OBJECTIVETo evaluate the rate of residual disease in the thyroid gland and rate of cervical lymph node metastasis after preliminary local resections in thyroid cancer.

METHODSFrom 1994 - 1999, 160 thyroid cancer patients who had previously been treated with nodulectomy or subtotal lobectomy in other hospitals were reoperated.

RESULTSThe rate of residual disease at the primary site was 42.5%. The lymph node metastatic rate at level VI was 28.1%. The rate of lymph node metastasis in those with enlarged lymph nodes in the ipsilateral internal jugular chain was 35.4%. The rate of laryngeal recurrent nerve injury was 12.5% at the first operation which is much higher than that of the second operation (1.9%).

CONCLUSIONBecause of the high rate of local residual disease, nodulectomy or subtotal lobectomy alone is not indicated for thyroid cancer. The exploration to level VI is needed for thyroid cancer. It is of utmost importance to be familiar with laryngeal recurrent nerve anatomy in thyroid surgery.

Adult ; Female ; Humans ; Male ; Neoplasm Recurrence, Local ; surgery ; Neoplasm, Residual ; surgery ; Thyroid Gland ; pathology ; surgery ; Thyroid Neoplasms ; surgery ; Thyroidectomy

Adult ; Carcinoma, Papillary ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Middle Aged ; Thyroid Gland ; pathology ; surgery ; Thyroid Neoplasms ; pathology ; surgery ; Thyroidectomy ; methods ; Video-Assisted Surgery ; methods ; Young Adult

Subcutaneous implantation of benign thyroid tissue is a rare complication of thyroid surgery. Here the authors report two cases of subcutaneous implantation of benign thyroid tissue following conventional thyroid surgery. The diagnosis and differential diagnosis of cervical subcutaneous thyroid tissue implantation, and their clinical pathological characteristics are retrospectively investigated. The mechanism of the implantation process is analyzed. The management of patient with cervical subcutaneous soft tissue implantation is also discussed.
Adult ; Female ; Humans ; Postoperative Complications ; Thyroid Gland ; pathology ; surgery ; Thyroidectomy ; adverse effects

OBJECTIVETo analyze the indication of reoperation of thyroid cancer and to explore the timing, surgical pattern of reoperation.

METHODSProtocols of 72 patients underwent reoperation of thyroid cancer from June 2003 to August 2006 were reviewed retrospectively. Causes for reoperation were as follows: residue of the tumor locally as the inappropriate initial operation; local recurrence and cervical lymph node metastasis; before (131)I ablation which differentiated thyroid cancer with distant place metastasis. The reoperation style included residual lobectomy plus isthmus with single tumor below 2 cm, total thyroidectomy in most the other conditions and selective lymph node dissection in finding or suspected cervical lymph node metastasis.

RESULTSThe rate of residual in thyroid confirmed by postoperative pathology was 47.1% (32/68). The rate of residual in cervical lymph node was 81.4% (35/43). The rates of temporary and permanent laryngeal recurrent nerve injury were 5.6% (4/72) and 1.4% (1/72) respectively. The rates of temporary and permanent hypocalcemia were 26.4% (19/72) and 1.4% (1/72) respectively.

CONCLUSIONSInadequate operation, local recurrence and cervical lymph node metastasis of thyroid cancer need revision surgery undoubtedly. The optimal treatment was total thyroidectomy and level VI, VII central compartment lymph node dissection plus intraoperative frozen-section evaluation.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neck Dissection ; Reoperation ; methods ; Retrospective Studies ; Thyroid Gland ; pathology ; surgery ; Thyroid Neoplasms ; pathology ; surgery ; Thyroidectomy ; methods

OBJECTIVETo investigate the indication, operative method and results of selective neck dissection (SND) for differentiated thyroid cancer.

METHODSAccording to the level system and the operative guideline of the American Head and Neck Society, 40 cases of thyroid cancer (phase I: 35 cases, phase II: 2 cases, phase III: 3 cases) were collected prospectively. Thyroidectomy plus SND was performed on all the cases. And the indication, operative methods and results were investigated.

RESULTSNine of the 40 cases received level VI dissection only. Twenty-four of the 40 cases received SND with levels 0.05). One parathyroid was found in 20% (8/40) of the specimen and 27% (11/40) of the patients had transient hypocalcemia, but no permanent hypocalcemia. Three (7.5%) of the patients had vocal cord paralysis for a short period of time and no permanent case was detected. Nineteen patients were followed up for more than 6 months after the operation and no enlarged neck lymph node was found by ultrasound at the 6th month postoperatively.

CONCLUSIONIt is reasonable to give SND to the early thyroid cancer patients.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neck Dissection ; methods ; Prospective Studies ; Thyroid Gland ; pathology ; surgery ; Thyroid Neoplasms ; pathology ; surgery ; Thyroidectomy ; methods ; Treatment Outcome

OBJECTIVE: To investigate the clinical applications of endoscopic thyroid lobectomy through subclavicular approach and to summarize the surgical experiences. METHOD: Thirty-five cases were subjected to endoscopic thyroid lobectomy through subclavicular approach. Briefly, operative cavities were established by automatic retractors and the affected lobes were dissected and removed using suction dissectors combined with the harmonic scalpels. The inferior thyroid artery was used as the mark to locate the recurrent laryngeal nerve. RESULT: All the operations achieved successfulness with no complication. 33 out of 35 were intraoperatively diagnosed by frozen-pathology as goiter and the last two cases were diagnosed as papillary thyroid carcinoma. There were no postoperative swelling, numbness or other kinds of uncomfortableness with benign patients and they were satisfied with the cosmetic outcomes. CONCLUSION Endoscopic thyroid lobectomy through subclavicular approach for thyroid benign lesions has the advantages of minimal invasion, high safety, easy manipulation and good cosmetic outcomes, which are worth of wide applications.
Adolescent ; Adult ; Clavicle ; surgery ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Thyroid Gland ; pathology ; surgery ; Thyroidectomy ; methods ; Young Adult

OBJECTIVETo study the clinicopathologic features and differential diagnosis of dyshormonogenetic goiter.

METHODSThe clinical features, histopathologic findings and immunohistochemistry of four cases of dyshormonogenetic goiter were reviewed.

RESULTSAmongst the cases of dyshormonogenetic goiter studied, three were females and one male. The age of disease onset ranged from 6 to 12 years and the age at operation ranged from 13 to 28 years. Three patients presented with symptoms of hypothyroidism and one patient had normal thyroid function. On gross examination, the thyroid was multinodular and covered by fibrous capsule. Histologically, three patterns were observed. The predominant pattern was microfollicular/trabecular, with hyperplastic follicular cells associated with scanty colloid material. The second pattern was macrofollicular, the follicular cells were cuboid in shape, with inconspicuous mitotic figures. The third pattern was microcystic, with papillary component frequently seen. No normal intervening thyroid parenchyma was found. All the patients were on long-term thyroxine replacement therapy after operation and remained well.

CONCLUSIONSDyshormonogenetic goiter is considered as a form of thyroid hyperplasia due to enzymatic defects in hormone synthesis. The architectural polymorphism and cellular atypia may mimic thyroid neoplasms and cause difficulties in differential diagnosis.

Adolescent ; Adult ; Carcinoma, Papillary ; pathology ; Diagnosis, Differential ; Female ; Goiter ; complications ; pathology ; surgery ; Humans ; Hypothyroidism ; complications ; pathology ; surgery ; Male ; Thyroid Gland ; metabolism ; pathology ; surgery ; Thyroid Neoplasms ; pathology ; Thyroidectomy ; Thyroiditis ; pathology ; Thyrotropin ; metabolism ; Young Adult

OBJECTIVE: To research the value of frozen section examination for intraoperation diagnosis of thyroid nodule and determination of extent of thyroidectomy. METHOD: A retrospective evaluation of a group of 1 057 patients with thyroid nodular disease was analyzed. The group was divided into frozen section examination group (FS group) and non-frozen section examination group (NFS group). RESULT: There were 750 cases in FS group. The diagnosis made by frozen section examination was carcinoma in 117; benign lesion in 626. Diagnosis was deferred in 7 patients. The final pathology diagnosis was carcinoma in 127; benign lesion in 623. The sensitivity, specificity, accuracy and disaccord rate of frozen section examination were 95. 9%, 100. 0%, and 98. 4%, and 1. 6%, respectively. There were 307 cases in NFS group, and the final pathology diagnosis was carcinoma in 30; benign lesion in 277. The disaccord rate with clinical diagnosis was 9. 77%. The binomial distribution analysis indicate that the difference of disaccord rate between the FS group and the NFS group was remarkable ( P <0. 01). CONCLUSION Frozen section examination has value in diagnosing the thyroid nodular, and is capable of determination of the extent of thyroidectomy.
Adolescent ; Adult ; Aged ; Female ; Frozen Sections ; methods ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Gland ; pathology ; Thyroid Nodule ; diagnosis ; pathology ; surgery ; Thyroidectomy ; Young Adult

Metastasis to the primary thyroid carcinoma is extremely rare. We report here a case of colonic adenocarcinoma metastasis to medullary thyroid carcinoma in a 53-yr old man with a history of colon cancer. He showed a nodular lesion, suggesting malignancy in the thyroid gland, in a follow-up examination after colon cancer surgery. Fine needle aspiration biopsy (FNAB) of the thyroid gland showed tumor cell clusters, which was suspected to be medullary thyroid carcinoma (MTC). The patient underwent a total thyroidectomy. Using several specific immunohistochemical stains, the patient was diagnosed with colonic adenocarcinoma metastasis to MTC. To the best of our knowledge, the present patient is the first case of colonic adenocarcinoma metastasizing to MTC. Although tumor-tumor metastasis to primary thyroid carcinoma is very rare, we still should consider metastasis to the thyroid gland, when a patient with a history of other malignancy presents with a new thyroid finding.
Adenocarcinoma/pathology/surgery ; Biopsy, Fine-Needle ; Carcinoma, Medullary/diagnosis/radiography/*secondary ; Colonic Neoplasms/*pathology/surgery ; Humans ; Male ; Middle Aged ; Neoplasms, Second Primary/*diagnosis ; Thyroid Gland/pathology ; Thyroid Neoplasms/diagnosis/radiography/*secondary ; Thyroid Nodule/diagnosis

BACKGROUNDPreparing hyperthyroid patients for thyroid surgery with a combination of antithyroid drugs and thyroxine has long been controversial because this combination usually results in only partial inhibition of thyroid function. We therefore used large doses of antithyroid drugs to completely inhibit the synthesis of thyroxine and render the thyroid gland defunctionalized. We then administered physiologic doses of thyroxine to inhibit thyroid-stimulating hormone secretion. We have named this treatment "sequential thyroid defunctionalization followed by thyroxine supplementation."

METHODSFour hundred and seventy-one hyperthyroid patients seen at our hospital were divided into experimental and control groups. The control group was treated preoperatively with antithyroid drugs and iodine preparation. The experimental group was further divided into four subgroups and treated with "sequential thyroid defunctionalization followed by thyroxine supplementation". Each of the four subgroups received different doses of antithyroid drugs and thyroxine for differing time periods. Thyroid function was assessed at each stage of treatment, as were operative blood loss volumes and postoperative complications.

RESULTSCompared to the control group, the four experimental groups showed less thyroid congestion and surface varices at surgery. Patients in subgroup A also had thyroid glands that were almost histologically normal. The mean operative blood loss volume of the experimental group was less than that of the control group (326 +/- 163) ml in the control group; (196 +/- 57) ml in subgroup A; (230 +/- 71) ml in subgroup B; (240 +/- 80) ml in subgroup C; and (312 +/- 97) ml in subgroup D). The postoperative complication rate of the experimental group was 8.64% (21/243) whereas that of the control group was 17.54% (40/228).

CONCLUSIONSSequential thyroid defunctionalization followed by thyroxine supplementation is effective in reducing the bleeding volume and postoperative complication rate in selected hyperthyroid patients undergoing thyroidectomy.

Adolescent ; Adult ; Aged ; Child ; Female ; Humans ; Hyperthyroidism ; physiopathology ; surgery ; Male ; Middle Aged ; Thyroid Gland ; pathology ; physiopathology ; Thyroidectomy ; Thyroxine ; administration & dosage