Objective:To investigate the value of retrograde thyroidectomy from top to bottom in the operation of retrosternal thyroid surgery. Methods:Retrospective analysis was performed on the cases of retrosternal goiter excised by our surgeons from January 2017 to June 2022,the technical points, feasibility and advantages of the operation were summarized. Results:A total of 15 cases of retrosternal goiter treated by retrograde thyroidectomy were collected, including 5 cases of type Ⅰ retrosternal goiter and 10 cases of type Ⅱ retrosternal goiter.The postoperative pathology was benign. The surgical time is 40-60 minutes for unilateral retrosternal goiter and 70-90 minutes for bilateral goiter. All patients were discharged normally within 7 days after operation, and no operative complications were observed such as bleeding, hoarseness or hypoparathyroidism. Conclusion:This surgical excision method of thyroid is suitable for the type Ⅰ and type Ⅱ retrosternal goiter surgery, which can avoid the difficulties in exposing and separating the the inferior thyroid behind the sternum in conventional surgical method, speed up the operation and reduced the difficulty of operation, and has certain promotion value in clinic.
Humans ; Thyroidectomy/methods* ; Retrospective Studies ; Goiter, Substernal/pathology* ; Hypoparathyroidism/surgery*

OBJECTIVETo investigate the protection of the parathyroid in the total thyroidectomy to avoid the postoperative permanent hypoparathyroidism.

METHODSForty-three consecutive cases underwent total thyroidectomy from June 2013 to June 2014 in Nanjing Tongren Hospital were reviewed. Of them 26 cases with malignant and 17 cases with benign thyroid diseases.

RESULTSIntraoperatively, all 4 parathyroid glands were identified in 27 cases, 3 parathyroids in 10 cases and 2 parathyroids in 6 cases. Intraoperative parathyroid transplantation was performed in 6 cases, including 5 cases with 1 parathyroid transplantation and 1 case with 2 parathyroid transplantation. With the follow-up of 1-3 months after surgery, 10 cases presented with transient hypocalcemia, 8 cases with temporary hypoparathyroidism and no case with permanent hypoparathyroidism.

CONCLUSIONAccurate identification and conservation in situ or auto-transplantation in total thyroidectomy could be effective for prevention of postoperative permanent hypoparathyroidism.

Biomedical Research ; Humans ; Hypoparathyroidism ; surgery ; Parathyroid Glands ; Postoperative Period ; Thyroid Diseases ; Thyroidectomy ; methods ; Transplantation, Autologous

OBJECTIVE: To systematically evaluate the efficiency and safety of total thyroidetomy (including near-total tyhroidectomy) versus subtotal thyroidectomy for multinodular goiter. METHODS: The literatures were searched from Cochrane Library, PubMed, Embase, Chinese Biological Medical Datebase, Chinese National Knowledge Infrastructure, and Chinese Science and Technology Journal Full-text Database as of November 2013. We included all randomizad controlled trials on total (including near-total) versus subtotal thyroidectomy in the treatment of multinodular goiter. The collecting of data and quality assessment were respectively completed by 2 researchers. RevMan5.1 software was used for Meta-analysis. RESULTS: We collected 7 literatures conforming to the standard, incuding 2 192 patients. The Metaanalysis outcomes showed that total thyroidectomy was associated with lower nodule recurrence rate (OR=0.13, 95% CI: 0.07-0.22, P<0.001) and higher in transient hypoparathyroidism rate (OR=2.33, 95% CI: 1.72-3.17, P<0.001). However, no statistical difference was seen comparing total and subtotal thyroidectomy in permanent recurrent laryngeal nerve paralysis rate (OR= 0.81, 95% CI: 0.24-2.74, P=0.74) and permanent hypoparathyroidism rate (OR=2.94, 95% CI: 0.48- 18.11, P=0.24). CONCLUSION Nodule recurrence rate of total thyroidectomy for multinodular goiter is lower than subtotal thyroidectomy and does not increase permanent complications.
Goiter, Nodular ; surgery ; Humans ; Hypoparathyroidism ; Randomized Controlled Trials as Topic ; Recurrence ; Thyroidectomy ; methods ; Vocal Cord Paralysis

To investigate the risk factors for hypoparathyroidism after thyroidectomy.
 Methods: Clinical data of 492 patients, who underwent thyroidectomy from April 2015 to December 2016 from Xiangya Hospital of Central South University, were studied retrospectively. Chi-square test and multivariable logistic regression were performed to find the risk factors for postoperative hypoparathyroidism.
 Results: The incidence of postoperative hypoparathyroidism was 43.5%, and the incidence of temporary and permanent hypoparathyroidism was 43.1% and 0.4%, respectively. Univariate analysis showed that tumor pathology, thyroidectomy types, the extent of lymph node dissection, application of carbon nanoparticles, and merged Hashimoto's thyroiditis were risk factors for postoperative hypoparathyroidism (all P<0.01). Logistic regression analysis showed that: thyroidectomy types (OR=0.149, 95% CI 0.078 to 0.28), the extent lymph node dissection (OR=0.779, 95% CI 0.617 to 0.983) and application of carbon nanoparticles (OR=1.729, 
95% CI 1.067 to 2.801) were independent risk factors for postoperative hypoparathyroidism (all P<0.05).
 Conclusion: Hypoparathyroidism is a common complication after thyroidectomy. The incidence of postoperative hypoparathyroidism is significantly increased in patients underwent total thyroidectomy and cervical lymph node dissection. Application of carbon nanoparticles intraoperatively can reduce the incidence of postoperative hypoparathyroidism.
Humans ; Hypoparathyroidism ; surgery ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Thyroid Neoplasms ; Thyroidectomy

Objective:To investigate the relationship between parathyroid hormone（PTH） level and permanent hypoparathyroidism（PHPP） on the first day after radical papillary thyroidectomy, and its predictive value. Methods:A total of 80 patients with papillary thyroid cancer who underwent total thyroid resection and central lymph node dissection were collected and analyzed from January 2021 to January 2022. According to whether PHPP occurred after surgery, the patients were divided into hypoparathyroidism group and normal parathyroid function group, and univariate and binary logistics regression were used to analyze the correlation between PTH and serum calcium levels and PHPP on the first day after surgery in two groups. The dynamic changes of PTH at different time points after operation were analyzed. The area under the receiver operating characteristic was used to evaluate the predictive power of PTH on the development of PHPP after surgery. Results:Among the 80 patients with papillary thyroid cancer, 10 cases developed PHPP, with an incidence rate of 12.5%. Binary logistics regression analysis showed that PTH on the first postoperative day（OR=14.534, 95%CI: 2.377-88.858, P=0.004） was an independent predictive risk factor for postoperative PHPP. Taking PTH=8.75 ng/L on the first postoperative day as the cut-off value, the AUC of the area under the curve was 0.874（95%CI: 0.790-0.958, P<0.001）, the sensitivity was 71.4%, the specificity was 100%, and the Yoden index was 0.714. Conclusion:PTH level on the first day after total thyroid papillary carcinoma surgery is closely related to PHPP, and is an independent predictor of PHPP.
Humans ; Calcium ; Hypoparathyroidism/surgery* ; Parathyroid Glands ; Parathyroid Hormone ; Postoperative Complications/surgery* ; Thyroid Cancer, Papillary/surgery* ; Thyroid Neoplasms/complications* ; Thyroidectomy

OBJECTIVEThyroid lobectomy can be programmed to operate as "step by step". Each step must be performed meticulously with quality control, so as to minimize the complications of surgery.

METHODSFrom May 2013 to Auguest 2014, the meticulous thyroid operation was conducted in 72 cases (144 lobectomies). Pre- and post-operative evaluations by strobe laryngoscopy, parathyroid hormone (PTH), and blood calcium examinations were conducted in all cases.

RESULTSFour cases (5.6%) had transient recurrent laryngeal nerve paralysis after surgery, but no permanent recurrent laryngeal nerve paralysis. There was no transient or permanent superior laryngeal nerve paralysis. Transient hypoparathyroidism occurred in 10 cases, with no permanent hypoparathyroidism. No case presented with postoperative bleeding or infection.

CONCLUSIONS"Meticulous operation of thyroid lobectomy" may minimize effectively the complication of surgery.

Humans ; Hypoparathyroidism ; Laryngeal Nerves ; Laryngoscopy ; Parathyroid Glands ; Parathyroid Hormone ; Postoperative Hemorrhage ; Postoperative Period ; Thyroid Gland ; surgery ; Thyroidectomy ; Vocal Cord Paralysis

OBJECTIVEIn order to explore the management of peri-operation and the therapeutic effect in the surgical treatment of hyperthyroidism.

METHODSFifty five cases of hyperthyroidism were undergone near-total thyroidectomy, during the operation recurrent laryngeal nerve was exposed, and the parathyroid was found with microscope when necessary. The third rank of inferior thyroid arteries were ligated to guarantee the blood supply for parathyroid.

RESULTSAll cases underwent near-total thyroidectomy. There was no mortality, and no permanent recurrent laryngeal nerve palsy occurred, and no permanent hypoparathyroidism, and no recurrent hyperthyroidism. Follow-up was carried out 16 months to approximately 5 years after near-total thyroidectomy patients, Hypothyroidism occurred in 15 cases (57.7%), serum calcium levels were 2.15-2.45 mmol/L.

CONCLUSIONSSpecial attention should be given to the management of peri-operation, the above the method can prevent operative complication in the surgical treatment of hyperthyroidism, with excellent result.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Humans ; Hypoparathyroidism ; surgery ; Male ; Middle Aged ; Thyroidectomy ; adverse effects ; methods ; Young Adult

OBJECTIVETo evaluate the protection of parathyroid glands in bilateral papillary thyroid cancer patients who underwent total thyroidectomy and bilateral central compartment dissection.

METHODSThe clinical data of 78 patients undergoing total thyroidectomy and bilateral central compartment dissection between May 2013 and May 2014 were analyzed retrospectively.

RESULTSAmong 78 patients, 131 superior parathyroid glands were protected in situ, among those, 112 parathyroid glands located at the level of inferior edge of parathyroid cartilage; 19 parathyroid glands located in the superior 1/3 part of the back sides of the thyroid glands. All the superior parathyroid glands located in the superior and lateral-superior part of the 2 cm part down from the entrance of recurrent laryngeal nerve. A total of 110 inferior parathyroid glands were protected in situ, among those, 57 glands located in the superior of inferior thyroid artery; 24 glands located just on the surface of inferior thyroid artery; 29 glands located below the superior of inferior thyroid artery. Three parathyroid glands were found in the dissected tissues and were implanted immediately. Seven parathyroid glands were found with post-operative pathologic examinations. During surgery, four parathyroid glands was found in 27 patients, three in 30 patients, two in 16 patients, and one in 5 patients.

CONCLUSIONFor papillary thyroid cancer patients who underwent total thyroidectomy and bilateral central compartment dissection, identification of parathyroid glands and protection of blood supply to glands are the most effective methods to prevent hypoparathyroidism.

Carcinoma ; surgery ; Carcinoma, Papillary ; Humans ; Hypoparathyroidism ; prevention & control ; Organ Sparing Treatments ; Parathyroid Glands ; surgery ; Recurrent Laryngeal Nerve ; Retrospective Studies ; Thyroid Neoplasms ; surgery ; Thyroidectomy

The aim of this study was to investigate the complications following surgical treatment of thyroid cancer and the association between the extent of surgery and complication rates. A total of 2,636 patients who underwent surgery due to thyroid cancer were retrospectively reviewed to identify surgical complications. Complication rates were assessed according to the extent of surgery, which was classified as follows; less-than-total thyroidectomy with central compartment node dissection (CCND) (Group I, n=636), total thyroidectomy with CCND (Group II, n=1,390), total thyroidectomy plus ipsilateral neck dissection (Group III, n=513), and total thyroidectomy plus bilateral neck dissection (Group IV, n=97). The most common surgical complication was symptomatic hypoparathyroidism, of which 28.4% of cases were transient and 0.3% permanent. The other surgical complications included vocal cord palsy (0.7% transient, and 0.2% permanent), hematoma (0.5%), seroma (4.7%), chyle fistula (1.8%), and Horner's syndrome (0.2%). The complication rates increased significantly with increasing the extent of surgery from Group I to Group IV. The more extensive surgery makes more complications, such as hypoparathyroidism, seroma, and others.
Adult ; Female ; Humans ; Hypoparathyroidism/etiology ; Male ; Middle Aged ; Paralysis/etiology ; Parathyroid Glands/surgery ; *Postoperative Complications ; Retrospective Studies ; Seroma/etiology ; Thyroid Neoplasms/*complications/pathology/*surgery

OBJECTIVETo evaluate the necessity of drainage after thyroidectomy for benign thyroid disorders.

METHODSA total of 272 patients who underwent thyroidectomy for benign thyroid disorders were randomly divided into drainage group or non-drainage group. Operating time, postoperative stay time in hospital, comfort of neck assessed by visual analogue scale (VAS) on postoperative day (POD) 0 and POD1 were and the incidence of complications, including post-thyroidectomy bleeding, hematoma, seroma, wound infection, hoarseness, and hypoparathyroidism, were assessed and compared between two groups.

RESULTSBoth groups were similar in the mean age, the sex ratio and the underwent procedure types. There was no significant difference in the mean operating time between two groups (87.5 ± 32.0) min and (93.8 ± 30.1) min (t = 0.12, P = 0.45). The mean postoperative hospital stay time of non-drainage group (1.9 ± 0.3) d was significantly shorter than that of drainage group (2.6 ± 0.6) d (t = 1.45, P = 0.02). The mean VAS scores of neck comfort on POD0 and POD1 in non-drainage group were significantly high than those in non-drainage group(t = 2.67, P = 0.03 and t = 0.33, P = 0.006). There were no significant difference in postoperative complications, including permanent hoarseness and hypoparathyroidism, between two groups.

CONCLUSIONSNo drainage after thyroidectomy for benign thyroid disorders does not increase postoperative complications, with the increase in postoperative neck comfort, the decrease in hospital stay time and potential wound infections. The routine drainage is not necessary after thyroid surgery for benign disorders.

Body Fluids ; Drainage ; Female ; Hematoma ; Hoarseness ; Humans ; Hypoparathyroidism ; Male ; Neck ; Neck Dissection ; Pain Measurement ; Postoperative Complications ; Postoperative Period ; Prospective Studies ; Thyroid Diseases ; surgery ; Thyroidectomy