[Recurrent laryngeal nerve injury following thyroid surgery]. / Uszkodzenia nerwu krtaniowego wstecznego po operacjach na gruczole tarczowym.

The permanent lesion of damaged recurrent laryngeal nerve (RLN) often manifests as an irreversible dysfunction of phonation and is the most common complication following thyroid surgery. The frequency of this complication ranges from 0.5 to 5% in different thyroid surgery centres and increases in case of both recurrent goiter and complete thyroidectomy due to thyroid cancer. The RLN lesion varies from irreversible, persistent and transient dysfunction with good prognosis of complete recovery. The time of RLN function recovery ranges from several weeks to two years (mainly 6 months). The aim of this study was to evaluate early and persistent RLN paralysis. We operated in our clinic 2323 patients between 1994 and 1997. 2137 patients were operated for the first time due to benign goiter. On the 3rd post-operative day 190 patients (8.9%) presented RLN paralysis of different grade. The follow-up examination (indirect laryngoscopy) was performed in 100 patients with early RLN paralysis in the period between 6 months and 3 years after surgery. The complete RLN recovery was diagnosed in 78%. The permanent paralysis was diagnosed in 1.9% of operated patients. In the light of law and medical aspects we suggest obligatory laryngological examination with the evaluation of vocal cords mobility before surgery and on the 3rd post-operative day in order to identify early RLN lesion. Permanent RLN paralysis may be diagnosed on the basis of multiple laryngological examination in the period between 3 and 24 months after surgery.

[Thyroiditis in patients operated on for goiter]. / Zapalenie tarczycy u chorych operowanych z powodu wola.

UNLABELLED: The paper is aimed at evaluating the frequency of incidence and the thyroiditis type in patients operated on for goiter. In the years 1989-2000, 5149 patients were operated on because of different thyroid disorders. The clinical data of 66 patients with thyroiditis, diagnosed in a post-operating histopathological examination, were subject to a retrospective analysis. There were 64 women and 2 men, aged from 22 to 70, on an average 50.1 years old. There were determined the preoperative diagnosis, the thyroid function--basing upon the levels of TSH and thyroid hormones, the type of operation effected as well as post operative complications. Then, there was also measured the weight of the resected lobes. The prevalent indication for the surgery was non-toxic goiter; instead, toxic goiter was such an indication only in a few cases. In most patients, the thyroid function revealed euthyreosis. The following complications were observed: transient hypocalcemia [two patients], transient paralysis of recurrent laryngeal nerve on one side [one], and wound suppuration [one]. The following types of thyroiditis were found in histopatological examination: Hashimoto (59 patients), Riedl (3 patients), de Quervain (2 patients) and non-specific thyroiditis (2 patients). CONCLUSIONS: 1. Thyroiditis is a rare case in patients operated on for goiter. 2. The most frequent pathological finding is Hasimoto disease.

[Malignant hemangioendothelioma of the thyroid gland]. / Zlosliwy sródbloniak naczyniowy tarczycy.

A case of malignant hemangioendothelioma, developing in a goiter of a 52-year-old woman is presented. This bleeding tumor of the thyroid gland has caused four operations within one month. Histologically, the tumor was composed of widely dilated, ramifying and intercommunicating vascular spaces lined by atypical malignant endothelial cells. Positive immunohistochemical reactions with endothelial markers including factor VIII-related protein, and CD34 and non reactivity with epithelial membrane antigen (EMA) and thyroglobulin, confirmed the endothelial origin of this tumor.