Research Article
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The efficacy and safety of total thyroidectomy in the elderly patients

Year 2017, Volume: 3 Issue: 2, 4960 - 510, 15.08.2017
https://doi.org/10.30569/adiyamansaglik.415883

Abstract

INTRODUCTION: In this study , we rewieved the
data from patients who had total thyroidectomy for benign thyroid disease and
evaluated the safety in patients aged ≥65 years.


METHODS: Two hundred and forty ninee
patients who underwent total thyroidectomy between 2011and 2013 were included
in the study. Patients were
divided into two groups: patients ≥65 years (
Group 2
;65) and those<65 years (Group 1;184)
The records including the data of sex, preoperative diagnosis, biopsy results,
postoperative complications, operation time and hospital stay results were
retrospectively analyzed. 

 

RESULTS: In both groups, the main
indication for surgery was multinodular goiter. In terms of complications, 1
patient had wound site infection, 2 patients had permanent hypocalcemia and 1
patient had unilateral permanent RLN injury in Group 2. There were no
significant differences in terms of complications, duration of operation time
and duration of hospital stay between two groups.










DISCUSSION AND CONCLUSION: Even with
all the knowledge acquired today, the safety of thyroid surgery in elderly
patients remains controversial. Our study revealed that total thyroidectomy was
similar in young and older patients in terms of complications and length of
hospitalization. Total thyroidectomy can be performed safely in elderly
patients by experience of the operation team (the surgeon),in experienced
centers
.

References

  • 1. Özkul F, Cinel A, Türkyılmaz S, Alhan E, Çan G, Akçay M. Total Tiroidektomi Yapılan Hastalarda Post Operatif Komplikasyonların Yaş Gruplarına Göre Karşılaştırılması. Düzce Tıp Dergisi 2013; 15(3): 5-8.
  • 2. Yetkin E. Tiroid Hastalıkları ve cerrahisi. “Tiroidektomi komplikasyonları”. 1. baskı Ed: İşgör A, Avrupa Tıp Kitapçılık yayınevi, 2000, pp 583-595.
  • 3. Rehman SU, Cope DW, Senseney AD, Brzezinski W. Thyroid disorders in elderly patients. South Med J 2005;98(5):543-9. (PMID:15954511).
  • 4. Chiovato L, Marotti S, Pinchera A. Thyroid diseases in the elderly. Baillieres Clin Endocrinol Metab 1997; 11:251-270.
  • 5. Hegedüs L, Perrild H, Poulsen LR, Andersen JR, Holm B, Schnohr P, et al. The determination of thyroid volume by ultrasound and its relationship to body weight, age and sex in normal subjects. J Clin Endocrinol Metab 1983; 56:260-263.
  • 6. Raffaelli M, Bellantone R, Princi P, et al. Surgical treatment of thyroid diseases in elderly patients. Am J Surg 2010;200(4):467-72 (PMID:20887839).
  • 7. Türkmen Ü A, Kara D, Çağlayan Köksal Ç. Tiroid Bezi Hastalıklarında Anestezik Yaklasım. Okmeydanı Tıp Dergisi, 2012; 28(Ek sayı 1):48-55, doi:10.5222/otd.supp1.2012.048.
  • 8. Sayek I ve ark: Temel Cerrahi.Güneş Kitabevi Ltd Şti, 1996; 1569-1583.
  • 9. Calık A, Küçüktulu V. Complications of 867 Thyroidectomies Performed in a Region of Endemic Goiter in Turkey. Int. Surg, 1996; 81:298-301.
  • 10. Kaplan EL. Thyroid and parathyroid. In: Schwartz Sl. Editor. Principles of surgery. 5th edition. Paris: Mc Graw – Hill Book Company , 1988; 2: 1613-1643.
  • 11. Assenza M, Ricci G, Romagnoli F, Binda B, Rengo M. Thyroid surgery: total and partial resection. Analysis of complications and a review of the literature . Chir Ital 2000; 56:371-382.
  • 12. Mutlu A T, Berkiten G, Kumral T L, Uyar Y. Tiroid Cerrahisinin Laringeal Komplikasyonları. Okmeydanı Tıp Dergisi, 2012; 28(Ek sayı 1):10-19, doi:10.5222/otd.supp1.2012.010.
  • 13. Pappalardo G, Guadalaxara A, Frattaroli FM, Illomei G, Falaschi P. Total compared with subtotal thyroidectomy in benign nodular disease: Personal series and review of published reports. Eur J Surg 1998;164:501-506.
  • 14. Mishra A, Agarwal G, Agarwal A, Mishra SK. Safety and efficacy of total thyroidectomy in hands of endocrine surgery trainees. Am J Surg 1999;178:377- 380.
  • 15. Jacobs JK, Aland JW Jr, Ballinger JR. Total thyroidectomy: A review of 213 patients. Ann Surg 1983; 197:542-549.
  • 16. Koyuncu A, Dökmetas HS, Turan M, et al. Comparison of different thyroidectomy tecniques for benign thyroid diseas. Endocr J 2003; 50:723- 727.
  • 17. Thomusch O, Machens A, Sekulla C, et al. Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: Prospective multicenter study in Germany. World J Surg 2000;24:1335-1341.
  • 18. Moley JF, Lairmore TC, Doherty GM, Brunt ML, DeBenedetti MK. Preservation of the recurrent laryngeal nerves in thyroid and parathyroid reoperations. Surgery 1999;125:673-679.
  • 19. Lo C, Kwok K, Yuen P. A prospective evaluation of recurrent laryngeal nerve paralysis during thyroidectomy.Arch Surg 2000;135:204-207.20. Mekel M, Stephen AE, Gaz RD, Perry ZH, Hodin RA, Parangi S. Thyroid surgery in octogenarians is associated with higher complication rates. Surgery 2009;146(5):913-21. (PMID:19744461).
  • 21. Chiang FY, Wang LF, Huang YF, Lee KW, Kuo WR. Recurrent laryngeal nerve palsy after thyroidectomy with routine identification of the recurrent laryngeal nerve. Surgery 2005;137:342-7.
  • 22. Rosato L, Avenia N, Bernante P, et al. Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg 2004; 28:271-6.
  • 23. Taneri F, Kurukahvecioğlu O. Hipertiroidizm ve Cerrahi Tedavi. Türkiye Klinikleri J Surg Med 2005; 12: 39-42.
  • 24. Gardiner KR, Russell CF. Thyroidectomy for large multinodular colloid goitre. JR Coll Surg Edinb. 1995; 40: 367-370.
  • 25. Ünal B, Bozkurt B, Karabeyoğlu M, ve ark. Tiroid Cerrahisinde Komplikasyonları Etkileyen Faktörler: 1022 Olgunun Analizi. Endokrinolojide Diyalog 2008; 2:38-43.
  • 26. Bliss R, Patel N, Guinea A, Reeve TS, Delbridge L. Age is no contraindication to thyroid surgery. Age Ageing 1999;28(4):363-6. (PMID:10459789).
  • 27. 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(12):1468-71. (PMID:12360381).
  • 28. Sadler GP, Clark OH, Van Heerden JA, Farley DR. Thyroid and Parathyroid. In: Principles of Surgery. Schwartz SI (eds), 7th Ed. New York, Mc Graw Hill 1999; 1661-1713.
  • 29. Tontuş Ö, Gönül E, Karakaş E, Mavili S. Tiroid cerrahisinde postoperatif erken dönem komplikasyonlar. Klin Deney Cerrah Derg 1994;2:98- 101.30. Barrett RM, Crumley R, Jalilie S, et al. Complications of thyroid surgery. Int Surg 1997;82:63-66.
  • 31. Delbridge L, Guinea AI, Reeve TS. Total thyroidectomy for bilateral benign multinodular goiter. Arch Surg 1999; 134:1389-1393.
  • 32. Sözen S, Emir E, Alıcı A, Aysu F, Yıldız F, Aziret M, Kısakürek M, Çakmak A. Total tiroidektomi sonrası komplikasyonlar ve cerrah faktörü. Ulusal Cerrahi Dergisi 2010; 26(1): 13-17. DOI: 10.5097/1300-0705.UCD.315-10.02.
  • 33. Toprak D, Doğanay M, Kama N. A. Tiroid Operasyonlarından Sonra Görülen Komplikasyonlar. Kocatepe Tıp Dergisi 2004; 5: 1- 6.
  • 34. Ng SH, Wong KP, Lang BH. Thyroid surgery for elderly patients: are they at increased operative risks? J Thyroid Res. 2012;2012:946276. doi: 10.1155/2012/946276. Epub 2012 Aug 16.
  • 35. Lang BH, Lo CY. Total thyroidectomy for multinodular goiter in the elderly. Am J Surg. 2005 Sep;190(3):418-23.36. Seybt MW, Khichi S, Terris DJ. Geriatric thyroidectomy: safety of thyroid surgery in an aging population. Arch Otolaryngol Head Neck Surg. 2009 Oct;135(10):1041-4. doi: 10.1001/archoto.2009.138.
  • 37. Del Rio P, Sommaruga L, Bezer L, Arcuri MF, Cataldo S, Robuschi G, Sianesi M. Thyroidectomy for differentiated carcinoma in older patients on a short stay basis. Acta Biomed. 2009 Apr;80(1):65-8.
  • 38. Grogan RH, Mitmaker EJ, Hwang J, Gosnell JE, Duh QY, Clark OH, Shen WT. A population-based prospective cohort study of complications after thyroidectomy in the elderly. J Clin Endocrinol Metab. 2012 May;97(5):1645-53. doi: 10.1210/jc.2011-1162. Epub 2012 Mar 14.
  • 39. Sosa JA, Mehta PJ, Wang TS, Boudourakis L, Roman SA. A population-based study of outcomes from thyroidectomy in aging Americans: at what cost? J Am Coll Surg. 2008 Jun;206(6):1097-105. doi: 10.1016/j.jamcollsurg.2007.11.023. Epub 2008 Feb 11.
  • 40. Akçakaya A, Koç B, Ferhatoğlu F. Tiroid Anatomisi ve Cerrahi Yaklaşım. Okmeydanı Tıp Dergisi, 2012; 28(Ek sayı 1):1-9, doi:10.5222/otd.supp1.2012.001.

Yaşlı hastalarda total tiroidektominin etkinliği ve güvenilirliği, retrospektif analiz

Year 2017, Volume: 3 Issue: 2, 4960 - 510, 15.08.2017
https://doi.org/10.30569/adiyamansaglik.415883

Abstract

GİRİŞ ve AMAÇ: Bu çalışmada, selim
tiroid hastalığı nedeniyle total tiroidektomi yapılan hastaların ameliyat
verileri ve bu cerrahinin 65 yaş üzeri hastalarda güvenilirliğinin değerlendirilmesi
amaçlandı. 
YÖNTEM ve GEREÇLER: 2011-2013
tarihleri arasında total tiroidektomi uygulanan 249 hasta çalışmaya alındı.
 Hastalar 65 yaş ve üstü (Grup 2;65) ve 65 yaş altı (Grup 1;184) olmak üzere iki gruba ayrıldı. Hastaların cinsiyet,
ameliyat öncesi tanı, biyopsi bulguları, ameliyat sonrasında görülen
komplikasyonlar, ameliyat süresi ve hastanede yatış süreleri
karşılaştırıldı. 
BULGULAR: Her iki grup için en sık
cerrahi endikasyon multinodüler guatırdır. Komplikasyonlar açısından değerlendirildiğinde
Grup 2'de, 1hastada yara yeri enfeksiyonu, 2'sinde kalıcı hipokalsemi, 1'inde
tek taraflı kalıcı RLS hasarı
gelişmiştir . Komplikasyonlar,
operasyon süresi ve hastanede kalış süreleri açısından açısından anlamlı fark
saptanmadı. 
TARTIŞMA ve SONUÇ: Günümüzde elde
edilen tüm bilgilere rağmen, yaşlı hastalarda tiroid cerrahisinin güvenliği
tartışmalıdır. Çalışmamızda total tiroidektominin hem genç hemde yaşlı hastalar
için komplikasyonlar ve hastanede yatış süresi açısından benzer olduğu gösterildi.
Tecrübeli merkezlerde, operasyon ekibinin (cerrah) deneyimi ile total
tiroidektomi yaşlı hastalarda güvenli bir şekilde uygulanabilir.

References

  • 1. Özkul F, Cinel A, Türkyılmaz S, Alhan E, Çan G, Akçay M. Total Tiroidektomi Yapılan Hastalarda Post Operatif Komplikasyonların Yaş Gruplarına Göre Karşılaştırılması. Düzce Tıp Dergisi 2013; 15(3): 5-8.
  • 2. Yetkin E. Tiroid Hastalıkları ve cerrahisi. “Tiroidektomi komplikasyonları”. 1. baskı Ed: İşgör A, Avrupa Tıp Kitapçılık yayınevi, 2000, pp 583-595.
  • 3. Rehman SU, Cope DW, Senseney AD, Brzezinski W. Thyroid disorders in elderly patients. South Med J 2005;98(5):543-9. (PMID:15954511).
  • 4. Chiovato L, Marotti S, Pinchera A. Thyroid diseases in the elderly. Baillieres Clin Endocrinol Metab 1997; 11:251-270.
  • 5. Hegedüs L, Perrild H, Poulsen LR, Andersen JR, Holm B, Schnohr P, et al. The determination of thyroid volume by ultrasound and its relationship to body weight, age and sex in normal subjects. J Clin Endocrinol Metab 1983; 56:260-263.
  • 6. Raffaelli M, Bellantone R, Princi P, et al. Surgical treatment of thyroid diseases in elderly patients. Am J Surg 2010;200(4):467-72 (PMID:20887839).
  • 7. Türkmen Ü A, Kara D, Çağlayan Köksal Ç. Tiroid Bezi Hastalıklarında Anestezik Yaklasım. Okmeydanı Tıp Dergisi, 2012; 28(Ek sayı 1):48-55, doi:10.5222/otd.supp1.2012.048.
  • 8. Sayek I ve ark: Temel Cerrahi.Güneş Kitabevi Ltd Şti, 1996; 1569-1583.
  • 9. Calık A, Küçüktulu V. Complications of 867 Thyroidectomies Performed in a Region of Endemic Goiter in Turkey. Int. Surg, 1996; 81:298-301.
  • 10. Kaplan EL. Thyroid and parathyroid. In: Schwartz Sl. Editor. Principles of surgery. 5th edition. Paris: Mc Graw – Hill Book Company , 1988; 2: 1613-1643.
  • 11. Assenza M, Ricci G, Romagnoli F, Binda B, Rengo M. Thyroid surgery: total and partial resection. Analysis of complications and a review of the literature . Chir Ital 2000; 56:371-382.
  • 12. Mutlu A T, Berkiten G, Kumral T L, Uyar Y. Tiroid Cerrahisinin Laringeal Komplikasyonları. Okmeydanı Tıp Dergisi, 2012; 28(Ek sayı 1):10-19, doi:10.5222/otd.supp1.2012.010.
  • 13. Pappalardo G, Guadalaxara A, Frattaroli FM, Illomei G, Falaschi P. Total compared with subtotal thyroidectomy in benign nodular disease: Personal series and review of published reports. Eur J Surg 1998;164:501-506.
  • 14. Mishra A, Agarwal G, Agarwal A, Mishra SK. Safety and efficacy of total thyroidectomy in hands of endocrine surgery trainees. Am J Surg 1999;178:377- 380.
  • 15. Jacobs JK, Aland JW Jr, Ballinger JR. Total thyroidectomy: A review of 213 patients. Ann Surg 1983; 197:542-549.
  • 16. Koyuncu A, Dökmetas HS, Turan M, et al. Comparison of different thyroidectomy tecniques for benign thyroid diseas. Endocr J 2003; 50:723- 727.
  • 17. Thomusch O, Machens A, Sekulla C, et al. Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: Prospective multicenter study in Germany. World J Surg 2000;24:1335-1341.
  • 18. Moley JF, Lairmore TC, Doherty GM, Brunt ML, DeBenedetti MK. Preservation of the recurrent laryngeal nerves in thyroid and parathyroid reoperations. Surgery 1999;125:673-679.
  • 19. Lo C, Kwok K, Yuen P. A prospective evaluation of recurrent laryngeal nerve paralysis during thyroidectomy.Arch Surg 2000;135:204-207.20. Mekel M, Stephen AE, Gaz RD, Perry ZH, Hodin RA, Parangi S. Thyroid surgery in octogenarians is associated with higher complication rates. Surgery 2009;146(5):913-21. (PMID:19744461).
  • 21. Chiang FY, Wang LF, Huang YF, Lee KW, Kuo WR. Recurrent laryngeal nerve palsy after thyroidectomy with routine identification of the recurrent laryngeal nerve. Surgery 2005;137:342-7.
  • 22. Rosato L, Avenia N, Bernante P, et al. Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg 2004; 28:271-6.
  • 23. Taneri F, Kurukahvecioğlu O. Hipertiroidizm ve Cerrahi Tedavi. Türkiye Klinikleri J Surg Med 2005; 12: 39-42.
  • 24. Gardiner KR, Russell CF. Thyroidectomy for large multinodular colloid goitre. JR Coll Surg Edinb. 1995; 40: 367-370.
  • 25. Ünal B, Bozkurt B, Karabeyoğlu M, ve ark. Tiroid Cerrahisinde Komplikasyonları Etkileyen Faktörler: 1022 Olgunun Analizi. Endokrinolojide Diyalog 2008; 2:38-43.
  • 26. Bliss R, Patel N, Guinea A, Reeve TS, Delbridge L. Age is no contraindication to thyroid surgery. Age Ageing 1999;28(4):363-6. (PMID:10459789).
  • 27. 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(12):1468-71. (PMID:12360381).
  • 28. Sadler GP, Clark OH, Van Heerden JA, Farley DR. Thyroid and Parathyroid. In: Principles of Surgery. Schwartz SI (eds), 7th Ed. New York, Mc Graw Hill 1999; 1661-1713.
  • 29. Tontuş Ö, Gönül E, Karakaş E, Mavili S. Tiroid cerrahisinde postoperatif erken dönem komplikasyonlar. Klin Deney Cerrah Derg 1994;2:98- 101.30. Barrett RM, Crumley R, Jalilie S, et al. Complications of thyroid surgery. Int Surg 1997;82:63-66.
  • 31. Delbridge L, Guinea AI, Reeve TS. Total thyroidectomy for bilateral benign multinodular goiter. Arch Surg 1999; 134:1389-1393.
  • 32. Sözen S, Emir E, Alıcı A, Aysu F, Yıldız F, Aziret M, Kısakürek M, Çakmak A. Total tiroidektomi sonrası komplikasyonlar ve cerrah faktörü. Ulusal Cerrahi Dergisi 2010; 26(1): 13-17. DOI: 10.5097/1300-0705.UCD.315-10.02.
  • 33. Toprak D, Doğanay M, Kama N. A. Tiroid Operasyonlarından Sonra Görülen Komplikasyonlar. Kocatepe Tıp Dergisi 2004; 5: 1- 6.
  • 34. Ng SH, Wong KP, Lang BH. Thyroid surgery for elderly patients: are they at increased operative risks? J Thyroid Res. 2012;2012:946276. doi: 10.1155/2012/946276. Epub 2012 Aug 16.
  • 35. Lang BH, Lo CY. Total thyroidectomy for multinodular goiter in the elderly. Am J Surg. 2005 Sep;190(3):418-23.36. Seybt MW, Khichi S, Terris DJ. Geriatric thyroidectomy: safety of thyroid surgery in an aging population. Arch Otolaryngol Head Neck Surg. 2009 Oct;135(10):1041-4. doi: 10.1001/archoto.2009.138.
  • 37. Del Rio P, Sommaruga L, Bezer L, Arcuri MF, Cataldo S, Robuschi G, Sianesi M. Thyroidectomy for differentiated carcinoma in older patients on a short stay basis. Acta Biomed. 2009 Apr;80(1):65-8.
  • 38. Grogan RH, Mitmaker EJ, Hwang J, Gosnell JE, Duh QY, Clark OH, Shen WT. A population-based prospective cohort study of complications after thyroidectomy in the elderly. J Clin Endocrinol Metab. 2012 May;97(5):1645-53. doi: 10.1210/jc.2011-1162. Epub 2012 Mar 14.
  • 39. Sosa JA, Mehta PJ, Wang TS, Boudourakis L, Roman SA. A population-based study of outcomes from thyroidectomy in aging Americans: at what cost? J Am Coll Surg. 2008 Jun;206(6):1097-105. doi: 10.1016/j.jamcollsurg.2007.11.023. Epub 2008 Feb 11.
  • 40. Akçakaya A, Koç B, Ferhatoğlu F. Tiroid Anatomisi ve Cerrahi Yaklaşım. Okmeydanı Tıp Dergisi, 2012; 28(Ek sayı 1):1-9, doi:10.5222/otd.supp1.2012.001.
There are 37 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Research Article
Authors

Selim Sözen

Seyfi Emir

İlhan Bali This is me

Bünyamin Cüneyt Turan This is me

Hatice Gül Sarıkaya This is me

Onur Sakallı This is me

Publication Date August 15, 2017
Submission Date April 17, 2018
Acceptance Date May 27, 2018
Published in Issue Year 2017 Volume: 3 Issue: 2

Cite

AMA Sözen S, Emir S, Bali İ, Turan BC, Sarıkaya HG, Sakallı O. Yaşlı hastalarda total tiroidektominin etkinliği ve güvenilirliği, retrospektif analiz. ADYÜ Sağlık Bilimleri Derg. August 2017;3(2):4960-510. doi:10.30569/adiyamansaglik.415883