Thyroid and parathyroid dysfunction after total laryngectomy in patients with laryngeal carcinoma

Abstract

The objective of this study is to investigate thyroid and parathyroid functions in patients with laryngeal carcinoma after total laryngectomy with hemithyroidectomy with or without irradiation, and to determine if irradiation when following surgery has an additive effect contributing to either or both glands hypo function. This study included 17 patients with laryngeal squamous cell carcinoma who were subjected to surgery. Nine of them were further justified for postoperative radiotherapy as well. All patients were subjected to Clinical assessment, including adequate history taking and physical examination, to detect the presence of hypothyroidism or hypoparathyroidism. Laboratory assessment of thyroid function included TSH and T4 assay, and parathyroid function included corrected serum calcium and parathormone levels. Eight (48 %) patients were treated with surgery alone, and 9 (52 %) patients received postoperative radiotherapy. In this study, 13 out of the 17 patients (78 %) were found to be hypothyroid and 4 (22 %) were euthyroid, while 7 (42 %) were found to have hypoparathyroidism. The study showed; among the 8 patients who were treated by surgery only, 5 (62.5 %) of them developed hypothyroidism and 3 (37.5 %) were euthyroid and 3 (37.5 %) developed hypoparathyroidism and 5 (62.5 %) were normal. Among the 9 patients who were treated by surgery and radiotherapy, 8 (88.9 %) developed hypothyroidism and 1 (11.1 %) was euthyroid and 4 (44.4 %) developed hypoparathyroidism and 5 (55.6 %) were normal. The study confirms the development of hypothyroidism with or without hypoparathyroidism after total laryngectomy with a higher incidence in those treated by combined surgery and radiotherapy and in supraglottic tumors.

Hypothyroidism and Wound Healing After Salvage Laryngectomy

“…We hypothesize that the previously radiated and surgically manipulated thyroid gland is predisposed to decreased function, leading to an inability to compensate for increased metabolic demands and compromises wound healing following surgery. 41–43 Therefore, the purpose of this study is to examine the relationship between hypothyroidism and wound healing after salvage laryngectomy.…”

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

“…In laryngectomy, the disruption to the thyroid and parathyroid glands, even if they are left in situ, may be significantly greater, and many of these patients will undergo radiotherapy, if they have not already. There are some cohort studies that suggest that retaining as much thyroid tissue as possible results in improved thyroid function following radiotherapy, but the power of these studies are low . The benefit in terms of thyroid function of retaining both lobes of the thyroid gland during laryngectomy is therefore unknown at this time.…”

“…There are some cohort studies that suggest that retaining as much thyroid tissue as possible results in improved thyroid function following radiotherapy, but the power of these studies are low. 15,16 The benefit in terms of thyroid function of retaining both lobes of the thyroid gland during laryngectomy is therefore unknown at this time. There are areas of limitation in this study.…”

Effect of general anesthesia and intubation on parathyroid levels in normal patients and those with hyperparathyroidism

“…Moreover, it assists surgical decision making (ie, whether to explore the neck for another adenoma or hyperplasia), thus enabling a 95% cure rate for primary hyperparathyroidism (HPT) . Another advantage of intraoperative PTH measurement is to predict transient or permanent hypocalcaemia after thyroidectomy or extensive neck surgery . Consequently, it is necessary to comprehend the factors that may alter PTH blood levels in the surgical setting.…”

“…[1][2][3][4][5] Another advantage of intraoperative PTH measurement is to predict transient or permanent hypocalcaemia after thyroidectomy or extensive neck surgery. [6][7][8][9] Consequently, it is necessary to comprehend the factors that may alter PTH blood levels in the surgical setting.…”