A Clinical Review of 81 Cases of Total Thyroidectomy

Total thyroidectomy has been used to treat benign or malignant thyroid diseases. However, concern about the postoperative complications after the extensive and aggressive operation makes surgeons reluctant to do total thyroidectomy. Instead, in many cases, less invasive and less complicating subtotal thyroidectomy has replaced it. But total thyroidectomy is required to eradicate bilateral and multiple nodules, diffuse toxic goiter, and thyroid cancer that cannot be cured by subtotal thyroidectomy. To evaluate the effectiveness and complications of total thyroidectomy, we reviewed retrospectively 81 patients who received total thyroidectomy from June 1987 to August 1993 according to the age, sex, clinical symptoms, duration of symptom, diagnoses, operative modalities, pathologies, postoperative complications and thyroid function. The results are as follows: 1) Male to female ratio was 1 to 4.8 (male:14, female:67). The sixth decade included 27 % of patients, and showed the peak incidence. 2) The most common symptom was the palpable mass on the precervical area or in the thyroid (96%). Palpitation (15%) and voice change (12%) were present in descending order. 3) On the duration of symptom, patients' visiting hospital after one to two years occupied the largest portion (26%). Three to four years occupied 19 cases (23%), and cases of more than five years were 17 cases (21%). Masses of 2 to 3 cm in diameter were the most common size (27%) and of 2 to 5 cm occupied more than half(59%). Most of the patients visited the hospital after full-blown of mass or symptoms. 4) Sixty five cases were cancers, and 16 cases were benign diseases. Modified radical neck dissection was done in 7 cases, suspicious of local lymph node invasion during the operation. Radical neck dissection was done in 6 cases with palpable cervial nodes. 5) The order of accuracy of preoperative diagnostic modality was thyroid scan (86%), frozen section (83%), and fine needle aspiration biopsy(80%). These result seemed different compared with the recent diagnostic value of fine needle aspiration biopsy, but might be due to the technique. 6) Pathological classification is composed of differentiated cancer (80%), toxic goiter (16%), nodular goiter (6%), adenomatous goiter (2%), and Hashimoto's thyroiditis (1%). Papillary cancer occupied 92 percent of cancer. Lymph node metastasis showed diffuse distribution according to the mass size. 7) No deaths were reported. The most common complication was hypocalcemia (38%), most of which was transient and 61 per cent of which was symptomatic. It usually persisted less than 7 days, and only 3 cases continued more than 7 days (3.7%). The other complications were hoarseness (19%), bleeding (7%), and the recurrent laryngeal nerve injury(1%). 8) Follow up on the postoperative thyroid function was available on 66 patients (81%). Of those, forty six patients (70%) were euthyroid, 2 (18%) were hypothyroid, and 8 (12%) were hyperthyroid. The cause of the hyperthyroid status after total thyroidectomy might be due to the medication for the thyroid supplementation or to the time of serum measurement shortly after the medication. We think that total thyroidectomy could be done without additional risk compared with subtotal thyroidectomy, if it were done meticulously. We suggest that total thyroidectomy should be considered for the treatment of diffuse thyroid diseases and carcinomas.

High-Dose Preoperative Radiation and Sphincter-Saving Procedure in Distal Rectal Cancer

A clinical study was made of 14 cases of distal rectal cancer treated at the Department of Surgery, St. Mary's Hospital, Catholic University Medical College, from January 1995 to April 1996. The patients were treated in a modified Thomas Jefferson program and received high doses of preoperative radiation followed by a sphincter saving procedure. The results are as follows: 1) There were 5 male patients (35.7%) and 9 female patients(64.3%). There was also a large number of patients in their 50s and 60s. 2) The preoperative pathologic type was a moderately differentiated adenocarcinoma. 3) Rectal bleeding was the most common symptom, followed by tenesmus, constipation, anal pain, and a tarry stool. 4) At diagnosis, the Thomas Jefferson (T.J.) system was used for the clinical stage of the patients. The clinical stage of disease showed a preponderance of T.J. stage I (10 patients), T.J stage II, III, and IV occurred in 2, 1, and 1 patient, respectively. 5) The most common site was 0-3 cm above dentate line (8 patients), followed by 4-6 cm (5 patients) and > 7 cm (1 patient) above the dentate line. 6) The complications after preoperative radiation therapy were diarrhea (3 patients) and perianal dermatitis (5 patients). 7) After preoperative radiation therapy, one case showed pathologic complete remission. 8) The procedure was a Transanal Abdominal TransAnal proctosigmoidectomy and coloanal anastomosis (TATA) in 11 patients, a low anterior resection in 1 patient, an abdominal perineal resection in 1 patient, and a colostomy in 1 patient. 9) The pathologic stage showed a preponderance of Duke's B2 and B1; 5 were B2, 4 were B1, 3 were C2, 1 was D, and 1 was O. 10) The postoperative complications after colostomy repair in TATA were frequent defecation, tenesmus, anal pain at defecation, and rectovaginal fistulas which subsided 3 months after colostomy repair.