Benign cervical schwannoma with tracheal invasion

ABSTRACT Schwannomas commonly develop in the cervical region, 25% - 45% of cases are diagnosed in this anatomical region. Tracheal neurogenic tumors are exceedingly rare and can be misdiagnosed as invasive thyroid carcinomas or other infiltrating malignancies when present at the level of the thyroid gland. Here, we present a case of synchronous benign cervical schwannoma with tracheal invasion and papillary thyroid carcinoma in a patient who was initially hospitalized for COVID-19. The patient presented with dyspnea that was later found to be caused by tracheal extension of a cervical tumor. Surgical excision was performed, and the surgical team proceeded with segmental tracheal resection, removal of the cervical mass, and total thyroidectomy. The specimen was sent for pathological analysis, which revealed synchronous findings of a benign cervical schwannoma with tracheal invasion and papillary thyroid carcinoma. The literature on this subject, together with the present case report, suggests that neurogenic tumors should be included in the differential diagnosis of obstructing tracheal cervical masses. Surgical excision is the first-line of treatment for benign cervical schwannomas.

Manejo anestésico para cirugía tiroidea. Una revisión no sistemática / Anesthetic management for thyroid surgery. A non-systematic review

Resumen: Las hormonas tiroideas forman parte fundamental del mantenimiento de la homeostasia, se encuentra particularmente relacionado con la función cardiovascular. Los estados distiroideos clínicos o subclínicos pueden comprometer este sistema en forma significativa durante los procedimientos quirúrgicos. Existen múltiples fármacos que pueden modificar la patología tiroidea en mayor o menor medida, disminuyendo el riesgo de complicaciones en la eventualidad de una cirugía. La utilización de anestesia general, ya sea balanceada o total endovenosa, se ha convertido en el estándar de oro, por la menor tasa de complicaciones asociadas. Durante el período perioperatorio se debe mantener un monitoreo estricto de la función cardiovascular para detectar alteraciones en forma temprana e iniciar las correcciones necesarias.

Abstract: Thyroid hormones are a fundamental part of the maintenance of homeostasis, it is particularly related to cardiovascular function. Clinical or subclinical dysthyroid states can significantly compromise this system during surgical procedures. There are multiple drugs that can modify the thyroid pathology to a greater or lesser extent, reducing the risk of complications in the event of surgery. The use of general anesthesia, whether balanced or total intravenous, has become the Gold standard, due to the lower rate of associated complications. During the perioperative period, strict monitoring of cardiovascular function must be maintained to detect alterations early and initiate the necessary corrections.

Theodor Kocher (1841-1917) and his outstanding contributions to surgery

Theodor Kocher (1841-1917), an exceptional Swiss surgeon who described a technique for the safe removal of enlarged thyroid unraveled the true function of this endocrine gland but also made significant contributions to many other fields of surgery. Kocher was the first surgeon awarded the Nobel prize in Physiology and Medicine in 1909 for his work on the physiology, pathology, and surgery of the thyroid gland. He was professor and clinical director at Insel Hospital during 45 years. Kocher created the prominent Surgeon's School in Bern. He was the first president of the International Society of Surgery in 1903 and the founding president of the Swiss Society of Surgery in 1913.

Theodor Kocher (1841-1917), excepcional cirujano suizo que describió una técnica para la extirpación segura del agrandamiento del tiroides y desentrañó la verdadera función de esta glándula endocrina, pero también hizo importantes aportaciones a muchos otros campos de la cirugía. Kocher fue el primer cirujano galardonado con el premio Nobel de Fisiología y Medicina en 1909 por sus trabajos sobre la fisiología, patología y cirugía de la glándula tiroides. Fue profesor y director clínico del Hospital Insel durante 45 años. Kocher creó la destacada Escuela de Cirujanos de Berna. Fue el primer presidente de la Sociedad Internacional de Cirugía en 1903 y el presidente fundador de la Sociedad Suiza de Cirugía en 1913.

Experiencia en cirugía de tiroides en el Hospital Oncológico Conrado Benítez de Santiago de Cuba

Introducción: Los nódulos de tiroides son un problema clínico común. La tiroidectomía es una de las técnicas más realizadas en los servicios de cabeza y cuello y constituye un tratamiento con intención curativa en el cáncer de tiroides y afecciones benignas como el bocio nodular y el adenoma. Objetivo: Describir la experiencia en cirugía de tiroides del servicio de cabeza y cuello en el Hospital Oncológico Conrado Benítez. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo de los pacientes que recibieron algún tratamiento quirúrgico por enfermedad tiroidea en el período comprendido entre el 1 de septiembre de 2017 y el 31 de agosto de 2022. Resultados: El 87 % de los pacientes eran mujeres, con una edad media de 47,1 años. A todos se les realizó ecografía y biopsia por aspiración con aguja fina con una estrecha concordancia con el diagnóstico definitivo. Predominó el carcinoma papilar (39,5 %), la tiroidectomía total como técnica más empleada (86,5 %) y el 94,6 % de los pacientes no tuvo complicaciones. La lesión recurrencial solo estuvo presente en el 1,1 % de los casos. Conclusiones: La experiencia en tiroidectomía en el Hospital Oncológico Conrado Benítez es buena, con una concordancia entre medios diagnósticos y biopsia definitiva, tiempo quirúrgico adecuado y pocas complicaciones.

Introduction: Thyroid nodules are a common clinical problem. Thyroidectomy is one of the most performed techniques in head and neck surgery services, as well a treatment with curative intent for thyroid cancer and benign conditions such as nodular goiter and adenoma. Objective: To describe the experience in thyroid surgery at the head and neck surgery service from Hospital Oncológico Conrado Benítez. Methods: A descriptive, longitudinal and prospective study was carried out with patients who received any surgical treatment for thyroid disease in the period from September 1, 2017 to August 31, 2022. Results: 87 % of patients were female, with a mean age of 47.1 years. All of them underwent ultrasonography and fine-needle aspiration biopsy, presenting a close concordance with their definitive diagnosis. Papillary carcinoma predominated (39.5 %), total thyroidectomy was the most commonly used technique (86.5 %) and 94.6 % of patients had no complications. Any recurrent lesion was present in only 1.1 % of cases. Conclusions: The thyroidectomy experience at Hospital Oncológico Conrado Benítez is good, based on the concordance between diagnostic means and definitive biopsy, as well as adequate surgical time and few complications.

Sintomas vocais, ansiedade e depressão pré e pós-tireoidectomia / Vocal symptoms, anxiety and depression pre and post thyroidectomy / Síntomas vocales, ansiedad y depresión pre y post tiroidectomía

Introdução: Alterações na tireoide e a tireoidectomia podem levar à sintomatologia vocal e emocional.Objetivo: Correlacionar sintomas vocais e traços de ansiedade e depressão pré e pós-tireoidectomia. Métodos: Estudo observacional, longitudinal. Participaram 20 pacientes submetidos à tireoidectomia, ao exame visual laríngeo e à Escala de Sintomas Vocais (ESV) e Escala Hospitalar de Ansiedade e Depressão (HADS) no pré-operatório, pós 1 semana e pós 3 meses, com média de idade de 54,5 anos, maior prevalência do sexo feminino (85%) e tireoidectomia parcial (70%). Resultados: Os pacientes autorreferiram sintomas vocais em todos os momentos, com maior frequência após uma semana e diferença significativa entre o domínio físico pré e pós 1 semana. Na HADS, observou-se maior escore total no pré-operatório e diferença significante nos três momentos, em todos os domínios, com maior diferença entre pré e pós 1 semana. Houve correlação positiva fraca entre os domínios limitação, emocional e escore total da ESV com a subescala de ansiedade pós 1 semana, entre o escore total da ESV e o escore total da HADS e correlação positiva moderada entre os domínios limitação e emocional da ESV com o escore total da HADS após uma semana. Conclusão: Pacientes submetidos à tireoidectomia autopercebem sintomas vocais e traços de grau leve de ansiedade tanto no pré quanto pós 1 semana e após 3 meses de cirurgia com pior autorreferência após uma semana. Quanto maior a autorreferência de sintomas vocais, mais traços de ansiedade o paciente pode apresentar. (AU)

Introduction: Thyroid alterations and thyroidectomy can lead to vocal and emotional symptoms.Purpose: To correlate vocal symptoms and anxiety and depression traits pre and post-thyroidectomy. Methods: Observational, longitudinal study. Participants were 20 patients who underwent thyroidectomy, laryngeal visual examination and the Voice Symptom Scale (VoiSS) and Hospital Anxiety and Depression Scale (HADS) preoperatively, 1 week and 3 months after, with a mean age of 54.5 years, higher prevalence of female gender (85%) and partial thyroidectomy (70%). Results: The patients self-reported vocal symptoms at all times, more frequently after one week and a significant difference between the physical domain pre and post 1 week. In HADS, there was a higher total score in the preoperative period and a significant difference in the three moments, in all domains, with a greater difference between pre and post 1 week. There was a weak positive correlation between the limitation, emotional and total score of the ESV domains with the anxiety subscale after 1 week, between the total score of the ESV and the total score of the HADS, and a moderate positive correlation between the limitation and emotional domains of the ESV with the HADS total score after one week. Conclusion: Patients undergoing thyroidectomy self-perceived vocal symptoms and mild anxiety traits both before and after 1 week and after 3 months of surgery with worse self-report after one week. The greater the self-report of vocal symptoms, the more traces of anxiety the patient may present. (AU)

Introducción: Cambios en la tiroides y tiroidectomía pueden provocar síntomas vocales y emocionales. Objetivo: Correlacionar síntomas vocales y rasgos de ansiedad y depresión antes y después de tiroidectomía. Metodos: Estudio observacional/longitudinal. Participaron 20 pacientes que se les realizó tiroidectomía, examen visual laríngeo, Escala de Síntomas Vocales (ESV) y Escala Hospitalaria de Ansiedad y Depresión (HADS) en preoperatorio, 1 semana y 3 meses después, con edad media de 54,5 años, prevalencia del género femenino (85%) y tiroidectomía parcial (70%). Resultados: Los pacientes informaron síntomas vocales en todo momento, con mayor frecuencia después de una semana y una diferencia significativa entre el dominio físico antes y después de 1 semana. En HADS, hubo mayor puntaje total en el preoperatorio y diferencia significativa en los tres momentos, con mayor diferencia entre pre y post 1 semana. Hubo una correlación positiva débil entre limitación, emocional y total de los dominios de la ESV con la subescala de ansiedad después de 1 semana, entre el total de la ESV y e total de la HADS, y una correlación positiva moderada entre la puntuación de limitación y dominios emocionales de la ESV con la puntuación total de HADS después de una semana. Conclusión: Los pacientes sometidos a tiroidectomía autopercibieron síntomas vocales y rasgos de ansiedad leve tanto antes como después de 1 semana y después de 3 meses de la cirugía con peor autoinforme después de una semana. Cuanto mayor es el autoinforme de síntomas vocales, más rastros de ansiedad puede presentar el paciente. (AU)

Postoperative serum magnesium levels as a predictor for the need for calcium replacement after total thyroidectomy: a prospective study

ABSTRACT Objective: Our aim was to assess the ability of serum magnesium (Mg), measured on the first postoperative day (Mg1PO), to predict the need for calcium (Ca) replacement in patients undergoing total thyroidectomy (TT). Subjects and methods: Eighty patients undergoing TT, with Mg1PO and PTH dosage in the first (PTH1h) and eighth (PTH8h) hours after TT, were evaluated for the need for Ca replacement. Data were evaluated by uni/multivariate logistic regression and Receiver Operating Characteristic (ROC) curve. Results: 32 patients (40%) required Ca replacement. Median PTH1h, PTH8h and Mg1PO were higher in the no replacement group: 17 versus (vs) 3 pg/mL (p < 0.001), 18.2 vs 3.0 pg/mL (p < 0.001) and 2 vs 1.6 mg/dL (p < 0.001), respectively. Mg1PO was the isolated predictor for this replacement (odds ratio = 0.0004, 95% confidence interval: 0.000003-0.04; p = 0.001), with the cut-off value of 1.8 mg/dL showing sensitivity and specificity of 78.1% and 87.5%, respectively. Conclusions: In this group of patients, serum Mg1PO was the isolated predictor for the need for Ca replacement.

Profile of thyroidectomies in Brazil from 2010 to 2020 from a macro-regional perspective

ABSTRACT Objective: To describe the distribution profile of thyroidectomies in Brazil from 2010 to 2020 from a macro-regional perspective. Materials and methods: This is a retrospective, detailed and descriptive study built on secondary data obtained from the Hospital Information System of the Unified Health System (SIH/SUS). We organized the data in tables and grouped them according to the federative unit, macro-region, type of procedure, mortality rate, and year of performance. We performed statistical analysis using the χ2 test to assess the association between the variables, observing a P value of < 0.05 and a confidence interval of 95%. Results: From 2010 to 2020, 160 219 thyroidectomy surgeries were performed, of which 77 812 (48.56%) were total, 38 064 (23.76%) partial and 41 191 (25.70%) oncological.The Southeast was responsible for the largest share of procedures, with 70 745 (44.15%), followed by the Northeast with 43 887 (27.39%). In 2020, the procedure was less performed, with 9226 (5.75%) surgeries. The total mortality rate was 0.16% during the study period. Conclusion: We found that thyroidectomies are carried out mainly in the Southeastern, Northeastern, and Southern regions, and showed a downward trend in 2020, which may be related to the COVID-19 pandemic. In addition, total thyroidectomy is the most performed surgery, and the Northern region had the highest mortality rate.

Rehabilitación del nervio recurrente laríngeo postiroidectomía / Recurrent laryngeal nerve rehabilitation after thyroidectomy

El carcinoma papilar tiroideo es el tipo de cáncer más común de esta glándula, y su tratamiento de elección es la tiroidectomía. Entre las complicaciones asociadas resalta la parálisis de las cuerdas vocales, la cual ocurre por una lesión directa del nervio laríngeo recurrente durante la cirugía. Se presenta una paciente de 22 años de edad con este diagnóstico, a la cual se le realizó una tiroidectomía total; en el postoperatorio inmediato la paciente comenzó con estridor laríngeo intenso que requirió una traqueotomía de urgencia. En el examen físico se constató una parálisis bilateral de las cuerdas vocales y se decidió comenzar un tratamiento de rehabilitación del nervio recurrente laríngeo con laserterapia y HIVAMAT-200 como modalidades combinadas. Los resultados alcanzados con la fisioterapia fueron satisfactorios y la paciente se reintegró rápidamente a su ámbito familiar, escolar y social.

Papillary thyroid carcinoma is the most common type of cancer of this gland, and its treatment of choice is thyroidectomy. Vocal cord paralysis stands out among the associated complications, in which a direct injury to the recurrent laryngeal nerve occurs during surgery. We present a 22-year-old female patient with this diagnosis, who underwent a total thyroidectomy; in the immediate postoperative period the patient began with intense laryngeal stridor requiring an emergency tracheotomy. Physical examination revealed bilateral vocal cord paralysis and it was decided to begin rehabilitation treatment of the recurrent laryngeal nerve with laser therapy and HIVAMAT-200 as combined modalities. The results achieved with physiotherapy were satisfactory and the patient was quickly reintegrated into her family, school and social environment.

Características clínicas, epidemiológicas y quirúrgicas de pacientes con afecciones nodulares tiroideas / Clinical, Epidemiological and Surgical Characteristics of Patients with Thyroid Nodular Conditions

Introducción: En las últimas décadas la incidencia del cáncer tiroideo en el curso de la enfermedad nodular se ha incrementado debido a las novedosas técnicas de diagnóstico; sin embargo, la tasa de mortalidad se ha mantenido muy baja. Objetivo: Evaluar las características clínicas, epidemiológicas y quirúrgicas de pacientes con afecciones nodulares tiroideas. Métodos: Se realizó un estudio descriptivo observacional de cohorte prospectivo, longitudinal con los pacientes operados de afecciones tiroideas durante el período comprendido entre enero del 2008 y diciembre del 2018. El universo y la muestra quedaron constituidos por 467 pacientes que cumplieron con los criterios de inclusión. Resultados: Predominaron el sexo femenino (89,5 por ciento) y el grupo etario de 45-60 años (29,5 por ciento). Asociaron comorbilidades 338 pacientes y algún factor de riesgo de malignidad (6,2 por ciento). Un total de 174 pacientes manifestaron síntomas y 264 mostraron algún signo. Predominaron los reportes ecográficos (TI-RADS) y citológicos (Bethesda) tipo II (54,3 por ciento) y (55,5 por ciento), respectivamente. La hemitiroidectomía fue el procedimiento más realizado (59,9 por ciento) y la disfonía la complicación más encontrada (1,9 por ciento). Conclusiones: El diagnóstico oportuno del cáncer tiroideo en el curso de una enfermedad nodular contribuye a individualizar todas las decisiones terapéuticas atendiendo a las características de cada paciente y sus circunstancias(AU)

Introduction: In recent decades, the incidence rates of thyroid cancer in the course of nodular disease has increased due to novel diagnostic techniques; however, the mortality rate has remained very low. Objective: To evaluate the clinical, epidemiological and surgical characteristics of patients with nodular thyroid disease. Methods: A descriptive, observational, of prospective cohort, longitudinal and observational study was conducted with patients operated on for thyroid disorders during the period from January 2008 to December 2018. The study universe and sample consisted of 467 patients who met the inclusion criteria. Results: The female sex (89.5 percent) and the age group 45-60 years (29.5 percent) predominated. Comorbidities were present in 338 patients, as well as some risk factor for malignancy in 6.2 percent. A total of 174 patients manifested symptoms and 264 showed some sign. There was a predominance of echography (TI-RADS) and cytology (Bethesda) type II reports, accounting for 54.3 percent and 55.5 percent, respectively. Hemithyroidectomy was the most performed procedure (59.9 percent), while dysphonia was the most encountered complication (1.9 percent). Conclusions: Timely diagnosis of thyroid cancer in the course of nodular disease contributes to individualizing all therapeutic decisions considering the characteristics of each patient and their circumstances(AU)

Risk Factors for Malignancy in Patients with Multinodular Goiter

Abstract Introduction The identification of thyroid cancer may be conducted through clinical detection, imaging method, and histopathological examination. Both solitary nodules and multinodular goiter are associated with malignancy. Objective To assess the risk factors for malignancy among patients with multinodular goiter submitted to total thyroidectomy. Methods A series of 712 consecutive patients, submitted to total thyroidectomy between 2005 and 2016 with multinodular goiter regarding clinical, ultrasound, and pathological variables, was retrospectively evaluated. Results There were 408 cases of papillary carcinoma (57.3%), with the remaining being benign. Gender had no statistical significance (p = 0.169) for malignancy, unlike the Bethesda index, higher age group (p = 0.005), shorter clinical history time (p = 0.036), smaller number of nodules (p < 0.0001), and smaller nodule size (p < 0.0001), which were related to malignancy. Conclusion The Bethesda index, older age group, shorter clinical history, smaller number of nodules, and smaller size of nodule were related to the diagnosis of papillary carcinoma.

Analgesic efficacy of Intraoperative lidocaine infusion in patients undergoing thyroidectomy

SUMMARY OBJECTIVE: A significant proportion of patients may experience moderate pain requiring treatment in the postoperative first 24 h following thyroidectomy. The aim of this study was to investigate the evaluation of postoperative patient-reported pain from intraoperative intravenous infusion of lidocaine in patients undergoing thyroidectomy surgery. METHODS: A total of 40 patients with American Society of Anesthesiologists physical status classifications I and II, aged 18-65 years, who were scheduled for elective thyroidectomy with the same indications under general anesthesia at the Ataturk University Medical Faculty's Ear, Nose, and Throat Clinic between November 2019 and February 2020, were divided into two equal groups as randomized and double-blind. Before induction of anesthesia, patients in the lidocaine group were given 1.5 mg/kg lidocaine IV bolus infusion during the operation and until the end of the first postoperative hour, followed by a continuous infusion of 1.5 mg/kg/h. Patients in the control group were given 0.9% isotonic solution according to the same protocol. In the postoperative period, 50 mg of dexketoprofen trometamol was administered and repeated every 12 h. Postoperative pain scores, additional analgesia, and side effects were recorded. RESULTS: Postoperative pain scores were significantly lower in the lidocaine group (n=20) compared to the control group (n=20) at 30 min and 1st, 2nd, 4th, 8th, and 12th h postoperatively (p < 0.05). Additional analgesia requirements were also significantly lower in the lidocaine group than in the control group (p<0.05). CONCLUSION: We recommended the use of intravenous lidocaine infusion intraoperatively in thyroidectomy surgery as it reduces pain scores.

Correlation between thyroid fine needle aspiration and pathological examination: a 10 year retrospective study

ABSTRACT Objective To establish the diagnostic performance of fine-needle aspiration in detecting benign and malignant neoplasm in comparison with post-thyroidectomy histopathological findings among patients who received a thyroidectomy. Methods Retrospective observational data collected between 2011-2021 were included from patients who received partial or total thyroidectomy. The Bethesda system was used to classify neoplasms from fine-needle aspiration procedures as benign or malignant. Sample characteristics, diagnostic accuracy, sensitivity, specificity, and predictive values were evaluated. Results Patients (n=360) who underwent thyroidectomy were analyzed, of whom 142 (39.4%) and 218 (60.6%) had benign and malignant neoplasms, respectively. Using the Bethesda system, 23 (6.4%) were classified as unsatisfactory result (BI), 83 (23.1%) as benign (BII), 50 (13.9%) as atypia of undetermined significance (BIII), 23 (6.4%) as suspected follicular or Hürthle cell neoplasia (BIV), 102 (28.3%) as suspected malignancy (BV) and 79 (21.9%) as malignant (BVI). The fine-needle aspiration diagnostic accuracy for carcinomas was 92%, while the sensitivity and specificity were 94.4% and 86.9%, respectively. The negative and positive predictive values were 87.9% and 93.9%, respectively. Conclusion Fine-needle aspiration has high diagnostic accuracy, sensitivity and specificity, and is a reliable test for distinguishing between benign and malignant thyroid pathologies.

Libro "Complicaciones de la cirugía tiroidea": texto útil para la docencia en Cuba / Book "Complications after thyroid surgery": useful text to be used for teaching in Cuba

Fundamento: la tiroidectomía tiene complicaciones reportadas hasta en un 25 % de los operados, las que pueden dejar secuelas invalidantes. Objetivo: mostrar los fundamentos teóricos del libro "Complicaciones de la cirugía tiroidea" como texto de aprendizaje para la superación profesional y la prevención de las complicaciones en los procesos quirúrgicos. Métodos: se realizó una investigación con enfoque cualitativo en la Universidad de Ciencias Médicas de Holguín, entre los años 2018-2020. Se emplearon métodos del nivel teórico para la fundamentación teórica; y empíricos: el análisis documental para verificar los nexos y relaciones que se ofrecen en los referentes teóricos relacionados con las características que debe poseer un libro de texto como medio de enseñanza en el proceso docente educativo, su importancia, ventajas y fundamentos. Se utilizó el criterio de expertos para valorar su pertinencia, factibilidad y estructura metodológica. Resultados: se presenta un libro diseñado como recurso del aprendizaje para la superación profesional; contiene las particularidades del contenido que se desea enseñar, y lo que los médicos necesitan conocer para la prevención de las complicaciones en el operado de tiroides. Está estructurado en trece capítulos, cada uno con una breve introducción y desarrollo sobre el tema. Su significación teórica viene determinada por su contribución a la educación médica, en especial a la Cirugía General y especialidades afines. Conclusiones: se mostraron los principales fundamentos teóricos del libro "Complicaciones de la cirugía tiroidea" como medio de enseñanza para la superación profesional del médico, y se resaltaron sus principales ventajas como componente didáctico del proceso docente educativo, cuyo contenido se aplica en la prevención, diagnóstico y tratamiento de las complicaciones.

Background: thyroidectomy complications has been reported in up to 25% of those operated on it, which can leave disabling consequences. Objective: to evidence the theoretical foundations of the book "Complications after thyroid surgery" as a learning text for professional improvement and the prevention of complications in surgical processes. Methods: From 2018 to 2020 a research with a qualitative approach was carried out at the University of Medical Sciences in Holguín. Theoretical methods were used for the theoretical foundation; and empirical methods: documentary analysis to verify the links and relationships offered in the theoretical references related to the characteristics that a textbook should have as a teaching medium to be used in the educational teaching process, its importance, advantages and foundations. Expert judgment was used to assess its relevance, feasibility and methodological structure. Results: a book designed as a learning resource for professional improvement is presented; it contains the particularities of the content to be taught, and what doctors need to know to prevent complications after thyroid surgery. This book is structured in thirteen chapters, each with a brief introduction and development about the topic. Its theoretical significance is determined by its contribution to medical education, especially General Surgery and related specialties. Conclusions: the main theoretical foundations of the book "Complications after thyroid surgery" as a teaching medium for the professional improvement of physicians were shown , and its main advantages as a didactic component of the educational teaching process, whose content is applied in prevention, diagnosis and treatment of complications, were highlighted.

Transoral thyroid and parathyroid surgery in Brazil: where are we? / Cirurgia transoral de tireóide e paratireóide no Brasil: onde estamos?

ABSTRACT Introduction: thyroid surgery through the transoral vestibular approach is a reality in many countries. While several competing remote access techniques have been developed in the last 20 years, many were not reproducible. Transoral Endoscopic Neck Surgery (TNS) has been shown to be reproducible in different centers around the world, and approximately five years after its description it has been adopted relatively quickly for various reasons. To date, there are at least 7 Brazilian studies published, including a series of more than 400 cases. The aim of this work is to study the progression of Transoral Neck Surgery in Brazil and describe the profile of surgeons involved in this new approach. Methods: this is a retrospective study with descriptive statistics. A REDCap based survey about transoral endoscopic thyroidectomy and parathyroidectomy vestibular approach (TOETVA/TOEPVA) was done with 66 Brazilian surgeons regarding surgeon profile, numbers of cases performed by geographic region, what kind of training was necessary prior to the first case and behavior of the surgeon proposing these new approaches. Results: response rate of this survey was 53%. To date, 1275 TOETVA/TOEPVA cases had been performed in Brazil, 1229 thyroidectomies (96.4%), 42 parathyroidectomies (3.3%) and 4 combined procedures (0.3%). Most of the cases were done in the southeast region (821, 64.4%), 538 (42.2%) cases in the State of São Paulo and 283 (22.2%) cases in the State of Rio de Janeiro. Conclusions: TOETVA is becoming popular in Brazil. Younger surgeons, especially those between 30 and 50 years old were more likely to adopt this approach.

RESUMO Introdução: a cirurgia de tireoide por via transoral vestibular é uma realidade em muitos países. Embora várias outras técnicas de acesso remoto tenham sido desenvolvidas nos últimos 20 anos, muitas não eram reprodutíveis. A cirurgia endoscópica cervical transoral (TNS - Transoral Neck Surgery) tem se mostrado reprodutível em diferentes centros ao redor do mundo sendo que, aproximadamente cinco anos após sua descrição, foi adotada de forma relativamente rápida por vários motivos. Até o momento, existem pelo menos 7 estudos brasileiros publicados, incluindo uma série de mais de 400 casos. O objetivo deste trabalho é estudar a evolução da Cirurgia Transoral do Pescoço (TNS) no Brasil e descrever o perfil dos cirurgiões envolvidos nesta nova abordagem. Métodos: trata-se de um estudo descritivo. Uma pesquisa online hospedada no REDCap sobre tireoidectomia e paratireoidectomia endoscópica transoral por abordagem vestibular (TOETVA/TOEPVA) foi realizada com 66 cirurgiões brasileiros. Foram levantados dados sobre o perfil do cirurgião, número de casos realizados por região geográfica, que tipo de treinamento foi necessário antes do primeiro caso e comportamento do cirurgião durante o relacionamento com o paciente ao abordar essas novas técnicas. Resultados: a taxa de resposta desta pesquisa foi de 53%. Até o momento, 1.275 casos de TOETVA/TOEPVA foram realizados no Brasil, sendo 1.229 tireoidectomias (96,4%), 42 paratireoidectomias (3,3%) e 4 procedimentos combinados (0,3%). A maioria dos casos foi realizada na região sudeste (821, 64,4%), 538 (42,2%) casos no estado de São Paulo e 283 (22,2%) casos no estado do Rio de Janeiro. Conclusões: a TOETVA está se popularizando no Brasil. Cirurgiões mais jovens, especialmente aqueles entre 30 e 50 anos, são mais propensos a adotar essa abordagem.

Association between intraoperative hypotension and postoperative nausea and vomiting: a retrospective analysis of 247 thyroidectomy cases

Abstract Background: Postoperative nausea and vomiting (PONV) are major complications after general anesthesia. Although various pathways are involved in triggering PONV, hypotension plays an important role. We hypothesized that intraoperative hypotension during general anesthesia might be responsible for the incidence of PONV. Methods: We retrospectively investigated patients who underwent thyroidectomy. The initial blood pressure measured before induction of anesthesia was used as the baseline value. The systolic blood pressure measured during the operation from the start to the end of anesthesia was extracted from anesthetic records. The time integral value when the measured systolic blood pressure fell below the baseline value was calculated as area under the curve (AUC) of s100%. Results: There were 247 eligible cases. Eighty-eight patients (35.6%) had PONV. There was no difference in patient background between the patients with or without PONV. Univariate analysis showed that the total intravenous anesthesia (TIVA) (p = 0.02), smoking history (p = 0.02), and AUC-s100% (p = 0.006) were significantly associated with PONV. Multiple logistic regression analysis revealed that TIVA (OR: 0.54, 95% CI: 0.29-0.99), smoking history (OR: 0.60, 95% CI: 0.37-0.96), and AUC-s100% (OR: 1.006, 95% CI: 1.0-1.01) were significantly associated with PONV. Conclusion: Intraoperative hypotension evaluated by AUC-s100% was related to PONV in thyroidectomy.

Autoavaliação de sintomas relacionados à voz em indivíduos com câncer de tireoide antes, imediatamente após e no pós-operatório tardio de tireoidectomia / Self-assessment of voice-related symptoms in individuals with thyroid cancer before, immediately after, and in the late postoperative period of thyroidectomy

RESUMO Objetivo Verificar autopercepção de sintomas vocais, de fadiga vocal e relacionados à tireoidectomia em indivíduos com câncer de tireoide, nos momentos pré-operatório, pós-operatório imediato e pós-operatório tardio, e analisar a influência do gênero. Métodos Trata-se de um estudo de intervenção antes e após com 20 indivíduos com câncer de tireoide, média de 46 anos de idade, avaliados em três momentos: pré-cirurgia (M1), imediatamente após cirurgia (M2) e no pós-operatório tardio (M3) da tireoidectomia. Os indivíduos responderam aos instrumentos Escala de Sintomas Vocais, Índice de Fadiga Vocal e Thyroidectomy-Related Voice and Symptom Questionnaire. Os dados foram analisados ​​de forma descritiva e inferencial. Resultados Na autoavaliação de sintomas vocais físicos e orofaringolaríngeos relacionados à tireoidectomia, o M3 apresentou valores estatisticamente menores que o M1 (p=0,006 e p=0,028, respectivamente) e o M2 (p<0,001 e p=0,004, respectivamente). Para os sintomas totais (p=0,001) e vocais (p=0,001) relacionados à tireoidectomia, os valores do M3 foram significativamente menores que os do M2. Na autoavaliação de sintomas vocais dos domínios total e limitação, o M1 (p<0,001; p<0,001) e o M3 (p=0,013; p=0,001) apresentaram valores significativamente menores que o M2. Indivíduos do gênero masculino apresentaram percepção de sintomas de fadiga no domínio fadiga e limitação vocal (p=0,035) e percepção de sintomas relacionados à tireoidectomia nos domínios total (p=0,044) e sintomas vocais (p=0,012) significativamente menores do que os do gênero feminino, independentemente do momento. Conclusão Sintomas vocais físicos e relacionados à tireoidectomia diminuem no pós-operatório tardio; sintomas vocais totais e limitação aumentam no pós-operatório imediato e diminuem no tardio. Mulheres têm maior percepção de fadiga e limitação vocal e de sintomas totais e vocais relacionados à tireoidectomia.

ABSTRACT Purpose To verify the self-perception of symptoms and vocal fatigue related to thyroidectomy in individuals with thyroid cancer in the pre, immediate post and late post-operative moments, and to analyze the influence of gender. Methods Intervention study before and after with 20 individuals, mean age 46 years, evaluated before surgery (M1), immediately after surgery (M2) and in the late postoperative period (M3) of thyroidectomy. Individuals answered the instruments: Voice Symptoms Scale, Vocal Fatigue Index and Thyroidectomy-Related Voice and Symptom Questionnaire. Data were analyzed descriptively and inferentially. Results In self-assessment of vocal symptoms of the total domains and limitation, M1 (p<0.001; p<0.001, respectively) and M3 (p=0.013; p=0.001, respectively) had significantly lower values than the M2. For the physical domain of self-assessment of vocal symptoms, the M3 showed statistically lower values than the M1 (p=0.006) and the M2 (p<0.001) assessments. Depending on the moment, the oropharyngolaryngeal symptoms in M3 had significantly lower values ​​than M2 (p=0.004) and M1 (p=0.028). Male scores were significantly lower than female scores in the self-assessment of fatigue symptoms in the fatigue and vocal limitation domain (p=0.035), regardless of the time of assessment. Conclusion Physical vocal symptoms and thyroidectomy-related symptoms decrease in the late postoperative period; total vocal symptoms and limitation increasing in the immediate postoperative period and decrease in the late postoperative period. Women have a higher perception of vocal fatigue and limitation, and of total and vocal symptoms related to thyroidectomy.

Treatment duration of wrist-ankle acupuncture for relieving post-thyroidectomy pain: A randomized controlled trial / 中西医结合学报

BACKGROUND@#Treatment duration of wrist-ankle acupuncture (WAA) is uncertain for post-thyroidectomy pain relief.@*OBJECTIVE@#This study evaluated the effect of different WAA treatment duration on post-operative pain relief and other discomforts associated with thyroidectomy.@*DESIGN, SETTING, PARTICIPANTS AND INTERVENTION@#This randomized controlled trial was conducted at a single research site in Guangzhou, China. A total of 132 patients receiving thyroidectomy were randomly divided into the control group (sham WAA, 30 min) and three intervention groups (group 1: WAA, 30 min; group 2: WAA, 45 min; group 3: WAA, 60 min), with group allocation ratio of 1:1:1:1. Acupuncture was administered within 1 hour of leaving the operating room.@*OUTCOMES AND MEASURES@#Primary outcome was patients' pain at the surgical site assessed by visual analogue scale (VAS) at the moment after acupuncture treatment (post-intervention). Secondary outcomes included the patients' pain VAS scores at 6, 12, 24, 48 and 72 h after the thyroidectomy, the 40-item Quality of Recovery (QoR-40) score, the grade of post-operative nausea and vomiting (PONV), and the use of additional analgesic therapy.@*RESULTS@#The adjusted mean difference (AMD) in VAS scores from baseline to post-intervention in group 1 was -0.89 (95% confidence interval [CI], -1.02 to -0.76). The decrease in VAS score at post-intervention was statistically significant in group 1 compared to the control group (AMD, -0.43; 95% CI, -0.58 to -0.28; P < 0.001), and in groups 2 and 3 compared to group 1 (group 2 vs group 1: AMD, -0.65; 95% CI, -0.81 to -0.48; P < 0.001; group 3 vs group 1: AMD, -0.66; 95% CI, -0.86 to -0.47; P < 0.001). The VAS scores in the four groups converged beyond 24 h after the operation. Fewer patients in group 2 and group 3 experienced PONV in the first 24 h after operation. No statistical differences were measured in QoR-40 score and the number of patients with additional analgesic therapy.@*CONCLUSION@#Compared with the 30 min intervention, WAA treatment with longer needle retention time (45 or 60 min) had an advantage in pain relief within 6 h after surgery. WAA's analgesic effect lasted for 6-12 h post-operatively. Please cite this article as: Han XR, Yue W, Chen HC, He W, Luo JH, Chen SX, Liu N, Yang M. Treatment duration of wrist-ankle acupuncture for relieving post-thyroidectomy pain: A randomized controlled trial. J Integr Med. 2023; 21(2): 168-175.

Efficacy of routine exposure versus neuromonitoring of superior laryngeal nerve in thyroid cancer surgery / 中国基层医药

Objective:To investigate the efficacy of routine exposure versus neuromonitoring of the external branch of the superior laryngeal nerve (EBSLN) in thyroid cancer surgery. Methods:The clinical data of 500 patients who underwent open thyroid cancer surgery in the Department of Breast and Thyroid Surgery, People's Hospital of Quzhou from July 2017 to June 2020 were retrospectively analyzed. These patients were divided into a monitoring group ( n = 300) and an unmonitored group (control group) ( n = 200) according to whether neuromonitoring was performed during surgery. In the control group, the EBSLN was routinely exposed during the surgery for naked observation. In the monitoring group, the EBSLN was monitored. The Voice Handicap Index score, vocal cord function, and serum levels of parathyroid hormone and calcium ion were compared between the two groups before and after surgery. All patients were followed up for 1 year to observe injury to the EBSLN, parathyroid gland injury, and hypocalcemia. Results:In the monitoring group, operative time (112.32 ± 10.42) minutes, intraoperative blood loss (10.58 ± 5.04) mL, time to extubation (2.07 ± 0.54) days, postoperative drainage flow (10.55 ± 3.58) mL, and postoperative hospital stay (3.03 ± 1.03) days were significantly shorter and less compared with the control group ( t = 18.68, 15.09, 15.24, 32.98, 27.37, all P < 0.001). Compared with before surgery, normalized noise energy, amplitude perturbation, fundamental frequency perturbation, and fundamental frequency value in each group were significantly decreased after surgery, harmonic to noise ratio and the Voice Handicap Index were significantly increased after surgery. These indices were more obviously improved in the monitoring group compared with the control group ( t = 43.31, 27.10, 46.45, 37.11, 8.97, all P < 0.001). Compared with before surgery, serum levels of parathyroid hormone and calcium ion in each group were significantly decreased after surgery. After surgery, serum levels of parathyroid hormone and calcium ion in the control group were significantly lower than those in the monitoring group ( t = 41.14, 5.99, both P < 0.001). The incidence of complications in the monitoring group [4 cases of hypocalcemia (1.33%), 0 cases of parathyroid injury (0.00%), 8 cases of injury to the EBSLN] was significantly lower than that in the control group ( χ2 = 73.41, 74.17, 76.29, all P < 0.001). Conclusion:Neuromonitoring of the EBSLN during open thyroid cancer surgery can effectively improve patient voice and vocal cord function, reduce the rate of injury to the EBSLN, and has a clinical application value.

Clinical analysis of gasless transoral endoscopic thyroidectomy via oral vestibular approach for papillary thyroid carcinoma / 中华普通外科杂志

Objective:To study the safety and feasibility of gasless transoral endoscopic thyroidectomy though vestibular approach using self-retaining retractor for papillary thyroid carcinoma.Methods:The clinical data of 39 papillary thyroid carcinoma patients undergoing gasless transoral endoscopic thyroidectomy were collected at Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from Nov 2020 to Jun 2021.Results:All cases successfully underwent laparoscopic surgery without conversion to open surgery. The mean duration of operation was (142±35) min, and the postoperative mean hospital stay was (4.1±0.8) days. The mean maximum diameter of the tumor was (8.5±4.5) mm, and the mean number of lymph node harvest of by central compartment dissection was 7.7±5.9. Postoperative complications were transient hypoparathyroidism in 2 cases but recovered in 1 month. Scalp hydrop in 1 patient,fading subsequently. Transient sensory change around the lower lip in 3 cases, which recovered in 6 months. No patient suffered from recurrent laryngeal nerve palsy or hematoma, no permanent hypoparathyroidism occurred, nor of the postoperative bleeding .Conclusion:The gasless transoral endoscopic thyroidectomy viaoral vestibular approach is a feasible approach in selected papillary thyroid carcinoma patients.

Protection of indocyanine green fluorescence imaging on parathyroid gland in gasless unilateral axillary approach endoscopic thyroidectomy surgery / 中华普通外科杂志

Objective:To evaluate the feasibility of indocyanine green fluorescence imaging technology applied in thyroid surgery to identify parathyroid gland.Methods:From Oct 2021 to May 2022, data of 42 patients undergoing thyroidectomy via gasless unilateral axillary approach in Zhejiang Provincial Hospital of Traditional Chinese Medicine were retrospectively analyzed. Cases using intraoperative fluorescence imaging technology(42 cases) were compared with conventional laparocopic approach.Results:The number of parathyroid glands dissected in the study group 1.57±0.61 was higher than that in the control group 0.56± 0.59 ( t=-5.472, P<0.05). The PTH value of the study group was (2.88±1.23)pmol/L on the first day after operation, which was higher than that of the control group (2.16±0.10)pmol/L ( t=-1.844, P<0.05). The blood parathyroid hormone value on the third day(3.22±1.31)pmol/L was higher than that of the control group (2.55±0.81) pmol/L ( t=-2.041, P<0.05). There were 2 cases of hypoparathyroidism in the study group, less than 5 cases in the control group, but there was no significant difference between the two groups( χ2=0.942, P>0.05). There was 1 case of hypocalcemia in the study group and 3 cases in the control group ( χ2=0.731, P>0.05). Conclusion:Using indocyanine green fluorescence imaging technology to identify parathyroid gland is feasible, simple, fast, safe and effective.