Less than total thyroidectomy for goiter: when and how?

Makay, Özer

doi:10.21037/gs.2017.10.02

Cited by 19 publications

(15 citation statements)

References 52 publications

(70 reference statements)

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“…Surgical treatment has been regarded as an acceptable and appreciated method of nontoxic multinodular goitre (NTMNG) management [ 1 ]. The most common indications for surgery are compressive symptoms (dysphagia or shortness of breath), substernal extension, hyperthyroidism resistant to medical therapy, and suspicion of malignancy [ 1 , 2 ]. Women are more likely to have thyroid disorders; however, in some studies, the overall prevalence of NTMNG does not differ between genders [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Nontoxic Multinodular Goitre and Incidental Thyroid Cancer: What Is the Best Surgical Strategy?—A Retrospective Study of 2032 Patients

Kaliszewski

Wojtczak

Grzegrzółka³

et al. 2018

International Journal of Endocrinology

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Objectives A discussion with regard to the most optimal surgical procedure in nontoxic multinodular goitre (NTMNG). We assessed and compared three main types of operations in 2032 patients with NTMNG. Methods This is a retrospective study of 2032 patients operated on in one center due to NTMNG. The observation period was 48 to 120 months (mean and SD: 87 ± 20). Results The early complications included uni- and bilateral recurrent laryngeal nerve paralysis (URLNP, BRLNP), overt tetany (OT), and postoperative bleeding (POB). We observed after TT, STT, and DO URLNP: 15 (1.73%), 3 (0.64%), and 2 (0.28%), respectively (p < 0.05); BRLNP: 3 (0.34%), 2 (0.43%), and 0 (0.0%), respectively (p = 0.25); OT: 42 (4.84%), 6 (1.29%), and 9 (1.28%), respectively (p < 0.0001); and POB: 11 (1.26%), 4 (0.86%), and 3 (0.42%), respectively (p = 0.209). Persistent complications we observed after TT, STT, and DO are the following: URLNP: 9 (1.03%), 3 (0.64%), and 1 (0.14%), respectively (p = 0.086); BRLNP: 1 (0.11%), 1 (0.21%), and 0 (0.0%), respectively (p = 0.51); and OT: 11 (1.26%), 2 (0.43%), and 2 (0.28%), respectively (p = 0.052). Incidental thyroid cancer (ITC) was recognized after TT, STT, and DO in 18 (2.07%), 21 (4.52%), and 11 (1.56%), respectively (p = 0.039). Recurrent goitre (RG) was observed in 1 (0.11%) after TT, 3 (0.64%) after STT, and 2 (0.28%) after DO (p = 0.234). Conclusions Performing less radical surgery in NTMNG is associated with a significantly lower risk of early and late URLNP and OT. In the case of BRLNP (early and persistent) and POB, no statistically significant differences are seen. The occurrence of ITC is higher following more radical surgeries. Less radical surgery is connected with a higher risk of RG.

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Section: Introductionmentioning

confidence: 99%

Nontoxic Multinodular Goitre and Incidental Thyroid Cancer: What Is the Best Surgical Strategy?—A Retrospective Study of 2032 Patients

Kaliszewski

Wojtczak

Grzegrzółka³

et al. 2018

International Journal of Endocrinology

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“…К менее распространенным осложнениям относятся кровотечения, травма трахеи и пищевода. Вышеперечисленные возможные осложнения при оперативных вмешательствах на ЩЖ приводят к увеличению финансовых затрат на медицинское обслуживание пациентов, негативно влияют на качество жизни и требуют заместительной терапии на протяжении всей жизни [11]. Несмотря на значительное снижение количества интраоперационных осложнений при вмешательствах на ЩЖ в современной литературе отсутствуют публикации, посвященные мерам предупреждения последних.…”

Section: Discussionunclassified

Risk Factors of Intraoperative Complications in Benign Thyroid Diseases and Their Prevention

Гринцов

Akhrameyev

Matiytsiv

et al. 2020

Tavricheskiy Mediko-Biologicheskiy Vestnik

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The work presents an analysis of the results of thyroid surgery in 3758 patients. The majority of interventions were performed within 1975-1985 and amounted to 2863 (76.18%) cases, of which 72 (1.92%) were for giant benign neoplasms. Diagnosis verification was carried out in 2613 (69.53%) patients using scintigraphy, and in 1145 (30.47%) - echography. The median age was 52.7±15.8 years. The distribution by sex is 713 (18.97%) male and 3045 (81.03%) female. Most 2572 (68.44%) surgical interventions were performed under local anesthesia. Damage to the return nerve after surgery occurred in 127 (3.38%) patients, and in giant neoplasms in 31. In 18 (0.48%) patients, clinical manifestations of return nerve injury occurred on the opposite side. Positive dynamics from the treatment complex were observed in 113 (88.97%) patients, at the same time, 14 (11.02%) had persistent damage to the return nerve. In the early postoperative period there were phenomena of hypocalcemia during the first day in 384 (10.22%) patients, by the end of the second day - in 292 (7.77%), by the end of the third day - in 12 (0.33%), of which 248 (6.59%) are elderly. 112 (2.98%) cases involved intraoperative bleeding. The source of hemorrhage in 103 (2.74%) cases was neoplasm capsule vessels. It has been established that the mismatch between the size of surgical access and pathological mass (giant thyrotoxic goiter), disruption of the stages of intervention (except early planned cases), intimate fusion with the capsule, its thin wall, disregard of video monitoring data are risk factors for intraoperative complications in benign thyroid diseases. The use of nonstandard techniques («making Novocain cushion,» change of intervention algorithm) allows to visualize clearly nearby anatomical structures, and therefore, in the future - atraumatic operation.

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“…), suspect or proven malignancy and cosmetic reasons. 6 A recent meta-analysis that included 1,305 participants, evaluated the impact of total/near-total thyroidectomy versus subtotal thyroidectomy in adults with non-toxic multinodular goiter. 7 The main point observed was that the recurrence of goiter was lower in patients who underwent thyroidectomy compared with those who underwent subtotal thyroidectomy, with rates of goiter recurrence of 84 in 1,000 patients with subtotal thyroidectomy and 5 in 1,000 patients with total thyroidectomy.…”

Section: Discussionmentioning

confidence: 99%

Presternal Goiter

Stumpf¹,

Marques²,

Kluthcovsky³

et al. 2019

J Coll Physicians Surg Pak

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An enlarging thyroid normally extends into the mediastinum, resulting in a presternal or substernal goiter, depending on its migration anteriorly or posteriorly, respectively. The first one was a rare entity in medical literature, being previously reported in only 6 cases worldwide. The present case reports a 54-year woman with a presternal goiter. She had a history of partial thyroidectomy due to a colloid goiter in 2004. Her thyroid function revealed subclinical hypothyroidism. No other abnormalities were present in physical exam or in laboratory tests. A resection of the remaining thyroid tissue was made, with great postsurgical recovery. The anatomopathological study revealed a colloid goiter. Such case porpoise is to remember physicians that unusual presentations of ordinary diseases can occur. This report differs on literature, which demonstrated that papillary thyroid carcinoma is the most important cause of presternal goiter. Moreover, unlike previous reports with normal thyroid function, this case is the only one reported with subclinical hypothyroidism.

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Less than total thyroidectomy for goiter: when and how?

Cited by 19 publications

References 52 publications

Nontoxic Multinodular Goitre and Incidental Thyroid Cancer: What Is the Best Surgical Strategy?—A Retrospective Study of 2032 Patients

Nontoxic Multinodular Goitre and Incidental Thyroid Cancer: What Is the Best Surgical Strategy?—A Retrospective Study of 2032 Patients

Risk Factors of Intraoperative Complications in Benign Thyroid Diseases and Their Prevention

Presternal Goiter

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