scholarly journals Completion Thyroidectomy for Initially Misdiagnosed Differentiated Thyroid Carcinoma-Study of 51 cases

2020 ◽  
Vol 32 (2) ◽  
pp. 22-26
Author(s):  
Subrata Ghosh ◽  
Abu Hena Mostafa Kamal ◽  
Muhammad Mahamudul Haque ◽  
Md Safiul Islam ◽  
Md Asadul Islam ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Recurrent Laryngeal Nerve ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Follicular Carcinoma ◽  
Differentiated Thyroid Carcinoma ◽  
Laryngeal Nerve ◽  
Completion Thyroidectomy ◽  
Initial Surgery ◽  
Thyroid Lobectomy

Introduction: Completion thyroidectomy is the removal of any residual thyroid tissue that remains after a less than total thyroidectomy. This procedure is usually done when the final histopathlogy of the excised ipsilateral thyroid lobe reveals papillary or follicular carcinoma. Objective: A retrospective analysis was done of patients undergoing completion thyroidectomy for thyroid malignancy who had undergone surgery elsewhere for solitary thyroid nodule. The incidence of complications in these patients after re-operation was investigated in this study. Material and Method: Our study included a total 51 patients who had undergone thyroid lobectomy for a solitary nodule as initial surgery in our hospital & elsewhere and were admitted in our hospital for completion thyroidectomy when histopathology revealed malignancy in last 5 years (2014-2018). Result: In this study-51 patients were enrolled; among them 42 were female and 9 male. Their mean age was 33.6 years (range-17-59 years). After initial surgery, the histopathology revealed papillary carcinoma in 45 patients (88.24%), follicular carcinoma in 6 patients (11.76%). Four out of 51 patients had recurrent laryngeal nerve palsy after initial surgery (7.8%). None of the patients had clinical hypocalcaemia after 1st surgery. Parathyroid glands are identified and preserved in all patients during completion thyroidectomy. No patient had additional recurrent laryngeal nerve injury in 2nd surgery. Mean follow-up was one year. Transient hypoparathyroidism occurred in 9.8% patients, but no permanent hypoparathyroidism. Seven patients were lost to follow-up. Conclusion: Completion thyroidectomy is a safe and appropriate procedure for the management of initially misdiagnosed differentiated thyroid carcinoma. TAJ 2019; 32(2): 22-26

Completion Thyroidectomy for Differentiated Thyroid Carcinoma

1998 ◽  
Vol 118 (6) ◽  
pp. 896-899 ◽  
Author(s):  
TZU-CHIEH CHAO ◽  
LONG-BIN JENG ◽  
JEN-DER LIN ◽  
MIIN-FU CHEN
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Nerve Palsy ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Differentiated Thyroid Carcinoma ◽  
Laryngeal Nerve ◽  
Completion Thyroidectomy ◽  
Initial Operation ◽  
Thyroid Remnant ◽  
Laryngeal Nerve Palsy ◽  
Transient Hypoparathyroidism

Completion thyroidectomy is performed because of a deferred diagnosis of differentiated carcinoma of the thyroid or a significant thyroid remnant after initial operation. During a period of 6 years, data from 40 patients with differentiated thyroid carcinoma undergoing completion thyroidectomy were retrospectively reviewed. There were 4 men and 36 women (1:9), and the average age was 39.6 ± 1.9 years (range, 20 to 62 years). The indications for the initial surgery were a solitary thyroid nodule in 36 (90%) patients, multi-nodular goiter in 3 (7.5%) patients, and Graves' disease in 1 (2.5%) patient. Three patients underwent completion thyroidectomy during the same hospital stay. In the remaining 37 patients, completion thyroidectomy was performed 4 to 252 days (44.1 ± 7.8 days) after the initial operation. The length of hospital stay for the initial operation was not different from that for completion thyroidectomy (5.1 ± 0.3 days vs. 5.2 ± 0.3 days). The length of time needed to accomplish the initial operation was not different from that required for the completion thyroidectomy (122 ± 7.5 minutes vs. 110.8 ± 5.9 minutes). There was no 30-day peri-operative mortality. The postoperative morbidity in completion thyroidectomy consisted of transient hypoparathyroidism in 3 (7.5%) patients, permanent hypoparathyroidism in 1 (2.5%) patient, transient recurrent laryngeal nerve palsy in 1 (2.5%) patient, and permanent recurrent laryngeal nerve palsy in 1 (2.5%) patient. On the other hand, one transient recurrent laryngeal nerve palsy and one transient hypoparathyroidism occurred at the initial operation. Completion thyroidectomy is a safe procedure to remove the thyroid remnant. (Otolaryngol Head Neck Surg 1998;118:896–9.)

Short- and Long-Term Results of Total vs Subtotal Thyroid- ectomies in the Surgical Treatment of Graves' Disease

Swiss Surgery ◽  
2001 ◽  
Vol 7 (1) ◽  
pp. 20-24 ◽  
Author(s):  
Robert ◽  
Mariéthoz ◽  
Pache ◽  
Bertin ◽  
Caulfield ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Nerve Palsy ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Laryngeal Nerve ◽  
Long Term Results ◽  
Graves Disease ◽  
Laryngeal Nerve Palsy ◽  
Short And Long Term

Objective: Approximately one out of five patients with Graves' disease (GD) undergoes a thyroidectomy after a mean period of 18 months of medical treatment. This retrospective and non-randomized study from a teaching hospital compares short- and long-term results of total (TT) and subtotal thyroidectomies (ST) for this disease. Methods: From 1987 to 1997, 94 patients were operated for GD. Thirty-three patients underwent a TT (mostly since 1993) and 61 a ST (keeping 4 to 8 grams of thyroid tissue - mean 6 g). All patients had received propylthiouracil and/or neo-mercazole and were in a euthyroid state at the time of surgery; they also took potassium iodide (lugol) for ten days before surgery. Results: There were no deaths. Transient hypocalcemia (< 3 months) occurred in 32 patients (15 TT and 17 ST) and persistent hypocalcemia in 8 having had TT. Two patients developed transient recurrent laryngeal nerve palsy after ST (< 3 months). After a median follow-up period of seven years (1-15) with five patients lost to follow-up, 41 patients having had a ST are in a hypothyroid state (73%), thirteen are euthyroid (23%), and two suffered recurrent hyperthyroidism, requiring completion of thyroidectomy. All 33 patients having had TT - with follow-ups averaging two years (0.5-8) - are receiving thyroxin substitution. Conclusions: There were no instances of persistent recurrent laryngeal nerve palsy in either group, but persistent hypoparathyroidism occurred more frequently after TT. Long after ST, hypothyroidism developed in nearly three of four cases, whereas euthyroidy was maintained in only one-fourth; recurrent hyperthyroidy was rare.

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

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.

scholarly journals Differentiated Thyroid Carcinoma and Late Onset of Lung Distant Metastasis. A Case Report

Reports ◽  
2019 ◽  
Vol 2 (1) ◽  
pp. 6
Author(s):  
Alessandro Semprebene ◽  
Anna Mangano ◽  
Guido Ventroni ◽  
Raffaella Barone ◽  
Francesca Piro ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Late Onset ◽  
Follicular Carcinoma ◽  
Differentiated Thyroid Carcinoma ◽  
Cure Rate ◽  
High Cure Rate ◽  
Case Presentation ◽  
Margins Of Excision ◽  
Very High

Background: Differentiated thyroid carcinoma (DTC), which includes the papillary and follicular variants, is a common neoplasm. DTC has a very high cure rate and is treated surgically, usually followed by ablation of the post-surgical remnant with radioiodine. Case Presentation: The case of a 68-year-old male patient who underwent a minimally invasive complete thyroidectomy on July 4, 2007 for capsulated follicular carcinoma with margins of excision exempted from neoplastic infiltration (AJCC 2002 pT2 PNX PMX) is presented. Discussion: As the patient showed the presence of a pulmonary metastasis after 11 years, the potential implications of DTC follow-up management are here summarized. Conclusions: Follow up must be continued throughout life.

Preservation of the Laryngeal Nerves during Total Thyroid Lobectomy

1977 ◽  
Vol 86 (6) ◽  
pp. 777-788 ◽  
Author(s):  
John M. Loré ◽  
Duck J. Kim ◽  
Samir Elias
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Vocal Cord ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Parathyroid Glands ◽  
External Branch ◽  
Thyroid Lobectomy ◽  
Maximum Protection

A technique of exposure and preservation of the recurrent laryngeal nerve at the very onset of thyroidectomy and preservation of the external branch of the superior laryngeal nerve at the close of the procedure is described, which is believed to afford maximum protection to these nerves during total thyroid lobectomy and isthmusectomy as well as total thyroidectomy. At the same time, preservation of the parathyroid glands is achieved. In 120 exposures and preservations of the recurrent laryngeal nerve there have been no instances of a single permanent paralysis of this nerve. In 111 total thyroid lobectomies in which the external branch of the superior laryngeal nerve was placed in jeopardy, only one patient had a slight bowing of the vocal cord with excellent voice function during a limited follow-up period.

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