MyMedR

Author response to: Comment on: Evolution of transoral endoscopic thyroidectomy vestibular approach according to the IDEAL framework

Lee SH, Moorthy R, Nagala S

Br J Surg, 2022 Oct 14;109(11):e118.

PMID: 35891610 DOI: 10.1093/bjs/znac236

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 Ultrasonic scissors-assisted 'open-book' thyroidectomy in massive goiter compressing airway and causing unilateral vocal cord paralysis

Irfan M, Yaroko AA, Soleh MN, Periasamy C

Med J Malaysia, 2013 Apr;68(2):183-5.

PMID: 23629575

A massive goiter may constrict the trachea resulting in shortness of breath. Recurrent laryngeal nerve compression may cause vocal cord paralysis. We highlight a case of a 62- year-old female with a 30 year history of an anterior neck swelling gradually increasing in size. She presented with acute symptoms of upper airway obstruction and voice changes. Emergency thyroidectomy was performed by dividing the middle part of the gland using ultrasonic scissors. The recovery was uneventful and the patient regained normal vocal cord function post operatively.

Matched MeSH terms: Thyroidectomy*

Fulltext Total thyroidectomy: the procedure of choice for toxic goitre

Hussain M, Hisham AN

Asian J Surg, 2008 Apr;31(2):59-62.

PMID: 18490216 DOI: 10.1016/S1015-9584(08)60059-7

Over the years, subtotal thyroidectomy has been the mainstay of treatment for toxic goitre; however, total thyroidectomy is increasingly being considered as the procedure of choice. This study aimed to review our experience with total thyroidectomy in toxic goitre and evaluate the outcome of this procedure.

Matched MeSH terms: Thyroidectomy*

Fulltext Primary Nonselective Laryngeal Reinnervation in Iatrogenic Acute Recurrent Laryngeal Nerve Injury: Case Series and Literature Review

Mansor WNW, Azman M, Remli R, Yunus MRM, Baki MM

Ear Nose Throat J, 2023 Mar;102(3):164-169.

PMID: 33559496 DOI: 10.1177/0145561321993605

Treating an acutely injured recurrent laryngeal nerve by primary nonselective laryngeal reinnervation (LR) during thyroidectomy is encouraged to minimize postoperative morbidity. Performing a concurrent transoral temporary injection laryngoplasty (IL) may improve the patient's voice while waiting for the effect of successful reinnervation. Chronological multidimensional voice outcomes (qualitative and quantitative) and combination of the primary nonselective LR with concurrent transoral IL were not explicitly demonstrated in previous cases that published the literature. In this study, the authors presented the multidimensional voice parameters of 3 patients undergoing primary nonselective LR with concurrent IL during thyroidectomy. The parameters were measured at different time points (2 weeks and 1, 3, 6, and 12 months) following the surgery. Laryngeal electromyography was done at 1 to 2 months and 12 months postsurgery. The results showed that the voices, qualitatively and quantitatively, were within normal range at within 3 months postintervention. The parameters were slightly beyond the normal limit at 3 months and returned to normal at 6 months postintervention and beyond. The LEMG depicted evidence of successful reinnervation in which the motor unit was normal comparable to the opposite normal vocal fold.

Matched MeSH terms: Thyroidectomy/adverse effects

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

Fulltext Primary Thyroid Lymphoma: Surgical experience in HUKM

Marjmin, O., Rohaizak, M., Naqiyah, I., Imtiaz, H., Hartinie, S.M.

International Medical Journal Malaysia, 2007;6(2):1-3.

MyJurnal

Primary thyroid lymphoma is a rare tumour of the thyroid gland, accounting for 1-2 % of all thyroid malignancies. Diagnosis by fine needle aspiration cytology occasionally inconclusive, needing bigger biopsy or even thyroidectomy. This study reviews our experience with primary thyroid lymphoma.

Matched MeSH terms: Thyroidectomy

Fulltext Emergency thyroidectomy for a bleeding multinodular goitre

Mohamad I, Wan Din SJ

Malays J Med Sci, 2009 Jul;16(3):45-6.

PMID: 22589665 MyJurnal

Goitre is a slow-growing thyroid mass, rarely presenting as an emergency. However, a superimposed infection or acute intralesional bleeding can cause the mass to increase rapidly in size. We report a patient with long-standing multinodular goitre who presented with bleeding from the left thyroid mass. Despite all appropriate measures, the continuous bleeding finally stopped upon thyroidectomy.

Matched MeSH terms: Thyroidectomy

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*

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*

Challenges in electromyographic endotracheal tube (EMG ETT) placement via awake fibreoptic intubation during emergency thyroidectomy

Mohammad Iskandar FF, Nik Lah NAS, Ismail AJ, Yeap TB

BMJ Case Rep, 2021 May 13;14(5).

PMID: 33986014 DOI: 10.1136/bcr-2021-242286

Recurrent laryngeal nerve (RLN) injury is one of the main complications of total thyroidectomy. If the injury is bilateral, total airway obstruction, aphonia and hoarseness of voice could be precipitated. Hence, it is wise for the operating surgeon to be guided by neural monitoring during thyroidectomy. We present a valuable experience handling a middle-aged man with a huge papillary thyroid carcinoma . He needed an urgent thyroidectomy due to obstructive symptoms. We highlight our intraoperative dexterity in handling his surgery in the context of continuous monitoring of RLN using electromyography.

Matched MeSH terms: Thyroidectomy*

Fulltext Papillary Thyroid Carcinoma Presenting with Chronic Cough and Hemoptysis in Primary Care: A Case Report

Abd Hamid MF, Abdul Razak S, Azraai AM, Miptah HN

Am J Case Rep, 2023 Nov 10;24:e941089.

PMID: 37946402 DOI: 10.12659/AJCR.941089

BACKGROUND The article discusses an unusual case of papillary thyroid carcinoma in which chronic cough and hemoptysis were the predominant symptoms. While the more common causes of hemoptysis are pulmonary in origin, extrapulmonary etiologies have been reported, including thyroid carcinoma. The clinical presentation of thyroid malignancy in this case mimics many other common disorders, such as pulmonary tuberculosis, bronchogenic carcinoma, bronchiectasis, and chronic obstructive pulmonary disease. Hence, making it challenging to suspect early when patients present to primary care. CASE REPORT A 54-year-old woman presented with a chronic cough and hemoptysis in our Primary Care Medicine Clinic. While initial assessments in the primary care medicine clinic yielded no remarkable findings, a subsequent high-resolution computed tomography scan of the thorax uncovered a thyroid lesion. Subsequent evaluation in the hospital setting included an ultrasound examination, revealing multiple thyroid nodules, and fine needle aspiration that confirmed papillary thyroid carcinoma. She underwent total thyroidectomy with central and left lateral neck dissection, complicated by left vocal cord palsy. She received 2 cycles of periodic radioactive iodine therapy and injection laryngoplasty postoperatively. There was no evidence of iodin avid disease and recurrence of hemoptysis after surgery. CONCLUSIONS This case report emphasizes the significance of considering papillary thyroid carcinoma when assessing hemoptysis in the primary care setting, as early detection and treatment of it would result in a better outcome.

Matched MeSH terms: Thyroidectomy/methods

Fulltext An Unusual Presentation of a Thyroid Malignancy: A Case Report

Irfan, M., Baharuddin, A., Ananda Dorai, A.

International Medical Journal Malaysia, 2010;9(1):55-57.

MyJurnal

Patient with thyroid mass rarely presents in emergency situation. It is because the nature of the mass is that it usually increases slowly in size. Thus, any surgical intervention can be planned electively. The most common condition that necessitates urgent intervention, is upper airway compromise due to sudden rapid increase in size of the swelling. This can be due to intralesional bleeding or superimposed infection on the enlarged gland. We report a case of urgent completion thyroidectomy performed to a patient with fungating recurrent papillary carcinoma who present with bleeding from the mass externally.

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

Fulltext Post-hemithyroidectomy hypothyroidism in non autoimmune thyroiditis patients: Incidence, risk factors and duration of follow up

Chong SS, Hoh SY, Huang SM

Asian J Surg, 2019 Nov;42(11):957-962.

PMID: 30987945 DOI: 10.1016/j.asjsur.2019.01.015

BACKGROUND: Hemithyroidectomy has a known but less predictable sequelae of hypothyroidism. Presence of anti-thyroid antibody is known, well studied risk factor. Other postulated risk factors include higher pre-operative TSH level and lower ratio of post-operative thyroid remnant to the patient's weight. We reviewed our data to address the above mentioned risk factors.

METHOD: This was a retrospective study done in National Cheng Kung University Hospital, Taiwan from 2015 to 2017. 125 patients underwent hemithyroidectomy, but 24 patients were excluded due to autoimmune thyroiditis, which was determined as the exclusion criteria. Standard panel of blood investigations were taken in each clinic visit before and after operation. A neck ultrasound was done 2 months post-operatively to assess the thyroid remnant. Chi-square test was used for categorical data analysis. Independent student t-test was used for continuous data with parametric distribution and Mann-Whitney U test for non parametric data. p 2.0 uIU/mL was a risk factor as Chi square test showed p

Matched MeSH terms: Thyroidectomy/adverse effects*; Thyroidectomy/methods

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 Rapid reversal of subclinical hyperthyroidism in patients with large multinodular goitres after thyroidectomy

Lum SK

Med J Malaysia, 2013 Oct;68(5):439-40.

PMID: 24632876 MyJurnal

A patient is said to have subclinical hyperthyroidism if he has a depressed thyroid stimulating hormone (TSH) level but is clinically euthyroid and has a normal thyroxine (T4) and triiodothyronine (T3) level. The aetiology of this condition is unknown, its progression is uncertain and the value of treatment is doubtful. These 2 cases show a rapid reversal of TSH suppression within a week after thyroidectomy. This suggest an unidentified potent but innocuous suppressor of TSH is produced by some large nodular goitres. Patients with multinodular goitres with subclinical hyperthyroidism can have their anxiety allayed with assurance that their condition is benign and that their TSH suppression is due to the presence of an innocuous substance which is protective in nature. This substance, when isolated, will find a useful place in the prevention and treatment of papillary carcinoma of the thyroid because of its potent effect on the pituitary-thyroid axis without causing any peripheral effects.

Matched MeSH terms: Thyroidectomy

Fulltext The minimum amount of fluids needed to achieve the fastest time to reach permissible level for release in well-differentiated thyroid patients undergoing high-dose I-131 therapy

Cheen Hoe AK, Fong LY, Halim FNA, Fatt QK, Hamzah F

World J Nucl Med, 2018 7 24;17(3):182-187.

PMID: 30034283 DOI: 10.4103/wjnm.WJNM_59_17

Radioiodine (131I) therapy is the mainstay of treatment for patients who had undergone total thyroidectomy for well differentiated thyroid carcinoma. Increased fluid intake has always been encouraged to minimize the risk of non-target organ exposure to I-131radiation. This study aimed to determine the minimum amount of fluids needed for patients to have the fastest time to achieve permissible level for release after high dose I-131therapy.

METHODOLOGY: All the patients who were treated with high dose I-131from 18th January 2016 till 31st December 2016 in Hospital Pulau Pinang, Malaysia were recruited. The data from 126 patients on thyroxine hormone withdrawal (THW) group and 18 patients on recombinant human thyroid stimulating hormone (rhTSH) group were analysed. There is no change in patient management in terms of preparation, dose or post therapy whole-body scan. Fluid intake of patients were monitored strictly and whole-body retention of I-131are measured using ionizing chamber meter immediately after ingestion of I-131then at 1 hour, 24 hours, 48 hours, 72 hours and 96 hours.

RESULTS: The median time to achieve permissible release limit (50 μSV/hr at 1 meter) was 21.6 hours and 22.1 hours post-ingestion of I-131in the THW and rhTSH group respectively. The minimum amount of fluid needed to reach permissible release limit in the fastest time was 2,103 ml and 2,148ml for the THW and TSH respectively.

CONCLUSION: Clinicians would be able to evidently advise their patient on the amount of fluid to consume and utilize their isolation wards faster to treat more patients.

Matched MeSH terms: Thyroidectomy

Fulltext Primary thyroid lymphoma: A rare malignancy in the head and neck

Mohd Shaiful Nizam Mamat Nasir, Bathma Dhevi Susibalan, Muhammad Nasri Abu Bakar, Suhaimi Yusof, Arfahiza Selimin, Kahairi Abdullah, et al.

Archives of Orofacial Sciences, 2018;13(2):1-4.

MyJurnal

Primary thyroid lymphoma is a relatively uncommon pathology of the thyroid gland that mainly occurs in elderly females. We describe a rare case of B-cell thyroid lymphoma in a young healthy male. It is an important diagnosis to be considered in patients presenting with a rapidly enlarging neck mass as its management is different from other differentiated thyroid carcinoma which require total thyroidectomy plus adjuvant radioactive iodine ablation. Our report emphasizes the need for clinical awareness leading to early detection, followed by early multidisciplinary management.

Matched MeSH terms: Thyroidectomy

Fulltext Outcome of total thyroidectomy and subtotal thyroidectomy in non toxic multinodular goiter: Hospital Universiti Sains Malaysia experience

Ikhwan, S.M., Irfan, M., Nazli, M.Z.M., Hassan, S., Rahman, M.N.G.

Malaysian Journal of Medicine and Health Sciences, 2013;9(1):3-8.

MyJurnal

Thyroid enlargement is one of the common surgical presentations in the Department of Surgery, Hospital Universiti Sains Malaysia (HUSM). Among them, benign non-toxic multinodular goiter constitutes one third (30%) of patients who underwent thyroidectomy. Common complications of thyroidectomy include recurrent laryngeal nerve (RLN) injury, hypocalcaemia, and recurrence of the thyroid lesion. Objective & Methods: This is a retrospective study of patients diagnosed with multinodular goiter treated in HUSM between January 1996 and December 2005. A total of 111 patients were studied and 52 of them underwent subtotal thyroidectomy while 59 underwent total thyroidectomy. The outcome in terms of RLN injury, hypocalcaemia and mass recurrence were analyzed. Results: Post operative complications were studied in both groups. Permanent recurrent laryngeal nerve injury occurs in 2.4% (1 case) in subtotal thyroidectomy group compared to total thyroidectomy group (3.6%, 2 cases). Five cases from total thyroidectomy group suffered from permanent hypocalcaemia but none in the other group. 70.7% (29 cases) from subtotal thyroidectomy group have functional remnant of thyroid tissue. Recurrence rate post subtotal thyroidectomy after 5 years is only 4.9% (2 cases). Conclusion: The post operative outcome in patients who underwent subtotal thyroidectomy in HUSM from January 1996 to
December 2005 was better than total thyroidectomy with significant functional thyroid remnant.

Matched MeSH terms: Thyroidectomy

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