MyMedR

Stomal recurrence after total laryngectomy: a 10-year review in Universiti Kebangsaan Malaysia Medical Center

bte Abdul Rashid NH, Yunus MR, bte Baki MM, bte Ami M, Athar PP

J Pak Med Assoc, 2012 May;62(5):466-9.

To determine the frequency of stomal recurrence in patients following total laryngectomy in our center and to compare the frequency of previously reported risk factors such as preoperative tracheostomy, subglottic invasion and the level of lymph node metastases, with the rest of the world.

Matched MeSH terms: Thyroidectomy

Laminated pedicled latissimus dorsi myocutaneous flap for single-stage reconstruction of a composite anterior neck and tracheal defect

Wu LY, Halim AS, Sain AH

J Otolaryngol, 2005 Feb;34(1):69-72.

PMID: 15966482

Matched MeSH terms: Thyroidectomy

Intrathyroidal oxyphilic parathyroid carcinoma: A potential diagnostic caveat in cytology?

Wong YP, Sharifah NA, Tan GC, Gill AJ, Ali SZ

Diagn Cytopathol, 2016 May 26.

PMID: 27229757 DOI: 10.1002/dc.23493

Oxyphilic (oncocytic) parathyroid lesions are very uncommon and their cytological features are rarely described. Due to the similarities in anatomical location and indistinguishable cytomorphological features, these lesions are easily confused with neoplastic and non-neoplastic thyroid lesions on fine needle aspiration (FNA). The diagnosis becomes more challenging in cases of unusual intrathyroidal location of the parathyroid lesions in the absence of clinical evidence of hyperparathyroidism, which simulate thyroid nodules clinically. We describe a case of intrathyroidal oxyphilic parathyroid carcinoma in a 66-year-old female, who presented with a dominant left "thyroid" nodule. FNA smears were cellular, comprising predominantly of oxyphilic cells arranged in papillary-like architecture with occasional nuclear grooves, which was mistaken for oncocytic variant of papillary carcinoma of the thyroid. The histological diagnosis of oxyphilic parathyroid "adenoma" was made following total thyroidectomy. The tumor, unfortunately, recurred 7 years later with associated multiple lung metastases. When dealing with thyroid lesions comprising predominantly of oncocytic cells, one should consider oxyphilic parathyroid neoplasms as one of the differential diagnosis. In difficult equivocal cases, a panel of immunocytochemical stains (PTH, GATA3, TTF-1, PAX8, and thyroglobulin) can be helpful. In addition, a combination of valuable clinical, radiological, and laboratory data, including serum calcium and parathyroid hormone levels are key to arriving at an accurate cytological diagnosis. Diagn. Cytopathol. 2016. © 2016 Wiley Periodicals, Inc.

Matched MeSH terms: Thyroidectomy

Fulltext The use of SPECT-CT improves accuracy of post-radioiodine therapy imaging and changes the management strategy in a case of advanced follicular thyroid carcinoma

Wong TH, Amir Hassan SZ

Med J Malaysia, 2015 Dec;70(6):356-7.

PMID: 26988209

This is a case of follicular thyroid carcinoma with extensive lung, bone and brain metastases. Multi-modality treatments including total thyroidectomy, modified radical neck dissection, cranial radiotherapy and Iodine-131 (RAI) therapy were instituted. Post RAI therapy planar whole body scan showed RAI avid metastases in the skull, cervical spine, bilateral lungs and abdomen. With the use of SPECTCT imaging, rare adrenal metastasis and additional rib metastasis were identified. Besides, management strategy was altered due to detection of non-RAI avid brain and lung metastatic lesions.

Matched MeSH terms: Thyroidectomy

Fulltext A Case Rarity: Papillary Thyroid Carcinoma with Squamous Metaplasia Complicated with Chronic Discharging Ulcers

Wan Sohaimi WF, Lee YF, Mat Nawi N, Mohd Rohani MF, Sapiai NA

Indian J Surg Oncol, 2019 Dec;10(4):676-678.

PMID: 31857764 DOI: 10.1007/s13193-019-00977-8

We report a unique case of differentiated thyroid carcinoma (DTC) with squamous metaplasia complicated with chronic discharging ulcer. A 76-year-old gentleman was referred to us after defaulted treatment 1 year post-total thyroidectomy. He presented to us with long-standing chronic, non-healing, ulcerative and discharging wound at the anterior neck at previous total thyroidectomy scar. The primary tumour was histologically diagnosed as papillary malignant cells with extensive squamous metaplasia. Squamous metaplasia is a rare finding in thyroid carcinoma that carried a poorer prognostic factor.

Matched MeSH terms: Thyroidectomy

Fulltext Airway emergency from spontaneous haemorrhagic thyroid cancer

Vijendren A, Ladha N, Hilger AW

Med J Malaysia, 2014 Aug;69(4):187-8.

PMID: 25500848

Spontaneous thyroid haemorrhages are rare. There are reported cases occurring in thyroid nodules and cysts but none in thyroid malignancies. We describe a 48 year old who presented to the on-call ENT team with a rapidly progressing neck swelling that was interfering with his airway. After resuscitation, the patient underwent a right lobectomy to stop the bleeding. Histology showed a thyroid follicular carcinoma. As per the regional multidisciplinary team discussion, he underwent a completion thyroidectomy followed by radioactive iodine treatment. We conclude that spontaneous haemorrhages of the thyroid gland can occur in malignancies and stress the importance of early histological diagnosis.

Matched MeSH terms: Thyroidectomy

Fulltext Reoperative thyroid surgery in hospital universiti sains malaysia

Tun M, Salekan K, Sain AH

Malays J Med Sci, 2003 Jan;10(1):86-9.

PMID: 23365506 MyJurnal

From 1996 to 2001, 393 thyroidectomies were performed and 25 (6.4%) patients underwent reoperative thyroid surgery at Hospital Universiti Sains Malaysia. All reoperated patients had undergone one prior thyroid operation. All were females with an average age of 39.1 years (18-61 years). The most frequent indication for reoperation was cancer in resected specimen of an originally misdiagnosed carcinoma treated by partial thyroid resection. Final histological diagnosis of 25 reoperations showed thyroid carcinoma in 22 (88%) cases and multinodular goiter in 3 cases. The overall interval between the initial and the reoperative procedures ranged from 3 weeks to 15 years. There was no post-operative mortality after reoperation. Post-operative complications were discovered in 5 patients, as 3 (12%) of whom had transient hypocalcaemia, one (4%) had wound breakdown and one (4%) had permanent recurrent laryngeal nerve palsy. Reoperative thyroid surgery is an uncommon operation with high complication rate.

Matched MeSH terms: Thyroidectomy

Fulltext A comparison of aesthetic outcome between tissue adhesive and subcuticular suture in thyroidectomy wound closure in a multiracial country: A randomized controlled trial

Teoh LY, Chong SS, Hoh SY, Teoh MS, Ng KL

Asian J Surg, 2019 May;42(5):634-640.

PMID: 30446424 DOI: 10.1016/j.asjsur.2018.09.014

OBJECTIVES: Monofilament sutures, both absorbable and non-absorbable, have been used for wound closure. Tissue adhesive has been used in closure of clean, low tension wounds. However, there have been very few published studies on the aesthetic outcomes in neck surgeries. The aim of this study is to compare the patients' and doctors' satisfaction scores in the aesthetic outcome between both methods of closure of thyroidectomy wounds using validated scoring systems.

METHODS: A double-blinded randomised controlled trial comparing the aesthetic outcome between tissue adhesive and conventional suture was conducted among patients undergoing thyroid and parathyroid surgeries. Ninety-six patients were randomised into two treatment groups. Patients' wounds were scored by an independent observer using the SBSES score at 6 weeks postoperatively and observer component of the POSAS score at 3 months.

RESULTS: Forty-nine patients were randomised to the tissue adhesive group while forty-seven patients received the conventional method. There was no statistical difference in the aesthetic outcome using the patient's scoring system between both arms, with a median score of 9 (p = 0.25, SD ± 6.5). The observer's satisfaction score using POSAS was also not statistically significant (median score of 14 (p = 0.77, SD ± 6.2)). No significance was found in the observer's median score using the SBSES scoring system either (score 3, p = 0.12, SD ± 1.3). However, there was significant reduction in the duration of closure using glue (4.42 mins vs 6.36 mins, p

Matched MeSH terms: Thyroidectomy/methods*

Pre-ablative diagnostic whole-body scan following total thyroidectomy for well-differentiated thyroid cancer: is it necessary?

Teoh CM, Rohaizak M, Chan KY, Jasmi AY, Fuad I

Asian J Surg, 2005 Apr;28(2):90-6.

PMID: 15851360

This study reviewed the incidence of positive pre-ablative diagnostic scan after total thyroidectomy and the efficacy of the current ablative dose. The predictive factors for outcome using a standard ablative dose and postoperative complications of total thyroidectomy were also examined.

Matched MeSH terms: Thyroidectomy*

Fulltext Anesthesia for massive retrosternal goiter with severe intrathoracic tracheal narrowing: the challenges imposed -A case report-

Tan PC, Esa N

Korean J Anesthesiol, 2012 May;62(5):474-8.

PMID: 22679546 DOI: 10.4097/kjae.2012.62.5.474

Anesthetic management of patients with mediastinal masses remains challenging as acute cardiorespiratory decompensation may follow induction of anesthesia. We describe a 57 year old lady with massive retrosternal goiter and severe intrathoracic tracheal compression who had a total thyroidectomy. Comprehensive contingency plans were an essential prerequisite for successful management of difficult airway, including multidisciplinary involvement of otorhinolaryngologic and cardiothoracic surgeons preparing for rigid bronchoscopy and cardiopulmonary bypass. Awake oral fiberoptic intubation was performed under dexmedetomidine sedation. Severe tracheal narrowing necessitated usage of a 5.0 mm uncuffed flexometallic endotracheal tube. Anesthesia was maintained with sevoflurane and dexmedetomidine infusion with target controlled infusion of remifentanil as analgesia. No muscle relaxant was given. Surgical manipulation led to intermittent total tracheal compression and inadequate ventilation. The tumor was successfully removed via the cervical approach. A close working relationship between anesthesiologists and surgeons was the key to the safe use of anesthesia and uneventful recovery of this patient.

Matched MeSH terms: Thyroidectomy

Management strategies in Graves' hyperthyroidism

Tan CE, Tan KT, Khoo D, Wang KW

Family Physician, 1991;3:42-45.

Antithyroid drugs, radioiodine and surgery are lhe three modalities of treatment for Graves' hyperthyroidism. The treatment strategy depends on a clear understanding of the relative advantages and disadvantages of each mode of treatment as well as the individual patient's preference. Recent studies favour the use of high dose antithyroid drugs with thyroxine supplementation to induce a higher rate of remission. Radioiodine is likely to be favoured as the definitive form of treatment. Surgery still has a place particularly for young female patients with large goitres. Keywords: Antithyroid drugs, radioiodine, thyroidectomy.

Matched MeSH terms: Thyroidectomy

Follicular thyroid cancer with sternal metastasis - challenges and outcomes

Syazni MA, Gendeh HS, Kosai NR, Ramzisham AR, Gendeh BS, Basiron NH, et al.

Med J Malaysia, 2017 02;72(1):80-82.

PMID: 28255152 MyJurnal

Sternal metastasis from differentiated thyroid carcinoma (DTC) is rare and presents a conundrum for surgeons. We present a lady diagnosed with follicular thyroid carcinoma and sternal metastasis who underwent thyroidectomy, sternectomy and sternoplasty with titanium mesh and acrylic plate. She developed a surgical site infection, of which multiple conservative approaches were attempted. She eventually required removal of the implant. Closure of sternal defect was completed with bilateral pectoralis major advancement flaps. This article highlights a series of complications faced during the course of treatment and how they were managed in a tertiary healthcare centre.

Matched MeSH terms: Thyroidectomy

Papillary thyroid microcarcinoma diagnosed in a patient presenting with hyperthyroidism

Surenthiran Ramanathan, Tong, Chin Voon

International e-Journal of Science, Medicine & Education, 2017;11(3):30-31.

MyJurnal

Papillary thyroid microcarcinoma is not uncommon
and constitutes almost one third of all differentiated
thyroid carcinomas. It is generally regarded as low risk
and usually an incidental finding from histopathology
examination. Some areas of management of this entity
remains uncertain and requires a multidisciplinary
approach. We present a patient who initially came to
us with symptoms of hyperthyroidism, later underwent
thyroidectomy for a suspicious lesion but was found to
have micropapillary thyroid carcinoma in another part
of her thyroid gland.

Matched MeSH terms: Thyroidectomy

A Rare Case of Monostotic Spinal Fibrous Dysplasia Mimicking Solitary Metastatic Lesion of Thyroid Carcinoma

Sharifudin MA, Zakaria Z, Awang MS, Mohamed Amin MA, Abd Aziz A

Malays J Med Sci, 2016 Jan;23(1):82-6.

PMID: 27540330 MyJurnal

Monostotic fibrous dysplasia of the vertebra is a rare entity. A case of a 53-year-old lady who presented with an 8 months history of pain in the thoracic spine region with paraparesis is discussed. She had a history of papillary thyroid carcinoma and had undergone total thyroidectomy one year prior to her current problem. Magnetic resonance imaging revealed isolated osteolytic lesion over the posterior element of the T12 vertebra with narrowing of the spinal canal causing compression of the cord. The diagnosis of fibrous dysplasia was made histologically. Fibrous dysplasia rarely occurs in axial bones compared with peripheral bones. This case illustrates that osteolytic lesion of the vertebrae should be evaluated with detailed radiological and histopathological examination before an empirical diagnosis of spinal metastasis is made in an adult with a background history of primary malignancy well-known to spread to the bone.

Matched MeSH terms: Thyroidectomy

Fulltext Primary lymphoma of the thyroid: diagnostic and therapeutic considerations

Sarinah B, Hisham AN

Asian J Surg, 2010 Jan;33(1):20-4.

PMID: 20497878 DOI: 10.1016/S1015-9584(10)60004-8

Primary thyroid lymphoma is uncommon and accounts for less than 2-5% of all thyroid malignancies. The aim of the present study was to review our experience and management of primary thyroid lymphoma and to discuss the diagnostic and therapeutic considerations.

Matched MeSH terms: Thyroidectomy

Fulltext Emergency thyroid surgery: a surgical challenge

Rohana A, Hisham AN

Asian J Surg, 2009 Apr;32(2):81-4.

PMID: 19423453 DOI: 10.1016/S1015-9584(09)60015-4

BACKGROUND: Acute life threatening presentations of thyroid disease are uncommon. The aim of this study was to review our experience of emergency thyroid surgery with regard to the incidence, management and outcome to this approach.
METHODS: Forty patients who underwent emergency thyroid surgery from December 1998 to December 2007 were prospectively accrued in this study. There were 30 female and 10 male patients. The mean age was 63.8 years (range, 33-83 years). All patients had total thyroidectomy, except one patient who only had a right hemithyroidectomy for a dominant right multinodular goiter. Eight of the patients had been intubated before referring to our centre.
RESULTS: The mean weight of specimen was 219 g (range, 32-800 g). A histopathology report confirmed 16 patients had multinodular goiters, eight patients had papillary thyroid carcinomas, seven patients had anaplastic cancers, four patients had follicular thyroid carcinomas, two patients had thyroid lymphoma, one patient had medullary carcinoma, one patient had sarcoma and one patient had thyroid abscess. A total of 28 patients were discharged well postoperatively.
CONCLUSION: Acute life threatening presentations of thyroid disease are uncommon. However, early recognition of these problems is crucial and may life saving. Emergency thyroidectomy is important to release the critically obstructed airways. Nonetheless it is associated with higher risk of surgery and complication rate then any elective thyroid surgery.

Matched MeSH terms: Thyroidectomy*

Fulltext Accuracy of fine needle aspiration cytology in solitary or dominant nodular goitre: a single centre study

Rohaizak, M., Aman Fuad, Y., Naqiyah, I., Saladina, J.J., Shahrun Niza, A.S.

International Medical Journal Malaysia, 2017;16(2):85-88.

MyJurnal

Background: Thyroid swelling or goitre is a common condition, either asymptomatic or symptomatic. The
diagnosis is usually established by ultrasound or fine needle aspiration cytology (FNAC) as a gold standard.
The sensitivity of the test is inversely related to increasing size of the nodule. The objective of this study is
to evaluate the accuracy of FNAC especially in cases of large goitre.

Material and methods: This is a
retrospective study on patients who underwent thyroidectomy between January 2000 to December 2007 for
solitary or dominant nodular goitre. The analysis was made only on those patients with complete data on
FNAC and histology.

Result: There were 235 patients, but only 161 patients were analysed after excluding
the suspicious and inadequate sample. The patients’ mean age was 42.1 year old (21 to 60). The size of the
thyroid nodule ranged from 2.1 to 5.0 cm (mean = 3.9 cm). The overall sensitivity was 67.4% and the overall
accuracy was 86.3%. The accuracy of FNAC according to the sizes above and below the value were as
follows; 2 cm (72.2% vs. 88.1%); 3 cm (88.0% vs. 87.4%) ; 4 cm (86.6% vs. 84.4%) ; 5 cm (87.3% vs. 78.8%).
This was most obvious in the sensitivity of the FNA which also showed reducing trend as the nodules
increased in size.

Conclusion: FNAC is an essential diagnostic tool in the management of nodular goitre.
Our study showed that the accuracy of FNAC decreased as the size of the nodule getting bigger. Cautious
approach should be taken in the management of large goitre and decision should not be based only on the
result of FNAC.

Matched MeSH terms: Thyroidectomy

Fulltext Scarless thyroid surgery

Rohaizak, M.

Journal of Surgical Academia, 2018;8(2):1-2.

MyJurnal

Thyroidectomy for benign and malignant diseases has progressed dramatically over the last two decades. Moving from large collar incision to no scar is a very good news to the patient with neck swellings. The morbidity of the surgery remains low regardless of the technique and approaches used but scarless surgery is still limited to benign diseases and small cancers. Further study and future refinement of the technique might make these techniques also applicable to large tumours.

Matched MeSH terms: Thyroidectomy

Fulltext Thyroid carcinoma in patients with familial adenomatous polyposis

Rohaizak M, Jasmi AY, Ismail MA, Munchar MJ, Meah FA

Asian J Surg, 2003 Jul;26(3):183-5.

PMID: 12925296 DOI: 10.1016/S1015-9584(09)60381-X

There has been a growing awareness of the association between papillary thyroid carcinoma and familial adenomatous polyposis (FAP). The cases of four young patients with papillary thyroid carcinoma occurring with FAP are presented. Three patients underwent surgery to provide specimens for detailed histological examination. The surgical specimens showed well-encapsulated multicentric tumours exhibiting a predominantly papillary architectural growth pattern. In some areas, follicular architecture and cribriform patterns were noted. Atypical areas of spindle cells in a trabecular or solid configuration, which are not normally seen in classical papillary thyroid carcinoma, were evident. Malignant cells exhibited a graduation of cuboidal to tall cells with abundant amphophilic cytoplasm. The nuclei did not exhibit the typical nuclear clearing as seen in papillary thyroid carcinoma, but nuclear grooving and inclusions were noted. Psammoma bodies were not seen in any of the specimens. In a limited review of these patients, features such as young age at presentation, multicentricity and unusual histology suggest that thyroid carcinoma associated with FAP may represent a distinct form of thyroid cancer.

Matched MeSH terms: Thyroidectomy/methods

Robotic thyroidectomy learning curve for beginning surgeons with little or no experience of endoscopic surgery

Park JH, Lee J, Hakim NA, Kim HY, Kang SW, Jeong JJ, et al.

Head Neck, 2015 Dec;37(12):1705-11.

PMID: 24986508 DOI: 10.1002/hed.23824

This study assessed the results of robotic thyroidectomy by fellowship-trained surgeons in their initial independent practice, and whether standard fellowship training for robotic surgery shortens the learning curve.

Matched MeSH terms: Thyroidectomy/methods*

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