Clinical signs and management strategies in thyroid masses

Abstract

Objectives: Patients who underwent surgery for thyroid masses were evaluated with regard to clinical symptoms, diagnostic and treatment methods, and the results of treatment. Patients and Methods: The study included 92 patients 72 women, 20 men; mean age 45 years; range 16 to 71 years . Clinical diagnoses were based on findings of ultrasonography, thyroid function tests, thyroid scintigraphy, and fine-needle aspiration biopsy. Operations performed were near-total thyroidectomy n=40 , hemithyroidectomy n=25 , bilateral subtotal thyroidectomy n=16 , and total thyroidectomy n=11 . Patients with carcinoma associated with neck lymph node metastasis also underwent lateral, anterolateral, modified radical, or radical neck dissections. Results: Postoperative histopathologic diagnoses were benign colloid nodule n=70 , papillary carcinoma n=16 , medullary carcinoma n=2 , anaplastic carcinoma n=2 , and Basedow-Graves disease n=2 . Unilateral vocal cord paralysis developed in 11 patients 11.9% , five of which persisted beyond one year followup. Two patients 2.2% had transient hypocalcemia and one patient 1.1% had postoperative hematoma. Conclusion: Preoperative determination of the structure and confines of thyroid masses increases success rates of surgical procedures and minimizes complication rates.

Keywords

• Thyroid gland/pathology, thyroid neoplasms/ surgery, thyroid nodule/diagnosis/surgery, thyroidectomy

Tiroid kitlelerinde klinik bulgular ve uyguladığımız tedavi yöntemleri

Abstract

Amaç: Kliniğimizde tiroid kitlesi nedeniyle tedavi edilen hastalar klinik bulgular, inceleme ve tedavi yöntemleri ve tedavi sonuçları açısından değerlendirildi.Hastalar ve Yöntemler: Çalışmaya 92 hasta alındı. Klinik tanı ultrasonografi, tiroid fonksiyon testleri, sintigrafi ve ince iğne aspirasyon biyopsisi bulguları ile kondu. Kırk hastaya totale yakın tiroidektomi, 25 hastaya hemitiroidektomi, 16 hastaya iki taraflı subtotal tiroidektomi, 11 hastaya total tiroidektomi uygulandı. Karsinom tanısı konan ve boyun lenf nodlarına metastaz olan hastalara lateral, anterolateral, modifiye radikal boyun diseksiyonu veya radikal boyun diseksiyonu uygulandı.Bulgular: Ameliyat sonrası histopatolojik tanılar şunlardı: Benign kolloidal nodül n=70 , papiller karsinom n=16 , medüller karsinom n=2 , anaplastik karsinom n=2 ve Basedow Graves hastalığı n=2 . On bir hastada %11.9 tek taraflı vokal kord paralizisi gelişti ve bir yıllık takip sonrasında bunların beşinde paralizi devam etti. İki hastada %2.2 geçici hipokalsemi, bir hastada %1.1 ameliyat sonrası hematom görüldü.Sonuç: Tiroid kitlelerinin yapısının ve sınırlarının ameliyat öncesinde saptanması, tedavi sonuçlarının başarılı olmasını ve komplikasyon oranlarının azalmasını sağlamaktadır

Keywords

• Tiroid bezi/patoloji, tiroid neoplazileri/cerrahi, tiroid nodülü/tanı/cerrahi, tiroidektomi

References

1. Tunçbilek A. Direkt radyografi, bilgisayarlı tomografi, ultrasonografi, renkli Doppler ultrasonografi. In: İşgör A, editör. Tiroit hastalıkları ve cerrahisi. İstanbul: Avrupa Tıp Kitapçılık; 2001. s. 169-75.
2. Belfiore A, La Rosa GL. Fine-needle aspiration biopsy of the thyroid. Endocrinol Metab Clin North Am 2001; 30:361-400.
3. Simental AA, Myers EN. Thyroidectomy: Technique and applications. Operative Techniques in Otolaryngology- Head and Neck Surgery 2003;14:63-73.
4. Mazzaferri EL. Management of a solitary thyroid nod- ule. N Engl J Med 1993;328:553-9.
5. Süslü N, Hoşal S. Tiroid nodülüne yaklaşım ve cer- rahi endikasyonlar. Türkiye Klinikleri J Surg Med Sci 2007;3:5-12.
6. Namou K, Lavertu P. Evaluation of a thyroid nodule. Otolaryngol Clin N Am 2003;36:17-33.
7. Kim EK, Park CS, Chung WY, Oh KK, Kim DI, Lee JT, et al. New sonographic criteria for recommending fine- needle aspiration biopsy of nonpalpable solid nodules of the thyroid. AJR Am J Roentgenol 2002;178:687-91.
8. Iannuccilli JD, Cronan JJ, Monchik JM. Risk for malig- nancy of thyroid nodules as assessed by sonographic criteria: the need for biopsy. J Ultrasound Med 2004; 23:1455-64.

9. Chan BK, Desser TS, McDougall IR, Weigel RJ, Jeffrey RB Jr. Common and uncommon sonographic features of papillary thyroid carcinoma. J Ultrasound Med 2003; 22:1083-90.
10. Seiberling KA, Dutra JC, Grant T, Bajramovic S. Role of intrathyroidal calcifications detected on ultrasound as a marker of malignancy. Laryngoscope 2004;114:1753-7.
11. Ersöz C. Tiroid kanserlerinde ince iğne aspirasyon sitolojisi ve frozen section. Türkiye Klinikleri J Surg Med Sci 2007;3:13-6.
12. Abboud B, Allam S, Chacra LA, Ingea H, Tohme C, Farah P. Use of fine-needle aspiration cytology and frozen section in the management of nodular goiters. Head Neck 2003;25:32-6.
13. Hamming JF, Vriens MR, Goslings BM, Songun I, Fleuren GJ, van de Velde CJ. Role of fine-needle aspira- tion biopsy and frozen section examination in deter- mining the extent of thyroidectomy. World J Surg 1998; 22:575-9.
14. Noyek AM, Finkelstein DM, Witterick IJ, Kirsh JC. Diagnostic imaging of the thyroid gland. In: Falk SA, editor. Thyroid disease. 2nd ed. Philadelphia: Lippincott- Raven; 1997. p. 135-43.
15. Wilson AG, O’Mara RE. Uptake tests, thyroid and whole body imaging with isotopes. In: Falk SA, editor. Thyroid disease. 2nd ed. Philadelphia: Lippincott-Raven; 1997. p. 113-31.
16. Greenspan FS. The thyroid gland. In: Greenspan FS, Gardner DG, editors. Basic and clinical endocrinology. 6th ed. New York: McGraw-Hill; 2001. p. 201-72.
17. Schlumberger MJ. Papillary and follicular thyroid car- cinoma. N Engl J Med 1998;338:297-306.
18. Rosai J. Thyroid gland. In: Rosai J, editor. Ackerman’s surgical pathology. 8th ed. St. Louis: Mosby; 1996. p. 493-567.
19. Thomusch O, Machens A, Sekulla C, Ukkat J, Lippert H, Gastinger I, et al. Multivariate analysis of risk fac- tors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg 2000;24:1335-41.
20. Daniel OG, Hamaker RC. Anatomy of the thyroid gland. In: Cummings CW, Fredrickson JM, editors. Otolaryngology-head and neck surgery. 3rd ed. St. Louis: Mosby Year Book; 1998. p. 2445-9.
21. Bellantone R, Lombardi CP, Bossola M, Boscherini M, De Crea C, Alesina P, et al. Total thyroidectomy for management of benign thyroid disease: review of 526 cases. World J Surg 2002;26:1468-71.
22. Wheeler MH. Thyroid surgery and the recurrent laryngeal nerve. Br J Surg 1999;86:291-2.
23. Aydoğan B, Kıroğlu F, Soylu L, Kıroğlu M, Çetik F, Akçalı Ç ve ark. Tiroid cerrahisi sonuçlarımız. KBB ve Baş Boyun Cerrahisi Dergisi 1999;7:135-8.
24. Marohn MR, LaCivita KA. Evaluation of total/near- total thyroidectomy in a short-stay hospitalization: safe and cost-effective. Surgery 1995;118:943-7.