The place of total thyroidectomy in the management of 909 patients with thyroid disease

Perzik, S. L.

doi:10.1016/0002-9610(76)90324-x

Cited by 117 publications

(72 citation statements)

References 11 publications

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“…Among 96 patients undergoing total thyroidectomy, 2 had permanent hypoparathyroidism and 3 had recurrent laryngeal nerve injury [2]. Similar low incidences of complications have been reported by many other groups using a similar technique [5][6][7]. …”

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confidence: 77%

Surgeon's Approach to the Thyroid Gland: Surgical Anatomy and the Importance of Technique

2000

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Abstract. The cornerstone of safe and effective thyroid surgery is thorough training in and understanding of thyroid anatomy and pathology. With appropriate techniques, total thyroid lobectomy and total thyroidectomy (which should be considered simply as a bilateral total thyroid lobectomy performed during the same operation) can be undertaken with minimal risk of damage to the recurrent laryngeal nerves, the external branches of the superior laryngeal nerves, and the parathyroid glands. Safe surgery requires a specific operative plan, progressing in a series of logical, orderly, anatomically based steps. Exposure of the thyroid gland is followed by careful dissection of the superior pole, utilizing the avascular plane between the superior pole and the cricothyroid muscle to identify and preserve the external branch of the superior laryngeal nerve. Medial retraction of the gland then allows dissection of the lateral aspect of the thyroid lobe. Protection of the recurrent laryngeal nerves and preservation of the blood supply to the parathyroid glands is best achieved by "capsular dissection," ligating the tertiary branches of the inferior thyroid artery on the gland surface. If a parathyroid gland cannot be preserved or becomes ischemic after dissection of its vascular pedicle, it should be immediately minced and autotransplanted into the ipsilateral sternocleidomastoid muscle. The current evolution of outpatient or shortstay thyroidectomy emphasizes the need to avoid complications by utilizing meticulous surgical technique. Minimally invasive thyroidectomy utilizing endoscopic techniques may also affect the practice of thyroid surgery. Even so, understanding the surgical anatomy of the thyroid gland and its possible variations is paramount to safe and effective surgery.During the latter half of the nineteenth century a revolution in surgery and surgical technique occurred. Before that time, thyroid surgery was limited to treating only life-threatening conditions. With a reported mortality rate of more than 20%, the reputation of thyroid surgery was so poor that the French Academy of Medicine banned its practice in 1850. Indeed, when Greene reported his successful thyroidectomies in America, he warned that the operations should be used "never, for the relief of deformity or discomfort merely; only, to save life" [1]. However, by the time the Nobel Prize was awarded to Kocher in 1909, the mortality rate in his hands had been reduced to 0.18% [2].The key to increasing safety of thyroid surgery was then, as now, a thorough understanding of thyroid anatomy and pathology. The general developments in surgical techniques and instrumentation, and the improvements in antisepsis and anesthetic techniques, were also crucial. When thyroidectomy became safe to perform, the specific complications of the procedure could be addressed, including prevention of injury to the recurrent laryngeal nerves and avoidance of accidental injury to, or removal of, the parathyroid glands. The surgical techniques developed at that time were, i...

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confidence: 77%

Surgeon's Approach to the Thyroid Gland: Surgical Anatomy and the Importance of Technique

2000

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“…In our follow-up period we did not see any recurrence, but in the long-term follow-up of our patients we may expect our prediction to come true. Permanent RLN paralysis ratios of total and subtotal operations are 0-1% and 0-1.3%, respectively [11][12][13]. Permanent hypoparathyroidism ratios of total and subtotal operations were 0-3.8% and 0.02% respectively [11,12].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Different Thyroidectomy Techniques for Benign Thyroid Disease

et al. 2003

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Abstract. Extent of thyroidectomy in the management of benign thyroid disease remains controversial. In this clinical study, three different thyroidectomy techniques were compared by means of the complication, short period recurrence and L-thyroxin requirement rates. Two hundred consecutive patients who had bilateral subtotal thyroidectomy (BST) (n = 71), unilateral total lobectomy + contralateral subtotal lobectomy (Dunhill Procedure (DP)) (n = 71), or total thyroidectomy (TT) (n = 58) for benign thyroid disorders were included in this study. One patient was re-operated due to bleeding in BST group. Wound infection was observed in 1 patient both in BST and DP group and 2 patients in TT group. Temporary hypocalcaemia was seen in 14 (19.7%) of BST group, in 19 (26.7%) of DP group, and in 14 (24.1%) patients of TT group (p>0.05). Transient recurrent laryngeal nerve palsy developed in 1 patient both in DP and TT group. One patient of DP group had secondary thyroidectomy due to postoperative diagnosis of papillary carcinoma. There was no significant difference in the mean durations of hospitalization between the groups. Mean postoperative follow-up periods were 27.7 months (6-56), 34.8 months (8-55), 26.5 months (6-54) in BST, DP and TT groups, respectively. While all patients were administered L-thyroxin in TT group, 26 (36.6%) patients in DP group and 34 (47.8%) patients in BST group needed no Lthyroxin supplementation and L-thyroxin requirement rates were not different in either group. We think that total thyroidectomy should be adopted for benign thyroidal diseases, because its complications are no different than those for BST and DP. If individual factors and patient's preference are not in favor of lifelong L-thyroxin supplementation, however, DP may be carried out for benign thyroidal diseases instead of BST.

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“…Total thyroidectomy (TT) was previously considered the treatment of choice for benign diseases and malignancies [1][2][3][4][5]. As a result, this surgical procedure has widespread indications at our institution [6,7].…”

Section: Introductionmentioning

confidence: 99%

The prevalence of post-thyroidectomy chronic asthenia: a prospective cohort study

Scerrino¹,

Raspanti²,

Attard³

et al. 2017

Langenbecks Arch Surg

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Purpose Chronic asthenia (CA) is complained by some patients that have undergone thyroid surgery. We evaluate its impact in patients undergoing unilateral or bilateral thyroidectomy, the trend during a 1-year follow-up, and the possible risk factors. Methods A prospective, cohort study was carried out on 263 patients scheduled for thyroidectomy from 2012 and 2014. Exclusion criteria were as follows: Graves' disease, malignancies requiring radioiodine therapy, post-surgical hypoparathyroidism, laryngeal nerve palsy, abnormal pre-and postoperative thyroid hormone levels, and BMI outside the normal range. Demographics; smoking and alcoholism addiction; cardiac, pulmonary, renal, and hepatic failure; diabetes; anxiety; and depression were recorded. The Brief Fatigue Inventory (BFI) was used to evaluate CA and its possible association with these comorbidities 6 and 12 months after thyroidectomy. Results One hundred seventy-seven patients underwent total thyroidectomy (TT), 54 hemithyroidectomy (HT). Thirty-two patients were not recorded because of the onset of exclusion criteria. In the 6 months after thyroidectomy, in the TT group, 64 patients (36.16%) reported an impairment in the BFI score and only 1 in the TL group. The mean BFI score changed from 1.663(±1.191) to 2.16 (±11.148) in the TT group, from 1.584 (±1.371) to 1.171 (±1.093) in the TL group (p < 0.001). No further significant variations in BFI were reported 1 year after surgery. Conclusions CA worsened after TT, but not after HT. Apart from operative procedure itself, no other risk factor was found be significantly associated with post-thyroidectomy asthenia. Further investigation is needed to determine the causes of CA.

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The place of total thyroidectomy in the management of 909 patients with thyroid disease

Cited by 117 publications

References 11 publications

Surgeon's Approach to the Thyroid Gland: Surgical Anatomy and the Importance of Technique

Surgeon's Approach to the Thyroid Gland: Surgical Anatomy and the Importance of Technique

Comparison of Different Thyroidectomy Techniques for Benign Thyroid Disease

The prevalence of post-thyroidectomy chronic asthenia: a prospective cohort study

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