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Thyroid follicular nodular disease (non-toxic multinodular goiter), the commonest thyroid disorder, can be managed with different surgical methods, including total thyroidectomy (TT), near-total thyroidectomy (NTT), subtotal thyroidectomy (STT), and Dunhill operation (DO). This systematic review and meta-analysis aimed to provide an update on the role of TT versus NTT, STT, or DO in MNG concerning goiter recurrence, thyroid cancer incidence, and reported complications. We conducted a systematic literature search in Medline, EMBASE, and CENTRAL. We included randomized controlled trials (RCTs) that compared TT to partial thyroidectomy (NTT, STT, or DO) in the management of multinodular goiter (MNG). The following outcomes, goiter recurrence, cancer incidence, and adverse events (hypoparathyroidism and recurrent laryngeal nerve injury), were evaluated. We used the risk ratio (RR) to represent the dichotomous outcome. Subgroup analysis was performed based on the different types of partial thyroidectomy (NTT, STT, and DO). A total of 7 RCTs that included 1909 individuals were deemed eligible. TT showed significantly better results compared to PT in terms of goiter recurrence (RR = 0.05, 95% CI 0.02 to 0.13, P = 0.001; I2 = 0%), whereas it showed similar results compared to PT in terms of thyroid cancer incidence (RR = 1.09, 95% CI 0.76 to 1.57, P = 0.63; I2 = 0%). PT was significantly better than TT concerning transient adverse events (RR = 2.18, 95% CI 1.64 to 2.89, P = 0.001: I2 = 63%). This meta-analysis showed that TT has a lower risk of goiter recurrence. TT is comparable to PT in terms of persistent adverse events but has a higher risk for transient adverse events. [ABSTRACT FROM AUTHOR]

Objectives: The extent of the surgical treatment for Graves' disease (GD) has evolved from subtotal to total thyroidectomy. This study analyzes the extent of thyroidectomy for GD and its impact on recurrence and complications, focusing on the relationship between remnant thyroid tissue and recurrence in subtotal thyroidectomy, comparing our current approach with historic data spanning over three decades. Methods: A retrospective analysis of 427 GD patients who underwent surgery at a tertiary hospital from 1988 to 2022. Patients were categorized into total/near-total thyroidectomy (TT, n=302) and subtotal thyroidectomy (ST, n=125). The groups were compared for demographics, postoperative complications, and recurrent hyperthyroidism rates. ROC analysis determined the remnant cut-off value for recurrence in the ST group. Results: Age and sex were similar across groups. Recurrent hyperthyroidism was found in 8% of ST patients but none in the TT group (p<0.001). Transient hypoparathyroidism was higher in the TT group (16.9% vs. 0.8%; p<0.001). Persistent hypoparathyroidism and vocal cord paralysis rates were comparable. ST patients with recurrence had more remnant tissue (5.3±0.94 g vs. 3.4±1.34 g; p<0.01). The remnant tissue cut-off for predicting recurrence was 4 g (<4 g: 0%, ≥4 g: 17.8%; p<0.001). Conclusion: Total thyroidectomy has lower recurrence rates than subtotal thyroidectomy without significantly increasing longterm complications. Remnant tissue larger than 4 g in subtotal thyroidectomy increases the risk of recurrence. [ABSTRACT FROM AUTHOR]

The anesthesia of patients with pemphigus vulgaris (PV) demands special emphasis in relation to the possible formation of bulla in tracheal mucosa following intubation and the consequent postoperative respiration difficulties. We demonstrate our application of cervical epidural anesthesia on a 58 year-old female patient with PV who underwent subtotal thyroidectomy. An 11 cm tuohy needle was inserted between C7-TI and an 18 G epidural catheter were placed under fluoroscopic guidance. During the operation, a total of 20 cc-mixture containing 120 mg lidocaine, 100 µgr fentanyl and saline solution was given through the epidural catheter. Additional 5 mg intravenous midazolam was injected for sedation. The anesthesia level was controlled with the pink prick test. Hemodynamic and respiratory parameters were calculated at preoperative 5th, 10th, 15th, 25th and postoperative 5th minutes. No complication was detected concerning epidural anesthesia. We recommend, therefore, cervical epidural anaesthesia in patients with PV in appropriate cases. [ABSTRACT FROM AUTHOR]

Abstract Background The surgical management of multinodular goiter is the treatment of choice for the majority of cases. There is controversy between radical resection with the lifelong thyroxine substitution and function-preserving resection with the risk for recurrence, and the complications associated with total thyroidectomy. Objective The aim of the present study was to compare the outcome of total thyroidectomy (TT) in comparison with subtotal thyroidectomy (ST) as regards hypocalcemia, transient nerve injury, and recurrence rate. Patients and methods This study included published English medical articles in the last 20 years, concerning the treatment of multinodular goiter. Results Meta-analysis was for the evaluation of surgical outcomes after surgical management of multinodular goiter including total thyroidectomy versus subtotal thyroidectomy by comparing the TT versus ST in our study including 23 studies included of the total number of patients (4485) who underwent subtotal thyroidectomy versus the total number of patients (7116) who underwent total thyroidectomy; a comparison was done as regards postoperative complications including RLN injury (transient or permanent), rate of recurrence, need for reoperation, and incidence of postoperative hypocalcemia. The incidence of RLN injury is lower in ST compared to TT, and its recurrence is much lower in TT than in ST. Conclusion This meta-analysis showed that the advantages of total thyroidectomy include adequate eradication of the disease, prevention of recurrent goiter, and avoidance of the need for completion surgery in case of occult malignancy, but it is associated with higher morbidity (postoperative thyroidectomy complications: RLN palsy and hypoparathyroidism) and the need for lifelong replacement therapy (L-thyroxin supplementation).

Background: The surgical management of multinodular goiter is the treatment of choice for the majority of cases. There is controversy between radical resection with the lifelong thyroxine substitution and function-preserving resection with the risk for recurrence, and the complications associated with total thyroidectomy. Objective: The aim of the present study was to compare the outcome of total thyroidectomy (TT) in comparison with subtotal thyroidectomy (ST) as regards hypocalcemia, transient nerve injury, and recurrence rate. Patients and methods: This study included published English medical articles in the last 20 years, concerning the treatment of multinodular goiter. Results: Meta-analysis was for the evaluation of surgical outcomes after surgical management of multinodular goiter including total thyroidectomy versus subtotal thyroidectomy by comparing the TT versus ST in our study including 23 studies included of the total number of patients (4485) who underwent subtotal thyroidectomy versus the total number of patients (7116) who underwent total thyroidectomy; a comparison was done as regards postoperative complications including RLN injury (transient or permanent), rate of recurrence, need for reoperation, and incidence of postoperative hypocalcemia. The incidence of RLN injury is lower in ST compared to TT, and its recurrence is much lower in TT than in ST. Conclusion: This meta-analysis showed that the advantages of total thyroidectomy include adequate eradication of the disease, prevention of recurrent goiter, and avoidance of the need for completion surgery in case of occult malignancy, but it is associated with higher morbidity (postoperative thyroidectomy complications: RLN palsy and hypoparathyroidism) and the need for lifelong replacement therapy (L-thyroxin supplementation). [ABSTRACT FROM AUTHOR]

Background: Surgery is offered to patients with Graves' disease (GD) refractory to medical or radio-iodine therapy. Total thyroidectomy (TT) has been shown to lower recurrence rates of hyperthyroidism because the whole thyroid tissue is removed but subtotal thyroidectomy (ST) is thought to be associated with lower risk of postoperative complications. Aim and objectives: To compare between the two techniques regarding postoperative recurrence of hyperthyroidism, hypocalcaemia and hypoparathyroidism. Subjects and methods: This was prospective controlled clinical trial, was carried out at Department of General Surgery, Assiut University Hospital, Assiut, Egypt on 80 patients were allocated randomly to one of the treatment groups Group TT And Group ST With a 1: 1 ratio, during two years duration (2020-2021), Result: There were significant difference between both groups as regard recurrent hyperthyroidism . Conclusion: With our findings demonstrating lesser relapse of hyperthyroidism and similar safety profiles of TT in tandem with a high proportion of patients eventually needing thyroxin replacement after ST, we believe that TT should be the surgical procedure of choice for patients with GD. We find little reason to continue to offer ST as an alternative. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of post-operative asymptomatic hypocalcaemia in patients with total and subtotal thyroidectomy. Study Design: Cross-sectional study. Setting: Department of Surgery, Sheikh Zayed Hospital, Rahim Yar Khan. Period: 1st July 2021 to 30th April 2022. Material & Methods: One hundred and Sixteen post thyroidectomy male and female patients of age 18-50 years were included in the study using consecutive sampling technique and two groups were formed. Group-A included those patients who underwent total thyroidectomy and in Group-B patients underwent sub-total thyroidectomy. Samples for serum calcium levels were collected in gel tube before and 24 hours after surgery. Post-operative Hypocalcemia was defined by serum total calcium < 8.5 mg/dL 24 hours after surgery. Patients with symptomatic post-operative hypocalcemia following total or subtotal thyroidectomy or hypocalcemia due to any other reason or systemic disease e.g. renal disease and pregnant females were excluded by history and medical record. Data was analyzed using SPSS 20. Results: In Group A the Mean age was 30.94 ±9.6 years, while those in Group B were 31.59± 11.03 years. In Group A 62 (35.63%) and in 30 (17.245%) of Group B patients respectively were identified with asymptomatic hypocalcemia. A statistically significant difference was seen in both groups. 0.00 is the probability value. Conclusion: When compared to sub-total thyroidectomy, the frequency of asymptomatic hypocalcaemia was substantially higher following total thyroidectomy. Asymptomatic hypocalcaemia after complete or partial thyroidectomy might affect both men and women equally. After subtotal or total thyroidectomy, both younger and older age groups had an equal likelihood of developing asymptomatic hypocalcaemia. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of post-operative asymptomatic hypocalcaemia in patients with total and subtotal thyroidectomy. Study Design: Cross-sectional study. Setting: Department of Surgery, Sheikh Zayed Hospital, Rahim Yar Khan. Period: 1st July 2021 to 30th April 2022. Material & Methods: One hundred and Sixteen post thyroidectomy male and female patients of age 18-50 years were included in the study using consecutive sampling technique and two groups were formed. Group-A included those patients who underwent total thyroidectomy and in Group-B patients underwent sub-total thyroidectomy. Samples for serum calcium levels were collected in gel tube before and 24 hours after surgery. Post-operative Hypocalcemia was defined by serum total calcium < 8.5 mg/dL 24 hours after surgery. Patients with symptomatic post-operative hypocalcemia following total or subtotal thyroidectomy or hypocalcemia due to any other reason or systemic disease e.g. renal disease and pregnant females were excluded by history and medical record. Data was analyzed using SPSS 20. Results: In Group A the Mean age was 30.94 ±9.6 years, while those in Group B were 31.59± 11.03 years. In Group A 62 (35.63%) and in 30 (17.245%) of Group B patients respectively were identified with asymptomatic hypocalcemia. A statistically significant difference was seen in both groups. 0.00 is the probability value. Conclusion: When compared to sub-total thyroidectomy, the frequency of asymptomatic hypocalcaemia was substantially higher following total thyroidectomy. Asymptomatic hypocalcaemia after complete or partial thyroidectomy might affect both men and women equally. After subtotal or total thyroidectomy, both younger and older age groups had an equal likelihood of developing asymptomatic hypocalcaemia. [ABSTRACT FROM AUTHOR]

Objectives: The extent of the surgical treatment for Graves' disease (GD) has evolved from subtotal to total thyroidectomy. This study analyzes the extent of thyroidectomy for GD and its impact on recurrence and complications, focusing on the relationship between remnant thyroid tissue and recurrence in subtotal thyroidectomy, comparing our current approach with historic data spanning over three decades., Methods: A retrospective analysis of 427 GD patients who underwent surgery at a tertiary hospital from 1988 to 2022. Patients were categorized into total/near-total thyroidectomy (TT, n=302) and subtotal thyroidectomy (ST, n=125). The groups were compared for demographics, postoperative complications, and recurrent hyperthyroidism rates. ROC analysis determined the remnant cut-off value for recurrence in the ST group., Results: Age and sex were similar across groups. Recurrent hyperthyroidism was found in 8% of ST patients but none in the TT group (p<0.001). Transient hypoparathyroidism was higher in the TT group (16.9% vs. 0.8%; p<0.001). Persistent hypoparathyroidism and vocal cord paralysis rates were comparable. ST patients with recurrence had more remnant tissue (5.3±0.94 g vs. 3.4±1.34 g; p<0.01). The remnant tissue cut-off for predicting recurrence was 4 g (<4 g: 0%, ≥4 g: 17.8%; p<0.001)., Conclusion: Total thyroidectomy has lower recurrence rates than subtotal thyroidectomy without significantly increasing long-term complications. Remnant tissue larger than 4 g in subtotal thyroidectomy increases the risk of recurrence., Competing Interests: None declared., (© Copyright 2024 by The Medical Bulletin of Sisli Etfal Hospital.)

Objective: To compare the occurrence of hypocalcemia in patients undergoing subtotal and total thyroidectomy. Study Design: Comparative prospective study. Place and Duration of Study: Surgical departments of Ayub Teaching Hospital, Abbottabad and Combined Military Hospital, Rawalpindi, from Mar 2018 to Feb 2020. Methodology: A total of 171 patients were selected for this study and they were divided into 2 groups. Group 1 consisted of 95 patients undergoing Total thyroidectomy whereas group 2 had 76 patients undergoing Subtotal thyroidectomy. It was a comparative prospective study and the groups were made by convenience sampling. The data was analyzed by SPSS-23. Results: In total thyroidectomy group Hypocalcemia was detected after 48 hours in 34 patients (35%) while in subtotal thyroidectomy group hypocalcemia was detected in 20 patients (28%). Tests for hypocalcemia were also done after two months of surgery and low levels were detected in 7 patients (7.5%) who had total thyroidectomy and in 2 patients (5%) in the group undergoing subtotal thyroidectomy. There was no significant difference in hypocalcemia after 48 hour (p=0.22) and 2 months postoperatively (p=0.6) between patients of Total Thyroidectomy and Subtotal Thyroidectomy. Conclusion: Total thyroidectomy is not associated with increased risk of permanent hypocalcemia as compared to Subtotal thyroidectomy. Because of its advantages Total thyroidectomy should be the preferred surgical procedure for patients presenting with benign euthyroid multi nodular goiter. [ABSTRACT FROM AUTHOR]

Background: Lithium carbonate is used to manage various mood disorders, but it can cause thyroid abnormalities, including goiter, hypothyroidism, and hyperthyroidism. In rare cases, it can lead to giant goiter and subclinical hyperthyroidism, which may require surgical intervention in severe cases., Case Summary: This case represents a rare development of giant goiter and subclinical hyperthyroidism in a schizophrenia patient who was subjected to prolonged lithium carbonate treatment. The enlarged thyroid gland caused pressure on the airway and recurrent laryngeal nerve, which led to respiratory distress, hoarseness, and dysphagia. The immediate danger of suffocation required urgent surgical intervention. In this report, we describe the case of a 41-year-old Chinese woman. This sheds light on the etiology and challenges associated with managing a giant goiter. The patient underwent a subtotal thyroidectomy to relieve airway compression and facilitate airway expansion. Prior to the procedure, the patient was given iodine to prepare. Concurrently, changes were made to the psychiatric medication regimen. Following surgery, the patient's respiratory function and vocal cord functionality improved significantly, and her mental state remained stable., Conclusion: It is essential to monitor thyroid function, test thyroid antibody levels, and perform thyroid ultrasounds consistently in all patients undergoing long-term lithium carbonate treatment. This vigilance helps prevent severe and potentially life-threatening thyroid enlargement., Competing Interests: Conflict-of-interest statement: All authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

A COMPARATIVE STUDY BETWEEN HARMONIC SCALPEL HEMOSTASIS AND CONVENTIONAL HEMOSTASIS IN TOTAL AND SUBTOTAL THYROIDECTOMY Mohammed Salim Mohammed*, Jasim D Saud#, Mansour Amin Mohammed$ & Mazin H Al-Hawaz@ *MB,ChB, Board Candidate. #MB,ChB, FICMS, CABS, Consultant Surgeon, Basrah General Hospital. $MB,ChB, DS, CABS, MRCS, Lecturer, Dept. of Surgery, College of Medicine. @ MB,ChB, CABS, DGS, FRCS, Prof. of General Surgery, Basrah Medical College., Basrah, IRAQ. Abstract Thyroid gland is highly vascularized organ, so good hemostasis during total or sub-total thyroidectomy is crucial to decrease the complications and to improve the outcome. This study aimed to evaluate the advantages and disadvantages of using harmonic scalpel device in comparison with conventional hemostasis for total and subtotal thyroidectomy in terms of operative time, nerves injury, post-operative blood loss, hematoma development, hypocalcemia and length of hospital stay. This study included 80 patients who underwent total or subtotal thyroidectomy. They were divided into two groups according to the type of hemostasis: conventional hemostasis group and harmonic hemostasis group. Different diseases were included (multinodular goiter, toxic goiter and malignant diseases). The results showed that time of operation was significantly shorter in the harmonic hemostasis group (79.52±14.98 min) than conventional hemostasis group (100.92 ±10.64 min) with p value 0.0001, also post-operative blood loss was lower in harmonic hemostasis group (52.5±26.23 ml) than conventional hemostasis group (75.13±17.8 ml) with p value 0.0001. Other outcome such as recurrent laryngeal nerve injury, post-operative hematoma, post-operative hypocalcemia and length of hospital stay did not show significant difference between the groups. In conclusion, using harmonic scalpel device in total or subtotal thyroidectomy reduced the operative time and post-operative blood loss, without any change in the incidence of nerve injury, hematoma, hypocalcemia and the length of hospital stay.

Background: Surgical treatment of benign thyroid disease varies from lobectomy, subtotal thyroidectomy, and total thyroidectomy (TT)., Objective: The current study aimed to compare complications of both total and subtotal thyroidectomy (STT) for patients with bilateral benign thyroid disorders., Methods: Sixty patients with benign goiter, 32 for TT and 28 for STT, where indications for surgery, operating time, hospital stay, and complications were studied., Results: The incidence of transient recurrent laryngeal nerve (RLN) palsy was (6.25%) for TT vs (3.57%) for STT, and temporary hypoparathyroidism was (9.38%) in TT patients compared to (7.14%) in STT patients. Permanent RLN palsy and hypoparathyroidism occurred only in one case (3.12%) from the TT group. No permanent complications occurred in STT patients. Recurrence of goiter occurred in two patients (7.14%) undergoing STT. Incidental papillary carcinoma was (7.14%) in STT patients and (3.13%) for follicular carcinoma in TT patients. There was no postoperative mortality., Conclusion: TT is a suitable surgical procedure in patients with bilateral benign thyroid disease as complication rate, operative time, and hospital stay are less comparable to STT. It will give a permanent cure without recurrences, and incidental thyroid malignancies can be avoided., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2024 by West African Journal of Medicine.)

Background Hypocalcemia is a major post-operative complication of total thyroidectomy, causing severe symptoms and increasing hospitalization time. The primary cause is secondary hypoparathyroidism following damage to or devascularization of one or more parathyroid gland during surgery. Objective To identify the occurrence rate of post-operative hypocalcemia as an indicator of parathyroid gland function and its relation to the type of the surgical procedure of thyroidectomy whether it's a subtotal or total thyroidectomy. Methods One hundred and ninety patients with total and subtotal thyroidectomy were selected in this study (144 females and 46 males). The patients were divided into 2 groups, group 1 (95 patients) represent the patients with total thyroidectomy, and group 2 (95 patients) represent the patients with subtotal thyroidectomy. Serum calcium and parathyroid hormone were done pre-operatively and post-operatively for all patients with a follow-up for serum calcium for 6 months. Results Of the total number serum calcium levels decreased from pre-operative levels in 156 patients (82%), but still within normal range (2.1-2.6 mmol/L). The overall incidence of transient hypocalcemia was 22 % (42 patients), 35 patients belong to group 1 and 7 patients to group 2, and that of permanent hypocalcemia (hypocalcemia persisted at the 6 months assessment) was 2.6 % (5 patients), 4 patients belong to group 1 and one patient to group 2. Most of the patients with hypocalcemia were asymptomatic 19.4% (n=37) and did not require calcium supplementation. Symptomatic hypocalcemia occurred in 5.2 % (n =10) patients. It was found that the overall incidence of hypocalcemia after thyroidectomy was 24.7 % (22% transient and 2.6% permanent). Conclusion It could be concluded that, insuring the integrity of parathyroid glands is important to avoid postthyroidectomy hypocalcemia. If incidental removal or devascularization of the parathyroid glands is noted, parathyroid auto-transplantation should be done. [ABSTRACT FROM AUTHOR]

Background Surgical management of Graves' disease (GD) is changing from subtotal to total thyroidectomy because the latter eliminates the risk of recurrence. However, to preserve thyroid function in a euthyroid state, subtotal thyroidectomy is still performed for GD in non-Western countries. Therefore, we designed a study to investigate the long-term outcomes in GD patients after subtotal thyroidectomy and the correlation between remnant weight and postoperative thyroid function. Materials and methods This was a retrospective cohort observation study. Between January 2005 and December 2011, 415 consecutive GD patients treated by subtotal thyroidectomy were enrolled. All data were collected from 385 patients who underwent bilateral subtotal thyroidectomy and 57 patients who underwent the Hartley-Dunhill operation. The median postoperative follow-up time was 72 months (range 12-144 months). Results The mean weight of the preserved thyroid remnant was 5.1 g. Persistent or recurrent hyperthyroidism was observed in 119 (28.7%) patients. The median time of recurrence was 36 months (range 12-120 months). Hypothyroidism developed in over 50% of patients. A euthyroid state was achieved in only 19.3% of patients, and the rate did not increase significantly as remnant weight increased. Based on a Cox regression analysis, the remnant weight is an independent risk factor for persistent or recurrent hyperthyroidism (hazard ratio: 1.323, 95% confidence interval: 1.198-1.461, P < 0.001). Conclusions Subtotal thyroidectomy with the intent to maintain a euthyroid state is not an optimal surgical strategy for the definitive treatment of GD because the persistence or recurrence rate is high and the euthyroid rate is lower than expected. [ABSTRACT FROM AUTHOR]

BACKGROUND: Combined open-heart surgery and thyroidectomy is a rare procedure. However, some difficulties will occur for cardiac surgery when thyromegaly extends into the retrosternal space. CASE DETAILS: A 54-year-old woman suffering from dyspnea, chest pain and decreased left ventricular function (EF=40%) was diagnosed with coronary artery disease (3 vessel disease) and became candidate for coronary artery bypass grafting (CABG). Also, she had multinodular goiter with normal thyroid function test. After midsternotomy, a huge goiter was seen in the upper mediastinum. Because the mass had covered the ascending aorta and involved the posterior aspect of the innominate vein making access to aorta impossible, thyroidectomy was performed at first followed by CABG. Postoperation course was satisfactory. Fourteen months later, the patient was euthyroid and in NYHA class 1. CONCLUSION: The evidence of the case showed that combined CABG and thyroidectomy can be performed safely. [ABSTRACT FROM AUTHOR]

Operating room fires are rare events, but when occur they result in serious and sometimes fatal consequences. Anaesthesia ventilator fire leading to cardiac arrest is a rare incident and has not been reported. We report a near catastrophic ventilator fire leading to cardiac arrest in a patient undergoing subtotal thyroidectomy. In the present case sparks due to friction or electrical short circuit within the ventilator might have acted as source of ignition leading to fire and explosion in the oxygen rich environment. The patient was successfully resuscitated and revived with uneventful recovery and no adverse sequelae. The cardiac arrest was possibly due to severe hypoxia resulting from inhalation of smoke containing high concentrations of carbon monoxide and other noxious gases.

Background: The objective of this study was to evaluate the safety of total thyroidectomy for thyroid disorders and summarise the treatment experience in a less-developed region. Methods: This was a retrospective observational cohort study using the computerised database of the First Affiliated Hospital of Harbin Medical University. All consecutive thyroidectomy patients from 2003 to 2014 were included in this study. Demographics, surgical procedure, diagnoses, morbidity and mortality were retrospectively reviewed. Results: There were a total of 714 men and 4845 women in this study, with a mean age of 55 (range 9-87) years. A total of 4632 patients underwent total thyroidectomy for primary surgical treatment, and 189 patients previously underwent partial thyroidectomy. A total of 56.2 % of the patients had multinodular goitre, including 12.23 % who were thyrotoxic. Graves' disease and Hashimoto's disease were diagnosed in 2.82 and 7.23 % of the patients, respectively. Papillary thyroid cancer was identified in 1336 patients, 44.99 % of whom had papillary microcarcinoma. The total prevalence of permanent complications of first-time and secondary surgeries was 0.35 and 7.41 %, respectively. During thyroid surgery, 945 patients underwent parathyroid autotransplantation. Conclusions: Initial total thyroidectomy can be safely performed for both benign and malignant thyroid diseases in a less-developed region. The morbidity of a secondary surgical procedure after subtotal thyroidectomy is significantly high compared to first-time surgery. [ABSTRACT FROM AUTHOR]

Background: Bilateral truncal ligation (BTL) of the inferior thyroid artery (ITA) is frequently used during subtotal thyroidectomy to reduce the risk of post-operative bleeding as well as to reduce the blood loss intra-operatively. However, its effect on parathyroid function has not been evaluated in relation to age, residual and resected thyroid volume. Methods: A total of 83 patients were randomized to receive non-BTL or BTL. After bilateral resection, the residual thyroid tissue on each side was measured by intra-operative ultrasonography. Laboratory and clinical examinations were performed the day before operation, intra-operatively and on post-operative days 2 and 5. The primary outcome measure was the difference in intact parathormone (PTHi) on post-operative day 5. Secondary outcomes were laboratory-diagnosed hypocalcaemia or hypoparathyroidism and clinically manifest hypoparathyroidism, respectively. Results: PTHi on post-operative day 5 was significantly lower in the BTL group (29.4 vs. 34.7 ng/l in the non-BTL group, p = 0.033), especially in 61- to 80-year-old patients (0 vs. -7.91 ng/l, p = 0.029). The biggest decline in PTHi was found in the BTL group (-14.067 ng/l PTH, p = 0.018) with a residual thyroid volume of 0.5-1.9 ml. There were two cases of asymptomatic hypoparathyroidism in each group (5.1 vs. 4.8%, respectively, p = 1.000). The only case of clinically manifest hypoparathyroidism was in a BTL group patient aged 64 years (2.4%, p = 1.000). Conclusion: BTL of the ITA during subtotal thyroidectomy causes a larger decrease in PTH but does not lead to a significantly higher rate of clinically manifest hypoparathyroidism. BTL of the ITA, age >61 years, and a very small thyroid remnant (<2 ml) may be risk factors for post-operative hypoparathyroidism. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Introduction There is still a debate on the management strategies for diffuse benign thyroid diseases mainly between total extracapsular and subtotal thyroidectomy in terms of effi cacy and complications. Aim To establish the best operative management of benign thyroid diseases and to determine postoperative complications. Patients and methods A prospective comparative study was carried out on patients with benign thyroid disease. Two types of surgical procedures were performed: total extracapsular thyroidectomy and subtotal thyroidectomy. Results The study included 60 patients operated for benign thyroid disease. Controlled toxic goiter was found in 36 patients (60%), simple multinodular goiter was found in 14 patients (23.3%), primary toxic goiter was found in eight patients (13.3%), and a dominant toxic nodule was found in two patients (3.3%). Thirty patients underwent total extracapsular thyroidectomy and the other 30 patients underwent subtotal thyroidectomy. In this study, one patient (3.3%) from the total thyroidectomy group developed a complication of transient recurrent laryngeal nerve injury compared with no patients (0%) in the subtotal thyroidectomy group. Also, in this study, two patients (6.7%) in the total thyroidectomy group developed complications of hypoparathyroidism and hypocalcemia, but not in patients (0%) in the subtotal thyroidectomy group. Conclusion Total extracapsular thyroidectomy is a safe and highly effective procedure, with low postoperative complications. [ABSTRACT FROM AUTHOR]

The main objective of this study was to identify the incidence of post-thyroidectomy hypocalcemia in patients underwent lobectomy, subtotal thyroidectomy or total thyroidectomy. This randomized trial study was performed from May 2010 to July 2011 among 108 consecutive patients undergoing thyroidectomy. Patients were allocated into 3 groups based on the 3 common type of thyroidectomy. Pre and postoperative serum calcium levels were determined by using standard protocol for all patients. All patients' preoperative serum calcium levels were normal. Post-thyroidectomy hypoglycemia occurred in 0%, 8.3% and 8.3% of patients who underwent total hypocalcemia, subtotal thyroidectomy and lobectomy, respectively, which represents 5.6% of all patients who shown hypocalcemia (P=0.58). Serum calcium levels were fall in 93% patients, however within several days were returned to normal ranges. We did not find a significant relation between the hypocalcemia and thyroidectomy types. We recommended determination other alternative factors as a more effective prediction for postoperative hypocalcemia.

Background: A prospective, analytical study conducted to compare the results of total thyroidectomy with subtotal thyroidectomy in the management of multinodular goitre. Objective: comparison of total thyroidectomy and subtotal thyroidectomy for the management of multinodular goitre in terms of postoperative complications. Patients and Methods: A prospective review of 120 patients with benign multinodular goitre (bilateral) undergoing total thyroidecotmy (Group A=60) and subtotal thyroidecotmy (Group B=60) during 2 years period (2011-12) was undertaken. Evaluation of results was done by analyzing the data in SPSS version 17. Results: In group A, total thyoidectomy was done, the postoperative complications were lesser (13.33%) than group B in whom subtotal thyroidectomy was done (16.67%). The complications seen in group A were seroma formation 1(1.67%), external laryngeal nerve (ELN) palsy 2 (3.34%), recurrent laryngeal nerve (RLN) palsy (temporary) 2 (3.34%) and hypoparathyroidism 3 (5.00%). The complications seen in group B were tension haematoma 01 (1.67%), seroma formation 2 (3.34%), ELN palsy 2 (3.34%), RLN palsy (temporary) 3 (5.00%) and hypoparathyroidism 2 (3.34%). No mortality was seen in both groups. Conclusions: Total thyroidectomy is better procedure than subtotal thyroidectomy for the treatment of benign mulitnodular goitre. This procedure also prevents future need of surgery for recurrence and incidental thyroid cancer. [ABSTRACT FROM AUTHOR]

The main objective of this study was to identify the incidence of post-thyroidectomy hypocalcemia in patients underwent lobectomy, subtotal thyroidectomy or total thyroidectomy. This randomized trial study was performed from May 2010 to July 2011 among 108 consecutive patients undergoing thyroidectomy. Patients were allocated into 3 groups based on the 3 common type of thyroidectomy. Pre and postoperative serum calcium levels were determined by using standard protocol for all patients. All patients' preoperative serum calcium levels were normal. Post-thyroidectomy hypoglycemia occurred in 0%, 8.3% and 8.3% of patients who underwent total hypocalcemia, subtotal thyroidectomy and lobectomy, respectively, which represents 5.6% of all patients who shown hypocalcemia (P=0.58). Serum calcium levels were fall in 93% patients, however within several days were returned to normal ranges. We did not find a significant relation between the hypocalcemia and thyroidectomy types. We recommended determination other alternative factors as a more effective prediction for postoperative hypocalcemia. [ABSTRACT FROM AUTHOR]

Background and purpose: Previous studies have reported a relatively high incidence of total and subtotal thyroidectomy complications in Iran. Fear of this complication has led some internists and patients to avoid thyroid surgery. The aim of study was to determine the recent decade frequency of total and subtotal thyroidectomy complications in Sari, Iran. Materials and methods: In this cross-sectional study, the patients underwent total or subtotal thyroidectomy during 2001-2011 at two referral hospitals in sari (Imam Khomeini as academic and Shafa as private hospital) were enrolled. The questionnaire included demographic information, diagnosis and pathology of the disease, type of thyroid surgery, serum calcium level after the surgery, recurrent laryngeal nerve injury, and hematoma data. Frequencies, Odds ratio and their 95%CI were reported. Results: Among the 382 subjects (66 men and 316 women), 86 cases (22.5%) underwent total and 296 cases (77.5%) underwent subtotal thyroidectomy. The final pathology was malignant in 25.1%. Hypocalcaemia occurred in 40.3% of patients (CI95%: 35.5-45.3) that 4.2% (CI95%: 2.3-6.6) were permanent. Recurrent laryngeal nerve injury was reported in 0.8% (CI95%: 0.3-2.3) [0.3% permanent (CI95% :0.05-1.5)] and two cases (0.5%) complicated by cervical hematoma (CI95%: 0.1-1.9). Total thyroidectomy was associated with more complications than subtotal. [OR: 6.4 (CI95%: 2.6-16.1), P = 0.0001]. Conclusion: The findings of this study show that total and subtotal thyroidectomy complications has significantly decreased that can be due to improved surgical techniques and increased proficiency of surgeons. [ABSTRACT FROM AUTHOR]

Purposes: There is an increasing trend towards performing more radical resections instead of a subtotal resection for benign thyroid disease. The aim of this study was to examine the effect of this change in practice on the surgical treatment of bilateral thyroid diseases in this unit. Methods: The data on 367 patients that underwent a bilateral thyroidectomy were categorized by dividing the operation types into 4 groups: (1) total thyroidectomy (TT), (2) near-total thyroidectomy, (3) Dunhill procedure, and (4) bilateral subtotal thyroidectomy. Results: A statistically significant change in the choice of thyroidectomy occured during the study period ( p < 0.001). TT has replaced subtotal thyroidectomy (STT; bilateral subtotal thyroidectomy and Dunhill procedure) as the preferred routine surgical procedure for bilateral benign thyroid diseases in this clinic. The permanent complication rates were similar for all surgical procedures. The rate of secondary thyroidectomy for both recurrence of multinodular goiter and incidental thyroid carcinoma were significantly higher in the STT groups, than the total in the TT and near-total thyroidectomy patients. Conclusions: Total or near total thyroidectomy procedures are now being increasingly employed to treat bilateral benign thyroid disease, and are as safe as the sub-total thyroidectomy procedures, which are more conservative and associated with significantly higher recurrence rates. [ABSTRACT FROM AUTHOR]

Background: Surgery for Graves' disease may be performed with the intent of preserving thyroid function (subtotal thyroidectomy) or ablating thyroid function (total thyroidectomy). This study examines the evolving practice in a specialist endocrine surgical unit. Method: Longitudinal cohort study of patients undergoing surgery for Graves' disease between 1986 and 2008. Outcome measures were thyroid failure, recurrent toxicity, recurrent laryngeal nerve (RLN) palsy, early reoperation and hypocalcaemia. Time to thyroid failure was analysed by potential predictors. Results: Of 149 patients (129 female), 78 (52.3 percent) underwent subtotal thyroidectomy with the intention to preserve function (PF) and 71 (47.6 percent) total thyroidectomy with the intention to ablate thyroid function (AF). Mean duration of follow-up was 11.1 years; 14.8 years and 7.0 years respectively. Of 78 PF procedures: six (7.7 percent) patients suffered recurrent toxicity; 68 (87.2 percent) developed thyroid failure (four after treatment for recurrent toxicity); and eight (10 percent) remained euthyroid without replacement. Male gender and remnant gland weight were significant predictors of failure (P = 0.021 and 0.022 respectively). One patient developed permanent RLN palsy and one permanent hypocalcaemia. Of 71 AF procedures: one developed acute airway obstruction; one permanent RLN palsy; four permanent hypocalcaemia; and none developed recurrent toxicity. There were no deaths within a year of surgery. There was no statistically significant difference in complication rates. Conclusion: Most PF resections resulted in eventual thyroid failure. The shift to ablative surgery virtually eliminated the need for lifelong specialist follow-up, albeit with an insignificant rise in permanent hypocalcaemia. [ABSTRACT FROM AUTHOR]

Abstract: Thyrotoxicosis is a common presentation of thyroid disease. The commonest cause is Graves’ disease. The clinical features including goitre, eye disease, causes and diagnosis of thyrotoxicosis are discussed. Treatment strategies of Graves’ disease include anti-thyroid drugs, radioiodine and thyroidectomy. It is important to adequately prepare patients prior to surgery to reduce the possibility of thyroid storm. The preferred surgical procedure today is a total thyroidectomy, although historically subtotal thyroidectomy was performed. Less common but relevant surgical causes of thyrotoxicosis are also discussed. Thyroiditis (thyroid inflammation) has a variety of causes. Hashimoto''s thyroiditis may present with a transient thyrotoxicosis or long term hypothyroidism. Surgery is rarely required. Subacute thyroiditis thought to be secondary to a viral infection can cause a short-term yet marked thyrotoxicosis due to thyroid damage. Other causes such as amiodarone-induced thyrotoxicosis can be more difficult to manage due to the underlying heart disease and may require thyroidectomy. [Copyright &y& Elsevier]

Purpose: In the recent years, total thyroidectomy is increasingly being accepted in the surgical treatment of benign multinodular goitre due to the high rate of recurrence after bilateral subtotal thyroidectomy. The aim of this study is to compare early postoperative complications of total and bilateral subtotal thyroidectomy in benign multinodular goitre. Materials and Methods: In our study, the findings of 419 patients operated due to multinodular goitre between January 2005 - December 2009 in Dicle University Medical School Department of General Surgery were retrospectively evaluated. Patients were divided into two groups as total thyroidectomy and bilateral subtotal thyroidectomy. Results: The mean age of patients was 41.72 ± 12.55. 329 (78.5%) patients were women and 90 (21.5%) were men. A total of 263 (62.8%) patients underwent total and 156 (37.2%) patients bilateral subtotal thyroidectomy. Six (2.3%) of total thyroidectomy patients and 3 (1.9%) of bilateral subtotal thyroidectomy patients had recurrent laryngeal nerve injury. Bilateral subtotal thyroidectomy group revealed no permanent damage whereas in total thyroidectomy group one (0.4%) patient did. Hypocalcemia was observed in 40 (15.2%) patients in the total thyroidectomy group and in 27 (17.3%) patients in the bilateral subtotal thyroidectomy group. One (0.4%) patient in total thyroidectomy group suffered from permanent hypocalcemia whereas it wasn't observed in bilateral subtotal thyroidectomy group. Haematoma occurred in 3 (1.9%) patients treated with bilateral subtotal thyroidectomy and in 3 (1.1%) treated with total thyroidectomy, wound infection occurred in one (0.6%) patient subjected to bilateral subtotal thyroidectomy and 3 (1.1%) patients treated with total thyroidectomy. Conclusion: In conclusion, our study supports total thyroidectomy for multinodular goitre involving both lobes as a safe technique with low complication rate. [ABSTRACT FROM AUTHOR]