The definitive management and prevention of recurrence of benign nodular goiter is primarily surgical. Total thyroidectomy essentially eliminates the risk of recurrence without an accompanying increased risk of permanent hypoparathyroidism or RLN injury. Therefore, total thyroidectomy should be considered the procedure of choice for benign multinodular goiter whenever possible, especially considering that reoperations for goiter are significantly more morbid than any initial operation.
Background: The prevalence of thyroid cancer survivors is rising rapidly due to the combination of an increasing incidence, high survival rates, and a young age at diagnosis. The physical and psychosocial morbidity of thyroid cancer has not been adequately described, and this study therefore sought to improve the understanding of the impact of thyroid cancer on quality of life (QoL) by conducting a large-scale survivorship study. Methods: Thyroid cancer survivors were recruited from a multicenter collaborative network of clinics, national survivorship groups, and social media. Study participants completed a validated QoL assessment tool that measures four morbidity domains: physical, psychological, social, and spiritual effects. Data were also collected on participant demographics, medical comorbidities, tumor characteristics, and treatment modalities. Results: A total of 1174 participants with thyroid cancer were recruited. Of these, 89.9% were female, with an average age of 48 years, and a mean time from diagnosis of five years. The mean overall QoL was 5.56/10, with 0 being the worst. Scores for each of the sub-domains were 5.83 for physical, 5.03 for psychological, 6.48 for social, and 5.16 for spiritual well-being. QoL scores begin to improve five years after diagnosis. Female sex, young age at diagnosis, and lower educational attainment were highly predictive of decreased QoL. Conclusion: Thyroid cancer diagnosis and treatment can result in a decreased QoL. The present findings indicate that better tools to measure and improve thyroid cancer survivor QoL are needed. The authors plan to follow-up on these findings in the near future, as enrollment and data collection are ongoing.
Background
Thyroidectomy and parathyroidectomy are the most commonly performed endocrine operations, and increasingly are completed on a same-day basis. Little data exists regarding the outpatient post-operative pain requirement of these patients. We aimed to describe the outpatient narcotic medication needs for patients undergoing thyroid and parathyroid surgery, and to identify predictors of higher requirement.
Method
We examined patients undergoing thyroid and parathyroid surgery at two large academic institutions from January1-May 30, 2014. Prospective data was collected on pain scores and the oral morphine equivalents (OMEQ) taken by these patients by their post-operative visit.
Results
313 adult patients underwent thyroidectomy or parathyroidectomy during the study period. 83% of patients took 10 or fewer OMEQ, and 93% took 20 or fewer OMEQ. Patients who took more than 10 OMEQ were younger (p<0.001) and reported significantly higher overall mean pain scores at their post-operative visit (p<0.001) than patients who took fewer than 10 OMEQ. A multivariate model was constructed on pre and intraoperative factors that may predict usage of greater than 10 OMEQ post-operatively. Age < 45 years (p=0.002), previous narcotic use (p=0.037) and whether parathyroid or thyroid surgery was performed (p=0.003) independently predicted the use of more than 10 OMEQ after surgery. A subgroup analysis was then performed on thyroidectomy only patients.
Conclusion
93% of patients undergoing thyroidectomy and parathyroidectomy require 20 or fewer OMEQ by their post-operative visit. We therefore recommend these patients be discharged with 20 oral morphine equivalents, both to minimize waste and increase patient safety.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.