Prevention and management of bleeding in thyroid surgery

Materazzi, Gabriele; Ambrosini, Carlo Enrico; Fregoli, Lorenzo; Napoli, Luigi De; Frustaci, Gianluca; Matteucci, Valeria; Papini, Piermarco; Bakkar, Sohail; Miccoli, Paolo

doi:10.21037/gs.2017.06.14

Cited by 60 publications

(78 citation statements)

References 20 publications

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“…Furthermore, some studies show that most postoperative bleeding occurs within six hours (even shorter than observed) and that late hematomas are not common. 20,21 Thirty five (43.2%) of the thyroidectomies were done for large goiters, and study had one case of tracheomalacia, which was managed by plicating the strap muscles around the trachea. This complication did not increase the postoperative stay of the patients.…”

Section: Discussionmentioning

confidence: 99%

The outcome of short stay thyroidectomy in rural medical outreach settings in Northern Nigeria

2020

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Background: The practice of short stay thyroidectomy is relatively new in developing nations like Nigeria. The primary reason for this is a lack of resources. Furthermore, the prevailing poverty prevents many patients from accessing tertiary health care, as such, ad hoc medical outreaches are usually conducted to bridge the gap. Thyroidectomies have not been routinely performed in these outreach settings due to safety concerns. The study seeks to analyse whether short stay thyroidectomy can be safely practiced under medical outreach settings with limited resources.Methods: The study is a prospective review of all patients that had short stay thyroidectomy at four rural medical outreach settings in Nigeria. Entire study spanned January 2019 to November 2019. Each outreach lasted one week, and patients were followed up for the duration of the outreach. All patients presenting at the outreach locations and diagnosed with goiters who have had no prior neck surgeries, are euthyroid, have no locally advanced malignancies or intrathoracic goiters, have adequate social support, possess a telephone, and have accommodation within the local government area where the outreach is carried out were included in the study. Exclusion criteria included patients who did not satisfy any of the above listed inclusion criteria. Thyroidectomy was done through a standard cervicotomy. Descriptive statistics were applied.Results: A total of 81 patients with non-toxic goiters had thyroid surgery. There were 76 (94%) females and five (6%) males. Average age was 46 years. Sixty-nine (85.2%) patients had no complication, while 12 (14.8%) patients had complications. Seventy-seven (95.1%) patients were discharged within 24 hours of surgery, while four (9.4%) patients were discharged within 48 hours. There was no mortality.Conclusions: The short-stay thyroidectomy model is feasible and safe in our environment, even in the presence of limited resources, and provides an alternative to the traditional 72 hour postoperative hospital stay.

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Section: Discussionmentioning

confidence: 99%

The outcome of short stay thyroidectomy in rural medical outreach settings in Northern Nigeria

2020

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“…Advances in hemostatic surgical techniques and agents, however, have decreased the mortality and morbidity associated with operative hemorrhage and postoperative hematomas, thus mitigating such concerns. 24,25 The TIA is considered a small arterial vessel, with an average diameter of 3 to 5 millimeters. Its origin is often a high-pressure large artery in which severe hemorrhage and blood loss can occur if prompt hemostasis is not achieved.…”

Section: Discussionmentioning

confidence: 99%

The prevalence of thyroid ima artery and its clinical significance

Chin

Zhou

Wan

et al. 2019

Int J Otorhinolaryngol Head Neck Surg

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Background: The thyroid ima artery (TIA) is an anatomical anomaly that commonly functions as an accessory blood supply for the isthmus and inferior aspect of the thyroid. Limited research has been performed to investigate the relative prevalence and clinical implications of the TIA in present literature.Methods: Dissections were conducted on cadavers in the anatomy laboratory at Touro College of Osteopathic Medicine, New York (Harlem Campus), with 94 subjects examined using standard methods to identify thyroid vasculature and to determine the presence of a thyroid ima artery. Known origins of the thyroid ima artery were also examined for possible branching. Results: Of the 94 cadavers, only one was found to have a thyroid ima artery present, suggesting a prevalence of 1.06 percent.Conclusions: The thyroid ima artery is significant in its influence in head and neck procedures as well as emergent airway creation. With its relative rarity, its presence is worthy of consideration as a possible hematological source for hemorrhage.

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“…After total thyroidectomy for well-differentiated thyroid carcinoma in 5670 SEER-Medicare patients (1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009), the frequency of unilateral vs. bilateral vocal cord paralysis was 8.2 vs. 1.3% [13]. Postoperative hematoma develops in 0.1-1% of patients and can lead to airway compression [14]. In addition, lifelong thyroid replacement treatment [15] is unavoidable after thyroidectomy.…”

Section: Introductionmentioning

confidence: 93%

Thyroid Nodules in Diagnostic Pathology: From Classic Concepts to Innovations

Fridrihsone¹,

Štrumfa²,

Strumfs³

et al. 2018

Histopathology - An Update

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Thyroid nodules are frequent in general population, found in 3.7-7% of people by palpation and 42-67% by ultrasonography (US). The differential diagnosis ranges from papillary (PC), follicular (FC) and medullary (MC) carcinomas to follicular adenoma (FA) and colloid goitre. Cancer risk in thyroid nodules varies: 5% in masses found by palpation, 1.6-15% by US, 3.9-11.3% by computed tomography (CT), 5-6% by magnetic resonance imaging (MRI) and 30-50% by positron emission tomography (PET). The final diagnosis depends on fine needle aspiration (FNA) findings and histopathology. The recent WHO classification (2017) is based on classic morphology, including assessment of invasion and nuclei. New entities are defined to designate tumours with doubtful invasion or controversial nuclear features. By immunohistochemistry, PC expresses HBME-1, TROP-2, CITED1 and CK19. Notably, PC can stain for CD20. MC is recognised by neuroendocrine differentiation. To distinguish FA vs. FC, evaluation of HBME-1, p27 and galectin has been suggested. Regarding miRNAs, miR-146b, miR-222, miR-221 and miR-181b are upregulated, while miR-145, miR-451, miR-613 and miR-137 are downregulated in PC. FC features downregulated miR-199a-5p and upregulated miR-197 and miR-346. In MC, miR-21 and miR-129-5p are downregulated. In addition, increased systemic inflammatory reaction can be poor prognostic factor in thyroid cancer. The aim of this chapter is to review classic and innovative histopathology of thyroid nodules for diagnostic pathology practice and research in multidisciplinary thyroid teams.

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Prevention and management of bleeding in thyroid surgery

Cited by 60 publications

References 20 publications

The outcome of short stay thyroidectomy in rural medical outreach settings in Northern Nigeria

The outcome of short stay thyroidectomy in rural medical outreach settings in Northern Nigeria

The prevalence of thyroid ima artery and its clinical significance

Thyroid Nodules in Diagnostic Pathology: From Classic Concepts to Innovations

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