Experience of thyroid surgery at a tertiary care hospital in Karachi, Pakistan

Abstract

Background: Thyroid disorders are common surgical pathology in our part of world. Most commonly encountered complication after thyroid surgery are hypocalcaemia, hoarseness of voice, wound infection, seroma formation and thoracic duct injuries secondary to modifi ed neck dissections. The aim of this study is to share the experience of thyroid surgery at a tertiary care hospital in Karachi, Pakistan with rest of the world. Methodology: The cross sectional descriptive study was conducted in Endocrine unit of Jinnah Postgraduate Medical Centre, Karachi, Pakistan from April 2009 till April 2019. About 2094 cases operated which includes multinodular goiter, malignant goiter, solitary thyroid nodules, recurrent goiter and goiter with retrosternal extension. Patients managed medically or not fi t for surgery or refused to surgery are not included in this study. Descriptive statistics were used to present the data. Results: Among 2094 cases 782 (37.3%) were diagnosed as MNG, 753 (35.9%) were malignant goiter, 487 (23.2%) were solitary thyroid nodules while 72 (3.43%) presented as recurrent goiter. Most common complication reported was transient hypocalcaemia which was reported in 89 (11.3%) patients who underwent thyroidectomy for MNG, 41 (5.4%) in patients with thyroidectomy for malignant goiter, 11 (2.3%) open lobectomy, 9 (12.5%) in thyroidectomy for recurrent goiter while only 1 (0.12%) reported permanent hypoparathyroidism who underwent surgery for MNG. Transient hoarseness was reported 10 (1.27%) with MNG and 14 (1.85%) in patients with malignancy proven goiter, while 2 (0.42%) in open lobectomy, 2 (13.3%) in endoscopic lobectomy and 1 (1.38%) in recurrent goiter. Permanent hoarseness was noted in only 1 (0.2%) who underwent completion thyroidectomy. Wound infection was reported in 10 (1.27%) with MNG, 18 (2.39%) with malignancy and 3 (0.63%) in open lobectomies. Seroma formation was associated with 7 (1.45%) in MNG, 13 in malignancy (1.7%), 11 (2.3%) open lobectomies, 2 (13.3%) in endoscopic lobectomies and 3 (4.1%) in recurrent goiters. Thoracic duct injury was reported in 7 (0.94%) left sided MRNDs. A total of 3 (0.14%) deaths were reported after surgery. Conclusion: Thyroid surgery is the treatment of choice for benign or malignant goiters where medical therapy is ineffective and not practical. Proper preoperative preparations, better understanding of anatomy, modifi cation of surgical techniques, use of energy devices and intraoperative nerve monitoring and careful follow-up has lead to major decline in postoperative complications and better surgical results with more detail understanding of thyroid surgery.

Appraisal of Thyroidectomy in Outlying Tertiary Care Hospital

“…Considering gender epidemiology, females were predominant in our study showed females, males ratio has gaps in 7.65: 1 supported by Altaf et al study represented 5.49:1 female, male ratio, and Vanderpump MPJ study reported a higher prevalence in females [22] [23]. Hegedus et al work also held up our result exhibited frequency higher in the elderly and female [4].…”

“…Disease pattern showed euthyroid benign goiter was 142 (82.08%) and euthyroid malignant goiter 31(17.92%) near to Pacini et al study showed the incidence of malignancy of thyroid swelling was 10% Thyroid malignancy in our study showed papillary carcinoma was 93.54%, follicular carcinoma 3.23%, and medullary carcinoma 3.23% near with Altaf et al work showed papillary was 83.1%, medullary 9.9%, and follicular 6.9% [22]. Plauche and Al-Salamah et al also exhibited papillary carcinoma was highest of all other thyroid malignancy 57-89% consistent with our study [39] [40].…”

“…The potential complications discussed [38]. Out of benign goiter, nodular was 73.24%, MNG 17.61%, and follicular adenoma 9.15% against our work by Vanderpump MPJ, and Altaf et al study showed MNG was 37.3%, nodular goiter 23.2% [23] [22].…”

Spectrum and Prevalence of Thyroid Diseases at a Tertiary Referral Hospital in Mogadishu, Somalia: A Retrospective Study of 976 Cases

“…Follicular thyroid cancer is the second most common malignancy accounting for 15 of the cases [ 27 ]. Our study showed that papillary thyroid cancer was the most common type followed by follicular thyroid cancer, and this was similar to the UAE [ 28 ], Saudi Arabia [ 29 ], and Yemen [ 30 ], while in Sudan, the most common type of thyroid cancer was follicular thyroid cancer [ 31 ], and in Pakistan, the most type seen was papillary thyroid cancer followed by medullary carcinoma, and follicular thyroid cancer is the third most common thyroid malignancy [ 32 ].…”

Endoscopic thyroid lobectomy vs Conventional open thyroid lobectomy

“…Chronic hypoparathyroidism with unrecovered normal function after six months was reported in 1.4% of cases and found in more extensive type of surgery. 16…”