franco-Akel ◽  
Regina Belokovskaya
Keyword(s):  
Thyroid Carcinoma ◽  
Total Thyroidectomy ◽  
Neck Dissection ◽  
Medullary Thyroid Carcinoma ◽  
Tumor Markers ◽  
Lateral Neck ◽  
Lateral Neck Dissection ◽  
Medullary Thyroid ◽  
Preoperative Ct

Abstract Medullary thyroid carcinoma (MTC) is a rare endocrine malignancy that arises from calcitonin (Ct) parafollicular C-cells. Most cases are sporadic with frequent presentation being a solitary thyroid nodule. Total thyroidectomy with central neck dissection of lymph nodes (LN) is the standard treatment for MTC. The need for lateral neck dissection is controversial, with poor efficacy of non-surgical treatments presenting a problem. We present a case of MTC with preoperative Ct >500 pg/mL and negative imaging for metastases who underwent total thyroidectomy without LN exploration with an excellent postoperative biochemical response. This is a case of a 52-year-old female with a three-year history of anterior neck growth. The repeat fine needle aspiration (FNA) of a, previously negative for malignancy, growing nodule was consistent with MTC. Preoperative Ct and CEA levels were significantly elevated, 834.0 pg/mL and 11.2 ng/dL, respectively; a preoperative pan- CT scan did not reveal any suspicious LN or metastatic lesions and a negative RET oncogene mutation with normal plasma normetanephrines and metanephrines suggested a spontaneous rather than familial MTC. Patient underwent total thyroidectomy without LN exploration. Pathology confirmed MTC stage T1b. The one and three months postoperative follow up showed a significant downtrend with no normalization of Ct and CEA levels, 9.1 – 9.2 and 11.1 – 1.2, respectively. Reoperation for central and lateral neck dissection was considered; however, given the excellent biochemical response as well as the lack of radiographic evidence of disease, it was decided to continue monitoring of Ct and CEA levels for now. MTC response is monitored by the postoperative serum Ct and CEA levels when compared to the preoperative values. Serum Ct serves as a sensitive tumor marker, which is thought to have correlation with malignancy mass size and its cellular differentiation. The term biochemically cured, refers to the postoperative normalization of CEA and undetectable levels of Ct which carries a 5-year recurrence of 5%. It is believed that the higher the levels and the faster doubling time of these tumor markers the worse is the prognosis. In addition, it is suggested that patient’s age and extent of disease at the time of surgery are proportionally correlated with disease recurrence. However, there are reports of large MTC metastatic deposits with low serum Ct and CEA, rising up the hypothesis that levels reflect cell production potential for tumor markers rather than the number of cells. Reoperation rarely results in biochemical cure, but it may slow disease progression. Normal postoperative Ct levels predict cure; however, the clinical course of those with upper normal limit levels postoperatively is markedly variable. Careful regular biochemical and imaging follow-up will be of the utmost importance for the patient presented in this case.

scholarly journals Transient Recurrent Laryngeal Nerve Palsy Post–Total Thyroidectomy

2019 ◽  
Vol 85 (1) ◽  
pp. 36-38
Author(s):  
Daniel J. Greenberg ◽  
Gina Luciano ◽  
James L. Frank
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Nerve Palsy ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Laryngeal Nerve ◽  
Laryngeal Nerve Palsy

scholarly journals Delayed Recurrent Laryngeal Nerve palsy following total thyroidectomy: A case report

2014 ◽  
Vol 13 (2) ◽  
pp. 23-24 ◽  
Author(s):  
D.N. Goyal ◽  
◽  
Venkateswara Rao Katta ◽  
Vijay Kumar V.R.N ◽  
Sumeera Farhath ◽  
...  
Keyword(s):  
Case Report ◽  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Nerve Palsy ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Laryngeal Nerve ◽  
Laryngeal Nerve Palsy
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