The use of haemostatic agents in thyroid surgery: efficacy and further advantages: Collagen-Fibrinogen-Thrombin Patch (CFTP) versus Cellulose Gauze.

Abstract Aim: To assess the efficacy of two widely used topical haemostatic agents: oxidised regenerated cellulose gauze and Collagen-Fibrinogen-Thrombin Patch in patients undergoing total thyroidectomy. Material of study: This was a prospective, comparative, non-randomised study in which consecutive patients undergoing total thyroidectomy for benign disease received standard treatment with no haemostatic agent, cellulose gauze, or CFTP. Main outcome measures were drainage volume 24 hours after surgical procedure and the occurrence of post-operative complications (haematoma, seroma, surgical-site infection). Results: Two hundred seventy-one (271) patients undergoing total thyroidectomy for benign disease: 65 received standard treatment, 60 received cellulose gauze and 146 received CFTP. Seroma was significantly reduced in the CFTP group compared with both the cellulose gauze group (p=0.006) and the standard treatment group (p=0.017). A significant reduction in drainage volume was also observed with CFTP compared with the other two groups (both p<0.001). Drainage volume was also significantly reduced with cellulose gauze versus standard treatment (p<0.001). No septic events were observed after application of CFTP. One hematoma was observed in the non haemostatic group. Conclusions: Both haemostatic agents reduced the amount of sero-hematic fluid during the first 24 hours post-surgery, with CFTP more effective than oxidized cellulose gauze. The use of haemostatic agents may increase the quality of thyroid surgery, improve patient comfort after surgery, and reduce hospital stay

Does thyroid surgery for Graves' disease improve health-related quality of life?

Abstract PURPOSE: Graves' disease can induce alterations of the psychosocial well-being that negatively influence the overall well-being of patients. Among the current treatments, surgery has limited indications, and its impact on the health-related quality of life has not been well clarified. The aim of this study was to assess the impact of surgery on the quality of life. METHODS: Fifty-seven patients who underwent total thyroidectomy for Graves' disease in our surgical unit between April 2002 and December 2009 were administered a questionnaire concerning four issues: organic alterations and clinical manifestations, neurovegetative system disturbances, impairment of daily activities, psychosocial problems. Patients were retrospectively questioned after thyroidectomy about the presence of these symptoms in both the pre and postoperative periods. RESULTS: There was a significant improvement after surgery in all four areas. Organic manifestations and psychosocial problems had higher average improvements, as did some aspects of the neurovegetative system and difficulties in undertaking daily activities. There were no reports of a worsening of symptoms. CONCLUSIONS: Surgery resolved the hyperthyroidism in 100 % of cases, and was associated with a quality of life improvement of about 70 % in the patients. Surgery can therefore provide an immediate and effective resolution of Graves' disease, with benefits in health-related quality of life

Esophageal motility changes after thyroidectomy; possible associations with postoperative voice and swallowing disorders: preliminary results.

Objective Swallowing and voice impairment are common after thyroidectomy. We evaluated short-term functional changes in esophageal motility in a series of patients who had undergone total thyroidectomy. Several studies have investigated these symptoms by means of interviews or questionnaires. Study Design Prospective study. Setting Academic research. Materials and Methods Thirty-six consenting patients were prospectively recruited. Eligibility criteria were thyroid volume ≤60 mL, benign disease, and age between 18 and 65 years. Exclusion criteria were previous neck surgery, severe thyroiditis, hyperthyroidism, and pre- or postoperative vocal cord palsy. Voice impairment score, swallowing impairment score, lower esophageal sphincter pressure, esophageal motility, upper esophageal pressure, and coordination were evaluated preoperatively and 30 to 45 days after surgery. Results Postoperative swallowing impairment (appearance or worsening of dysphagia) was found in 20% of patients and voice impairment in more than 30%. Both preoperative and postoperative esophageal motility were similar. All patients showed an average decrease of 25% in upper esophageal pressure, although the pressure was within normal range. Swallowing alterations were associated with upper esophageal incoordination (P &lt; .03), and proximal acid reflux was significantly associated with voice impairment (P &lt; .02). Conclusion After uncomplicated thyroidectomy, decreased upper esophageal pressure may explain both pharyngeal (dysphagia) and laryngeal (vocal impairment) exposure to acid. In the future, proton pump inhibitor therapy protocols should be evaluated

Skip metastases to lateral cervical lymph nodes in differentiated thyroid cancer: A systematic review

Papillary thyroid carcinoma is a slow-growing cancer with a generally good prognosis that sometimes have an aggressive behaviour. Metastases to neck lymph nodes is the first step of the diffusion. The central neck compartment is involved most commonly. The ipsilateral lateral neck compartments are usually involved afterwards, and the involvement of the contralateral one is considered a quite rare occurrence. In more rare cases, metastases to lateral neck compartment without central lymph node metastasis (so called skip metastases) could be observed. Aim of this literature review study is to analyse the average incidence, pattern and risk factors of this occurrence.This study was performed according to PRISMA criteria. A final selection of 13 articles published in English language from 1997 to 2017 was performed. Any research article, review or meta-analysis was taken into consideration. Research was expanded considering the related references of articles.The incidence of skip metastases ranged from 1.6 to 21.8%. Risk factors such as age&gt;45years, size &lt;5mm and tumor located in the upper pole or isthmus of thyroid gland were found.Due to the frequency of skip metastases in thyroid cancer, a careful preoperative examination of lateral lymph nodes should be necessary

Quantification of the risk of relapses after thyroid loboisthmusectomy for benign thyroid nodules

AIM OF THE STUDY: To evaluate correlations between pre-operating epidemiological, clinical and diagnostic data and relapses concerning to patients operated on for benign thyroid nodules. MATERIAL AND METHODS: The AA. carried out a new ultrasonographic exam in 155 patients selected at random among 1012 treated by thyroid lobectomy between September 1976 and December 2002; 107 relapses were found (69%). The obtained data are analysed by chi2 test and a significant correlation between recurrence and data preceding first operation was found: non-homogeneous thyroid structure, multiple nodules, presence of peri-lesional halo, anti-thyroid antibodies, and non-adenomatous histological structure. CONCLUSION: The AA. conclude that it is possible to establish a "high risk" population; in spite of that, the high risk of relapse related to low surgical risk of total thyroidectomy suggest a more aggressive surgical procedure at the moment of first operation

Editorial: Recent Advances in Thyroid Surgery

Thyroid surgery has been, since its earliest application, one of the most notable fields in medicine, illustrated by the fact that the Nobel Prize in Medicine was won, for the first time, for thyroid surgery by Emil Theodor Kocher (1841–1917) in 1909, for his contributions to thyroid physiology, pathology, and surgery [...

Predicting risk factors of postoperative hypocalcemia after total thyroidectomy: is safe discharge without supplementation possible? A large cohort study

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Long-term esophageal motility changes after thyroidectomy: associations with aerodigestive disorders.

BACKGROUND: Patients undergoing thyroidectomy often complain aerodigestive disorders. In a previous study we showed the associations between voice impairment and proximal acid reflux, swallowing impairment and Upper Esophageal Sphyncter (UES) incoordination and the decrease in UES pressure in thirty-six patients observed before and soon afterwards uncomplicated thyroidectomy. This study investigated the state of post-thyroidectomy esophageal motility changes and its associations with these disorders after 18-24 months. PATIENTS AND METHODS: The thirty-six patients prospectively recruited according to selection criteria (thyroid volume ≤60 ml, benign disease, age 18-65 years, previous neck surgery, thyroiditis, pre- or postoperative vocal cord palsy) underwent voice (VIS) and swallowing (SIS) impairment scores, esophageal manometry and pH monitoring once again. RESULTS: After 18-24 months, both VIS and SIS recovered (respectively: p=0,022; p=0,0001); UES pressure increased (p=0,0001) nearing the preoperative values. The persistence of swallowing complaints were associated with the persistence of esophageal incoordination (p=0,03); the association between voice impairment and proximal acid reflux was confirmed (p&lt;0,001). CONCLUSIONS: Our study confirms that aerodigestive disorders after uncomplicated thyroidectomy, largely transient, are strictly connected with upper esophageal motility changes. In this viewpoint, the innervation of upper aerodigestive anatomical structures (larynx, pharynx, upper esophagus) and its variations should be focused