Complicaciones post operatorias en la tiroidectomía total por bocio multinodular en el Instituto Nacional del Cáncer*

Blás Antoni Medina Ruíz

doi:10.18004/

Authors

Blás Antoni Medina Ruíz Cátedra de Anatomía Descriptiva. Facultad de Ciencias Médicas. Universidad Nacional de Asunción Departamento de Cirugía Oncológica del Instituto Nacional del Cáncer.

DOI:

https://doi.org/10.18004/

Keywords:

Multinodular goiter, total thyroidectomy, hypocalcemia, nerve injury, Paraguay

Abstract

Introduction: The multinodular goiter is the most frequently thyroid disease treated at the National Cancer Institute of Paraguay. Frequently the process affects the entire glandular volume and the total thyroidectomy, when indicated, is a valid therapeutic resource. Critics of this technique argue about the increased risk of postoperative complications, however in referral centers is shown that this does not happen. By studying the complications of the operative technique is demonstrated the advantages and disadvantages of it are demonstrated in the Institution. Material and method: Observational, descriptive, cross-sectional study with an analytical component, of 185 patients who underwent total thyroidectomy for multinodular goiter or totalizations of previous partial thyroidectomy for the pathology, in the Department of Surgery, Cancer Institute from , 2000 to 2011. Results: The surgeries performed were: total thyroidectomy in 176 cases and 9 previous partial thyroidectomy for recurrent goiter were totalized. Presented temporary hypocalcemia 15.1% cases, permanent hypocalcemia 1% and temporary dysphonia 8.6%. No case of permanent dysphonia was registered. We had no mortality in this study. Conclusion: The presence of parathyroid glands in the biopsy sample occurred in 15,9% and was not associated with hypocalcemia. The results show that the total thyroidectomy has similar complication rate with others centers with experience in thyroid disease management. Occult carcinoma was presented as a finding in the surgical specimen of 12,4% of cases.

References

1. Dralle H, Lorenz K, Machens A. State of endemic goiter- a plea for individualizing the extent of resection instead of heading for routine total thyroidectomy. Langenbecks Arch Surg 2011; 396:1137–1143.

2. Salvaneschi J P, García J R A R. El bocio endémico en la República Argentina. Antecedentes, extensión y magnitud de la endemia, antes y después del empleo de la sal enriquecida con yodo. Primera parte. Rev Argent Endocrinol Metab 2009; 46(2): 35-57.

3. Mendes H, Zagalo- Cardoso J A. Estudo epidemiológico de prevalencia do bocio endémico em Oleiros. Acta Medica Portuguesa 2002;15:101-11.

4. Oré J, Saavedra J. Patología quirúrgica de la glándula tiroides. An Fac Med 2008; 69(3):182-7.

5. Hillman Gadea N, Álvarez Escolá C, Dassen C. Bocio. Bocio difuso y multinodular normofuncionante. Medicine 2004;9(14):831-837.

6. Hegedüs L, Steen S, Bonnema J, Bennedbaek F N. Management of simple nodular goiter: Current status and future perspectives. Endocrine Reviews 2003;24(1):102-32.

7. Paredes Suárez M. Historia de la Medicina. Aspectos históricos de la deficiencia de Yodo en América. Revista Medicina 2001;23(2):124-31.

8. Efremidou E, Papageorgiou M, Liratzopoulos N, Manolas K. The efficacy and safety of total thyroidectomy in the management of bening thyroid disease: a review of 932 cases. Can J Surg 2009;Vol 52(1):39-44.

9. Acun Z, Comert M, Cihan A, Suat Can U, Bulent U y Guldeniz K. Near-total thyroidectomy could be best treatment for thyroid disease in endemic regions. Arch Surg 2004;139(4):444-7.

10. Barcynski M, Konturek A, Hubalewska A, Golkowski F, Cichon S, Nowak W. Five-year follow-up of a randomized clinical trial of Total Thyroidectomy versus Dunhill Operation versus Bilateral Subtotal Thyroidectomy for multinodular nontoxic goiter. World J Surg 2010;34:1203–13.

11. Pappalardo G, Guadalaxara A, Frattaroli F M, Illomei G, Falashchi P. Total compared with Subtotal Thyroidectomy in benign nodular disease: Personal series and review of published reports. Eur J Surg 1998;164:501-6.

12. Khadra M, Delbridge T, Reeve A, Poole G y Crummer P. Total thyroidectomy: Its role in the management of thyroid disease. Aust N Z Surg 1992;62:91-5.

13. Hisham A N, Azlina A F, Aina E N, Sarojah A. Total Thyroidectomy: The procedure of choice for multinodular goitre. Eur J Surg 2001;167:403-5.

14. Müller P E, Jakoby R, Heinert G, Spelsberg F. Surgery for Recurrent Goitre: Its complications and their risk factors. Eur J Surg 2001;167:816-21.

15. Delbridge L, Guinea A, Reeve T. Total thyroidectomy for bilateral bening multinodular goiter. Arch Surg 1999;134(12):1389-93.

16. Mohamed S A, Thrush S, Scott- Coobes D M. Acute stridor secondary to recurrent multinodular goitre after previous subtotal thyroidectomy: Compartment syndrome of the neck. Eur J Surg 2002;168:372-3.

17. Ríos A, Rodriguez J M, Canteras M, Riquelme J, Illana J, Balsalobre M D, Parrilla P. Estudio multivariable de los factores de riesgo para desarrollar complicaciones en la cirugía del bocio multinodular. Cir Esp 2005;77(2):79-85.

18. Boucek J, Kastner J, Skrivan J, Grosso E, Gibelli B, Giugliano G, Betka J. Occult thyroid carcinoma. Acta Otorhinolaryngol Ital 2009;29:296-304.

19. Hall S F, Walker H, Siemens R, Schneeberg A. Increasing Detection and Increasing Incidence in Thyroid Cancer. World J Surg 2009;33:2567-71.

20. Ríos Zambudio A, Rodriguez J, Riquelme J, Soria T, Canteras M, Parrilla P. Prospective study of postoperative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery. Ann Surg 2004;240(1):18-25.

21. Hulley S, Cummings S, Browner W, Grady D, Newman T. Diseño de investigaciones clínicas. 3° Edición Wolters Kluwer-Lippincott- Williams & Wilkins 2007: 102 .

22. Gómez Palacios A, Gutiérrez M T, Gómez J, Taibo M A; Gómez Zabala J, Barrios B, Escobar A, Iturburu I. Evolución y resultados en el manejo quirúrgico del bocio multinodular. Cir Esp 2006;80(2):83-9.

23. Tezelman S, Borucu I, Senyurek G, Tunca F, Terzioglu T. The change in surgical practice from subtotal to near-total or total thyroidectomy in the treatment of patients with bening multinodular goiter. World J Surg 2009;33(3):400-5.

24. Erbil Y, Barbaros U, Salmashoglu A, Tulumöglu Y, Bozbora A, Özarmagan S. the advantage of near-total thyroidectomy to avoid postoperative hypoparathyridism in benign multinodular goiter. Langenbecks Arch Surg 2006;391:567-73.

25. Müller P E, Kabus S, Robens E, Spelsberg F. Indications, risks, and acceptance of total thyroidectomy for multinodular benign goiter. Surg Today 2001;31:958-62.

26. Araújo Filho V J F, Machado M T A S, Sondermann A, De Carlucci D, Ajub Moysés R, Ferraz A R. Hipocalcemia e hipoparatireoidismo clínico após tireoidectomia total. Rev Col Bras Cir 2004;31(1):233-5.

27. Ballantone R, Lombardi C P, Bossola M, Boscherini M, De Crea C, Alesina P, Traini E, Princi P. Total Thyroidectomy for management of benign thyroid disease: Review of 526 cases. World J Surg 2002;26:1468-71.

28. Perzik S L. Cirugía en la enfermedad tiroidea. Indicaciones para una tiroidectomía total. Editorial Médica Panamericana , Bs As- Argentina 1983:65-7.

29. Kuriloff D B, Kizhner V. Parathyroid gland preservation and selective autotransplantation utilizing topical lidocaine in total thyroidectomy. The Laryngoscope 2010;120:1342–4.

30. Sheng Dong W, Li G. Is routine calcium supplementation necessary in patients undergoing total thyroidectomy plus neck dissection?. Surg Today 2011;41:183-8.

31. Andrade Sousa A, Porcaro Salles J M, Arantes Soares J M, Meyer de Moraes G, Rezende Carvalho J, Savassi Rocha P R. course of ionized calcium after thyroidectomy. World J Surg 2010;34:987-92.

32. Wiseman J E, Mossanen M, Ituarte P H G, Bath J M T, Yeh M W. An algorithm informed by the parathyroid hormone level reduces hypocalcemic complications of thyroidectomy. World J Surg 2010;34:532-7.

33. Wong C, Price S, Scott Coombes D. Hypocalcaemia and parathyroid hormone assay following total thyroidectomy: Predicting the future. World J Surg 2006;30:825-32.

34. Erbil Y, Bozbora A, Özbey N, Issever H, Aral F, Özarmagan S, Tezelman S. Predictive value of age and serum parathotmone and vitamin D3 levels for postoperative hypocalcemia after total thyroidectomy for nontoxic multinodular goiter. Arch Surg 2007;142(12):1182-7.

35. Gauger P G, Reeve T S, Wilkinson M, Delbridge L W. Routine parathyroid autotransplantation during total thyroidectomy: the influence of technique. Eur J Surg 2000;166:605-9.

36. Jumaily J S, Noordzij J P, Dukas A G, Lee S L, Bernet V J, Payne R J, McLeod I K, Hier M P, Black M J, Kerr P D, Raffaelli M, Bellantone R, Lombardi R, Dietrich M S. Prediction of hypocalcemia after using 1-to 6-hour post operative parathyroid hormone and calcium levels: An analysis of pooled individual patient data fron 3 observational studies. Head Neck 2010;32:427-34.

37. Abboud B, Sleilaty G, Braidy C, Zeineddine S, Ghorra C, Abadjian G, Tabchy B. Careful examination of thyroid specimen intraoperatively to reduce incidence of inadvertent parathyroidectomy during thyroid surgery. Arch Otolaryngol Head Neck Surg 2007;133(11):1105-10.

38. Asari R, Passler C, Kaczirek K, Scheuba C, Niederle B. Hypoparathyroidism after total thyroidectomy. Arch Surg 2008;143(2):132-7.

39. Pascual Palmieri N, Poenitz F, Novelli J L. Glándulas paratiroides en tiroidectomías totales: identificación y características. Glánd Tir Paratir 2009; (18):24-27.

40. Pfleiderer A G, Ahmad N, Draper M R, Vrotsou K, Smith W K. The timing of calcium measurements in helping to predict temporary and permanent hypocalcaemia in patients having completion and total thyroidectomies. Ann R Coll Surg Engl 2009;91:140-6.

41. Gac P, Cabané P, Amat J, Huidobro F, Rossi R, Rodríguez F, Ferrada C, Cardemil F. Incidencia de hipocalcemia pos tiroidectomía total. Rev Med Chile 2007;135:26-30.

42. Sakorafas G H, Stafyla V, Bramis C, Kotsifopoulos N, Kolettis T, Kassaras G. Incidental parathyroidectomy during thyroid surgery: An underappreciated complication of thyroidectomy. World J Surg 2005;29:1539-43.

43. Vaiman M, Nagibin A, Olevson J. Complications in Primary and Completed Thyroidectomy. Surg Today (2010) 40:114-8.

44. Casella C, Pata G, Nascimbeni R, Mittempergher F, Salerni B. Does extralaryngeal branching have an impact on the rate of postoperative transient or permanent recurrent laryngeal nerve palsy. World J Surg 2009;33:261-5.

45. Shindo M, Chheda N N. Incidence of vocal paralysis with and without recurrent laryngeal nerve monitoring during thyroidectomy. Arch Otolaryngol Head Neck Surg 2007;133:481-5.

46. Van Lierde K, D´haeseleer E, Wuyts F L, Baudonck N, Bernaert L, Vermeersch H. Impact of thyroidectomy without laryngeal nerve injury on volcal quality characteristics: An objective multiparameter approach. Laryngoscope 2010;120:338-45.

47. Rosato L, Carlevato M T, De Toma G, Avenia N. Recurrent laryngeal nerve damage and phonetic modifications after total thyroidectomy: Surgical malpractice only or predictable sequence?. World J. Surg 2005;29:780-4.

48. Echternach M, Maurer C, Mencke T, Schilling M, Verse T, Richter B. Laryngeal complications after thyroidectomy. Is it always the surgeon?. Arch Surg 2009;144(2):149-53.

49. Kocak S, Aydintug S, Özbas S, Kocak I, Kücük B, Baskan S. Evaluation of vocal cord function after thyroid surgery. Eur J Surg 1999;165:183-6.

50. Terris D J, Khichi S, Anderson S K, DO, Seybt M W. Reoperative thyroidectomy for benign thyroid disease. Head Neck 2010;32:285-9.

51. Aggarwal G, Agarwal V. Is total thyroidectomy the surgical procedure of choice for benign multinodular goiter?. An evidence-based review. World J Surg 2008;32:1313-24.

52. Mishra A, Agarwal A, Agarwal G, Mishra SK. Total thyroidectomy for benign disorders in a endemic region. World J Surg 2001;25(3):307-10.

53. Baloch M N, Aslam T, Maher M. Rationale for near total thyroidectomy in patients with multinodular goiter. Pakistan J Surg 2007;23(3):177-9.

54. Tezelman S, Borucu I, Senyurek G, Tunca F, Terzioglu T. The change in surgical practice from subtotal to near-total or total thyroidectomy in the treatment of patients with bening multinodular goiter. World J Surg 2009;33(3):400-5.

55. Ríos Zambudio A, Rodríguez González J M, Canteras M, Balsalobre M D, Tebar F J, Parrilla P. Diagnóstico perioperatorio de malignidad asociada al bocio multinodular. Cir Esp 2004;76(6):369-75.

56. Erbil Y, Barbaros U, Salmashoglu A, Mete Ö, Ïssever H, Özarmagan S, Yilmazbayhan D, Tezalman. Effect of thyroid gland volumen in preoperative detection of suspected malignat thyroid nodules in a multinodular goiter. Arch Surg 2008;143(6):558-63.

57. Lo C Y, Chan W F, Lang B H H, Lam K Y, Wan K Y. Papillary microcarcinoma: Is there any difference between clinically overt and occult tumors?. World J Surg 2006;30:759-66.

58. Friguglietti C U M, Lin C, Kulcsar M A V. Tireoidectomia total para bócio multinodular. Arq Bras Endocrinol Metab 2003;47(5):558-65.

59. Sukumar R, Agarwal A, Grupta S, Mishra A, Agarwal G, Verma A K, Mishra S K. Prediction of LT4 replacement dose to achieve euthyroidism in subjets undergoing total thyroidectomy for benign thyroid disorders. World J Surg 2010;34:527-31.