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INTRODUÇÃO: A sofisticação dos métodos de diagnóstico por imagem, em especial o ultra-som, contribuiu para que nódulos cada vez menores fossem diagnosticados com maior frequência. Nódulos tireóideos são encontrados ao exame ultra-sonográfico, em até 17% das mulheres adultas. A lobectomia total é considerada procedimento adequado para o tratamento dos nódulos benignos laterais da tireóide. O hipotireoidismo pode ocorrer em 5% a 35% dos doentes, após esse procedimento e está relacionado tanto com a quantidade de tecido glandular remanescente, quanto com a sua qualidade funcional. Neste estudo avaliou-se a ocorrência do hipotireoidismo após lobectomia total, visando identificar os indivíduos com maior risco de desenvolver essa doença. MÉTODOS: No período de março de 1996 a julho de 2005, foram selecionados 228 indivíduos eutireóideos submetidos à lobectomia total da tireóide por bócio não tóxico, do Departamento de Cirurgia de Cabeça e Pescoço do Instituto Brasileiro de Controle do Câncer e da clínica privada do autor. Realizou-se estudo retrospectivo com 186 indivíduos passíveis de análise, considerando os níveis séricos de tireotrofina (TSH) pré e pós-operatórios e a dosagem de anticorpos antitireóideos. O volume do coto tireóideo remanescente foi determinado por exame ultrasonográfico. Os exames anatomopatológicos foram revistos e quantificaram, por meio da análise semiquantitativa, os agregados linfocitários e os folículos linfóides: graduados de 0 a IV e de 0 a III, respectivamente. O hipotireoidismo foi diagnosticado quando TSH = 5,5 mU/L em até oito semanas após a operação. RESULTADOS: Houve predomínio do sexo feminino neste estudo (88%), com a idade variando de 16 a 72 anos e com média de 45 anos...
INTRODUCTION: Thyroid nodules, recently, have their diagnosis increased because of the improvement of imaging methods, especially ultrasound. Around 17% of these nodules may be identified in adult women by ultrasound. Total lobectomy is considered an appropriate procedure for benign thyroid nodules. Hypothyroidism may occur in 5% to 35% patients after total lobectomy and it is related to the volume of the remnant thyroid tissue and its functional quality. This study was designed to evaluate the incidence of postoperative hypothyroidism and to determine patients with high risk for this disease. METHODS: From March 1996 to July 2005, 228 euthyroid patients, from the Department of Head and Neck Surgery of the Brazilian Institute for Cancer Control (IBCC) and from the author?s private office, had a total lobectomy due to non-toxic goiter. Out of these patients, 186 were selected for this retrospectively study. Thyrotrophin (TSH) levels, antithyroid antibodies, volume of the remnant thyroid by ultrasound and a semiquantitatively review of the histological specimens considering lymphocytic infiltration were studied. Hypothyroidism was defined for TSH = 5,5 mU/L up to eight weeks postoperative. RESULTS: Women were predominant (88%) with ages varying from 16 to 72 years old and the median age of 45 years old. The average time of follow-up was 29 months, ranging from six months to nine years. TSH ³ 5,5 mU/L occurred in 61 patients (32,8%). Adenomatous goiter was the principal diagnosis in 82% of the hypothyroids patients and 80,7% of the euthyroids...
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Humans , Goiter, Nodular/surgery , Hypothyroidism/diagnosis , Thyroiditis, Autoimmune , Thyroidectomy/methodsABSTRACT
Objective To explore the safety,minimal invasion and cosmetic effect of endoscopic thyroidectomy.Methods From May 2007 to April 2008,among 413 cases of thyroid operations,238 cases were operated by endoscopic techniguc and 175 cases were operated by traditional methods.the operation time,intra operative blood loss,incision cosmetic score,postoperative hospitalization time,cost of hospitalization,and surgical complications between the two mehods were compared.Results Both groups of patients were operated successfully without postoperative bleeding,hoarseness,or hypocalcemia.Compared with traditional thyroid surgery,endoscopic thyroidectomy had less blood loss,shorter operation time,and higher-satisfaction cosmetic effect without significant scars or skin color changes.Conclusions Compared with traditional thyroid surgery,endoscopic thyroidectomy has the desired advantages of excelent cosmetic result,safety,and quick recovery.It is an ideal operation method for treatment of benign thyroid diseases.
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Objective To analyze the clinical significance of modified thyroidectomy by trans-isthmus approach.Methods The clinical data of 5 751 patients who underwent thyroidectomy from Jan.1996 to Jan.2006 were retrospectively analyzed.All cases were divided into two groups.The modified operation group(n=3288) was treated by trans-isthmus thyroidectomy.Another group(n=2463) was treated by routine approach.The operation time,bleeding volume,and complications were observed and compared.Results In modified operation group,the mean operation time,bleeding volume,temporary injury of recurrent laryngeal nerve,tracheal discomfort,and hypocalcemia were significantly decreased than those in routine approach group(P
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Objective To evaluate the clinical application of endoscopic thyroidectomy(ESTC) via the approach of areola of breast.Methods The clinical data of 46 cases of endoscopic thyroidectomy via the breast areola approach from October 2004 to November 2006 were retrospectively analyzed.Results The operation was successfulmy completed endoscopically in 44 cases,including 18 cases of unilateral partial thyroidectomy,26 cases of bilateral partial thyroidectomy,and 2 cases were converted to open operation for thyroid cancer neck dissection.The operation time of ESTC was 80~160minutes(mean 110min),and the intraoperative blood loss was 25~45ml,(mean,33?9.5ml).Pathological findings showed 25 cases of thyroid adenoma,16 cases of nodular goiter,and 3 cases of Graves disease.The length of postoperative hospital stay was 3~6day(mean4.5d).Complications occurred in 2 cases,including 1case of bleeding from left puncture tract,and 1 case of temporary hoarseness.Conclusions Endoscopic thyroidectomy via breast areola approach is a technically feasible and safe procedure,and has the advantage of minimal trauma,and with excellent cosmetic outcomes.