Diagnosis and Surgical Management of Solitary Thyroid Nodule

Aim Preoperative distinction between benign and malignant in solitary thyroid nodules is important. It helps to avoid unnecessary surgery and its adverse effects, such as hypothyroidism, hypocalcemia, and recurrent nerve injury. Methods Descriptive perspective analyzed data over a period of 6 years April 2015__April 2021 in Saudi Hospital at Hajjah, Yemen. 226 thyroid operations for 207 patients ,135 patients diagnosis as Solitary thyroid nodule and 72 patients as Multi nodular goiter. Patients with a clinically solitary thyroid nodule were included in the study group. Results 135 cases of clinically detected STN,126 female and 9 male patients, between 14_65 years age, median 41 years and mean 39.76 years, (94, 41)patients respectively Rt side thyroid effect more than Lt side, FNAC sensitivity, specificity and accuracy was (61%, 72%, 64%)respectively. Postoperative histopathology reported 100 (74%) patients as having benign thyroid nodules and 35 patients (26%) as having malignant thyroid nodules. Postoperative transient hypocalcemia was observed in 9 patients (7%), and temporary horsnese was observed in 3 patients (2%). Conclusion The incidence of malignancy in STN is high. Rapid growth by history and hard fixed nodule by examination and hypoechoic, micro calcification and cervical lymphadenopathy on USG frequently in malignant nodules. Male risk factors for thyroid cancer included age, number and size of nodules. FNAC is more helpful for diagnosing aspiration under USG guidance and reading by experience histopathologists. The type of surgery depends on preoperative evaluation, including history, examination, ultrasound, FNAC result, and intraoperative assessment of the nodule. There are fewer complications of thyroid surgery by experienced surgeons.

Solitary Thyroid Nodule High Incidence of Thyroid Cancer

The Aim: The preoperative distinguish between benign and malignant in solitary thyroid nodule is important. It helps to avoid unnecessary surgery and its adverse effects, such as hypothyroidism, hypocalcemia, and recurrent nerve injury.Methods: descriptive perspective analyzed data over a period of 6 years April 2015__April 2021 In Saudi hospital at Hajjah, Yemen. 226 thyroid operations for 207 patients ,135 patients diagnosis as Solitary thyroid nodule and 72 patients as Multi nodular goiter. the patients with a clinically as solitary thyroid nodule were included in the study group. Results: 135 cases of clinically detected STN,126 female and 9 male patients, between 14_65 years age, median 41 years and mean 39.76 years, (94 , 41)patients respectively Rt side thyroid effect more than Lt side, FNAC sensitivity, specificity and accuracy was (61% , 72% , 64%)respectively. Postoperative histopathology was reported 100(74%)patients as benign thyroid nodule and 35 patients(26%) as malignant thyroid nodule . Post operative transient hypocalcemia in 9 patients (7%), and temporary horsnese in 3 patients (2%). Conclusion: The incidence of malignancy in STN is high. Rapid growth by history and hard fixed nodule by examination and hypoechoic, micro calcification and cervical lymphadenopathy on USG frequently in malignant nodules. Male risk factor for thyroid cancer while age, number and size of nodules were not. FNAC more helpful for diagnosis if aspiration under USG guide and reading by experience histopathologest .Type of surgery depending on preoperative evaluation including history, examination, ultrasound, FNAC result, and intraoperative assessment of the nodule .Less complications of thyroid surgery by experience surgeon.

Endoscopic treatment of esophageal injury after thyroidectomy – a case report

The most common complications after thyroidectomy are postoperative neck hematoma, laryngeal recurrent nerve injury and hypoparathyroidism. [1] However, iatrogenic cervical esophageal perforation is a very rare repercussion of this procedure. In literature there are a few reported cases concerning that complication. We want to report a case of a patient with severe esophageal injury resulted from thyroidectomy.

S152 – Injury Predictive Value of Nerve Monitoring in Thyroidectomy

Objectives 1) To evaluate the efficacy of a nerve monitoring(NM) system in a series of patients submitted to thyroidectomy; 2) To critically analyze the negative-predictive-value(NPV) and positive-predictive-value(PPV) of the method. Methods NIM® system efficacy was prospectively analyzed in 447 patients submitted to thyroidectomy between 2001 and 2008(366 female/81 male; 420 Caucasian/47 non-Caucasian; 11- to 82-years-old, median: 43 year-old). There were 421 total thyroidectomies and 21 partial thyroidectomies leading to 868 nerves at risk. The gold standard to evaluate inferior laryngeal nerve function was early postoperative videolaryngoscopy, which was repeated after 4 to 6 months in all patients with abnormal endoscopic findings. Results At the early evaluation, 858 nerves (98.8%) presented normal videolaryngoscopic features postoperatively. 10 paretic/paralyzed nerves (1.2%) were detected (2 unexpected unilateral paresis, 1 unexpected bilateral paresis, 1 unexpected unilateral paralysis, 2 unexpected bilateral paralysis and 1 expected unilateral paralysis). At the late videolaryngoscopy, only 2 permanent nerve paralysis were noted (0.2%), with an ultimate result of 99.8% functioning nerves. NM showed absent or markedly reduced electrical activity at the end of the operations in 25/858 nerves (2.9%), including all 10 endoscopically compromised nerves, with 15 false-negative nerves. There were no false-positive nerves. Therefore, NPV was 40.0% and PPV was 100%. Conclusions In the present series, NM had a very high PPV, but a low NPV for the detection of recurrent nerve injury.

Safely Increasing the Efficiency of Thyroidectomy Using a New Bipolar Electrosealing Device (LigaSure™) versus Conventional Clamp-and-Tie Technique

Operative time in thyroid surgery can be safely reduced through use of a new bipolar electro-sealing device (LigaSure). We evaluated consecutive patients undergoing thyroid surgery from January 2003 through January 2005 (n = 155). During the first half of the study, hemostasis was obtained using silk ties (conventional group, n = 70). During the second half of the study period, hemostasis was obtained with a bipolar electrosealing device (LigaSure group, n = 85). The mean operative time was 130 ± 37 minutes in the conventional group and 110 ± 33 minutes (P < 0.001) in the LigaSure group. EBL in the LigaSure group was statistically significantly less (43 ± 53 vs 33 ± 33 mL; P < 0.05). Postoperative calcium level was statistically significantly higher in the Liga-Sure group (8.2 ± 0.5 vs 8.4 ± 0.6 mg/dL, P < 0.05). Hospital length of stay (LOS) did not differ significantly. One patient in each group developed neck hematoma requiring reoperation. One permanent recurrent nerve injury occurred in the conventional group and one transient bilateral recurrent nerve injury occurred in the LigaSure group. The occurrence of symptomatic hypocalcemia was similar between the two groups. The training level of the surgical resident had no significant impact on the operative time, estimated blood loss (EBL), LOS, or complication rate. LigaSure bipolar electrosealer as the primary means of hemostasis during thyroidectomy significantly reduces mean operative times. Rates of operative complications were unchanged. LigaSure use in thyroid surgery can safely increase efficiency.