Outcomes of Early Versus Delayed Completion Thyroidectomy for Malignancy

Purpose To determine whether time interval between hemi-thyroidectomy and subsequent completion thyroidectomy impacts outcomes. Methods Retrospective review of 68 patients having completion thyroidectomy from August 2012 to December 2019. Patients were separated into two groups based on the time interval between surgeries: early (≤10 days) or delayed (≥90 days). Results Patients who underwent delayed completion thyroidectomy (n = 17) had significantly higher rates of hypocalcemia and/or hypoparathyroidism ( P = .03) and higher rates of requiring postoperative hospitalization ( P=.07) compared to those who underwent early completion thyroidectomy (n = 51). Delayed completion had significantly lower risk of developing one or more of dysphonia, dysphagia, or vocal cord paresis postoperatively ( P=.02). No patients developed hematoma or wound infection. Conclusions Delayed completion thyroidectomy is associated with increased rates of hypocalcemia, but lower rates of dysphonia and dysphagia. Given the low risk of long-term complications in both groups, it may be beneficial to perform completion thyroidectomy early in order to expedite cancer treatment.

Thyroidectomy Related Complications in Post-Thyroid Lobectomy (Unilateral) in Addition to Thyroid Isthmusectomy

Objective: To identify thyroidectomy related complications in post-thyroid lobectomy (unilateral) in addition to isthmusectomy. Study Design: Cross-sectional study Place and Duration: Department of ENT, Islamic International Medical College, Islamabad from 1st April 2019 to 31st March 2020. Methods: Sixty patients were enrolled. These patients were those who have to undergo complete thyroidectomy post unilateral-thyroid lobectomy in addition to isthmusectomy. The age pf the patients was 16-72 years. Each patient’s demographic, clinical as well as surgical details were recorded and calcium tests were run. Results: There were 34 females and 26 males in this study. The mean age of the enrolled patients was 41.12±5.9 years. The mean BMI calculated of the patients was 25.4±2.5 kg/m2. Hypocalcaemia (transient) was identified 10% whereas 3.3% got seroma and 1.6% each suffered from transient voice hoarseness and hematoma in neck. Conclusion: Transient hypocalcaemia is the most frequent complication followed with seroma and hematoma. Keywords: Completion Thyroidectomy, Thyroid lobectomy, Thyroidectomy

Is Completion Thyroidectomy Necessary in Patients with Papillary Thyroid Carcinoma who Underwent Lobectomy?

Background/Objectives: Although thyroid lobectomy recently is considered as sufficient for low-risk papillary thyroid carcinoma (PTC), completion thyroidectomy is required due to the insufficiency of the preoperative evaluation. The aim of this study was to investigate recurrence rate and disease free survival depending on the gross extrathyroidal extension (gETE) or the number of metastatic lymph node identified in patients with PTC.Materials & Methods: We assessed 3373 patients with PTC who underwent lobectomy at Seoul St. Mary’s Hospital (Seoul, Korea) between January 2009 and December 2014. Clinicopathological characteristics and long-term surgical outcomes were retrospectively analyzed through complete chart reviews. The mean follow-up duration was 97.1 ± 21.4 months.Results: The rate of recurrence was higher in gETE group (1.8% vs. 6.0%, p=0.004), leading to decreased disease free survival in Kaplan-Meier analysis (log-rank p<0.001). N1 group (n=1389) was analyzed into two groups whether the number of positive nodes is more than 5 or less. For the group of the more metastatic nodes, the recurrence rate higher compared to the other group (3.0% vs. 9.3%, p<0.001). DFS was longer in the group that had lesser metastatic nodes (log-rank p<0.001). However, in terms of N1 group over 1cm (n=492), No statistical difference was observed according to the number of positive lymph nodes (4.5% vs. 9.1%, p=0.092)Conclusion: When it comes to node positive PTC, Despite the number of positive lymph nodes was over 5, follow-up with no further surgery can be an option.

Variability in Thyroid Cancer Multidisciplinary Team Meeting Recommendations Is Not Explained by Standard Variables: Outcomes of a Single Centre Review

Multidisciplinary team (MDT) meetings are the mainstay of the decision-making process for patients presenting with complex clinical problems such as papillary thyroid carcinoma (PTC). Adherence to guidelines by MDTs has been extensively investigated; however, scarce evidence exists on MDT performance and variability where guidelines are less prescriptive. We evaluated the consistency of MDT management recommendations for T1 and T2 PTC patients and explored key variables that may influence therapeutic decision making. A retrospective review of the prospective database of all T1 and T2 PTC patients discussed by the MDT was conducted between January 2016 and May 2021. Univariate analysis (with Bonferroni correction significance calculated at p < 0.006) was performed to establish clinical variables linked to completion thyroidectomy and Radioactive iodine (RAI) recommendations. Of 468 patients presented at thyroid MDT, 144 pT1 PTC and 118 pT2 PTC met the selection criteria. Only 18% (n = 12) of pT1 PTC patients initially managed with hemithyroidectomy were recommended completion thyroidectomy. Mean tumour diameter was the only variable differing between groups (p = 0.003). pT2 patients were recommended completion thyroidectomy in 66% (n = 16) of instances. No measured variable explained the difference in recommendation. pT1 patients initially managed with total thyroidectomy were not recommended RAI in 71% (n = 55) of cases with T1a status (p = 0.001) and diameter (p = 0.001) as statistically different variables. For pT2 patients, 60% (n = 41) were recommended RAI post-total thyroidectomy, with no differences observed among groups. The majority of MDT recommendations were concordant for patients with similar measurable characteristics. Discordant recommendations for a small group of patients were not explained by measured variables and may have been accounted for by individual patient factors. Further research into the MDT decision-making process is warranted.

Subjective Voice Outcomes in Surgeon Versus Technician-Monitored Recurrent Laryngeal Nerves in Thyroidectomy

Objectives: To compare subjective voice outcomes and postoperative laryngoscopic examination findings of patients with subjective voice complaints between surgeon-monitored and certified technician–monitored thyroidectomies. Methods: Patients who underwent hemithyroidectomy, total thyroidectomy, and completion thyroidectomy using a nerve monitoring system between November 2015 and June 2018 were included in the study. Retrospective chart review was carried out to assess how often patients reported voice changes and to record postoperative flexible laryngoscopic findings of patients when that examination was performed. Data were analyzed using the χ2 test to identify significant differences in outcomes for the 2 groups. Results: A total of 293 procedures was performed among 3 surgeons. Surgeons monitored the nerves in 147 cases and a certified technician monitored the nerves in 146 cases. Subjective voice changes were identified in 11 (7.48%) cases in the surgeon-monitored group and in 20 (13.70%) cases in the technician-monitored group ( P = .084). Among the patients who expressed subjective voice changes, 7 patients were identified with vocal cord hypomobility or immobility in the surgeon-monitored group and 13 patients had an abnormal examination in the technician-monitored group ( P = .234). Conclusions: Subjective voice changes or proven vocal cord mobility problems were not different between surgeon-monitored patients and technician-monitored patients in thyroidectomies.

Should Contralateral Nodules Be an Indication of Total or Completion Thyroidectomy for Patients With Unilateral Papillary Thyroid Carcinoma?

ObjectiveTo determine whether papillary thyroid carcinoma (PTC) patients with benign or nonsuspicious nodules in the contralateral lobe have a higher rate of recurrence or worse survival after lobectomy compared to those without nodules in the contralateral lobe.MethodsAdult patients who underwent lobectomy and were diagnosed with unilateral PTC (2013-2015), were identified from an institutional database. Patients who previously had cytologically benign nodules or nonsuspicious nodules in the contralateral lobe comprised the contralateral nodule (CN) group. Patients who did not have nodules in the contralateral lobe comprised the unilateral nodule (UN) group.Results370 patients were included: 242 in the UN group and 128 in the CN group. After a median follow-up of 62 months (range, 16–85 months), recurrence was confirmed in 4.1% patients in the UN group and 5.5% patients in the CN group (p = 0.559). Clinical contralateral lobe PTC was detected in 2.9% (7/242) of patients from the UN group and 3.9% (5/128) of patients from the CN group (p = 0.601). The 5-year contralateral lobe recurrence-free survival (RFS) rates were 96.8% in the UN group and 97.4% in the CN group (p = 0.396). The 5-year loco-regional RFS rates were 98.4% in the UN group and 97.8% in the CN group (p = 0.690). The 5-year disease-specific survival rates were both 100%.ConclusionPTC patients with benign or nonsuspicious CNs have similar recurrence and survival rates after lobectomy compared to those without CNs. CNs alone should not be an indication for total or completion thyroidectomy.

Intraparotid Recurrence of Papillary Thyroid Carcinoma After Thyroidectomy Coincident With Declining Thyroglobulin Levels: A Case Report and Review of the Literature

Papillary thyroid carcinoma (PTC) is the most frequent thyroid malignancy. Intraparotid recurrence of PTC is, however, rare. Most parotid malignancies are either primary or metastatic from cancer outside the head and neck. We report a case of a 71-year-old man who had undergone lobectomy and completion thyroidectomy for PTC and presented to our clinic with an insidious intraparotid recurrence, for which he underwent a superficial parotidectomy and radioactive iodine therapy. We also present a review of the literature on similar cases. Intraparotid metastasis of PTC should be considered in the differential diagnosis of a parotid mass.

Postoperative Hypoparathyroidism after Completion Thyroidectomy for Well-Differentiated Thyroid Cancer.

Objective Thyroid surgery may lead to postoperative complications. The aim of this paper was to determine whether the rate of postoperative hypoparathyroidism (HPT) is influenced by whether surgery is staged. Design Single-institution retrospective observational study. Methods The clinical records of 786 patients treated at the Otolaryngology Unit of the Azienda USL-IRCCS di Reggio Emilia between January 1990 and December 2015 were reviewed. Patients were divided into two groups according to the surgical treatment received: Group TT (637 patients, 81.04%) underwent single-stage total thyroidectomy; Group cT (149 patients, 18.96%) underwent loboisthmusectomy and delayed completion total thyroidectomy. Transient and permanent HPT, assessed after 6 months of follow-up, were the primary endpoints. Risk factors of postoperative HPT were also analysed as secondary outcomes. Results: Rates of transient HPT in Group TT were higher than those observed in Group cT, (P = 0.0057). Analysis of risk factors identified sex as an independent risk factor for transient HPT only for Group TT (P = 0.0012) and the number of parathyroid glands remaining in situ (PGRIS) as an independent risk factor for transient and permanent HPT for Group TT (P <0.0001 and P = 0.0002, respectively). Conclusions This study suggests that the risk of transient postoperative HPT is lower in patients that undergo completion thyroidectomy. Further independent risk factors for postoperative HPT are female sex and PGRIS score. In light of the growing use of conservative surgery for thyroid neoplasms, these findings could help to adequately plan surgery in order to reduce endocrine complications.

Comparison of Near Total thyroidectomy with Sub total thyroidectomy for Multindular goipe in terms of recurrence rate.

Objective: To compare the outcome of NTT and STT for multinodular goiter in terms of Recurrence rate. Study Design: Experimental study. Setting: Department of Surgery DHQ Teaching Hospital Rawalpindi. Period: July 2016 to December 2017. Material & Methods: All patients were admitted through OPD according to the already set inclusion and exclusion criteria. Two groups were made first group was NTT group and second group was STT group. Patients were divided into two groups by lottery method (Probability sampling). Follow up period for recurrence was 1 year. Analysis of data was done by SPSS version -20. Chisquare test was used to see the statistical significance. Value of P was set at 0.05. Results: A total of 63 (n=63) patients were included in the study. Over all there were 71.40% females and 28.60% males. Average age of the female patients was 36.3 years and in males average age was 40.60 years. In NTT group there were 32 patients (n=32) and in STT group there were 31 patients (n=31). There was no recurrence in NTT group whereas recurrence was noted in 5 out of 31 patients (16.10%) in STT group which was found statistically significant (p = 7.61). Overall incidental carcinoma was noted in 6 out of 63 patients (9.52%). So completion thyroidectomy had to be carried in 4 patients of incidental carcinoma from STT group whereas 2 patients of incidental carcinoma from NTT group did not require any further treatment. Conclusion: Results of this study prove the superiority of NTT over STT regarding recurrence rate and safety of treatment for multinodular goiter. NTT eliminates recurrence rate of MNG which is very high in STT. NTT also obviates the need for completion thyroidectomy in case of incidental carcinoma.