• Asian Pacific Journal of Cancer Prevention
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• 제13권10호
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• pp.5225-5228
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• 2012

Introduction : The objective of this study was to analyze the complication rates after completion thyroidectomy and compare them with primary total benign and malign thyroidectomy causes in total of 647 patients. Patients and Methods: Among 647 patients, there were 159 receiving completion thyroidectomy for differentiated thyroiud cancer (DTC) (Group 1); 217 patients receiving total thyroidectomy for DTC (Group 2) and 271 given total thyroidectomy for benign diseases (Group 3). Results: When groups were compared for complications, there were no significant difference except temporary hypocalcemia between completion thyroidectomy and total thyroidectomy for DTC. When the total thyroidectomies were compared (Group 2 and 3), there were no significant difference observed except unilateral temporary RLN palsy. Conclusion: With improvements in surgical technique and experience, complication rates of thyroidectomy performed for benign or malign diseases are reduced. In spite of the improvement in surgical experience, temporary RLN palsy and hypoparathyroidism are the main complications in completion thyroidectomies which need special attention. To evaluate the patients more carefully in preoperative period and performing adequate thyroidectomy appears more logical.

• 대한두경부종양학회지
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• 제13권1호
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• pp.35-39
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• 1997

Background: Completion thyroidectomy is defined as the surgical removal of the remnant thyroid tissue following procedures less than total or near-total thyroidectomy. Although some authors advocate subtotal thyroidectomy with lower complication rates, total or completion thyroidectomy have been defended by others because of the improved survival and lower morbidity that is comparable with subtotal thyroidectomy. Objectives: The purpose of this paper is to review the necessity and safety of completion thyroidectomy for differentiated thyroid carcinoma(DTC). Materials & Methods: During the past 10 years(1986 to 1996) , authors have performed 211 total thyroidectomy. Ten of these patients were treated by completion thyroidectomy for DTC. Initial operation of 7 patients had been performed at St. Vincents Hospital and 3 patients at other hospital. The medical records of patients undergoing completion thyroidectomy were retrospectively reviewed. Results: The completion thyroidectomy specimen contained residual tumor cells in 8 of the 8 patients with papillary carcinoma and none of the two patients with follicular carcinoma. Complications of completion thyroidectomy were transient hypoparathyroidism in two patients and transient unilateral recurrent laryngeal nerve palsy in one patient. But permanent complications were not noticed. Conclusion: We recommend completion thyroidectomy as an efficient and safe method of surgical treatment with a low complication rate for DTC.

• 대한두경부종양학회지
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• 제8권1호
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• pp.14-20
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• 1992

To clarify the safety of both total and near-total thyroidectomy, and to guide a selectionof an adequate type of surgical treatment of thyroid diseases, 192 consecutive total or near-total thyroidectomy cases were reviewed. They were divided into two groups: ont, the total thyroidectomy group(Group T,N=111) and the other, the near-total thyroidectomy group (Group NT, N=81). In both groups, complication rates, associations of complication rates with extents of surgery and stage of lesion were observed. Complication rate was significantly higher in Group T (53.6% vs 12.3%, p<0.05). But the rate of permanent complications such as permanent hypoparathyroidism and recurrent laryngeal nerve injury was remarkably low(4.5% in Group T, 6.0% in Group NT) and shows no significant difference in both groups. There was no permanent complication in cases where any type of neck dissection had not been performed regardless of the type thyroidectomy. But among whom underwent central compartmental neck dissection(CCND) and functional neck dissection(FND), 4(4.4%) and 4(6.4%) cases showed permanent complications. There was no statistical significance in differences between Group I and NT. In cases who underwent concomittant classical radical neck dissection(RND), 3(25.5%) showed permament complications. In this subgroups, complications were significantly higher in Group T(p<0.005). Complications were also directly related to the stage of the lesion. Only one patient showed permanent complication in 74 intracapsular lesions but 9 permanent complications were observed in 118 advanced lesions. We could clarify both total and near-total thyroidectomy were safe operations and the complications were related to accompanying neck dissections and the disease status rather than total or near-total thyroidectomy itself. Thus, we think that for the cases where higher complication rates are expected, such as locally advanced thryoid cancers or the cases which required wider neck dissection, the near-total thyroidectomy would be a preferrable method.

• 대한두경부종양학회지
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• 제14권1호
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• pp.94-98
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• 1998

Background: Completion thyroidectomy can most accurately be described as reexploration of the neck to remove the contralateral thyroid lobe. This procedure has commonly been performed when the histopatholoic condition of the ipsilateral thyroid lobe reveals papillary or follicular carcinoma of the thyroid. Because of a definitely increased risk of complications with completion thyroidectomy, avoiding its routine use is important. But this operation is safe procedure with minimal morbidity by coinsidering interval, surgical approach, surgeon's experience. The purpose of this review is to define the indication, and the safety of completion thyroidectomy. Materials & Methods: Recent 2 years(1995. 1 to 1996. 12), we have performed 161 thyroid operations. Fourteen of these patients were treated by completion thyroidectomy. The patients ranged in age from 21 to 66 years. We have routinely used ultrasound guided needle biopsy and intraoperative frozen section. Result: The completion thyroidectomized specimen contained papillary carcinoma in 12 (86%), follicular carcinoma in 1(7%) and follicular adenoma(no residual tumor) in 1(7%). The complication of completion thyroicetomy was absent, although case number was a few. The indication of completion thyroidectomy in our study was defined recurrence in 9 and staging in 5. The site of recurrence consists of residual thyroid in 7 and residual thyroid added cervical lymph node in 2. The staging consists of incomplete thyroidectomy 3, questionable frozen biopsy 1, and huge follicular carcinoma. Conclusion: The incidence of completion thyroidectomy appear to be increasing by application of ultrasonogram in follow-up of thyroidectomized patients, especially, for the improving of well differentiated thyroid carcinoma. Experience suggests that the morbidity of completion thyroidectomy is low, so we recommend completion thyroidectomy as an efficient and safe method of surgical treatment.

• 대한두경부종양학회지
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• 제13권1호
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• pp.45-50
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• 1997

Total thyroidectomy has been advocated as the treatment of choice for most well differentiated thyroid carcinomas. Many surgeons have an aversion to total thyroidectomy, however, because of an allegedly high frequency of complications as compared with those resulting from other operation methods. In this report we reviewed our experience with 37 consecutive total thyroidectomy(January 1995 to December 1996). The clinical features are similar to other studies. The sex ratio is 1 : 3.1(M : F), third decade occupies 33% of cases. The anterior neck mass is the most frequent symptom(95%). In the duration of symptom, 35% of patients was within 3 months. Thirty five cases are cancer, and two cases are Hashimoto's thyroditis. The papillary carcinoma is the most common pathologic type(86%). Total thyroidectomy was done in 20 cases, and total thyroidectomy with modified neck dissection was done in 17 cases. The five postoperative complications occurred in 3 patients among 37 patients: postoperative bleeding in 1, transient hoarseness in 2, transient hypoparathyroidism in 2. Thirty four cases received $I^{131}$ scan and therapy, two cases received thyroid hormone replacement, and one case received chemotherapy. We think that total thyroidectomy can be done without additional risk compared with other thyroid operation methods, with meticulous and careful surgical technique.

• 대한기관식도과학회지
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• 제16권1호
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• pp.27-32
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• 2010

Organ preservation surgery and minimally invasive surgery have been developed during the past 20 years with major focus on transoral laser surgery, endoscopic surgery, and robotic surgery. Two major robotic surgeries in head and neck area are transoral robotic surgery (TORS) and robotic thyroidectomy. Transoral robotic surgery is a safe and efficacious method of surgical treatment of oropharyngeal. hypopharyngeal and laryngeal neoplasm. Advantages of the technique include adequate ability to visualize and manipulate lesions with two hands. TORS can provide magnified three dimensional views and overcome the limitation resulting from the "line of sight" which hinders transoral laser procedure. The swallowing function following transoral robotic surgery show superior and patients were able to retain or rapidly regain swallowing function in the majority of cases. Recently, robotic thyroidectomy has also been developed to overcome the [imitation of endoscopic thyroidectomy. Robotic thyroidectomy by a gasless unilateral axillo-breast or axillary approach using a da Vinci S Surgical Robot is a feasible and cosmetically excellent procedure. It can be a promising alternative to endoscopic thyroidectomy or conventional open thyroidectomy.

• 말소리와 음성과학
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• 제7권4호
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• pp.77-83
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• 2015

Voice complication without the laryngeal nerve injury can occur after thyroidectomy. The purpose of this study is to investigate voice changes according to extent of thyroidectomy with acoustic analysis. Thirty-five female patients with papillary thyroid carcinoma took voice evaluation at before and 1 month, and 3 months after thyroidectomy. Acoustic analysis parameters were speaking fundamental frequency(SFF), min $F_0$, max $F_0$, dynamic range $F_0$, jitter, shimmer, noise-to-harmonic ratio(NHR), and Cepstral prominence peak(CPP). Repeated-measured analysis of variance was applied. Time-related voice changes showed significant differences in all parameters except NHR. At 1 month after surgery, voice quality was worse and pitch was decreasing, but voice quality and pitch were improving at 3-month follow-up. Voice changes according to the extent of surgery were in SFF, max $F_0$, and dynamic range $F_0$. Time by surgery-related voice change existed only in min $F_0$. The result showed that the severity of voice complication depended on the extend of thyroidectomy which had a negative impact on $F_0$-related parameters. The deterioration of voice quality at 1 month after thyroidectomy may be affected by the loss of thyroid hormone in the blood. The descent of $F_0$-related parameters may be impacted by laryngeal fixation of surgical site adhesion.

• 대한한방내과학회지
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• 제42권5호
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• pp.746-759
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• 2021

Objectives: This study assessed the effect of a combination of Korean medicine and immunotherapy on three papillary thyroid cancer patients following thyroidectomy. Methods: The three patients who underwent thyroidectomy received Korean medical treatments, including acupuncture, moxibustion, pharmacopuncture, and immunotherapy. To evaluate the patients, symptoms were measured using the Numerical Rating Scale (NRS) and Karnofsky Performance Status Scale (KPS). Blood tests, including thyroid function tests, were conducted during treatment. Results: After treatment, postoperative pain and general weakness were gradually alleviated. Conclusions: These cases provide evidence that treatment with a combination of Korean medicine and immunotherapy can have substantial benefits for postoperative complications following thyroidectomy.

• Journal of Acupuncture Research
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• 제40권4호
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• pp.377-381
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• 2023

This study included a 42-year-old female farmer with a 2-year history of Graves' disease who visited the hospital for a total thyroidectomy for her grade III goiter based on World Health Organization classification. Besides Hegu (LI4) and Neiguan (PC6), extensively used for acupuncture analgesia in thyroid surgery in previous studies, three additional acupuncture points for acupuncture analgesia in thyroidectomy were evaluated in this study: Shuitu (ST10), Quepen (ST12), and Yifeng (SJ17). In this case, we used an electroacupuncture stimulator to stimulate the acupuncture points and combined acupuncture analgesia with diazepam and atropine sulfate administration as adjunct medications to calm the patient. The operation was completed without any complications. The findings revealed that stimulating the five acupuncture points, i.e., Hegu (LI4), Neiguan (PC6), Shuitu (ST10), Quepen (ST12), and Yifeng (SJ17), for acupuncture analgesia combined with adjunct medications is safe for maintaining an adequate level of analgesia and hemodynamic stability during thyroidectomy.

• 대한두경부종양학회지
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• 제11권2호
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• pp.185-190
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• 1995

Transient and permanent hypocalcemia after various types of thyroidectomy are well-known complications, and are more common after bilateral subtotal thyroidectomy for Graves' disease. However, their causative mechanisms are not well explained. Four hundred thirty patients with Graves' disease who underwent bilateral subtotal thyroidectomy from January 1983 through December 1992 were analyzed to determine the incidence and risk factors for the development of postthyroidectomy hypocalcemia. Of the 430 patients underwent bilateral subtotal thyroidectomy, symptomatic transient and permanent hypocalcemia developed in 24.2 % (104/430) and 0.5 % (2/430), respectively. With analysis of potential risk factors, the increase in incidence of the postthyroidectomy hypocalcemia was found to be statistically related to the larger thyroid gland, the larger amount of blood loss during thyroidectomy, the smaller remnant thyroid tissue, the higher levels of serum alkaline phosphatase and TBII titers. Our data suggest that impairment of parathyroid gland blood supply, degree of thyrotoxic osteodystrophy and autoimmune process of each patient are regarded as main mechanisms of postthyroidectomy hypocalcemia in patients with Graves' disease.