The Indications and Safety Assessment of Total Thyroidectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Huiyuan , WANG Xiaohui , LI Fei ,  LUO Bin

Department of General Surgery， Xuanwu Hospital of Capital Medical University， Beijing 100053， China;

Corresponding author：

LUO Bin, Email: luobin@xwh.ccmu.edu.cn

Keywords：

Thyroidectomy; Recurrent laryngeal nerve; Parathyroid; Complication

Video：

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Objective 　To investigate the indications and prevention of complications of total thyroidectomy in the management of thyroid diseases.
Methods 　Eighty five patients who received total thyroidectomy between Jan. 2009 and Dec. 2011 were retrospectively analyzed with regard to the surgical procedures and postoperative complications. There were 46 thyroid cancers， 38 nodular goiters， and 1 Hashimoto thyroiditis.
Results 　The postoperative pathological exam-inations revealed that 9 （19.6%） of 46 thyroid cancers were bilateral， and all of nodular goiters were also bilateral multiple nodule. Bilateral recurrent laryngeal nerves were exposed in all of the patients in which 4 recurrent laryngeal nerves were invaded by cancer and 1 was sacrificed. There were 5 patients whose parathyroids were not identified and protected during the operation. Two patients developed postoperative bleeding and needed reoperation， 6 patients developed hoarseness of whom 5 patients recovered except for the one whose nerve was sacrificed. And in terms of hypoparathyroidism， 33 （38.8%） patients developed transient hypocalcemia related symptoms. The permanent hypoparathyroidism occurred only in 2 patients.
Conclusions 　Total thyroidectomy is a safe procedure in the management of thyroid cancer and bilateral nodular goiter. Exposing the recurrent laryngeal nerve and parathyroid is an effective method to prevent major complica-tions. Invasion of recurrent laryngeal nerve by thyroid cancer might not lead to hoarseness.

Citation： WANG Huiyuan,WANG Xiaohui,LI Fei,LUO Bin,.. The Indications and Safety Assessment of Total Thyroidectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(4): 427-431. doi: Copy

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2.	Byrd JK， Yawn RJ， Wilhoit CS， et al. Well differentiated thyroid carcinoma：current treatment[J]. Curr Treat Options Oncol， 2012， 13(1)：47-57.
3.	Grant CS， Stulak JM， Thompson GB， et al. Risks and adequacy of an optimized surgical approach to the primary surgical manag-ement of papillary thyroid carcinoma treated during 1999-2006[J]. World J Surg， 2010， 34(6)：1239-1246.
4.	Barczyński M， Konturek A， Stopa M， et al. Total thyroidectomy for benign thyroid disease： is it really worthwhile?[J] . Ann Surg， 2011， 254(5)：724-730.
5.	Efremidou EI， Papageorgiou MS， Liratzopoulos N， et al. The efficacy and safety of total thyroidectomy in the management of benign thyroid disease： a review of 932 cases [J]. Can J Surg， 2009， 52(1)：39-44.
6.	Barczyński M， Konturek A， Hubalewska-Dydejczyk A， et al. Five-year follow-up of a randomized clinical trial of total thyroidectomyversus Dunhill operation versus bilateral subtotal thyroidectomy for multinodular nontoxic goiter[J]. World J Surg， 2010， 34(6)：1203-1213.
7.	Barczyński M， Konturek A， Hubalewska-Dydejczyk A， et al. Randomized clinical trial of bilateral subtotal thyroidectomy versustotal thyroidectomy for Graves’ disease with a 5-year follow-up[J]. Br J Surg， 2012， 99(4)：515-522.
8.	Wilhelm SM， McHenry CR. Total thyroidectomy is superior to subtotal thyroidectomy for management of Graves’ disease in the United States[J]. World J Surg， 2010， 34(6)：1261-1264.
9.	徐少明. 对甲状腺癌应慎行甲状腺全切术[J]. 中国普外基础与临床杂志， 2009， 16(5)：344-347.
10.	房居高，马泓智，张忠宝，等. 甲状腺全切术适应症及并发症探讨[J]. 中华耳鼻咽喉头颈外科杂志， 2010， 45(11)：904-907.
11.	张少强，姚小宝，白艳霞，等. 甲状腺全切术的安全性分析[J].临床耳鼻咽喉头颈外科杂志， 2011， 25(9)：817-822.
12.	孙团起，吴毅. 甲状腺结节手术适应症和术式选择[J]. 中国普外基础与临床杂志， 2011， 18(8)：803-805.
13.	王会元，李非，罗斌. 甲状腺手术中常规显露喉返神经的意义[J]. 国际外科学杂志， 2011， 38(5)：314-318.
14.	Schmitz-Winnenthal FH， Schimmack S， Lawrence B， et al. Quality of life is not influenced by the extent of surgery in patients with benign goiter[J]. Langenbecks Arch Surg， 2011， 396(8)：1157-1163.
15.	Skinner MA， Moley JA， Dilley WG， et al. Prophylacticthyroidectomyin multiple endocrine neoplasia type 2A[J]. N Engl J Med，.
16.	Mazzaferri EL， Jhiang SM. Long-term impact of initial surgicaland medical therapy on papillary and follicular thyroid cancer[J]. Am J Med， 1994， 97(5)：418-428.
17.	Pelizzo MR， Boschin IM， Toniato A， et al. Papillary thyroid carc-inoma：35-year outcome and prognostic factors in 1 858 patients[J]. Clin Nucl Med， 2007， 32(6)：440-444.
18.	Bilimoria KY， Bentrem DJ， Ko CY， et al. Extent of surgeryaffects survival for papillary thyroid cancer[J]. Ann Surg， 2007，.
19.	NCCN Guideline. http：//www.nccn.org/professionals/physician_gls/f_guidelines.asp #thyroid.
20.	Cocchiara G， Cajozzo M， Amato G， et al. Terminal ligature of inferior thyroid artery branches during total thyroidectomy for mult-inodular goiter is associated with higher postoperative calcium andPTH levels[J]. J Visc Surg， 2010， 147(5)：329-332.
21.	Chiang FY， Lee KW， Chen HC， et al. Standardization of intraoperative neuromonitoring of recurrent laryngeal nerve in thyroid operation[J]. World J Surg， 2010， 34(2)：223-229.
22.	Zedenius J， Wadstrom C， Delbridge L. Routine autotransplantation of at least one parathyroid gland during total thyroidectomy may reduce permanent hypoparathyroidism to zero[J]. 1999， 69(11)：794-797.
23.	Nishida T， Nakao K， Hamaji M， et al. Preservation of recurrent laryngeal nerve invaded by differentiated thyroid cancer[J]. Ann Surg， 1997， 226(1)：85-91.
24.	(3)：375-381.
25.	， 353(11)：1105-1113.

1. Cooper DS， Doherty GM， Haugen BR， et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer[J]. Thyroid， 2009， 19(11)：1167-1214.
2. Byrd JK， Yawn RJ， Wilhoit CS， et al. Well differentiated thyroid carcinoma：current treatment[J]. Curr Treat Options Oncol， 2012， 13(1)：47-57.
3. Grant CS， Stulak JM， Thompson GB， et al. Risks and adequacy of an optimized surgical approach to the primary surgical manag-ement of papillary thyroid carcinoma treated during 1999-2006[J]. World J Surg， 2010， 34(6)：1239-1246.
4. Barczyński M， Konturek A， Stopa M， et al. Total thyroidectomy for benign thyroid disease： is it really worthwhile?[J] . Ann Surg， 2011， 254(5)：724-730.
5. Efremidou EI， Papageorgiou MS， Liratzopoulos N， et al. The efficacy and safety of total thyroidectomy in the management of benign thyroid disease： a review of 932 cases [J]. Can J Surg， 2009， 52(1)：39-44.
6. Barczyński M， Konturek A， Hubalewska-Dydejczyk A， et al. Five-year follow-up of a randomized clinical trial of total thyroidectomyversus Dunhill operation versus bilateral subtotal thyroidectomy for multinodular nontoxic goiter[J]. World J Surg， 2010， 34(6)：1203-1213.
7. Barczyński M， Konturek A， Hubalewska-Dydejczyk A， et al. Randomized clinical trial of bilateral subtotal thyroidectomy versustotal thyroidectomy for Graves’ disease with a 5-year follow-up[J]. Br J Surg， 2012， 99(4)：515-522.
8. Wilhelm SM， McHenry CR. Total thyroidectomy is superior to subtotal thyroidectomy for management of Graves’ disease in the United States[J]. World J Surg， 2010， 34(6)：1261-1264.
9. 徐少明. 对甲状腺癌应慎行甲状腺全切术[J]. 中国普外基础与临床杂志， 2009， 16(5)：344-347.
10. 房居高，马泓智，张忠宝，等. 甲状腺全切术适应症及并发症探讨[J]. 中华耳鼻咽喉头颈外科杂志， 2010， 45(11)：904-907.
11. 张少强，姚小宝，白艳霞，等. 甲状腺全切术的安全性分析[J].临床耳鼻咽喉头颈外科杂志， 2011， 25(9)：817-822.
12. 孙团起，吴毅. 甲状腺结节手术适应症和术式选择[J]. 中国普外基础与临床杂志， 2011， 18(8)：803-805.
13. 王会元，李非，罗斌. 甲状腺手术中常规显露喉返神经的意义[J]. 国际外科学杂志， 2011， 38(5)：314-318.
14. Schmitz-Winnenthal FH， Schimmack S， Lawrence B， et al. Quality of life is not influenced by the extent of surgery in patients with benign goiter[J]. Langenbecks Arch Surg， 2011， 396(8)：1157-1163.
15. Skinner MA， Moley JA， Dilley WG， et al. Prophylacticthyroidectomyin multiple endocrine neoplasia type 2A[J]. N Engl J Med，.
16. Mazzaferri EL， Jhiang SM. Long-term impact of initial surgicaland medical therapy on papillary and follicular thyroid cancer[J]. Am J Med， 1994， 97(5)：418-428.
17. Pelizzo MR， Boschin IM， Toniato A， et al. Papillary thyroid carc-inoma：35-year outcome and prognostic factors in 1 858 patients[J]. Clin Nucl Med， 2007， 32(6)：440-444.
18. Bilimoria KY， Bentrem DJ， Ko CY， et al. Extent of surgeryaffects survival for papillary thyroid cancer[J]. Ann Surg， 2007，.
19. NCCN Guideline. http：//www.nccn.org/professionals/physician_gls/f_guidelines.asp #thyroid.
20. Cocchiara G， Cajozzo M， Amato G， et al. Terminal ligature of inferior thyroid artery branches during total thyroidectomy for mult-inodular goiter is associated with higher postoperative calcium andPTH levels[J]. J Visc Surg， 2010， 147(5)：329-332.
21. Chiang FY， Lee KW， Chen HC， et al. Standardization of intraoperative neuromonitoring of recurrent laryngeal nerve in thyroid operation[J]. World J Surg， 2010， 34(2)：223-229.
22. Zedenius J， Wadstrom C， Delbridge L. Routine autotransplantation of at least one parathyroid gland during total thyroidectomy may reduce permanent hypoparathyroidism to zero[J]. 1999， 69(11)：794-797.
23. Nishida T， Nakao K， Hamaji M， et al. Preservation of recurrent laryngeal nerve invaded by differentiated thyroid cancer[J]. Ann Surg， 1997， 226(1)：85-91.
24. (3)：375-381.
25. ， 353(11)：1105-1113.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The Indications and Safety Assessment of Total Thyroidectomy

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