ABSTRACT
Objective:To estimate and analyze the occurrence of post-thyroidectomy syndrome (PTS) following endoscopic thyroidectomy via areola approach (ETAA) vs open thyroidectomy (OT) .Methods:Data of 903 consecutive cases, aged from 20 to 66 with 231 males and 672 females, in Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, from Jan. 2016 to Dec. 2017 were analyzed retrospectively. They were enrolled according to the same criteria. Based on different procedures, the cases were divided into ETAA group (n=162) and OT group (n=741) . Intraoperative procedure was according to unified principle. Drainage tube was removed if 24-hour drainage volume was less than 20 ml. Following-up was implemented by telephone or outpatient clinic. Data of 2 groups of 5 PTS items during 1 m, 3 m, 6 m and 1 y postoperatively and the scores of the medical outcomes study short form 36-item health survey (SF-36) V2 were analyzed by independent sample t test and repeated measures analysis of variance. Results:The patients of 2 groups were all followed up for more than 1 y with 43 cases censored (4.8%) . Demographic data of the rest of 2 groups were not different statistically ( P>0.05) . Median of every phase scores of the 5 items of PTS were 0 to 1. Scores of the 5 items were decreased gradually in accordance with time factor ( P=0.000) . The scores of peculiar feeling at the surgical site and discomfort in neck were different statistically during 1 m and 3 m postoperatively ( P=0.000) . Incidence of peculiar feeling at the surgical site in 1 m and 3 m postoperatively in ETAA group (54, 38.8% and 8, 5.8%) was higher than that in OT group (153, 21.2% and 20, 2.8%) . However, incidence of discomfort in neck in ETAA group (14, 10.1% and 0) was lower than in OT group (194, 26.9% and 53, 7.4%) . The other 3 items at all phases were not different statistically ( P>0.05) . The SF-36 V2 scores at 1 y postoperatively of 2 groups were not different statistically ( P=0.458) . Conclusions:PTS is a common symptom after OT or ETAA. It is frequent within early phase after thyroidectomy and is decreased significantly within 6 m. Peculiar feeling at the surgical site occurs less in OT than in ETAA in early postoperative phase and discomfort in neck occurs more, conversely.
ABSTRACT
Thyroid surgery is frequently complicated by hematoma collection, nerve injury, hypothyroidism and rarely infections but persistent discharge from the gland is unusual. We report a case of persistent sinus discharge from the thyroid of the patient who underwent thyroidectomy 5 years back. The patient had persistent discharge from the wound site along with recurrent swelling all the years afterward. Fine needle aspiration cytology proved it was recurrent papillary cancer. Swab culture from discharge showed no growth. Completion thyroidectomy with functional lymph node dissection was done and specimen was not harbouring any foreign body and biopsy showed recurrent papillary cancer. Although post thyroidectomy sinus discharges are usually secondary to foreign body or chronic inflammation like tuberculosis, the tumour itself can be considered as a cause.
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Background: This aim of study was to evaluate the ability of consecutive measurements of serum calcium levels to predict clinically relevant post-thyroidectomy hypocalcaemia and to assess risk factors for post-thyroidectomy hypocalcaemia.Methods: The study design was a prospective observational study, total 65 patients who undergoing completion or total thyroidectomy. Serum calcium level was measured at the time of first follow up (nearly 20th postoperative day) and patient was examined for signs of hypocalcemia.Results: In this study, 65 patients of all age group included from 19 years to 78 years. The mean (±SD) age of the patients was 47.65±12.35 years with range from 19 to 78 years. The mean difference of calcium values after 6 hours, 12 hours, 24 hours and 48 hours post-operative period were statistically significant (p<0.001) between patients with hypocalcaemia and patient with normokalaemia in unpaired t-test.Conclusions: There was no significant increase in morbidity (including postoperative hypocalcaemia) in completion thyroidectomy compared to primary total thyroidectomy.
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The incidence of thyroid nodule is increasing day by day, and surgery is the main remedy at present. However, patients have a very high incidence of cough. Western medicine has no effective measures, while TCM has good efficacy. Combined with constitutions of thyroid patients and its unique postoperative changes, this article discussed the etiology and treatment of post-thyroidectomy cough from the aspects of "wind", "phlegm","congestion", and "innutrition".
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BACKGROUND AND OBJECTIVES: To evaluate the efficacy and safety of early neck exercises to reduce post-thyroidectomy symptoms and syndromes for patients undergoing thyroid surgery. MATERIALS AND METHODS: One hundred patients who had undergone thyroid surgery were randomly assigned 1:1 to control (delayed exercise, initiating at postoperative 2 weeks) or early exercise group (initiating at postoperative 1 day). Questionnaire survey (voice, globus sense, neck discomfort, swallowing difficulty) and objective measurement (surgical wound adhesion, range of neck motion and scar scale) were performed at 2 weeks and 3 months postoperatively. RESULTS: Compared to control, early exercise significantly decreased the degree of neck discomfort at 2 weeks after thyroid surgery (p=0.037) while other subjective symptoms including voice change, globus sense, and swallowing difficulty were not significantly different between the two groups. The degree of surgical wound adhesion was significantly decreased (p<0.001) and the range of motion was improved in early exercise group (p=0.010). In addition, the objective scores of Vancouver Scar Scale (VSS) were decreased in early exercise group compared to those of control group (p=0.020). CONCLUSION: Early neck exercises are safe and effective to reduce postoperative neck discomfort, wound adhesion, or hypertrophy of scar and to improve the range of motion in patients undergoing thyroid surgery.
Subject(s)
Humans , Cicatrix , Deglutition , Exercise , Hypertrophy , Neck , Prospective Studies , Surveys and Questionnaires , Range of Motion, Articular , Thyroid Gland , Voice , Wounds and InjuriesABSTRACT
Anesthesia in post-thyroidectomy patients carries the risk of potential complications such as the depression of myocardial function, decreased spontaneous ventilation, abnormal baroreceptor function, reduced plasma volume, anemia, hypoglycemia, hyponatremia, and impaired hepatic drug metabolism. In addition, these patients may be complicated by pigment induced acute renal failure such as rhabdomyolysis. Rhabdomyolysis is a common syndrome in which injury to skeletal muscle results in the leakage of intracellular contents from myocytes into plasma. Moreover, massive rhabdomyolysis can produce life-threatening disseminated intravascular coagulation, myoglobinuric renal failure, acute cardiomyopathy, and various other complications. We experienced a case of acute renal failure caused by rhabdomyolysis during emergence from anesthesia in a post-thyroidectomy patient.