Complication Risk in Secondary Thyroid Surgery

Aygün, Nurcihan; Besler, Evren; Yetkın, Gürkan; Mihmanlı, Mehmet; İşgör, Adnan; Uludağ, Mehmet

doi:10.14744/semb.2017.87609

Cited by 3 publications

(2 citation statements)

References 33 publications

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“…In the surgical strategy evaluation of vocal cord function by preoperative vocal cord, examination carries utmost importance. [75] Evaluation of the Findings of the First Surgery: It is very important for surgical strategy to examine the first images, surgical notes or drawings and pathology reports. Information about the extent of dissection and size of the lesion can be obtained from surgical notes.…”

Section: Confirmation Of Diagnosismentioning

confidence: 99%

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Surgical Treatment Of Primary Hyperparathyroidism: Which Therapy To Whom?

Aygün¹

2019

Sisli Etfal

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Primary hyperparathyroidism (pHPT) is characterized by an increase in the levels of PTH and Ca, or one of these (Ca, PTH) as a result of a dysregulation of calcium (Ca) metabolism due to inappropriate excess parathyroid hormone (PTH) autonomously produced from one or more than one parathyroid glands. Ninety to 95% of pHPT is a sporadic type, which is not associated with the familial history and other endocrine organ tumors, and 5-10% of it is hereditary. While 80-85% of pHPT arises from a single parathyroid adenoma, 4-5% is caused by a double adenoma, 10-15% by multigland hyperplasia and less than 1% by parathyroid cancer. The diagnosis of pHPT is reached biochemically. The only curative treatment of pHPT is surgery. The choice of surgery in pHPT may vary depending on whether the patient has hereditary HPT or thyroid disease requiring surgical treatment, preoperative localization studies and the findings in these studies, the possibilities of using intraoperative PTH and the preference of the surgeon. The preoperatively determined surgical strategy can be revised according to intraoperative findings in case of need to achieve excellent results. The two main approaches in the surgical treatment of pHPT are BNE (bilateral neck exploration) and MIP (minimal invasive parathyroidectomy). Although BNE is a consistently valid option that has excellent results in the surgical treatment of pHPT and is considered the gold standard, MIP is the ideal approach in selected patients with clinically and radiologically considered a single-gland disease. Negative imaging is not a contraindication for parathyroid surgery and is not a criterion for the presence or absence of surgical indication. Although both methods are safe and effective in the surgical treatment of sporadic pHPT, there is still controversy regarding the effectiveness of both methods. Surgical intervention should establish the risk-benefit balance well, minimize the risk of persistent and recurrent disease and provide the highest cure rate without increasing the risk of complications. Complication rates are higher in the secondary surgery, thus in secondary procedures, selective surgery should be performed under guidance of an imaging modality. The surgical strategy should be determined to achieve maximum cure with minimum dissection and minimal morbidity. In this study, we aimed to determine the type of surgical treatment and pHPT patients suitable for the surgical treatment.

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Section: Confirmation Of Diagnosismentioning

confidence: 99%

“…Intraoperative nerve monitoring should be used in secondary surgeries. [75] The use of ioPTH is recommended, particularly in secondary interventions. [58] Intraoperative US may provide contribution during surgery.…”

Section: Intraoperative Contributionsmentioning

confidence: 99%

Surgical Treatment Of Primary Hyperparathyroidism: Which Therapy To Whom?

Aygün¹

2019

Sisli Etfal

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Factors Associated With Injury to Recurrent Laryngeal Nerve in Patients Undergoing Surgery for Thyroid Cancer: A Single-centre Study Using Translaryngeal Ultrasound

Wolff¹,

Galazka

Borkowski³

et al. 2022

Journal of Voice

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Effects of central neck dissection on complications in differentiated thyroid cancer

et al. 2021

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Objective: It is still controversial whether performing central neck dissection (CND) in addition to total thyroidectomy (TT) increases the risk of complications. In the present study, we aimed to evaluate the effect of CND on the development of complications in differentiated thyroid cancer (DTC) compared to TT. Material and Methods: The data of 186 patients (136 females and 50 males) with a mean age of 48.73 ± 14.78 (range, 17–82) whom were operated for DTC were evaluated retrospectively. The patients were divided into two groups; TT (Group 1) and CND±TT/Completion thyroidectomy±lateral neck dissection (Group 2). Results: There were 117 (91 F, 26 M) patients in Group 1 and 69 (45 F, 24 M) patients in Group 2. Parathyroid auto transplantation (PA) was significantly higher in Group 2 compared to Group 1 (42% vs. 6%) ( p =0.000). Total (58% vs. 21.4%, respectively; p =0.000) and transient hypoparathyroidism (52.2% vs. 20.5%, respectively; p =0.000) were significantly higher in Group 2 than in Group 1, but permanent hypoparathyroidism rates were statistically not significant (5.8% vs. 0.9%, respectively; p =0.064). In the multinomial logistic regression analysis, CND alone was determined as an independent risk factor for increased both total and transient hypoparathyroidism. The relative risk (RR) of CND for total hypoparathyroidism was 5.2 times increased (odds ratio [OR]: 0.192) ( p =0.007), while the RR for transient hypoparathyroidism was 3.5 times increased (OR: 0.285) ( p =0.036). According to the number of nerves at risk, CND was performed in 119 neck side and only thyroidectomy was performed in 253 neck side. Total vocal cord paralysis (VCP) rate (9 [7.6%] vs. 6 [2.4%], respectively) ( p =0.017) and transient VCP rate (7 [6%] vs. 4 [1.6%], respectively) ( p =0.021) in patients who underwent CND were significantly higher compared to those who underwent only thyroidectomy. In multinomial logistic regression analysis performing only CND was an independent risk factor for total VCP, and increased the total VCP RR approximately 5.34 times (OR:0.184; p =0.007). Conclusion: Although CND can be applied without increasing the rates of permanent hypoparathyroidism and VCP compared to TT, it increases the risk of total and transient hypoparathyroidism, total, and transient VCP. Patients undergoing CND should be followed carefully in terms of transient hypoparathyroidism.

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Complication Risk in Secondary Thyroid Surgery

Cited by 3 publications

References 33 publications

Surgical Treatment Of Primary Hyperparathyroidism: Which Therapy To Whom?

Surgical Treatment Of Primary Hyperparathyroidism: Which Therapy To Whom?

Factors Associated With Injury to Recurrent Laryngeal Nerve in Patients Undergoing Surgery for Thyroid Cancer: A Single-centre Study Using Translaryngeal Ultrasound

Effects of central neck dissection on complications in differentiated thyroid cancer

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