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Total Thyroidectomy in Treatment of Graves' Ophthalmopathy

100%

Konturek A., Barczyński M., Cichoń S., Anielski R., Cichoń W., Jonkisz J., Orlicki P.

Polish Journal of Surgery

2008

vol. 80

issue 9

455-464

The aim of the study. The present report is an attempt at answering the question regarding the ocular status in the course of thyroid ophthalmopathy following surgical treatment. A retrospective analysis included a group of patients presenting with various ophthalmologic symptoms in the course of Graves' disease. The analysis focused on the clinical ophthalmologic status determined based on eye examinations and determinations of the level of thyroid stimulating hormone receptor antibody (TRAb), as well as on changes in the above parameters in pre and postoperative examinations.Material and methods. Between January 2005 and December 2006, 61 patients were managed surgically for Graves' disease. The group consisted of 53 (86.9%) females and eight (13.1%) males. Their mean age was 45.5±12 years, with the range of 18 to 71 years. Prior to surgery, the mean duration of pharmacotherapy was 27.3 months, with the range of 3-120 months. The severity of the disease was determined using the NOSPECS classification and the resultant ophthalmopathy index according to Donaldson. Ocular symptoms were assessed prior to treatment and subsequently at 3, 6 and 12 months after thyroidectomy. Determinations of TSH, fT4 and antithyroid antibodies TRAb were done in all the patients before and 12 months after surgical treatment. In the present investigations, determinations of the thyroid stimulating hormone receptor antibody (TRAb) levels were done by radioimmunoassay.Results. All the 61 patients were treated surgically. The following procedures were performed: total thyroidectomies in 35 (57.4%) patients, the so-called Dunhill operations (total lobectomy plus subtotal resection of the contralateral side) in 14 (23%), and subtotal bilateral lobectomies in 12 (19.6%) subjects. Determinations of thyroid stimulating hormone receptor antibody TRAb levels were done preoperatively in 61 (100%) patients and postoperatively in 54 (88.5%) individuals. In the present series, preoperative TRAb values were significantly elevated (>2 IU/L) in as many as 56 (91.8%) patients. After the surgery, TRAb normalized in 35 (57.4%) patients (<1 IU/L - absent) from 9.14±10.7 to 0.95±0.45 IU/L (p<0.001, test t). The differences are statistically significant. Borderline antibody values (between 1 and 2 IU/l) were noted in 5 (8.1%) patients before and in 18 (29.5%) after the procedure. The ophthalmologic assessment based on the Donaldson ophthalmopathy index, which combines scores awarded while evaluating five classes (soft tissues, degree of exophthalmus, oculomotor muscle status, corneal status, visual acuity) included 54 (88.5%) of 61 patients. The value of the index changed in the entire investigated group, what was manifested in a statistically significant decrease in the ophthalmopathy index from 6.1±2.32 prior to treatment to 3.31±2.09 after the surgery (p<0.001, test t). Deterioration of the general ocular status as confirmed by the initial ophthalmopathy index was confirmed by ophthalmology in five patients. Subjective complaints of deteriorated vision were reported by three patientsConclusions. The use of ultrasonic scalpel in thyroid surgery a reduction of mean operating time, achieving good hemostasis and improved cosmetic results without increased risk of morbidity

Ultrasonic Scalpel Versus Classic Procedures with Limited Access in Thyroid Gland Surgery

84%

Konturek A., Barczyński M., Cichoń S., Anielski R., Cichoń W., Jamski J., Jonkisz J., Orlicki P.

Polish Journal of Surgery

2007

vol. 79

issue 7

468-474

The aim of the study was to demonstrate the advantages of employing the ultrasonic scalpel in maintaining appropriate intraoperative hemostasis as compared with traditional methods of thyroid vessel ligation and coagulationMaterial and methods. Between December 2003 and May 2006, 2410 patients were managed for various thyroid diseases at the Department of Endocrine Surgery. In the presented group, 179 procedures that employed minimally invasive surgical techniques including 101 operations in which US was used to secure the thyroid vessels (group A) and 78 operations in which the superior thyroid vessels were clipped and subjected to bipolar coagulation without US (group B) were performed. Both groups were similar with respect to gender, age, indications for surgery and mean thyroid volume. Statistical analysis included mean operative time, postoperative blood loss, scar length and cosmetic satisfaction assessed on visual-analogue scale (VAS) at 1 month following surgery.Results. Mean operative time was significantly greater in group B vs A (54.5±14.2 vs 35.4±8.7 min, respectively; t-test; p<0.001). Mean postoperative blood loss was significantly higher in group B vs A (32.8±13.0 vs 12.9±5.7 ml, respectively; t-test; p<0.001). One case of transient paralysis of the recurrent laryngeal nerve and two instances of postoperative drop in calcium concentration values below the normal range was observed. The mean scar length at 1 month following surgery was significantly longer in group B vs A (21.5±1.9 vs 15.6±1.4 mm, respectively; t-test; p<0.001). Cosmetic satisfaction was significantly lower in group B vs. A patients (81.9±5.4 vs 88.9±9.7pts, respectively; t-test; p<0.001).Conclusion. The use of an ultrasonic scalpel in thyroid surgery reduces the mean operative time, achieves good hemostasis and improves cosmetic results without increasing the risk of morbidity

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2 Polish Journal of Surgery

1 2008

1 2007

2 Anielski R.

2 Barczyński M.

2 Cichoń S.

2 Cichoń W.

2 Jonkisz J.

2 Konturek A.

2 Orlicki P.

1 Jamski J.

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Total Thyroidectomy in Treatment of Graves' Ophthalmopathy

Ultrasonic Scalpel Versus Classic Procedures with Limited Access in Thyroid Gland Surgery