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Objective:To investigate the effects of cervical plexus block anesthesia combined with general anesthesia on subtotal thyroidectomy in patients with hyperthyroidism and stress response.Methods:A total of 68 patients with hyperthyroidism who underwent subtotal thyroidectomy in Zhangjiagang City Hospital of Traditional Chinese Medicine, Jiangsu Province, from January 2018 to January 2021 were selected as observation subjects, and were divided into control group and observation group according to the random number table method, both of which were 34 cases. Patients in control group were given general anesthesia, and the observation group was given cervical plexus block anesthesia combined with general anesthesia. The heart rate and mean arterial pressure before anesthesia (T0), immediately before intubation (T1), immediately after intubation (T2), and at the end of surgery (T3), the time of awakening and extubation after surgery, the visual analog score (VAS) of pain at 1, 4, 12, and 24 hours after surgery, stress response of before and 24 hours after surgery, and complications after surgery were compared between the two groups.Results:There was no significant difference in heart rate and mean arterial pressure between the two groups at T0 ( P > 0.05); the heart rate and mean arterial pressure at T1 were lower than those at T0 in the same group ( P < 0.05); the heart rate and mean arterial pressure at T2 and T3 in the control group were higher than those at T0 in the same group ( P < 0.05); the heart rate and mean arterial pressure at T2 and T3 in the observation group did not change significantly compared with those at T0 in the same group ( P > 0.05), but were lower than those in the control group at the same time ( P < 0.05). The awakening time and extubation time of patients in the observation group were shorter than those in the control group ( P < 0.001). The VAS scores of patients in the observation group were lower than those in the control group at 4, 12 and 24 hours after surgery ( P < 0.001). The serum norepinephrine (NE) and cortisol (COR) levels of patients in the two groups at 24 hours after surgery were higher than those before surgery, and the levels in the observation group were lower than those in the control group at the same time ( P < 0.05). The total incidence of postoperative complications in the observation group (8.82%, 3/34) was lower than that in the control group (29.41%, 10/34, χ 2 = 4.66, P = 0.031). Conclusion:Cervical plexus block anesthesia combined with general anesthesia has a good effect on subtotal thyroidectomy in patients with hyperthyroidism, which can speed up the patients' awakening, reduce complication, and has little impact on stress response.
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Background: Thyroid surgery are among the most common operations performed all over the world. Hypocalcemia following total thyroidectomy is a fairly common complication. Occurrence of acute hypocalcemia can be predicted in patients undergoing thyroid surgery, based on serial calcium measurement and this helps in early prediction of hypocalcemia. The aim of present study was to assess the incidence of post thyroidectomy hypocalcemia and factors which might play a role in its occurrence.Methods: A total 30 patients who underwent bilateral thyroidectomy were analysed. The study period was from June 2017 to March 2019. The incidence of hypocalcemia was analysed with serial calcium estimation in immediate post-operative period, 4 hours and 24 hours after surgery and on 5th post-operative day. The factors analysed included pre-operative and post-operative serum calcium levels, clinical features, the disease type and factors related to surgery. The ethical approval was taken from the ethical committee of the institute. At the end of the study data was collected and analysed by using student t-test and chi square test. A p-value of less than 0.05 was considered significant.Results: Post-operative transient hypocalcemia developed in 21 patients out of 30 (70%). Of them six patients (28.75%) developed severe hypocalcemia and 15 (71.42%) developed mild to moderate hypocalcemia. Out of six patients, five patients were histopathologically diagnosed as malignant thyroid disease. 15 patients who developed mild to moderate hypocalcemia were diagnosed to be having benign thyroid conditions.Conclusions: Patients underwent thyroid surgery for malignant conditions showed higher incidence and severity hypocalcemia as compared to cases where surgery was performed for benign thyroid disease. This complication can be prevented with meticulous perioperative dissection, prompt identification of parathyroid glands and frequent postoperative monitoring of serum calcium levels.
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Background: The prevalence of thyroid nodule ranges from 4-10% in general population. Its treatment includes either conservative management or surgical excision of gland. Fine needle aspiration cytology (FNAC) has emerged as most accepted, accurate diagnostic procedure and considered the gold standard diagnostic test in evaluation of thyroid nodule, other tests like ultrasound, nuclear scan used in conjunction with FNAC. The aim of study was to study the spectrum of diseases in thyroid swelling and accuracy of FNAC in the diagnosis.Methods: A prospective study, with total 50 patients, was conducted during period from 2017-2019 in department of surgery, Gandhi Medical College Bhopal. All patients who underwent thyroid surgeries were selected for study. All patients underwent detailed history, clinical examination, routine investigations, thyroid function test, FNAC, ultrasonography neck and histopathological examination.Results: Of 50 cases female to male ratio was 9.2:1, with median age group was 38.6 years. Among all, 42 (84%) were benign, 3 (6%) malignant and 5 (10%) suspicious. Of 5 suspicious lesions, only 1 (5%) case found malignant. Hemi thyroidectomy was common surgery performed, followed by subtotal/near total and total thyroidectomy.Conclusions: Thyroid swellings are common in females occur in 3rd and 4th decade most commonly. FNAC is very useful and indispensable in the diagnosis. Most common non neoplastic and neoplastic lesion was solitary thyroid nodule and papillary carcinoma respectively.
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@#【Background】 The aim of this prospective randomized study was to evaluate the feasibility of subtotal thyroidectomy leaving a unilateral remnant based on the upper pole. 【Methods】 Patients who underwent the subtotal thyroidectomy and isthmusectomy leaving either a unilateral remnant based on the upper pole（GroupⅠ ，59 patients）or with the bilateral dorsal thyroid tissue remained（Group Ⅱ，54 patients）were prospectively compared in operation time， blood loss，recurrence，and postoperative complications.【Results】The operation time remained similar between the two groups，but the blood loss，the reoperation time，recurrent laryngeal nerve injury，and recurrence in GroupⅠwere much less than those in Group Ⅱ. In addition ，no postoperative hemorrhage occurred in GroupⅠ. Three patients （5.56%） underwent postoperative hemorrhage in Group Ⅱ. Two patients（3.39%）in GroupⅠand 4 patients（7.40%）in Group Ⅱ experienced transient hypocalcemia.【Conclusion】In terms of blood loss，reoperation time，postoperative complication， and recurrence ，subtotal thyroidectomy with recurrent laryngeal nerves identification and the unilateral superior pole remnant of the gland provides a better outcome than subtotal thyroidectomy with bilateral dorsal thyroid tissue remnant.
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Objective:To discuss the appropriate thyroid operation for the treatment of bilateral multinodular goiter.Methods: 328 bilateral multinodular goiter patients undergoing surgery in the department of general surgery of Capital Medical University Beijing Tongren Hospital from June 2012 to June 2016. were retrospectively analyzed. Of these patients, 85 underwent hemithyroidectomy combined with contralateral nodule resection or subtotal resection and 243 underwent bilateral subtotal thyroidectomy. The rate of postoperative complications and recurrence between hemithyroidectomy combined with contralateral nodule resection or subtotal resection and bilateral subtotal thyroidectomy were compared.Results: The follow-up time was 1 month to 48 months after operations. In hemithyroidectomy combined with contralateral nodule resection or subtotal resection group 1 patient developed recurrent laryngeal nerve palsy, 2 patients had transient hypoparathyroidism and 1 patient had hematoma in the operative cavity. In bilateral subtotal thyroidectomy group, 2 patients developed recurrent laryngeal nerve palsy and 2 patients had subcutaneous hematoma. The rate of recurrent disease was 2.35%(2 patients) in hemithyroidectomy combined with contralateral nodule resection or subtotal resection group and 7%(17 patients) in bilateral subtotal thyroidectomy group. There was no patient in both groups needed reoperation.Conclusions:Hemithyroidectomy combined with contralateral nodule resection or subtotal resection had similar complication rate compared with bilateral subtotal thyroidectomy, but it had a significantly lower risk of recurrence than bilateral subtotal thyroidectomy, Furthermore, the rest one lobe could be resected for many times which would not cause severe complications. Hemithyroidectomy combined with contralateral nodule resection or subtotal resection is worthed to be recommended.
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Objective To investigate the safety of thyroid gland resection and primary resection in the treatment of thyroid nodule and its influence to thyroid function.Methods 86 patients with thyroid nodules were selected as the research subjects.The patients were randomly divided into two groups.43 cases in the observation group implemented the thyroid gland resection treatment.43 cases in the control group received thyroid gland subtotal resection.The curative effect,safety,thyroid function and other indicators were compared between the two groups.Results The operation time and hospitalization time in the observation group after operation[(105.65 ± 12.54)min;(6.35 ± 2.01)d]were shorter than those in the control group[(149.41 ± 13.68)min;(9.62 ± 2.45)d].The amount of bleeding during operation in the control group [(134.51 ± 9.64) mL] was significantly higher than the observation group [(84.62 ± 6.35) mL],there was significant difference between the two groups (P ＜ 0.05).The total effective rate of the observation group was 95.55％,which was significantly higher than 72.09％ in the control group,the difference was statistically significant (P ＜ 0.05).Before operation,the between the two groups had no significant difference (P ＞ 0.05).After surgical treatment,serum FT3 and serum FT4 levels in two groups were decreased,but those in the observation group[(11.62 ± 3.02),(51.24 ± 7.25)pmol/L] were significantly lower than the control group [(14.14 ± 5.11) pmoL/L;(60.52 ± 6.35) pmol/L],there were obvious differences (P ＜ 0.05).The incidence rate of complications such as throat edema,hemorrhage,postoperative hoarseness in the observation group was 9.30％,which in the control group was 23.26％,the difference was statistically significant (P ＜ 0.05).Conclusion The thyroid gland resection therapy for thyroid nodules has high safety and significant curative effect,it can quickly improve the thyroid function,reduce relapse rate,has higher application value in benign and malignant tumors indistinguishable after surgery.It can reduce the length of stay in hospital,is conducive to the recovery of patients,it is worthy of clinical promotion.
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Objective: To compare the results of total thyroidectomy and subtotal thyroidectomy amongst the surgically treated patients with Graves’ Disease. Material and Method: This study includes 50 patients of Graves’ disease out of which 27 patients underwent for total thyroidectomy and 23 underwent for subtotal thyroidectomy. Comparison done in regards to postoperative complication between total and subtotal thyroidectomy in terms of advantages and disadvantages. Results: Incidence of transient or permanent recurrent laryngeal nerve palsy and hypocalcemia were high amongst the patients operated for total than subtotal thyroidectomy. Thyroid function tests were normal in all patients after total thyroidectomy with hormone replacement therapy and 17.39% of patients had hypothyroidism after subtotal thyroidectomy. Recurrence rate was nil and 21.73% respectively in total and subtotal thyroidectomy. One patient of subtotal thyroidectomy had occult carcinoma in histopatholical examination which required revision of surgery. Conclusion: Total thyroidectomy is superior to subtotal thyroidectomy based on the considerable surgical risk and lack of recurrence in total thyroidectomy as well as the risk of occult carcinoma and questionable ability of the subtotal thyroidectomy to maintain the euthyoid state.
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Objective: To analyze the safety and effectiveness of total thyroidectomy in the surgical management of bilateral benign multinodular goiter. Materials and Methods: A prospective review of patients with bilateral benign multinodular goiter undergoing subtotal thyroidectomy (Group 1), and near-total thyroidectomy and total thyroidectomy (Group 2) during 5-year period was undertaken. Patients’ demographics, indications for surgery, type of operation performed, final histological diagnosis and complications were recorded. Transient and permanent complications regarding hypoparathyroidism and recurrent laryngeal nerve paralysis were analyzed for each surgical procedure. Results: Out of a total of 207 patients, recurrence of benign multinodular goiter was recorded in 27 (30%) cases in group 1 while there was no recurrence in group 2 (p < 0.01). Completion thyroidectomies were performed in 31 (34%) patients in group 1 whereas none was required in group 2 (p < 0.01). Incidental thyroid malignancy was found to be 18% (n= 38/207) in this study which necessitated completion thyroidectomy in group 1 patients. Permanent hypoparathyroidism was documented in 4(4%) and 3(1.8%) and transient hypoparathyroidism in 5 (6%) and 4 (2.8%) cases in groups 1 and 2, respectively; p value not significant. Permanent hypoparathyroidism and transient RLN palsy were recorded in 9 (29%) and 8 (25%) patients, respectively in those patients who underwent second thyroid surgery (P < 0.05). Conclusion: Total or near-total thyroidectomy is effective and safe for the surgical treatment of bilateral multinodular goiter to prevent recurrence and to eliminate the need for completion thyroidectomy in case of final diagnosis of incidental thyroid malignancy.
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Objective To explore effects of endoscopic subtotal thyroidectomy on nodular goiter and its clinical significance.Methods From Jun.2004 to Dec.2009,72 patients with nodular goiter underwent endoscopic subtotal thyroidectomy in Southwest Hospital.Of the 72 cases,22 cases had left-side nodule,31 cases had right-side nodule and 19 cases had bilateral nodules.Single thyroid nodule occurred in 41 cases and multiple nodules in 31 cases.The total number of nodules was 113.The average nodule size was 2.8 cm(ranging from 0.4 to 6.3 cm).Results Of the 72 cases,19 patients underwent bilateral subtotal thyroidectomy and the mean operative time was 97 min(ranging from 80 to 150 min).53 patients underwent unilateral subtotal thyroidectomy and the mean operative time was 65 min(ranging from 25 to 120 min).The mean intraoperative blood loss was 45 ml (ranging from 5 to 120 ml).Of the 72 cases,68 cases were given cervical plexus block regional anesthesia and among them 66 cases(97%)acquired good anesthesia.Temporary hoarse voice occurred in 2 cases and postoperative bleeding occurred in the subcutaneous tunnel of breast in 2 cases.Patients were followed up from 3 to 5years and the cosmetic result was satisfactory.The postoperative review half year later showed that unilateral nodule recurred in 1 case and the recurrence rate was 1.4%.Conclusions Endoscopic subtotal thyroidectomy through anterior chest wall or breast approach under local anesthesia is a safe and effective treatment in nodular goiter.In the process of dissecting thyroid,blunt maneuver and proper use of ultrasonic knife instead of clamping thyroid nodules directly are recommended in order to reduce intraoperative blood loss and enhance safe practice.
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PURPOSE: Subtotal thyroidectomy has been the standard operation for Graves' disease in achieving a favorable outcome in recovery of euthyroid state. However, the postoperative outcomes following subtotal thyroidectomy differ by surgeon and postoperative thyroid dysfunctions develop as time passes. Here, we have studied the validity of total thyroidectomy for Graves' disease patients, with a comparison to subtotal thyroidectomy. METHODS: A total of 299 patients with Graves' disease underwent thyroid operation consecutively in Asan Medical Center, Seoul, Korea from December 1995 to December 2005. Among them, 241 cases had subtotal thyroidectomy and 43 had total thyroidectomy. The subtotal thyroidectomy cases were divided into 3 groups according to estimated remnant thyroid; or =6 g. Also, according to postoperative thyroid function, the patients were divided into euthyroid, hypothyroidism and hyperthyroidism groups. The postoperative changes of thyroid function, postoperative complications and hospital days were analyzed. RESULTS: In subtotal thyroidectomy, postoperative thyroid function showed euthyroid in 25 (10.4%), hypothyroidism 206 (85.5%) and hyperthyroidism 10 (4.1%). However, total thyroidectomy showed no persistent hyperthyroidism or recurrence. The postoperative thyroid function state changed in 24 patients out of 148 who had more than 2 years postoperative follow-up. Hyper-functional changes developed with higher rates (Hypo-6 vs. hyper-18). The postoperative complication rate was higher in subtotal thyroidectomy including bleeding, hoarseness and hypocalcemia. CONCLUSION: In our study, the patients showing normal thyroid function after subtotal thyroidectomy were very limited and thyroid dysfunction developed continuously with time lapse, especially towards hyperthyroid state. Therefore, we suggest that total thyroidectomy should be considered as a treatment option in Graves' disease.
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Humans , Follow-Up Studies , Graves Disease , Hemorrhage , Hoarseness , Hyperthyroidism , Hypocalcemia , Hypothyroidism , Korea , Postoperative Complications , Recurrence , Thyroid Gland , ThyroidectomyABSTRACT
Objective To summarize the experience of endoscopic thyroidectomy for hyperthyroidism.Methods Endoscopic total or subtotal thyroidectomy was performed through anterior chest wall approach in 7 patients with primary or secondary hyperthyroidism.Results The operation was successfully performed in all the 7 patients.The operation time was 130~260 min(mean,168 min),and the intraoperative blood loss was 10~200 ml(mean,70 ml).No recurrent laryngeal nerve or superior laryngeal nerve injuries,or postoperative hemorrhage,or conversions to open surgery were encountered.The postoperative recovery was uneventful.Short-term follow-up observations demonstrated satisfactory cosmetic results and no recurrence.Hypothyroidism occurred in 2 patients and thyroid functions restored to normal levels in 1 of them 2 months after operation.Conclusions Endoscopic thyroidectomy is a safe and effective procedure for hyperthyroidism.Apart from conventional pre-operative preparation,CT examination is also necessary for identifying the measurements of thyroid glands and determining the proportion and location of residual glands.
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Graves disease occur in association with myasthenia gravis is rare. We report a case of Graves disease and myasthenia gravis treated by bilateral subtotal thyroidectomy and total thymectomy simultaneously. A 37 year old woman was admitted with anterior neck mass and ptosis. Various examinations were compatible with combined Graves disease and myasthenia gravis. The bilateral subtotal thyroidectomy and total thymectomy were done simultaneously. The pathologic diagnosis was Graves disease and thymic hyperplasia. The patients postoperative course was uneventful. The thyroid function of patient became euthyroid and the clinical symptoms related with myastenia gravis resolved during follow up period.
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Adult , Female , Humans , Diagnosis , Follow-Up Studies , Graves Disease , Myasthenia Gravis , Neck , Thymectomy , Thymus Hyperplasia , Thyroid Gland , ThyroidectomyABSTRACT
One hundred patients who underwent bilateral subtotal thyroidectomy for Graves' disease between January 1980 and September 1984 have been evaluated. The observation period ranged from 5 to 9 years, the average being 6.2 years. Postoperative thyroid function was evaluated with T3, T4 and TSH and compared with their clinical manifestations. Eighty-two patients became euthyroid, 14 patients had recurrence and 4 patients developed hypothyroidism. The thyroid hormone level of euthyroid patients were in an unstable state up to 5 years after the operation. Sixteen variables which might influence the postoperative recurrence and hypothyroidism were analyzed but no statistically significant factors were determined, although recurrences were found frequently in patients over 30 years, the patients with lower infiltration of lymphocytes and absent of fibrosis of thyroid tissue. The results obtained in the present study suggest that mean 6.0 gm of remnant thyroid is suitable for maintaining euthyroidism postoperatively in a majority of patients. In addition, patients should be followed closely for many years and should undergo hormonal determination periodically because recurrence and hypothyroidism can occur at 5 years or more after the operation.
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Adolescent , Adult , Female , Humans , Male , Chi-Square Distribution , Follow-Up Studies , Graves Disease/physiopathology , Logistic Models , Middle Aged , Prognosis , Thyroid Gland/physiopathology , Thyroidectomy/methodsABSTRACT
Objective To evaluate the effect of medicial and surgical treatment for juvenile hyperthyroidism.Methods Ortapazole was administ rated separately in drug therapy group for 1.5-2 years.Bilateral subtotal thyroidectomy was done in surgical therapy group.Results In drug therapy group,effective rate was 60 percent in 6 months and 70 percent in one year.Recurrence rate was 40 percent after drug withdrawal in 2 years curative rate was 60 percent.In surgical therapy group,the average stay in hospital was 16 days.There was no nerve injury,parathyroidal hypofunction,thyroid crisis or hypothyroidism complications,with 100 percent curative rate after 2 years′ followup.Postoperative growth and development were normal.Conclusions Surgical treatment may be suitable for those who have no response to drug therapy,with recurrence after drug withdrawal,whose compression symptom was obvious,with moderate and severe hyperthyroidism or those who could not take medicine persistently.Bilateral subtotal thyroidectomy applied in juvenile hyperthyroidism could achieve quick and better recovery,and has no influence on the juvenile growth and development.