Surgery in Hashimoto′s thyroiditis: Indications, complications, and associated cancers

Pradeep, P. V.; Ragavan, M; Ramakrishna, Baddukonda Appala; Jayasree, B; Skandha, S H

doi:10.4103/0022-3859.81867

Cited by 24 publications

(16 citation statements)

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“…The incidence of these complications increases with thyroid pathology associated with increased gland size, fibrosis, vascularity, or inflammation (4–6). Although certain disease states such as hyperthyroidism, goiter, and thyroiditis are associated with more difficult thyroidectomies, the degree of difficulty often varies widely, and it is difficult to quantify or predict the level of difficulty of these cases preoperatively (3, 5–11). Surgical risk in thyroidectomy is well studied, but there is no literature regarding the quantification of “difficulty” or an objective measure of “difficulty” for a thyroidectomy (4–9, 12–15).…”

Section: Introductionmentioning

confidence: 99%

Identifying predictors of a difficult thyroidectomy

Mok

Oltmann

Chen

et al. 2014

Journal of Surgical Research

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Introduction A Thyroidectomy Difficulty Scale (TDS) was previously developed that identified more difficult operations, which correlated with longer operative times and higher complication rates. The purpose of this study was to identify pre-operative variables predictive of a more difficult thyroidectomy using the TDS. Methods A four item, 20-point TDS, was used to score the difficulty of thyroid operations. Patient and disease factors were recorded for each patient. Difficult thyroidectomy (DT) and non-difficult thyroidectomy (NDT) patients were compared. A final multivariate logistic regression model was constructed with significant (p<0.05) variables from a univariate analysis. Results 189 patients were scored using TDS. 69 (36.5%) suffered from hyperthyroidism, 42 (22.2%) from Hashimoto’s, 34 (18.0%) from thyroid cancer and 36 (19.0%) from multinodular goiter. Among hyperthyroid patients, the DT group had a greater number preoperatively treated with Lugol’s potassium iodide (81.6% DT vs. 58.1% NDT, p=0.032), presence of ophthalmopathy (31.6% DT vs. 9.7% NDT, p=0.028) and presence of (>4 IU/mL) anti-thyroglobulin antibodies (34.2% DT vs. 12.9% NDT, p=0.05). Using multivariate analysis, hyperthyroidism (OR 4.35, 95% CI 1.23–15.36, p=0.02), presence of anti-thyroglobulin antibody (OR 3.51, 95% CI 1.28–9.66, p=0.015), and high (>150 ng/mL) thyroglobulin (OR 2.61, 95% CI 1.06–6.42, p=0.037) were independently associated with DT. Conclusion Using TDS, we demonstrated that a diagnosis of hyperthyroidism, pre-operative elevation of serum thyroglobulin and anti-thyroglobulin antibodies are associated with DT. This tool can assist surgeons in counseling patients regarding personalized operative risk and improve OR scheduling.

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Section: Introductionmentioning

confidence: 99%

Identifying predictors of a difficult thyroidectomy

Mok

Oltmann

Chen

et al. 2014

Journal of Surgical Research

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“…The main complications associated with thyroidectomy include injury to the recurrent laryngeal nerve, damage to the parathyroid glands, and postoperative hematoma. Recurrent laryngeal nerve injury and hypoparathyroidism have the potential to be life-long, costly issues for a patient (4)(5)(6). The incidence of these complications increases with thyroid pathology associated with increased gland size, fibrosis, vascularity, or inflammation (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

“…Recurrent laryngeal nerve injury and hypoparathyroidism have the potential to be life-long, costly issues for a patient (4)(5)(6). The incidence of these complications increases with thyroid pathology associated with increased gland size, fibrosis, vascularity, or inflammation (4)(5)(6). Although certain disease states such as hyperthyroidism, goiter, and thyroiditis are associated with more difficult thyroidectomies, the degree of difficulty often varies widely, and it is difficult to quantify or predict the level of difficulty of these cases preoperatively (3,(5)(6)(7)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

“…The incidence of these complications increases with thyroid pathology associated with increased gland size, fibrosis, vascularity, or inflammation (4)(5)(6). Although certain disease states such as hyperthyroidism, goiter, and thyroiditis are associated with more difficult thyroidectomies, the degree of difficulty often varies widely, and it is difficult to quantify or predict the level of difficulty of these cases preoperatively (3,(5)(6)(7)(8)(9)(10)(11). Surgical risk in thyroidectomy is well studied, but there is no literature regarding the quantification of "difficulty" or an objective measure of "difficulty" for a thyroidectomy (4)(5)(6)(7)(8)(9)(12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

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Identifying Predictors of a Difficult Thyroidectomy

Mok

Oltmann

Chen

et al. 2014

Journal of Surgical Research

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“…However, no improvements in thyroid function have been observed with these approaches. Thyroidectomy, on the other hand, will only lead to a relief of mechanical symptoms including a feeling of compression, voice problems and tightness in the neck [8,9]. Keeping in mind that the association between HT and other autoimmune diseases likely derives from a polyclonal autoimmune response against organ-specific autoantigens [10], thyroidectomy will not lead to improvements in a majority of associated conditions und, thus, will only have minor impact on overall quality of life [4].…”

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confidence: 99%

Hashimoto’s Thyroiditis – the Need for a Specific Therapy

Ott¹

2012

Thyroid Disorders Ther

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Hashimoto's thyroiditis (HT) is one of the most common autoimmune disorders and is the most prevalent cause of subclinical or overt hypothyroidism in areas with sufficient iodine intake [1]. Over the last three decades, its incidence has increased substantially, regardless whether it was defined by laboratory, clinical and ultrasonographic features [2] or histological characteristics [3]. Moreover, various characteristics of HT have changed over the decades. Affected patients had become younger and the incidence of clinically diagnosed HT in males had increased [2].Apart from its substantial impact on thyroid function, HT also influences general health independent from hypo-or hyperthyroidism [4]. It is associated with decreased quality of life levels [5] as well as a wide range of organ-specific and non-organ-specific autoimmune disorders, as well as other diseases, including neuropsychological/ psychiatric deficits, disorders of the gut, fibromyalgia, and reproductive health issues, among many others [4].Thus, one of the main questions is whether HT patients who suffer from impairment in quality of life and HT-related symptoms can find medical help. Evidence suggests that both levothyroxine replacement and selenium supplementation are associated with reduce in concentrations of thyroid peroxidase antibodies [6,7]. However, no improvements in thyroid function have been observed with these approaches. Thyroidectomy, on the other hand, will only lead to a relief of mechanical symptoms including a feeling of compression, voice problems and tightness in the neck [8,9]. Keeping in mind that the association between HT and other autoimmune diseases likely derives from a polyclonal autoimmune response against organ-specific autoantigens [10], thyroidectomy will not lead to improvements in a majority of associated conditions und, thus, will only have minor impact on overall quality of life [4].Notably in HT patients, low-level laser therapy of the thymus, thyroid, and supraclavicular fossa induces systemic immunomodulation [11]. A recent randomized, placebo-controlled trial on the efficacy of low-level laser therapy in patients with HT-induced hypothyroidism demonstrated that thyroid function was improved and thyroid peroxidase antibody levels were reduced [12]. This effect was also evident at the last follow-up examination nine months after treatment.HT is considered a multifactorial disease. Recently, Effraimidis et al. [13] proposed a model for the natural history of autoimmune thyroid disease suggesting that a particular genetic background allows development of autoantibodies against thyroid peroxidase. Then, environmental exposure plays a significant role whether the patient will become hyper-or hypothyroid; for example, a high iodine intake and refraining from smoking will favor development toward hypothyroidism [13]. Together with possible influences of radiation [14], the sex hormones [15], and fetal microchimerism [16] the development is based on a variety of factors. Thus, it seems unlikely that primary preven...

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Surgery in Hashimoto′s thyroiditis: Indications, complications, and associated cancers

Cited by 24 publications

References 0 publications

Identifying predictors of a difficult thyroidectomy

Identifying predictors of a difficult thyroidectomy

Identifying Predictors of a Difficult Thyroidectomy

Hashimoto’s Thyroiditis – the Need for a Specific Therapy

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