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.
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.
The clinical, biochemical and pathological features of 31 patients with thyroid carcinoma managed at Hospital Universiti Sains Málaysia, Kubang Kerian from 1985 to 1989 were analyzed. There were 25 females and 6 males. The types of carcinoma were: papillary-17 cases; follicular-10 cases; medullary-2 cases and anaplastic-2 cases. For papillary carcinoma the mean age of the patients was 52.9 years. For follicular carcinoma the mean age was 48.3 years, for medullary carcinoma, 48.5 years and for anaplastic, 74.5 years. All patients had pre-existing goitre except for 2 and most presented with advanced disease. The mean duration of symptoms for papillary carcinoma was 3.7 years, follicular carcinoma 1.6 years, medullary carcinoma 13.5 years and anaplastic carcinoma 6 months. 12 patients presented with goitre of increasing size; 9 had compression symptoms; 4 presented with cervical lymph node enlargement and 6 presented with bony pains of whom 2 had paraplegia. None of the patients were ever thyrotoxic or hypothyroid. Treatment in general was unsatisfactory because of patients' non-acceptance of surgery and/or radioactive iodine.
Mask ventilation is one of the most important skills in airway management. Difficulty in mask ventilation can become life threatening if it is associated with difficulty in intubation during general anesthesia. We report a potential impossible ventilation condition which was safely and easily overcome with appropriate innovative modification of an Opsite adhesive film.
Papillary thyroid cancer (PTC) is the most prevalent form of malignancy among all cancers of the thyroid. It is also one of the few cancers with a rapidly increasing incidence. PTC is usually contained within the thyroid gland and generally biologically indolent. Prognosis of the cancer is excellent, with less than 2% mortality at 5 years. However, more than 25% of patients with PTC developed a recurrence during a long term follow-up. The present article provides an updated condensed overview of PTC, which focuses mainly on the molecular alterations involved and recent biomarker investigations.