Displaying publications 1 - 20 of 71 in total

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  1. The management of solitary thyroid nodules under local anaesthesia
    Cunningham IG, Lee YK
    Aust N Z J Surg, 1975 Aug;45(3):285-9.
    PMID: 1058690
    A group of patients with solitary nodules of the thyroid were treated at the University of Malaya by surgery under local anaesthesia. This was done in order to expedite exploration of a potentially malignant condition. This group comprised 43 patients, and four cancers were found. The standard technique used was satisfactory from the viewpoint of both the patient and the surgeon. The pattern of this condition in a Malaysian population is documented, the technique used is described, and thyroidectomy under local aneaesthesia is discussed.
    Matched MeSH terms: Thyroidectomy
  2. Fulltext Arteriovenous fistula of the superior thyroid artery: post thyroid operation
    Abdul Ghani S, Hashim R
    Med J Malaysia, 1984 Dec;39(4):314-6.
    PMID: 6544941
    A case of A. V. fistula of the superior thyroid vessels following thyroidectomy is reported. Though the standard treatment of such a fistula is ligation and excision, a more simple Iigation and division of the superior thyroid artery is adequate for reasons mention. The demonstration of the feeding vessel by angiogram has to be accurate.
    Matched MeSH terms: Thyroidectomy
  3. Thyroid eye disease--medical or surgical therapy?
    Khalid BA, Ng ML
    Ann Acad Med Singap, 1991 Mar;20(2):273-6.
    PMID: 1883189
    Thyroid eye disease is autoimmune in nature and associated with Graves' Disease. Autoantibodies to the 64 kDa antigen in thyroid membranes cross-react to the 64 kDa proteins in human eye muscle membranes. Antibody dependent cell mediated cytotoxicity against eye muscle cells are also found in patients with thyroid eye disease. The purpose of this paper is to review the treatment available and to share the authors' experience using cyclosporin A. In the majority of cases, thyroid eye disease is mild, manifest only as bilateral or unilateral proptosis, with/without grittiness of the eyes. This is usually treated conservatively with eye drops. If proptosis is more severe and there is incomplete closure of eyelids, epiphora and conjunctival injection, then lateral tarrsorrhaphy is usually effective, combined with use of eye pads and eye drops. The problem of diplopia can be treated conservatively with special lenses, or with surgical correction of tethered muscles. However when proptosis is severe, with raised intraocular pressure, severe chemosis and danger of blindness, then the choice of therapy is controversial: rapid decompression by surgical means or use of high doses of prednisolone. Most prefer prednisolone therapy initially, surgical decompression if it fails. Various other methods have been tried, aimed at the immunological nature of the disease, namely plasmapheresis, radiotherapy and immunosuppressive drugs such as cyclosporin, with variable success. Our experience with cyclosporin had been mixed and inconclusive.
    Matched MeSH terms: Thyroidectomy
  4. 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
  5. Carcinoma in multinodular goitre
    Koh KB, Chang KW
    Br J Surg, 1992 Mar;79(3):266-7.
    PMID: 1555099
    A retrospective review of 107 patients operated on for multinodular goitre was carried out to determine the incidence of carcinoma. Of the group 7.5 per cent harboured incidental carcinomas with papillary carcinoma being the most common variety. The indications for removal of multinodular goitre should be compressive symptoms, suspicion of malignancy and cosmesis.
    Matched MeSH terms: Thyroidectomy
  6. Primary hyperparathyroidism presenting with pathological fracture
    Deshmukh RG, Alsagoff SA, Krishnan S, Dhillon KS, Khir AS
    J R Coll Surg Edinb, 1998 Dec;43(6):424-7.
    PMID: 9990797
    Primary hyperparathyroidism (PHPT) is an intriguing condition. Routine automated biochemical screening has made the diagnosis commonplace in developed countries and the disease is diagnosed early in its course when it is often asymptomatic. In developing countries or in recent immigrants from these countries, PHPT is often seen in an advanced stage with bone involvement. Associated dietary deficiencies may alter the biochemical profile and cause a diagnostic dilemma. It is important to include it in the differential diagnosis of pathological fractures. We report three cases of PHPT presenting with pathological fractures and discuss their diagnosis and management.
    Matched MeSH terms: Thyroidectomy
  7. Zuckerkandl's tubercle of the thyroid gland in association with pressure symptoms: a coincidence or consequence?
    Hisham AN, Aina EN
    Aust N Z J Surg, 2000 Apr;70(4):251-3.
    PMID: 10779054
    BACKGROUND: The Zuckerkandl's tubercle (ZT) of the thyroid gland is a well-described anatomical landmark, but few studies have clearly defined its association with pressure symptoms.

    METHODS: Sixty-six consecutive patients who had primary thyroid surgery were prospectively included in the present study between late January and early August 1998.

    RESULTS: A total of 96 capsular dissections were performed at thyroid surgery. Grades two and three ZT were recognized in 77 (80.2%) dissections. In general 49 (63.6%) of them were associated with significant pressure symptoms. In 43 (87.8%) of the dissections with pressure symptoms, grade 3 ZT was observed (mean weight of goitre: 154.8 g). Interestingly in this group, 16 (37.2%) patients with pressure symptoms had a goitre that was < 100 g and in one patient it was only 21 g.

    CONCLUSIONS: The pressure symptom of the thyroid gland does not always appear to be due to the large size of the goitre. In a relatively small-size goitre the ZT may cause significant pressure symptoms. Observations in the present study supported a strong association of enlarged ZT with pressure symptoms. We believe this is unlikely to be simply a coincidence but rather a consequence of the enlarged tubercle. Nonetheless a prospective randomized study is called for to allow meaningful and objective evidence to be drawn.

    Matched MeSH terms: Thyroidectomy
  8. Removal of a fish bone in the thyroid gland without the need for thyroid lobectomy
    Arumainathan UD, Lwin S, Suan TL, Raman R
    Ear Nose Throat J, 2000 Apr;79(4):314-5.
    PMID: 10786396
    We report the first published case of the removal of a migratory fish bone from the thyroid gland that did not necessitate a thyroid lobectomy.
    Matched MeSH terms: Thyroidectomy
  9. Cytology of columnar-cell variant of papillary thyroid carcinoma
    Jayaram G
    Diagn Cytopathol, 2000 Apr;22(4):227-9.
    PMID: 10787142
    Columnar cell variant of papillary carcinoma (CCV-PC) thyroid is a rare and aggressive tumor composed of tall columnar cells that form papillae, glands and solid structures. This paper describes fine needle aspiration (FNA) cytologic features in a case of CCV-PC occurring in the right thyroid lobe of a 27-year-old female. Smears showed tall columnar cells in monolayered, three-dimensional, acinar and occasional papillary clusters. Nuclei were oval or elongated and monomorphic. Nuclear pseudostratification, resembling that seen in respiratory epithelial cells, was present in some of the cell clusters. Occasional cells showed squamous or Hurthle cell metaplasia. Nuclear grooves and intranuclear cytoplasmic inclusions were not seen. Sections of the right lobectomy specimen showed an well-encapsulated CCV-PC with capsular and vascular permeation. Tall cell variant of papillary carcinoma (TCV-PC) can be distinguished from CCV-PC by the oxyphilia of the tumor cells and the absence of nuclear pseudostratification. Colorectal and endometrial adenocarcinomas metastatic to the thyroid may be difficult to distinguish from CCV-PC.
    Matched MeSH terms: Thyroidectomy
  10. External laryngeal nerve in thyroid surgery: recognition and surgical implications
    Aina EN, Hisham AN
    ANZ J Surg, 2001 Apr;71(4):212-4.
    PMID: 11355727
    Injury to the external laryngeal branch of the superior laryngeal nerve during thyroid surgery is not uncommon. Most surgeons tend to avoid rather than expose and identify the external laryngeal nerve (ELN). The aim of the present study was to analyse the frequency and types of ELN crossing the avascular space in relationship to the structures to the upper pole of the thyroid and related thyroid pathology.
    Matched MeSH terms: Thyroidectomy/adverse effects*; Thyroidectomy/methods*
  11. External laryngeal nerve in thyroid surgery: is the nerve stimulator necessary?
    Aina EN, Hisham AN
    Eur J Surg, 2001 Sep;167(9):662-5.
    PMID: 11759734 DOI: 10.1080/11024150152619282
    OBJECTIVE: To find out the incidence and type of external laryngeal nerves during operations on the thyroid, and to assess the role of a nerve stimulator in detecting them.
    DESIGN: Prospective, non-randomised study.
    SETTING: Teaching hospital, Malaysia.
    SUBJECTS: 317 patients who had 447 dissections between early January 1998 and late November 1999.
    MAIN OUTCOME MEASURES:
    Number and type of nerves crossing the cricothyroid space, and the usefulness of the nerve stimulator in finding them.
    RESULTS: The nerve stimulator was used in 206/447 dissections (46%). 392 external laryngeal nerves were seen (88%), of which 196/206 (95%) were detected with the stimulator. However, without the stimulator 196 nerves were detected out of 241 dissections (81%). The stimulator detected 47 (23%) Type I nerves (nerve > 1 cm from the upper edge of superior pole); 86 (42%) Type IIa nerves (nerve < 1 cm from the upper edge of superior pole); and 63 (31%) Type IIb nerves (nerve below upper edge of superior pole). 10 nerves were not detected. When the stimulator was not used the corresponding figures were 32 (13%), 113 (47%), and 51 (21%), and 45 nerves were not seen. If the nerve cannot be found we recommend dissection of capsule close to the medial border of the upper pole of the thyroid to avoid injury to the nerve.
    CONCLUSION: Although the use of the nerve stimulator seems desirable, it confers no added advantage in finding the nerve. In the event of uncertainty about whether a structure is the nerve, the stimulator may help to confirm it. However, exposure of the cricothyroid space is most important for good exposure in searching for the external laryngeal nerve.
    Matched MeSH terms: Thyroidectomy/adverse effects
  12. Post-thyroidectomy sore throat following endotracheal intubation
    Hisham AN, Roshilla H, Amri N, Aina EN
    ANZ J Surg, 2001 Nov;71(11):669-71.
    PMID: 11736830 DOI: 10.1046/j.1445-1433.2001.02230.x
    Background:  Sore throat is not an uncommon complaint following general anaesthesia (GA) with endotracheal intubation. It has been a source of considerable discomfort particularly in those patients who had thyroid surgery. Driven by the increased number of patients with post-intubation sore throat following thyroid surgery, the aim of the present study was to evaluate the contributing factors of sore throat in patients who had thyroid surgery under general anaesthesia.
    Methods:  A total of 57 consecutive patients who had thyroid surgery from November 1998 to April 1999 was included in this prospective study. Factors such as intubation time, number of intubation attempts, size and type of endotracheal tube (ETT) used, gender and age were recorded. The nature and extent of the surgical procedures were also studied. Postoperative symptoms were assessed by questionnaire on the day after surgery and the different parameters were compared and analysed.
    Results:  The incidence of post-intubation sore throat following thyroid surgery was documented in 39 (68.4%) patients. Twenty-seven (47.4%) patients had a mild complaint of sore throat, which resolved after the third day. The data from the present study show that the size of ETT and extent of surgical procedure were significant contributing factors affecting the postoperative recovery.
    Conclusion:  The outcome of the present study demonstrated a substantial increased incidence of sore throat after thyroid surgery under GA. Postoperative sore throat following thyroid surgery under GA may be caused by multiple contributing factors. Nonetheless effort and care should be taken during endotracheal intubation and surgery to reduce this unpleasant complaint arising mainly from pharyngeal irritation or trauma.
    Matched MeSH terms: Thyroidectomy*
  13. Fulltext Non-recurrent laryngeal nerve in thyroid surgery
    Hisham AN, Sarojah A, Alvin A
    Med J Malaysia, 2001 Dec;56(4):500-2.
    PMID: 12014772
    A case of non-recurrent laryngeal nerve is reported. The non-recurrent laryngeal nerve was found on the right side and was not associated with any vascular abnormalities. The anatomy and surgical implication of this rare condition is discussed
    Matched MeSH terms: Thyroidectomy*
  14. A reappraisal of thyroid surgery under local anaesthesia: back to the future?
    Hisham AN, Aina EN
    ANZ J Surg, 2002 Apr;72(4):287-9.
    PMID: 11982518 DOI: 10.1046/j.1445-2197.2002.02372.x
    BACKGROUND: Thyroid surgery is usually performed under general anaesthesia. However, for a selected group of patients, local anaesthesia may be preferable. The aim of this study was to review the authors' experiences with local anaesthesia with regard to the safety and outcome of this approach.
    METHODS: A total of 65 consecutive patients who underwent primary thyroid surgery were accrued prospectively into this study from May to December 1999. A field block with 0.5% bupivacaine and adrenaline in 1:200 000 dilutions was given in all cases. In addition, light sedative and narcotics were given as necessary to achieve patient comfort and cooperation. The pain experienced during surgery was recorded using a visual analogue scoring system on a scale of 1-10.
    RESULTS: Unilateral thyroid resection was performed in 58 patients, isthmectomy in four patients and bilateral thyroid resection in three patients, two of which were in their second trimester of pregnancy diagnosed with papillary thyroid cancer. There were 55 women and 10 men with an average age of 38.2 years (range: 18-67 years). No conversion to general anaesthetic was needed, and the mean operating time was 80 min. The postoperative recovery was quick with this technique and, of interest, 22 (33.9%) patients were discharged within 6 h following the surgery. Overall 62 (95.4%) patients were discharged in the first 24 h and three (4.6%) patients after 24 h. There were no significant postoperative complications encountered except for wound infection in two (3.1%) patients.
    CONCLUSIONS: Thyroid surgery under local anaesthesia can be performed safely in a selected group of patients. It offers an effective alternative approach to general anaesthesia and is associated with low morbidity and high levels of patient satisfaction.
    Matched MeSH terms: Thyroidectomy/methods*
  15. Recurrent laryngeal nerve in thyroid surgery: a critical appraisal
    Hisham AN, Lukman MR
    ANZ J Surg, 2002 Dec;72(12):887-9.
    PMID: 12485227 DOI: 10.1046/j.1445-2197.2002.02578.x
    BACKGROUND: Identification and preservation of the recurrent laryngeal nerve (RLN) is of major concern in surgery of the thyroid gland. The purpose of this study was to review the surgical anatomy of the nerve and to describe its relationship to other important structures.
    METHODS: A total of 325 patients were accrued in this prospective non-randomized study from January 1999 to December 2000. All patients who had total, subtotal and hemithyroidectomies were included in this study. Each side of the thyroid gland was considered as a separate unit in the analysis of the results.
    RESULTS: Two hundred and seventy-six patients had thyroidectomies as their primary operation, while 49 patients had them as a reoperative procedure. There were 276 women and 46 men (6:1 female to male ratio) with a mean age of 43.1 years (range: 10-84 years). The total number of dissections was 502. The RLN was clearly identified in 491 (97.8%) dissections: single trunk in 323 dissections (65.8%), two extralaryngeal branches in 164 dissections (33.4%), and three extralaryngeal branches in three dissections (0.6%). One non-recurrent laryngeal nerve was encountered (0.2%) in the series. The proximity of the RLN to the inferior thyroid artery (ITA) was noted in 444 (90.4%) dissections: 372 (83.8%) nerves were described to be posterior and intertwined between the branches of the ITA, and in 72 (16.2%) RLNs, they were observed to be anterior to the ITA. The close association of RLN to an enlarged tubercle of Zuckerkandl was documented in 381 dissections (73.7%). A total of 231 RLNs (60.8%) was seen in the tracheoesophageal groove, 18 (4.9%) nerves were observed to be lateral to the trachea, and in 109 (28.3%), they were posterior in location. Of concern in 23 (6.0%) dissections the RLN was on the anterior surface of the thyroid gland, which is at highest risk of injury before curving down to pass behind the tubercle of Zuckerkandl. It appears that the anterior course of the RLN was seen more often in the reoperative procedures to the thyroid gland (20%).
    CONCLUSIONS: Although various methods of localizing the RLN have been described, surgeons should be aware of the variations and have a thorough knowledge of normal anatomy in order to achieve a high standard of care. This will ensure the integrity and safety of the RLN in thyroid surgery. The anatomical variation may be minor in degree, but is of great importance as it may affect the outcome of the surgery and the patient's quality of life.
    Matched MeSH terms: Thyroidectomy*
  16. 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
  17. 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
  18. Immunohistochemical localisation of RET and p53 mutant protein of thyroid lesions in a North-Eastern Malaysian population and its prognostic implications
    Omar E, Madhavan M, Othman NH
    Pathology, 2004 Apr;36(2):152-9.
    PMID: 15203751
    To investigate RET and p53 expression in local thyroid lesions, in order to shed light on the pathogenesis of papillary carcinoma and explain the high prevalence of this condition among the nodular hyperplasia (multi-nodular goitre) cases.
    Matched MeSH terms: Thyroidectomy
  19. 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
  20. 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*
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