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Article
13.POST-OPERATIVE HYPOCALCEMIA AMONG ONGOING PATIENTS AFTER TOTAL AND SUBTOTAL THYROIDECTOMY

Author: Raghad E. Naji رغده عماد الدين ناجي
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2018 Volume: 16 Issue: 1 Pages: 92-99
Publisher: Al-Nahrain University جامعة النهرين

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Background:Hypocalcemia is a major post-operative complication of total thyroidectomy, causing severe symptoms and increasing hospitalization time. The primary cause is secondary hypoparathyroidism following damage to or devascularization of one or more parathyroid gland during surgery.Objective:To identify the occurrence rate of post-operative hypocalcemia as an indicator of parathyroid gland function and its relation to the type of the surgical procedure of thyroidectomy whether it’s a subtotal or total thyroidectomy.Methods:One hundred and ninety patients with total and subtotal thyroidectomy were selected in this study (144 females and 46 males). The patients were divided into 2 groups, group 1 (95 patients) represent the patients with total thyroidectomy, and group 2 (95 patients) represent the patients with subtotal thyroidectomy. Serum calcium and parathyroid hormone were done pre-operatively and post-operatively for all patients with a follow-up for serum calcium for 6 months. Results:Of the total number serum calcium levels decreased from pre-operative levels in 156 patients (82%), but still within normal range (2.1-2.6 mmol/L). The overall incidence of transient hypocalcemia was 22 % (42 patients), 35 patients belong to group 1 and 7 patients to group 2, and that of permanent hypocalcemia (hypocalcemia persisted at the 6 months assessment) was 2.6 % (5 patients), 4 patients belong to group 1 and one patient to group 2. Most of the patients with hypocalcemia were asymptomatic 19.4% (n=37) and did not require calcium supplementation. Symptomatic hypocalcemia occurred in 5.2 % (n =10) patients. It was found that the overall incidence of hypocalcemia after thyroidectomy was 24.7 % (22% transient and 2.6% permanent). Conclusion:It could be concluded that, insuring the integrity of parathyroid glands is important to avoid post-thyroidectomy hypocalcemia. If incidental removal or devascularization of the parathyroid glands is noted, parathyroid auto-transplantation should be done.Keywords:Post-operative hypocalcemia, total thyroidectomy, subtotal thyroidectomy.Citation:Naji RE. Post-operative hypocalcemia among ongoing patients after total and subtotal thyroidectomy. Iraqi JMS. 2018; Vol. 16(1): 92-99. doi: 10.22578/IJMS.16.1.13


Article
Sutureless Focus Harmonic Thyroidectomy versus Conventional Clamping and Knot‑Tying Technique

Author: Ibrahim Falih Noori, Mansour Amin Mohammad
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2018 Volume: 15 Issue: 4 Pages: 300-305
Publisher: Babylon University جامعة بابل

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Abstract

Background: Thyroidectomy is the most frequent procedure in endocrine surgery. Since thyroid is the highly vascular organ, therefore, promptand meticulous hemostasis is extremely important. Although conventional thyroidectomy is used frequently with acceptable outcomes, it istime‑consuming and resulted in significant intraoperative blood loss with possible risk of injury to parathyroid glands and laryngeal nerves. Theadvent of ultrasonically activated focus harmonic device in thyroid surgery was encouraging for improving safety, effectiveness, and reductionof operative time. Aim of this Study: The purpose of this study was to analyze the effectiveness and surgical outcomes of using ultrasonicharmonic scalpel for thyroid surgery compared to conventional techniques (clamping and suture ligation (knots tying) and electrocautery.Patients and Methods: This is a prospective, randomized study in which 64 patients with various types of goiters presented for thyroidectomy.The patients were divided into two comparable groups. Group A (32 patients) included patients who had focus harmonic thyroidectomy andGroup B (32 patients) included patients who received conventional thyroidectomy. Results: Focus harmonic thyroidectomy showed significantreduction in operative time, intraoperative blood loss, volume of postoperative fluid drainage, and postoperative pain scores compared withconventional thyroidectomy. There were no significant differences in the incidence of postoperative hypocalcemia and laryngeal nerve injurybetween both the groups. The total cost of focus harmonic thyroidectomy and hospital stay were also less compared with conventional techniques.Conclusions: Focus harmonic thyroidectomy was a safe, effective, faster, and beneficial alternative to conventional technique since it reducesthe time of surgery, blood loss, postoperative drainage, and pain with comparable postoperative complications


Article
INCIDENCE OF COMPLICATIONS IN POST-OPERATIVE THYROIDECTOMY
مدى حدوث مضاعفات جراحة الغدة الدرقية بعد العملية الجراحية

Author: Amel Baqer Mohammed
Journal: AL-TAQANI مجلة التقني ISSN: 1818653X Year: 2012 Volume: 25 Issue: 2 Pages: 123-128
Publisher: Foundation of technical education هيئة التعليم التقني

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Abstract

1-Back ground:The study and follow up of postoperative thyroidectomy patient is important in evaluation of postoperative complications.2-Objectives: to determine the incidence of postoperative complications of thyroid surgery.Methods: sixty- six patients with thyroid diseases were admitted to surgical unit, Medical city- teaching center in the period from 1- Oct. 2001 to 1- Oct. 2002. All patients were examined clinically, biochemically. Nuclear scanning, ultrasonography, computed tomography CT were used selectively (depending upon the needs of cases). After operation a careful follow up was done for three days to determine the presence of complications.Result:the incidence of complications in this study was Tetany six cases (four cases were toxic).Hematoma three cases (all were toxic).Stridor three cases (allwere toxic).Recurrent laryngeal nerve injury twocases (both of them are bilateral and transient in one case goitre was toxic). The mortality rate was zero.Conclusion:mortality rate following thyroidectomy is zero. The morbidity rate is about 21% in this study, there are four major complications of thyroid surgery- Titany, wound haematoma, recurrent laryngeal nerve injuryand hypoparathyroidism. Sonorography, computed tomography CT scan are helpful in some cases such as retrosternal goitere, when a posterior or accessory nodule is suspected.

أجريت هذه الدراسة لتوضيح مدى حدوث مضاعفات الغدة الدرقية بعد الاجراءات الجراحية حيث تمت الدراسة في مستشفى مدينة الطب التعليمي- الوحدة الجراحية للفترة من الأول من تشرين أول 2001 الى تشرين أول 2002 حيث تم إدخال 66 مريض للمستشفى جميعهم مصابين بمختلف أمراض الغدة الدرقية. تم اجراء الفحوصات السريرية والمختبرية لجميع المرضى, وتم اختيار بعض الحالات للفحص بالاشعة السينية والمسح الضوئي باليود المشع وفحوصات الانف والأذن والحنجرة. كما تم الفحص بالموجات فوق الصوتية و المفراس لبعض الحالات.بعد إجرائهم العملية تمت متابعتهم بعناية سريريالمدة ثلاثة ايام لمعرفة المضاعفات الجراحية بعد العملية واتضح ان هذه المضاعفات رغم انها قليلة الحدوث الا انها خطيرة في بعض الأحيان.هذه المضاعفات تشمل ست حالات تكززو ثلاث حالات تجمع دموي و ثلاث حالاتصرير في الصوت وحالتين اصابة العصب الحنجري الراجع.لم تحدث حالة وفاة في هذه المجموعة.


Article
Significance of Hypothyroidism in Post Thyroidectomy hypocalcaemi

Author: Taqi Saadoon Atiyah*;
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2012 Volume: 5 no 1 Issue: 11 Pages: 1243-1249
Publisher: Kerbala University جامعة كربلاء

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background: Postoperative hypocalcaemia is one of the most common complications of thyroid surgery.Objective: To evaluate the significance of thyrotoxicosis in developing hypocalcaemia after thyroid surgery.Patients and Methods: A prospective study for patients whom submitted to bilateral subtotal thyroidectomy in AL-Kadhimiya Teaching Hospital in the period from Mars 2006-Mars 2011 were included in this study. Patients were divided into two groups; in group A the patients had toxic goiter, while in group B, the patients had euthyroid goiter. Both groups are nearly identical for age, sex, size of the goiter, and the size of the removed thyroid tissue. All the operations were done by the same surgeon and same technique. At least 2 parathyroid glands are identified and carefully preserved in every patient. Serum calcium was measured before and after operation. Patients with malignant thyroid and those underwent lobectomy were excluded from this study.Results: The total number was 97 patients. Group A, include 24 patients, 10(41.6%) of them had transient hypocalcaemia and 5(20.8%) patients had permanent hypocalcaemia. One patient (4.1%) died eighteen months after the operation due to cardiomyopathy and heart failure.GroupB, include 73patients, 5(6.8%) of them had transient hypocalcemia.The relative risk of hypocalcaemia in toxic goiter is 3.53 (confidence interval 95%) in comparison with euthyroid goiter; P value <0.001which is very significant.Conclusion: Thyrotoxicosis is a significant risk factor in developing hypocalcaemia after thyroid surgery.


Article
Incidence And Risk Factors Of Hypocalcemia After Thyroid Surgery

Author: Haydar Almousawi
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2016 Volume: 9 Issue: 2 Pages: 2436-2442
Publisher: Kerbala University جامعة كربلاء

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background: Hypocalcemia is a major post- operative complication of total thyroidectomy, causing severe symptoms and increasing hospitalization time. The primary cause is secondary hypo-parathyroidism following damage to, or devascularisation of, one or more parathyroid glands during surgery.Aim: Is to determine the incidence of hypocalcemia after thyroid surgery and find out the risk factors involved leading to hypocalcemia regarding gender and body habitus ,clinical diagnosis, extent of surgery, ligation of the inferior thyroid artery ,pathology report and the experience of the surgeon.Material and method: Prospective study of 100 patients in Al-Immamian Al-Kadhymian Medical City in peroid between November 2012-November 2013 included in subtotal, near total, total thyroidectomies. Serum calcium is estimated at day 1,2,3 postoperatively.Results and discussion: Thirty patients developed hypocalcemia postoperatively ,in 24 patients it was transient and in six patients was permanent (three of those six patients had underwent total thyroidectomy ,the other two had underwent near total thyroidectomy and the last patient had underwent subtotal thyroidectomy).Conclusion: Post-thyroidectomy hypocalcemia is relatively common phenomenon especially after extensive thyroid surgery.


Article
Preventing nerve damage during total thyroidectomy or total lobectomy surgeries
منع تلف الأعصاب أثناء استئصال الدرقية الكلي أو جراحات استئصال الفص الكلي

Authors: Masrur Sleman Aziz --- Karzan Mohammed Salih --- Mohammed I. Gubari --- Diary A. smael --- et al.
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2016 Volume: 20 Issue: 2 Pages: 1390-1395
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Background and objective: Thyroidectomy is an operation that involves surgical removal of all or part of the thyroid gland. The main postoperative complications of thyroidectomy are hypoparathyroidism and recurrent laryngeal nerve injury. This study aimed to find out the main postoperative complications particularly nerve damage during total thyroidectomy or total lobectomy.Methods: The medical records of patients who were diagnosed with thyroid disease and underwent surgery between January 2nd, 2013 and December 30th, 2014 in Teaching, Shar, Soma and Zhian hospitals in Sulaimaniyah were retrospectively reviewed. Results: All patients who underwent total thyroidectomy or total lobectomy surgeries were discharged within 24 hours of the operation. During the average follow-up of 24 months, no case of permanent recurrent laryngeal nerve injury was registered. Vocal cord paralysis was considered to be present, when there was absent or markedly reduced movement of the affected vocal cord. Conclusions: Meticulous hemostasis and a delicate technique are required to prevent nerve injury. We recommend dissection and division of all the vessels flush with the thyroid capsule at the anterior and peripheral aspect of the gland. Separate ligation of anterior and posterior branched of the superior thyroid artery will preserve the external branch of the superior laryngeal nerves.


Article
Total Thyroidectomy versus Near Total thyroidectomy in Surgical Management of Patients of Multinodular Goiter

Author: Salah Hadi Al Janaby
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2014 Volume: 11 Issue: 1 Pages: 235-240
Publisher: Babylon University جامعة بابل

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Background: Near total thyroidectomy represented an appealing option for junior surgeons to perform in managing multinodular goiter however total resections in the hands of well-trained surgeons are safe and resect the whole gland with no need for completion surgery in cases of occult malignancy.Objectives: to compare the results of neat total with total thyroidectomy.Patients and Methods: 100 cases of total thyroidectomy are compared with 100 cases of near total thyroidectomy, prospectively and in continuously updated bases ,those patients admitted to Al Hilla General Teaching Hospital from Dec 2008 to Sep 2013.Average age in total thyroidectomy cases was 41 and in near total thyroidectomy cases was 38 and male: female ratio was 1:2.2 and 1:2.7 respectively.Results: No permanent complications were faced in both groups apart from hypothyroidism in all cases.Conclusion: No advantages for near total thyroidectomy. Occult malignancy detected on postoperative histopathology of near total resections may need completion surgery which carries the highest incidence of complication. Near total thyroidectomy is no more recommended for surgeons with sufficient training to perform total resections.

يمثل الاستئصال الكلي لما جنب الدرقية خيارا جذابا للجراحين المبتدئين في ادارة الكويتر المتعدد العقيدات ولكن استئصال الدرقية على أيادي الجراحين المدربين تدريبا جيدا وتهدف الدراسة لمقارنة النتائج من الاستئصال الكلي لما جنب الدرقية واستئصال الدرقية الكامل.تتم مقارنة 100 حالة من استئصال الدرقية الكامل مع 100 حالات الاستئصال الكلي لما جنب الدرقية ، من ديسمبر 2008 إلى سبتمبر 2013. واظهرت النتائج عدم وجود مضاعفات في كلا الحالتين.


Article
Role of Prophylactic Postoperative Calcium Supplementation Following Total Thyroidectomy in Preventing Hypocalcemia

Authors: Adil Rahman Faraj Al-Budaerany --- Jaber Qataa Jaber Al-Mohammedawi --- Hawraa Kamil Shaalan
Journal: Karbala Journal of Medicine مجلة كربلاء الطبية ISSN: 19905483 Year: 2018 Volume: 11 Issue: 2 Pages: 4002-4010
Publisher: Kerbala University جامعة كربلاء

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background:Hypocalcemia remains a major post-operative complication of total thyroidectomy causing potentially serious side effects and tension in influenced patients and expanding hospitalization time. Accurate prediction and appropriate management may help reduce morbidity and hospital stay. Aim of study: To evaluate the effect of Ca supplementation following thyroidectomy in preventing hypocalcemia.Patients and Methods: A randomized prospective study including 74 patients who underwent total thyroidectomyin the surgical unit, Department of Surgery, Al-Khidhir Hospital in Al-Muthanna provinceduring a period of two years and six months from Oct, 2015 – April, 2018. Group A - patients who didn’t receive any supplement (37 patients), group B - patients who received Ca therapy immediately after operation (37 patients). Laboratory tests for S.Ca were done preoperatively and postoperatively at day 0, day one, day two, day three, and then after 10 days and for patient who developed hypocalcaemia, another reading was done after 10 – 20 days and followed monthly.Results: No significant differences (P ≥ 0.05) between study groups regarding age, BMI and duration of goiter. At day zero and day one postoperatively, no significant association between prevalence of hypocalcemia and receiving Ca postoperatively (P≥0.05) while at day two and three, this association was significant and hypocalcemia occurred more prevalent in patient of group A. Patients of group B were discharged earlier than patients of group A (58.9% versus 41.1%). Conclusion: Routine Ca supplementation following total thyroidectomy is better than no supplement. Although they do not completely eliminate the occurrence of postoperative hypocalcemia.

Keywords

Thyroidectomy --- calcium --- Muthanna --- Iraq --- hypocalcemia


Article
The routine insertion of drains after total thyroidectomy by harmonic scalpel, is it always necessary?
الإدراج الروتيني للمنزح بعد استئصال الغدة الدرقية الكلي بواسطة مشرط متناسق، هل هو ضروري دائمًا؟

Author: Ali A. Al-Dabbagh
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2016 Volume: 20 Issue: 3 Pages: 1419-1423
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Background and objective: Routine use of drains after thyroidectomy is not evidence based; nevertheless most surgeons use drains to alert them to the presence of postoperative bleeding and for the prevention of hematoma and seroma. This comparative study was conducted to evaluate the necessity of routine drainage after total thyroidectomy.Methods: A total of 150 patients who underwent total thyroidectomy due to different indications at different hospitals in Erbil city, Iraq from June 2011 to December 2015, were included. A retrospective comparison was made between those drained (group 1) and those without drain (group 2). Operating time, postoperative complications and hospital stay were assessed.Results: Operation time was significantly less in group 2 compared to group 1; 64.9 ± 7.64 minutes versus 73.8 ± 9.81 minutes, respectively. There was no statistically significant difference in the incidence of postoperative complications. Only two patients, both from group 1, developed a postoperative hematoma. Wound infection occurred only in 2 patients in group 1. Hospital stay was significantly shorter in group 2 compared to group 1; 21.1 ± 3.98 hours versus 41.7 ± 8.64 hours, respectively.Conclusion: The routine use of drain is not necessary after total thyroidectomy; it increases the hospital stay and may increase the rate of postoperative sepsis.


Article
OUTCOME OF TRANSCERVICAL THYROIDECTOMY FOR RETROSTERNAL GOITRE
د ا رسة نتائج عمليات استئصال تضخم الغدة الدرقية خلف عظم القص من خلال الرقبة

Author: HAYDER H. IBRAHIM حيدر ابراهيم
Journal: Duhok Medical Journal مجلة دهوك الطبية ISSN: ISSN: 20717334 (online)/ ISSN: 20717326 (Print) Year: 2011 Volume: 5 Issue: 1 Pages: 62-68
Publisher: University of Dohuk جامعة دهوك

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Background and objectives The management of retrosternal goiter is a problem which has challenged surgeons. The development of multinodular retrosternal goiter is still common and knowledge of their treatment is important. The aim of this study was to analyze a series of patients who underwent surgery for retrosternal goitre, and explore the results of surgical treatment via transcervical approach in term of morbidity and mortality.Methods A total of 50 patients out of 250 with retrosternal goiter who underwent thyroidectomy by the researcher in Mosul and Duhok from February 1995–December 2009 were included in the study.Results Out of the total two-hundred fifty patients, fifty (20%) presented with retrosternal extension of goitre.The mean age of the patients with retrosternal extension were 40 years.Out of the fifty patients, females constituted 80%. The most common preoperative symptom was shortness of breath (74%). Twelve percent of patients were asymptomatic. Preoperative chest radiograph showed tracheal compression in 80% (by lateral view) and tracheal deviation in 20% of patients. The retrosternal goitre was resected via cervical approach in all patients. Postoperative complication rate was 20% which includes haematoma in 3 patients, wound infection in 2 patients, early hypoparathyroidisim in 3 patients and temporaryrecurrent laryngeal nerve injury in 2 patients. There were no patients with permanent recurrent laryngeal nerve injury, permanent hypoparathyroidisim or tracheomalacia. All of the patients for whom the surgery was done survived. Conclusion Resection of thyroid gland through a cervical approach for retrosternal goitres is associated with low rate of morbidity and no mortality.

خلفية واهداف البحث: المرضى المصابين بتضخم الغدة الدرقية خلف عظم القص (الد ا رق) تعتبر من المشاكل الج ا رحية من ناحية الطريقة الج ا رحية للعلاج وهي حالة طبية غير قليلة. إن الهدف من هذه الد ا رسة هو تحليل مجموعة من المرضى الذين أجريت لهم عمليات استئصال الغدة الدرقية الممتدة خلف عظم القص ود ا رسة نتائج العمليات (المضاعفات والوفيات) من خلال فتح الرقبة أي دون اللجوء إلى فتح عظم القص.طرق البحث: تم د ا رسة عمليات استئصال الغدة الدرقية للفترة من شباط 1995 ولغاية كانون الأول 2009 للحالات الذين لديهم تضخم الغدة( الد ا رق) خلف عظم القص.النتائج: من مجموع مئتي وخمسون مريض, خمسون منهم ( 20 %) لديهم تضخم الغدة الدرقية خلف عظم القص. خواص 80 %) نساء 10 رجال ( 20 %). أكثر الأع ا رض شيوعا هي ضيق التنفس ) المرضى تشمل معدل العمر 4 سنة، 40 37 مريض ( 74 %)، و 6 مرضى ( 12 %) بدون أع ا رض انظغاطية. أشعة الصدر قبل العملية أخذت لكافة المرضى وتبين مايلي: الضغط على ألرغامي (القصبة الهوائية) في 40 مريض ( 80 %)، انح ا رف ألرغامي في 10 مرضى%20 ). جميع الحالات المرضية تم استئصال الغدة من الرقبة وبدون فتح عظم القص. كانت نسبة المضاعفات بعد )10 م ريض) والتي تشمل تجمع دموي في 3، التهاب الجرح في 2، فشل مبكر وقتي في الدريقة 3، وإصابة ) % العملية 20 جزئية في العصب ال ا رجع للحنجرة 2 من المرض .لا يوجد مريض في حالة إصابة دائمية في العصب ال ا رجع للحنجرة أو هبوط دائمي في الغدة المجاورة للدرقية (الدريقة) كما لأتوجد حالات تلين ألرغامي أو حالات وفيات في هذه الد ا رسة.الاستنتاج: استئصال الغدة الدرقية من خلال فتح الرقبة بدون فتح عظم القص لمرضى تضخم الغدة الدرقية (الد ا رق) ذات الامتداد خلف عظم القص تعتبر عملية أمينة مع مضاعفات قليلة وبدون وفيات.

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