Sledzinski, Maciej1,2; Sledzinski, Zbigniew2
1 Department of Emergency Medicine, Medical University of Gdansk, Poland
2 Department of General, Endocrinology and Transplant Surgery, Medical University of Gdansk, Poland
Background: Thyroidectomy is a common procedure performed at the department of general surgery in Poland. In spite of not much operational difficulty, it requires precision and experience.
Methods: Among 66 patients (52 females, 14 males; mean age 53.23years) with thyroid cancer 64 thyroidectomies and 2 lobectomies followed by radicalization were performed within 2 years. Data from the procedure, histopathological examination and 1-year follow-up were analyzed.
Results: 56 papillary carcinoma, 6 follicular carcinoma, 2 medullary carcinoma, 1 DLBCL lymphoma, 1 Hurtle cell carcinoma were diagnosed. Neuromonitoring was used occasionally. In 57 procedures both laryngeal nerves were visible. Histopathological studies found 16 fragments of parathyroid gland tissue and 9 infiltrations of cancer in the cut line. Ultrasonography showed 16 remnant thyroid tissue <1ml and in 7 >1ml including 1 patient with local recurrence which needed resection. 14 patients had reactive lymph nodes, none metastatic. 14 patients were qualified for complementary J131 therapy. After 1-year thyroglobulin level and iodine uptake was low. Calcium and PTH levels were normal. Patients assessment of the wound was satisfactory. Laryngoscopy revealed 6 unilateral vocal fold paresis: 2 transient and 1 due to cancer infiltration. The occurrence of vocal cord paresis depended on the shorter duration of surgery and the operator’s confidence in the full identification of both nerves.
Conclusion: The analysis showed a good therapeutic effect. The occurrence of vocal cord paresis confirms the importance of precision and accuracy in this surgical procedure and the need for more frequent use of neuromonitoring of recurrent laryngeal nerves.