Hypothesis All thyroid nodules ≥4 cm should be surgically removed regardless of fine-needle aspiration biopsy (FNAB) results due to an unacceptably high rate of false-negative pre-operative biopsies in these large nodules. Design Retrospective cohort study. Setting Single institution, tertiary academic referral center. Patients and Methods A retrospective analysis was done on all patients who underwent surgery for a thyroid nodule ≥4 cm from 5/94 through 1/07. Preoperative FNAB results were correlated with final surgical pathologic results. FNAB results were reported as non-diagnostic, benign, inconclusive (follicular neoplasm), or malignant while final surgical pathologic data was reported as benign or malignant. Results Of 155 patients who had a thyroidectomy for a ≥4cm nodule, 21 patients (14%) had clinically significant thyroid carcinoma within the ≥4cm nodule on final pathology. Preoperative cytology of the ≥4cm mass was obtained and read as benign in 52/97 patients, inconclusive in 23/97 patients, non-diagnostic in 11/97 patients, and malignant in 11/97 patients. In lesions ≥4cm, 26/52 (50%) FNAB results reported as benign turned out to be either neoplastic (22/52) or malignant (4/52) on final pathology. Among patients with non-diagnostic FNAB, the risk of malignancy was 27%. Conclusions In patients with thyroid nodules ≥4cm, FNAB results are highly inaccurate, misclassifying half of all patients with reportedly benign lesions on FNAB. Furthermore, those patients with a non-diagnostic FNAB display a very high risk of differentiated thyroid carcinoma. Therefore, we recommend that diagnostic lobectomy, at a minimum, be performed in patients with thyroid nodules ≥4 cm regardless of FNA cytology.

Background-The purpose of this study was to determine the incidence of and identify risk factors for post-operative hypothyroidism in patients undergoing thyroid lobectomy.

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.

No abstract

Background Patients with thyroid disease frequently complain of dysphagia. To date, there have been no prospective studies evaluating swallowing function before and after thyroid surgery. We used the swallowing quality of life (SWAL-QOL) validated outcomes assessment tool to measure changes in swallowing-related quality-of-life in patients undergoing thyroid surgery. Methods Patients undergoing thyroid surgery from May 2002 to December 2004 completed the SWAL-QOL questionnaire before and one year after surgery. Data were collected on demographic and clinicopathologic variables, and comparisons were made to determine the effect of surgery on patients’ perceptions of swallowing function. Results Of 146 eligible patients, 116 (79%) completed the study. The mean patient age was 49 years, and 81% were female. Sixty-four patients (55%) underwent total thyroidectomy and the remainder received thyroid lobectomy. Thirty patients (26%) had thyroid cancer. The most frequent benign thyroid conditions were multinodular goiter (28%) and Hashimoto’s thyroiditis (27%). Mean pre-operative SWAL-QOL scores were below 90 for nine of the eleven domains, indicating the perception of impaired swallowing and imperfect quality of life. After surgery, significant improvements were seen in eight SWAL-QOL domains. Recurrent laryngeal nerve injury was associated with dramatic score decreases in multiple domains. Conclusions In patients with thyroid disease, uncomplicated thyroidectomy leads to significant improvements in many aspects of patient-reported swallowing-related quality-of-life measured by the SWAL-QOL instrument.