Clinical and Metabolic Changes Following Complicated Thyroid Resection Procedures

• Authors: Norbert Sławeta , Stanisław Głuszek , Jacek Heciak
• Languages of publication: EN

Abstracts

EN

Clinical and metabolic consequences of complicated thyroid resection procedures are rarely an object of complex analysis, and teams participating in treatment may have a very limited knowledge of them.The aim of the study was to assess clinical and metabolic consequences of complicated thyroid surgical procedures.Material and methods. In the years 2002-2007, 756 patients underwent surgery due to non-neoplastic thyroid diseases. Sixty-nine (9.1%) patients experienced complications manifesting as vocal cord paralysis and/or hypoparathyroidism. Follow-up examination was conducted in a group of 42 persons, which amounted to 61% of patients who experienced complications following thyroid surgical procedures. Follow-up examination, comprising assessment of morphotic blood elements, electrolyte, lipid and parathormone blood concentrations, thyroid hormone activity, respiratory function, vocal cord mobility, bone mineralization and ultrasound examination of the pocket left after thyroid resection, was conducted after the mean period of 43 months following surgery.Results. In the analyzed group, no significant differences in plasma electrolyte content were found (sodium, potassium, magnesium, calcium and phosphorus ions). In the group of patients with chronic hypoparathyroidism, no hypophosphatemia was observed, and there were no reports of concomitant nephrolithiasis or cataract. Increased cholesterol concentration was observed in the group of patients with chronic hypoparathyroidism and without hypoparathyroidism (p = 0.07). In 35% of patients with chronic vocal cord paralysis, abnormal results of spirometry tests were obtained. In the group of patients with chronic hypoparathyroidism, densitometry examination revealed higher T-score values compared with patients with transient hypoparathyroidism and vocal cord paralysis (p = 0.07). No bone mineralization disorders manifesting as pathological fractures were noted.Conclusions. The knowledge of clinical and metabolic consequences of complicated thyroid surgical procedures, due to their complexity, may be very limited among the members of both surgical teams and teams involved in management of complications. Development of a complication following thyroid surgery may be associated with significant homeostasis disorders, especially as regards calcium-phosphate metabolism, the skeletal system and the respiratory system.Such disorders can manifest long after the disease onset, only properly intensified and long-term management allows limitation of their extent.

Keywords

EN

thyroid surgery; thyroid surgery complications; hypoparathyroidism; vocal cord paralysis

• Journal: Polish Journal of Surgery
• Year: 2013
• Volume: 85
• Issue: 5
• Pages: 235-246

Dates

published

1 - 05 - 2013

online

12 - 06 - 2013

Contributors

author

Norbert Sławeta

• Department of General, Oncologic and Endocrine Surgery, District Hospital in Kielce. Kierownik: prof. dr hab. S. Głuszek

author

Stanisław Głuszek

• Department of General, Oncologic and Endocrine Surgery, District Hospital in Kielce. Kierownik: prof. dr hab. S. Głuszek
• Faculty of Health Sciences, Jan Kochanowski University in Kielce. Kierownik: prof. dr hab. S. Głuszek

author

Jacek Heciak

• Department of Diagnostic Imaging, District Hospital in Kielce. Kierownik: dr n. med. J. Heciak

References

• 1. Prades JM, Dumollard JM, Timoshenko A et al.: Multinodular goiter: surgical management and histopathological findings. Eur Arch Otorhinolaryngol 2002; 259: 217-21.
• 2. Erickson D, Gharib H, Li H, van Heerden JA: Treatment of patients with toxic multinodular goiter. Thyroid 1998; 8: 277-82.[PubMed][Crossref]
• 3. Okamoto T, Iihara M, Obara T: Management of hyperthyroidism due to Graves’ and nodular diseases. World J Surg 2000; 24: 957-61.[PubMed][Crossref]
• 4. DeGroot LJ: Treatment of multinodular goiter by surgery. J Endocrinol Invest 2001; 24: 820-22.[PubMed]
• 5. Dogan L, Karaman N, Yilmaz KB et al.: Total thyroidectomy for the surgical treatment of multinodular goiter. Surg Today 2011; 41: 323-27.[Crossref][WoS]
• 6. Sheikh IA , Waleem SS, Haider IZ et al.: Total thyroidectomy as primary elective procedure in multinodular thyroid disease. J Ayub Med CollAbbottabad 2009; 21: 57-59.
• 7. Tezelman S, Borucu I, Senyurek Giles Y et al.: The change in surgical practice from subtotal to near-total or total thyroidectomy in the treatment of patients with benign multinodular goiter. WorldJ Surg 2009; 33: 400-05.[Crossref]
• 8. Agarwal G, Aggarwal V: Is total thyroidectomy the surgical procedure of choice for benign multinodular goiter? An evidence-based review. WorldJ Surg 2008; 32: 1313-24.[Crossref]
• 9. Pelizzo MR, Toniata A, Gemo G: Zuckerkandl’s tuberculum: an arrow pointing to the reccurent laryngeal nerve. J Am Coll Surg 1998; 187: 333-36.
• 10. Farrar WB : Complications of thyroidectomy. Surg Clin Nort Am 1983; 63: 1353-61.
• 11. Vaiman M, Nagibin A, Hagag P et al.: Hypothyroidism following partial thyroidectomy. OtolaryngolHead Neck Surg 2008; 138: 98-100.
• 12. Bauer DC, Ettinger B, Nevitt MC, Stone KL i Group, Study of Osteoporotic Fractures Research. Risk for fracture in women with low serum levels of thyroid-stimulating hormone. Ann Intern Med 2001; 134: 561-68.
• 13. Mazziotti G, Canalis E, Giustina A: Drug-induced osteoporosis: mechanisms and clinical implications. Am J Med 2010; 123: 877-84.
• 14. Eriksen EF, Mosekilde L, Melsen F: Kinetics of trabecular bone resorption and formation in hypothyroidism: evidence for a positive balance per remodeling cycle. Bone 1986; 7: 101-08.[Crossref][PubMed]
• 15. Amashukeli M, Giorgadze E, Tsagareli M et al.: The impact of thyroid diseases on bone metabolism and fracture risk. Georgian Med News 2010; (184-185): 34-39.
• 16. Lakatos P: Thyroid hormones: beneficial or deleterious for bone? Calcif Tissue Int 2003; 73: 205-09.
• 17. Sławeta N, Głuszek S: Wpływ powikłanych zabiegów chirurgicznych na życie osobiste i zawodowe chorych. Pol Przegl Chir 2012; 84(9): 437-44.
• 18. Misołek M, Cecherz K, Namysłowski G, MisiołekH: Ewolucja postępowania operacyjnego w obustronnym porażeniu fałdów głosowych. Otolaryng Pol 2006; 5: 107-11.
• 19. Harnisch W, Brosch S, Schmidt M, Hagen R: Breathing and voice quality after surgical treatment for bilateral vocal cord paralysis. Arch OtolaryngolHead Neck Surg 2008; 134: 278-84.
• 20. Quanjer PH, Tammeling GJ, Cotes JE et al.: Lung volumes and forced ventilatory flows. Work Group on Standardization of Respiratory Function Tests. European Community for Coal and Steel. Official position of the European Respiratory Society. Rev Mal Respir 1994; 11: 5-40.
• 21. Białek EJ, Trzebińska A: Pomiary tarczycy w Jakubowski W: Pomiary w ultrasonografii. Warszawa-Zamość 2004; 47-50.
• 22. Trzebińska A: Badanie usg tarczycy w Jakubowski W. Standardy badań usg Polskiego Towarzystwa Ultrasonograficznego. Warszawa-Zamość 2008, wyd. trzecie; 85-87.
• 23. Osmólski A, Frenkiel Z, Osmólski R: Chirurgiczne leczenie chorób tarczycy - powikłania pooperacyjne. Otolaryng Pol 2006; LX: 165-70.
• 24. Bellantone R, Lombardi CP, Bossola M et al.: Total thyroidectomy for management of benign thyroid disease: review of 526 cases. World J Surg 2002; 26: 1468-71.[Crossref]
• 25. Karamanakos SN, Markou KB , PanagopoulosK et al.: Complications and risk factors related to the extent of surgery in thyroidectomy. Results from 2043 procedures. Hormones 2010; 9: 318-25.
• 26. Mishra A, Agarwal A, Agarwal G, Mishra SK: Total thyroidectomy for benign thyroid disorders in an endemic region. World J Surg 2001; 25): 307-10.[Crossref]
• 27. Zagólski O, Składzień J: Leczenie jatrogennych porażeń fałdów głosowych. Pol Przegl Chir 2001; 73: 819-29.
• 28. Zalesska-Kręcicka M, Kustrzycka H, Kręcicki T: Porażenie fałdów głosowych - doświadczenia własne w diagnostyce i leczeniu. Otolaryng Pol 1994: 2; 169-77.
• 29. Piaskowska-Kazimierska M, Maniecka-AleksandrowiczB: Odległe skutki porażeń krtani po operacji tarczycy. Otolaryng Pol 1995; 49: 640-43.
• 30. Schäffler A: Hormone replacement after thyroid and parathyroid surgery. Dtsch Arztebl Int 2010; 107: 827-34.[WoS][PubMed]
• 31. Marx SJ: Hyperparathyroid and hypoparathyroid disorders. N Engl J Med 2000; 343: 1863-75.
• 32. Wirowski D, Schwarz K, Lammers BJ, GoretzkiPE: Hormone replacement after thyroid and parathyroid surgery: Importance of postoperative hypocalcaemia. Dtsch Arztebl Int 2011; 108: 133.[PubMed]
• 33. ShobackD: Clinical practice. Hypoparathyroidism. N Engl J Med 2008; 359: 391-403.
• 34. Bilezikian J, Khan A, Potts J Jr et al.: Hypoparathyroidism in the adult: Epidemiology, diagnosis, pathophysiology, target organ involvement, treatment and challenges for future research. J Bone Miner Res 2011; 26: 2317-37.[WoS][Crossref]
• 35. Lee DM, Rutter MK, O’Neill TW Group, EuropeanMale Ageing Study. Vitamin D, parathyroid hormone and the metabolic syndrome in middleaged and older European men. Eur J Endocrinol 2009; 161: 947-54.
• 36. Kayaniyil S, Vieth R, Harris SB et al.: Association of 25(OH)D and PTH with metabolic syndrome and its traditional and nontraditional components. J Clin Endocrinol Metab 2011; 96: 168-75.[Crossref][WoS]
• 37. Reis JP, von Mühlen D, Miller ER 3rd: Relation of 25-hydroxyvitamin D and parathyroid hormone levels with metabolic syndrome among US adults. Eur J Endocrinol 2008; 159: 41-48.
• 38. Sijanovic S, Karner I: Bone loss in premenopausal women on long-term suppressive therapy with thyroid hormone. Medscape Womens Health 2001; 6: 3.[PubMed]
• 39. Barczyński M, Konturek A, Stopa M i wsp.: Ocena wartości klinicznej śródoperacyjnego neuromonitoringu nerwów krtaniowych wstecznych w poprawie wyników leczenia operacyjnego zróżnicowanego raka tarczycy. Pol Przegl Chir 2011; 83: 362-72.
• 40. D’Andrea V, Cantisani V, Catania A et al.: Thyroid tissue remnants after “total thyroidectomy”. G Chir 2009; 30: 339-44.
• 41. Salvatori M, Raffaelli M, Castaldi P et al.: Evaluation of the surgical completeness after total thyroidectomy for differentiated thyroid carcinoma. Eur J Surg Oncol 2007; 33: 648-54.[WoS][Crossref]
• 42. Arlt W, Fremerey C, Callies F et al.: Well-being, mood and calcium homeostasis in patients with hypoparathyroidism receiving standard treatment with calcium and vitamin D. Eur J Endocrinol 2002; 146: 215-22.
• 43. Rubin MR, Bilezikian JP: Hypoparathyroidism: clinical features, skeletal microstructure and parathyroid hormone replacement. Arq Bras EndocrinolMetabol 2010; 54: 220-26.[WoS][Crossref]
• 44. Amrein K, Dimai HP, Dobnig H, Fahrleitner-Pammer A: Low bone turnover and increase of bone mineral density in a premenopausal woman with postoperative hypoparathyroidism and thyroxine suppressive therapy. Osteoporos Int 2011; 22: 2903-05. [Crossref]
• 45. Amashukeli M, Giorgadze E, Tsagareli M et al.: The impact of thyroid diseases on bone metabolism and fracture risk. Georgian Med News 2010; (184-185): 34-39.
• 46. Heijckmann AC , Huijberts MS, Geusens P et al.: Hip bone mineral density, bone turnover and risk of fracture in patients on long-term suppressive L-thyroxine therapy for differentiated thyroid carcinoma. Eur J Endocrinol 2005; 153: 23-29.
• 47. Eftekhari M, Asadollahi A, Beiki D et al.: The long term effect of levothyroxine on bone mineral density in patients with well differentiated thyroid carcinoma after treatment. Hell J Nucl Med 2008; 11: 160-63.

Identifiers

DOI

10.2478/pjs-2013-0037