HYPOCALCEMIA IN TOTAL VERSUS SUBTOTAL THYROIDECTOMY

Objective: To compare the occurrence of hypocalcemia in patients undergoing subtotal and total thyroidectomy. Study Design: Comparative prospective study. Place and Duration of Study: Surgical departments of Ayub Teaching Hospital, Abbottabad and Combined Military Hospital, Rawalpindi, from Mar 2018 to Feb 2020. Methodology: A total of 171 patients were selected for this study and they were divided into 2 groups. Group 1 consisted of 95 patients undergoing Total thyroidectomy whereas group 2 had 76 patients undergoing Subtotal thyroidectomy. It was a comparative prospective study and the groups were made by convenience sampling. The data was analyzed by SPSS-23. Results: In total thyroidectomy group Hypocalcemia was detected after 48 hours in 34 patients (35%) while in subtotal thyroidectomy group hypocalcemia was detected in 20 patients (28%). Tests for hypocalcemia were also done after two months of surgery and low levels were detected in 7 patients (7.5%) who had total thyroidectomy and in 2 patients (5%) in the group undergoing subtotal thyroidectomy. There was no significant difference in hypocalcemia after 48 hour (p=0.22) and 2 months postoperatively (p=0.6) between patients of Total Thyroidectomy and Subtotal Thyroidectomy. Conclusion: Total thyroidectomy is not associated with increased risk of permanent hypocalcemia as compared to Subtotal thyroidectomy. Because of its advantages Total thyroidectomy should be the preferred surgical procedure for patients presenting with benign euthyroid multi nodular goiter.

Left parathyroid adenoma with features of brown tumor, incidental finding: a case report

Primary hyperparathyroidism (PHPT) occurs in a setting of excessive parathyroid hormone (PTH) secretion with an autonomous parathyroid gland which resulting in hypercalcemia. Cases of parathyroid adenoma are rare, PTH is a chief regulator of calcium homeostasis in the human body. PHPT could be caused by solitary adenomas, hyperplasia, multiple adenomas and carcinomas. A 35-year-old female who came in with complaints of left hip pain past 1 month which aggravated since 1 week, with previous medical history of hyperthyroidism. Laboratory and biochemical findings suggested features of PHPT. She underwent left parathyroid excision with subtotal thyroidectomy. Histopathology analysis revealed features of parathyroid adenoma with eosinophilic to clear cytoplasm, few foci with oxyphilic nodules. Patient showed significant fall in PTH levels after tumor excision and is being discharged 5th day after surgery. PHPT occurs at any age, but it is most commonly seen in people over the age of 50 years and postmenopausal women. The current presentation of PHPT shifts from the classical symptomatic form to the asymptomatic form. parathyroidectomy is still the treatment of choice for both symptomatic and asymptomatic forms. Parathyroid adenoma has an excellent prognosis with surgical treatment.

Comparing the Outcomes of Thyroid Surgical Procedures for Benign Diseases with Expertise of the Surgeon in a Tertiary Care Hospital in Rawalpindi, Pakistan

Background: There is a lack of standardized guidelines regarding selection of appropriate thyroid surgery for patients with benign diseases. As a result, an inexperienced surgeon may select a more aggressive surgical option, which may increase the complication rate. The objective of this study was to compare the outcomes of thyroid surgical procedures for benign diseases with the expertise of the surgeon.Material and Methods: A retrospective cross-sectional study from 1999 to 2018. The study setting is of a public sector tertiary care teaching hospital. Patients undergoing thyroid surgery (lobectomy with isthmusectomy, subtotal thyroidectomy (STT), near total thyroidectomy (NTT), or total thyroidectomy (TT)) were included. Expertise level 1, 2 and 3 (L1, L2, L3) of the surgeon was based on years of experience or number of thyroid surgeries to their credit. Postoperative complications (hypocalcemia, recurrent laryngeal nerve (RLN) damage, airway obstruction, hemorrhage and mortality) were measured against type of thyroid surgery and expertise of the surgeon.Results: A total of 833 thyroid surgeries were performed on 695 (83.43%) females and 138 (16.57%) males. About 502 (60.26%) STT, 228 (27.37%) TT, 61 (7.32%) NTT, 42 (5.04%) lobectomies with isthmusectomies were performed, with LI, 2, and 3 surgeons performing 21.25%, 45.74% and 33% of these procedures, respectively. Surgeons with L1, 2 and 3 levels of expertise caused 49.47%, 33.45% and 17.08% of adverse events, respectively. Permanent hypocalcemia, RLN damage and mortality were significantly more common in surgeries performed by L1 compared with L2 and L3 surgeons (P<.05). Transient and permanent hypocalcemia, transient and permanent RLN damage and mortality were significantly more common for total thyroidectomy compared to subtotal thyroidectomy (P<.01).Conclusions: Minimizing the occurrence of complications like permanent hypocalcemia, RLN damage and mortality, expertise of the surgeon and anticipated difficulty of the procedure needs to be taken into account while selecting a thyroid procedure.

Quality of life of patients after total and subtotal thyroidectomy

Introduction: Thyroid diseases, especially those that require surgical treatment, are an extremely strong emotional stimulus for the patient. They evoke not only anxiety disorders, but also in the case of complications (especially those long-lasting) can even generate depressive disorders, or significantly affect the patient’s self-esteem, and thus its functioning at the social level. Aim of the study: The objective of the study was to examine the quality of life of patients who underwent surgical treatment of total and subtotal thyroidectomy. Material and methods: The study was conducted in a group of 102 patients undergoing surgery at the General Surgery Ward of the Hospital. St. Łukasz in Tarnów in the period from December 2018 to April 2019, as well as residents of Małopolska, who had performed thyroidectomy. In research have been used ThyPROpl, VAS Scale, and self-prepared questionnaires. Results and conclusions: The most common complications of thyroidectomy were tingling and numbness around the mouth and limbs (42.2%). Patients who had symptoms of tetany had a reduced perception of quality of life and health, as well as the quality of life in all its areas. The respondents had a degraded, reduced quality of life in terms of the negative impact of the disease on life (62.01) and fatigue (56.23). The greater the intensity of pain, the lower the quality of life of patients after thyroidectomy. Conclusions. There is the relationship between the quality of life and the number of complications, as well as the severity of pain. This dependence is directly proportional.

Indications and complications of thyroidectomy in Al-Ramadi teaching hospital

Thyroidectomy is one of the common operations performed worldwide. It is a main option of treatment for different benign and malignant thyroid problems. Despite improvements in procedures have decreased mortality and even and morbidity rates to a minimum; however, postoperative complications remain a major concern among surgeons. We aimed to evaluate the indications and complications of thyroidectomy. A Prospective study was conducted at Al-Ramadi Teaching Hospital/Ramadi city/Iraq during the period from January 2009 to January 2010. There were 130 patients underwent thyroidectomy. A demographic and clinical data for each patient was recorded to assess indications and complications of different types of thyroidectomies. The majority of the patients were females (93{df6391716bcab23f197eab8ba5a452daee5812a1941604c42f67c7803ea6be47}). The most age group affected was 21-30 years (41.54{df6391716bcab23f197eab8ba5a452daee5812a1941604c42f67c7803ea6be47}). Pressure symptoms were accounting for 61.54{df6391716bcab23f197eab8ba5a452daee5812a1941604c42f67c7803ea6be47} of the indications. Thyroid enlargement in euthyroid states (80{df6391716bcab23f197eab8ba5a452daee5812a1941604c42f67c7803ea6be47}) was the common presenting state. Subtotal thyroidectomy (58.46{df6391716bcab23f197eab8ba5a452daee5812a1941604c42f67c7803ea6be47}) was the commonest procedure. Out of 130 patients, 36 patients (27.69{df6391716bcab23f197eab8ba5a452daee5812a1941604c42f67c7803ea6be47}) were suffered from complications. The 2 most common complications encountered in the study were hypocalcemia (61.11{df6391716bcab23f197eab8ba5a452daee5812a1941604c42f67c7803ea6be47}) and recurrent laryngeal nerve palsy (5.38{df6391716bcab23f197eab8ba5a452daee5812a1941604c42f67c7803ea6be47}). In conclusion, subtotal thyroidectomy is a common procedure in our hospital. Compressive complaints were the most common indication. Hypocalcemia and recurrent laryngeal nerve palsy were the 2 most postoperative complications.