| 1. |
- Grodski, S, et al.
(författare)
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Surgery versus radioiodine therapy as definitive management for Graves' disease: The role of patient preference
- 2007
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Ingår i: Thyroid. - : Mary Ann Liebert Inc. - 1050-7256 .- 1557-9077. ; 17:2, s. 157-160
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Tidskriftsartikel (refereegranskat)abstract
- Background: Thyroidectomy is an option for the definitive management of Graves' disease. The aim of this study was to examine the role of patient preference for selecting surgery as definitive treatment. Patients and Methods: This is a retrospective cohort study comprising all patients (n = 63) presenting to a single surgeon for surgical management of Graves' disease over 3 years. Documented reasons for surgery were compared with accepted indications, as well as patients' perceptions as assessed by questionnaire. Results: The most frequent absolute indication was the presence of a large goiter (n = 8; 13%) or associated thyroid nodule (n = 6; 10%). Ophthalmopathy, a relative indication, comprised the largest single group overall (n = 18; 29%); however, a significant number of patients (n = 17; 27%) elected surgery in the absence of a recognized indication. There was strong concordance (73%) between the recorded indication and the patients' survey response. Overall, there was a high level of satisfaction with surgery with 88% of respondents giving a satisfaction score of 7 or greater on a visual analog scale (VAS) (0–10). Conclusions: One-third of all patients electing surgery as definitive management do so in the absence of a specific indication. Overall, there is a high level of satisfaction with the decision for surgery as definitive management of Graves' disease.
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| 2. |
- Snook, KL, et al.
(författare)
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Recurrence after total thyroidectomy for benign multinodular goiter
- 2007
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Ingår i: World Journal of Surgery. - : Springer Science and Business Media LLC. - 0364-2313 .- 1432-2323. ; 31:3, s. 593-600
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Tidskriftsartikel (refereegranskat)abstract
- Background Total thyroidectomy is now the preferred option for the management of benign multinodular goiter (BMNG), and it ought not be associated with recurrent disease. The aim of the present study was to examine the efficacy of total thyroidectomy for BMNG and to review reasons for recurrence. Material and methods The study group comprised all patients from January 1980 to December 2005 who underwent a definitive procedure to remove all thyroid tissue for BMNG, and who were subsequently identified as having developed a recurrence. Included were patients who underwent primary total thyroidectomy at our unit, or a two or more stage procedure where a definitive secondary total thyroidectomy was performed at our unit. Results There were 3,044 total or secondary total thyroidectomies performed for BMNG during the study period. Ten patients were identified as having developed recurrent BMNG requiring reoperation despite previous complete “total” thyroidectomy. There were 11 sites of recurrence in 10 patients. Only one was a true local recurrence in the thyroid bed. Another 9 recurrences related to the embryology of the thyroid gland, 4 in the pyramidal tract and 5 in the thyrothymic tract. There was one recurrence at another site (submandibular) in a patient with presumed metastatic thyroid cancer despite benign histology. There were no complications in any of the 10 patients. Conclusions Total thyroidectomy for BMNG is not only a safe procedure but is efficacious in preventing recurrent disease. Failure to remove embryological remnants such as thyrothymic residue or pyramidal remnants during total thyroidectomy is the major cause of recurrence.
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| 3. |
- Stålberg, Peter, et al.
(författare)
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Cervical thymectomy for intrathymic parathyroid adenomas during minimally invasive parathyroidectomy
- 2007
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Ingår i: Surgery. - : Elsevier BV. - 0039-6060 .- 1532-7361. ; 141:5, s. 626-629
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Tidskriftsartikel (refereegranskat)abstract
- Background The development of an intrathymic parathyroid adenoma is common, and thymectomy is a significant component of the parathyroid surgeon’s technical armamentarium. Over the last decade, minimally invasive parathyroidectomy (MIP) has become the standard technique for removal of an abnormal parathyroid gland, and the requirement for thymectomy should remain unchanged during the era of minimally invasive techniques. The aim of this paper was to assess the feasibility and outcomes of cervical thymectomy for intrathymic parathyroid adenomas during MIP. Methods This is a retrospective case series. The study group comprised all patients undergoing parathyroidectomy in the University of Sydney Endocrine Surgical Unit during a 5-year period (January 2001 to December 2005). Patients undergoing MIP and open parathyroidectomy with a concomitant cervical thymectomy were compared. Results A total of 840 patients underwent parathyroid surgery for primary hyperparathyroidism (PHPT) during this period. A total of 30 MIP procedures with concurrent thymectomy were performed, and 99 open bilateral neck explorations with cervical thymectomy were performed. Of the MIP thymectomy group, there were 25 female and 5 male patients; the average age was 57 years (range, 22 to 82). A mean length of 34 mm of thymus was extracted via the minimally invasive approach (range, 8 to 85 mm). In 5 cases, only fatty tissue was identified histologically, and, in 5 cases, a small supernumerary parathyroid gland was identified in the histologic specimen. Only 1 patient suffered temporary, recurrent laryngeal nerve palsy; there were no cases of postoperative hemorrhage requiring return to the operating room. Conclusions Cervical thymectomy for removal of intrathymic parathyroid adenomas can be performed during lateral focused mini-incision MIP with a safety and efficacy equivalent to open bilateral neck explorations.
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| 4. |
- Stålberg, Peter, et al.
(författare)
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Minimally invasive parathyroidectomy and thyroidectomy : current concepts
- 2007
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Ingår i: The Surgeon. - 1479-666X. ; 5:5, s. 301-308
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Forskningsöversikt (refereegranskat)abstract
- The introduction of various techniques for minimally invasive parathyroidectomy (MIP) and minimally invasive thyroid surgery (MITS) have changed both the conceptual and surgical approach to parathyroid disease and single thyroid nodules. Perceived advantages of minimally invasive surgery both among clinicians and patients, have been a major factor in the development of new surgical techniques, as well as refinement in preoperative localisation techniques. Worldwide the number of patients being operated on using MIP or MITS has steadily increased. At some major centres as many as 70% of patients with primary hyperparathyroidism have their operation using MIP. In this review we discuss the underlying pathology and investigative procedures, as well as the various techniques used, all of which now have excellent outcomes at a minimal cost and with minimal complications. Based on our own experience we recommend the use of a lateral focused mini-incision for both MIP and MIT since they both use standard equipment and standard dissection techniques familiar to all experienced endocrine surgeons.
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