Surgery for recurrent goiter: complication rate and role of the thyroid-stimulating hormone-suppressive therapy after the first operation

Miccoli, Paolo; Frustaci, Gianluca; Fosso, Alessandra; Miccoli, Mario; Materazzi, Gabriele

doi:10.1007/s00423-014-1258-7

Cited by 13 publications

(11 citation statements)

References 19 publications

(22 reference statements)

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“…The mean interval between the initial and the reoperative procedure has been reported to be less than 20 years (14.9, 17.5, and 18.7 years in some previous series [ 2 , 5 , 10 ]). The mean intervals from the first operation to recurrence were more than 20 years (24 and 27 years in other series [ 11 , 12 ]). Recurrence in remnant thyroid has a slow progression rate as confirmed by 61.2% of our patients who had redo surgery after more than 20 years from primary surgery.…”

Section: Discussionmentioning

confidence: 80%

Displacement of the Recurrent Laryngeal Nerve in Patients with Recurrent Goiter Undergoing Redo Thyroid Surgery

Gürleyik

Cetin

Doğan

et al. 2018

Journal of Thyroid Research

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Thyroid reoperations are surgically challenging because of scarring and disturbances in the anatomy of the recurrent laryngeal nerve (RLN). This study was conducted on 49 patients who underwent redo surgery. 61 RLNs were identified and completely exposed. Their functional integrity was evaluated using intraoperative nerve monitoring (IONM). Indications for secondary surgery, anatomical changes secondary to recurrent goiter mass and prior surgery, and results of IONM were studied. Frequent indications for redo surgery were multinodular goiter (MNG) in 19 (38.8%) and results of cytology in 14 (28.5%) patients. The mean time interval between primary and redo thyroid surgery was 23.4 years. We laterally approached 41 (67.2%) thyroid lobes between the sternocleidomastoid and sternohyoid muscles. 16 (26.2%) RLNs were found to be adherent to the lateral surface of the corresponding thyroid lobe. The functional integrity of all RLNs was confirmed by IONM. The remnant thyroid tissue can then lead to goiter recurrence requiring secondary surgery after a long period of time. The indications for redo surgery were similar to primary cases. Lateral displacement of the RLN which is adherent to the lateral surface of recurrent goiter mass is common anatomic variation. Thyroid reoperations based on awareness of anatomical disturbances can be performed safely by an experienced surgeon with support of ancillary electrophysiological technology.

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Section: Discussionmentioning

confidence: 80%

Displacement of the Recurrent Laryngeal Nerve in Patients with Recurrent Goiter Undergoing Redo Thyroid Surgery

Gürleyik

Cetin

Doğan

et al. 2018

Journal of Thyroid Research

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“…In the first randomized prospective study of 1,000 patients undergoing thyroid reoperation for recurrent goiter, Barczyński et al showed that the prevalence of transient RLN palsy was significantly lower among patients whose surgery utilized IONM (2.9% lower in high risk patients and 0.9% lower in low-risk patients) than among those whose operations involved only RLN visualization (39). Reoperations are undoubtedly more dangerous for the RLN than primary operations (11,12,14,15), hence the utilization of IONM should be always recommended to minimize the risk of nerve injury due to certain advantages the technique has over visual identification alone.…”

Section: Ionm In Recurrent Goitermentioning

confidence: 99%

Intermittent neural monitoring of the recurrent laryngeal nerve in surgery for recurrent goiter

Wojtczak

Barczyński

2016

Gland Surg.

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Reoperative thyroid surgery is still challenging even for skilled surgeons, and is associated with a higher incidence of complications, such as hypoparathyroidism and recurrent laryngeal nerve (RLN) palsy. Displacement of the RLN, scar tissue from previous neck surgery and difficulty in maintaining good hemostasis are risk factors in reoperations. The prevalence of RLN injury in reoperative thyroid surgery ranges as high as 12.5% for transient injury and up to 3.8% for permanent injury. Bilateral paresis can also occur during reoperations, and is a dangerous complication influencing the quality of life, sometimes requiring tracheostomy. RLN identification is the gold standard during thyroidectomy, and the use of intraoperative neuromonitoring (IONM) can be a valuable adjunct to visual identification. This technique can be used to identify the RLN and the external branch of the superior laryngeal nerve (EBSLN), both of which are standardized procedures. The aim of this review was to evaluate the use of intermittent neural monitoring of the RLN in surgery for recurrent goiter, and to assess the prevalence of RLN injury while using IONM reported in the current literature.

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“…Miccoli G et al 3 Prospective observational study N=214 -After the re-intervention there was temporary hypoparathyroidism in 37.7% of the patients, and definitive hypoparathyroidism occurred in 7.2%.…”

Section: Resultsmentioning

confidence: 99%

“…There are a number of known and frequent postoperative complications after a thyroidectomy such as hypocalcaemia (being the most frequent), the presence of re-bleeding leading to a hematoma with less or greater severity, recurrent laryngeal nerve paralysis. 1,3,5,6,7,9,10 According to Cauley et al 4 the complications recorded at 30 days out of a total of 40,025 patients undergoing total thyroidectomy were 7.74%. Preoperative factors that affected the complication rates for thyroidectomies in hospitalized patients included: age ≥70 years, non-Caucasian, dependent functional status, history of congestive heart failure, history of smoking, bleeding disorder (According to Quéralt et al 17 % vs. 13% of patients who performed hematoma were treated with anticoagulation) other complications were wound infection and preoperative sepsis.…”

Section: Discussionmentioning

confidence: 99%

“…3 As all surgery is not risk-free, there are a series of known and frequent postoperative complications such as hypocalcaemia (this being the most frequent), the presence of resuscitation producing a hematoma with less or greater severity or recurrent laryngeal nerve paralysis, especially after a total thyroidectomy. [1][2][3][4][5][6][7] The relationship between the patient and the rate of postoperative complications is complex and is influenced by the intrinsic factors of the disease, the comorbidities of the patient and the same surgical treatment. 5,6 There are several factors that can influence, such as age, race, functional status, smoking history, etc.…”

Section: Introductionmentioning

confidence: 99%

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Main care to avoid complications associated with thyroidectomy

Ferrés¹

2019

IJFCM

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General objective: To identify the main care in patients undergoing total or partial thyroidectomy to avoid complications associated with surgery. Methodology: Articles were searched in the databases: Pubmed, CINAHL y Cochrane Library Plus, with the free terms: laryngotracheal stenosis, tracheal stenosis, complications, surgery and care. Limited in Indian: English or Spanish, +18 years and published in the last 10 years. Results: Out of a total of 140 articles found, 30 met the inclusion criteria of the finally selected topics. 17 that dealt with the stated objective and that were added to a 2002 article because of its relevance. Hyperthyroidism affects 1-3% of the general population and is usually more common in women. There are different treatment options available depending on their more or less invasive individualization. Surgery offers an early remission of endocrine disorder and more stable than more conservative strategies and also an earlier detection of thyroid cancer. Hypocalcemia is the most frequent, symptomatic or asymptomatic, rebleeding with hematoma, laryngeal nerve injury, acute pain or infection as the most important. There is a series of care that favors the early detection of these and other things. Conclusion: This review has been made with the aim of knowing more about the most frequent complications after a thyroidectomy and establishing the basic learning needs that patients should know at discharge to take responsibility for their health. In addition, a series of recommendations has been made to patients at discharge to empower the patient to be responsible for their health and to recognize early complications, know and take responsibility for medication, know how to heal the wound, etc.

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Surgery for recurrent goiter: complication rate and role of the thyroid-stimulating hormone-suppressive therapy after the first operation

Abstract: Our results clearly show that the interval between the two surgical interventions was significantly reduced in patients undergoing TSH-suppressive therapy with levothyroxine. The incidence of hypoparathyroidism dramatically increased.

Cited by 13 publications

References 19 publications

Displacement of the Recurrent Laryngeal Nerve in Patients with Recurrent Goiter Undergoing Redo Thyroid Surgery

Displacement of the Recurrent Laryngeal Nerve in Patients with Recurrent Goiter Undergoing Redo Thyroid Surgery

Intermittent neural monitoring of the recurrent laryngeal nerve in surgery for recurrent goiter

Main care to avoid complications associated with thyroidectomy

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