Management of the thyroid gland during total laryngectomy in patients with laryngeal squamous cell carcinoma

Abstract

N/A.

Preserving Hemithyroid During Total Laryngectomy: Report of a Disease-Free &Complication- Free Case

“…It is known that thyroidectomy is not compulsory in all patients going for total laryngectomy. 5,7,8 Extension of tumor subglotically, thyroid cartilage invasion, and pyriform sinus involvement are the indications for hemithyroidectomy and isthmectomy, rather than total thyroidectomy. 8 Thyroid gland involvement in laryngeal carcinoma patients is rare and only account for 7.7% 6 .…”

“…4 Anatomically subglottis, paraglottic space, cricothyroid space, thyroid cartilage, and cricothyroid membrane lie very close to each otherwhich helps to explain further regarding the thyroid gland involvement and extension in advanced stage laryngeal tumors. 7 Hemithyroidectomy still poses a risk of hypothyroidism with an incidence of 5.0% to 41.9% in all patients underwent hemithyroidectomy.The etiology causing hypothyroidism in hemithyroidectomy patients still remain uncertain 9 . In our daily life, in order for us to remain euthyroid, thyrocytes produced by one thyroid lobe is enough and with that believe many doctors choose to do hemithyroidectomy as to reduce the usage of postoperative thyroid hormone therapy.…”

How reliably can computed tomography predict thyroid invasion prior to laryngectomy?

“…As part of a total laryngectomy the thyroid gland is divided and may be removed, either as a hemithyroidectomy or a total thyroidectomy. The evidence base for this decision is scanty; traditionally at least the thyroid lobe, ipsilateral to the tumor, would be excised, but in recent years there has been a drive to establish if this is truly necessary …”

“…Although oncological control of the tumor with adequate margins is the overriding priority, the removal of thyroid tissue may have significant consequences. Evidence shows that high levels of hypothyroidism are seen even if one thyroid lobe is preserved, and this may be exacerbated by radiotherapy . Furthermore, the parathyroid glands are closely aligned to the thyroid poles on their end‐arteriole supply.…”

“…Several recent articles have sought to improve the evidence behind the decision to remove the thyroid during laryngectomy. The main route of spread of malignancy from the larynx to the thyroid appears to be direct invasion through the cartilage or adjoining membranes, rather than hematogenous or lymphatic . It has been shown that involvement of the subglottis carries a significantly higher risk of thyroid invasion .…”