Chapter-111 Total Thyroidectomy with Left Radical Neck Dissection�Five Years Postoperative Picture

2013 ◽  
pp. 111-111
Author(s):  
Madan Kapre
Keyword(s):  
Total Thyroidectomy ◽  
Neck Dissection ◽  
Radical Neck Dissection

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.

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.

scholarly journals P32: POST-OPERATIVE RELATIVE PARATHORMONE DECLINE (ΔPTH%) AND ABSOLUTE PARATHORMONE DECLINE (ΔPTH) LEVELS ARE BETTER MARKERS OF SYMPTOMATIC HYPOCALCEMIA FOLLOWING TOTAL THYROIDECTOMY THAN POST-OPERATIVE PTH ALONE

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
B Ravindhran ◽  
S Rajan ◽  
L N Mohan
Keyword(s):  
Total Thyroidectomy ◽  
Neck Dissection ◽  
Thyroid Surgery ◽  
Tertiary Care ◽  
Radical Neck Dissection ◽  
Early Discharge ◽  
Central Neck Dissection ◽  
Tertiary Care Centre ◽  
Exact Test ◽  
Symptomatic Hypocalcemia

Abstract Introduction Hypocalcemia is a frequent complication following thyroidectomy which can delay discharge and increase overall treatment expenditure. We aimed to assess the predictive value of absolute and relative intact Parathormone(iPTH) decline levels as reliable markers of post-operative hypocalcemia. Method This prospective study included 95 consecutive patients at our tertiary care centre. Patients underwent either Total Thyroidectomy(TT), TT+Central Neck Dissection(CND) or TT+CND+Modified Radical Neck Dissection(MRND). iPTH levels were measured four hours after surgery and the following morning after surgery(POD 1). iPTH, absolute iPTH decline(ΔPTH) and relative iPTH decline(ΔPTH%) were calculated and correlated with hypocalcemia. Comparisons between groups were measured by chi-square test, Fischer's exact test and Mann-Whitney U test. Result Of the 95 patients, 59 had malignant disease, while 36 patients had benign histopathology. TT was performed in 69 patients, TT+CCLND in 7, and TT+CCLND+MRND in 19. 32.6% of patients(n=31) had biochemical hypocalcemia and 20%(n=19) had symptomatic hypocalcemia. The mean calcium of the cohort on Post-operative day(POD)-1 was 8.3±0.66(range=6.5-9.9) and POD-3 was 8.4±0.69(range=6.3–10.7). Median PTH, measured 4 hours after surgery was 24pg/ml(IQR–23.4;range 2.5–85.5), and measured on POD-1 was 28pg/ml(IQR–27.6;range=2-79). The ΔPTH(U=206;p<0.001) & ΔPTH% (U=127;p<0.001) were significantly higher in patients with symptomatic hypocalcemia. A ΔPTH% of 20%(sensitivity=84%;specificity=91%) and ΔPTH of 3.75 pg/ml(sensitivity = 74%; specificity=87%) were good predictors of symptomatic hypocalcemia. Conclusion Post-operative ΔPTH and ΔPTH% are reliable predictors of hypocalcemia following thyroid surgery and have the potential to facilitate a safe early discharge for patients undergoing TT. 20% fall in the PTH level(ΔPTH%) can be useful as a marker of hypocalcemia. Take-home message Post-operative ΔPTH and ΔPTH% are better predictors of hypocalcemia following thyroid surgery than a single value of post-operative PTH alone.

The Extent of Surgery for Thyroid Medullary Cancer

1994 ◽  
Vol 80 (6) ◽  
pp. 427-432 ◽  
Author(s):  
Maria Rosa Pelizzo ◽  
Paolo Bernante ◽  
Andrea Piotto ◽  
Antonio Toniato ◽  
Maria Elisa Girelli ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Total Thyroidectomy ◽  
Neck Dissection ◽  
Medullary Thyroid Carcinoma ◽  
Radical Neck Dissection ◽  
Stage I ◽  
Stage Iii ◽  
Medullary Thyroid ◽  
The Impact

Aims Evaluation of the impact of the extent of primary surgery and reintervention on the outcome of patients with medullary thyroid carcinoma. Methods Seventy-two patients with medullary thyroid carcinoma (MTC) were surgically treated between 1967 and 1992. Results Fifty-five cases were sporadic, 5 patients had MEN 2A, 4 MEN 2B syndrome and 8 familial non-MEN MTC; 1 patient had stage I disease, 30 patients stage II, 36 stage III and 5 stage IV. Sixty-four had their initial treatment at our center, and 8 came for subsequent treatment. At first treatment, 8 patients were subjected to partial thyroidectomy, 10 to total thyroidectomy, 53 to total thyroidectomy with neck dissection, and 1 to only radical neck dissection; postoperative serum calcitonin (Ct) levels returned to normal in 3, 6 and 27 patients, respectively. In the patient with only radical neck dissection, Ct levels remained elevated. No patient with Ct normalization after surgery became responsive to pentagastrin in the follow-up. Thirteen patients had a reoperation due to nodal relapse. At a mean follow-up of 5.7 years (6-252 months), the 10-year survival rate was 84.5% with a significant difference between patients under and over 40 years of age (96.4 vs 57%), between stage I-II (100%) and stage III, IV (83.8%, 0% respectively). At the last follow-up, 36 (50%) patients were alive and disease free and 26 were alive with disease (15 with distant metastases). Of the 10 deaths, 7 were due to tumor recurrence, 3 to 120 months after surgery. Conclusions Data suggest that an earlier diagnosis rather than more extensive surgery could improve survival and reduce recurrences. However, the least treatment required is total thyroidectomy plus central neck and upper mediastinum clearance and in addition, according to the extent of nodal involvement, mono- or bilateral neck dissection. To avoid ineffective reoperation due to distant (mainly liver) micro-metastases, persistent residual microscopic disease requires a more aggressive restaging.

Sign in / Sign up

Export Citation Format

Share Document