ACTA ENDOCRINOLOGICA (BUC)

Introduction. Surgery for thyroid cancer carries a higher risk of morbidity given the region’s complicated anatomy, the setting of malignancy and extent of the surgery. Aim. To investigate the rate of complications related to the recurrent nerve and parathyroid glands lesions in patients with thyroid carcinoma that undergo thyroid surgery and lymph node dissection. Patients and Methods. The data of 71 patients who underwent total thyroidectomy and 19 patients who underwent total thyroidectomy and central neck dissection with various associated neck dissection techniques were investigated using appropriate statistical tests. Results. As expected, the rate of recurrent nerve injury observed in the neck dissection group was higher than in the total thyroidectomy group (15.7% vs. 2.8%, p=0.05). As for postoperative hypocalcemia, the rate observed in the neck dissection group, both for postoperative day 1 (p<0.0001) and day 30 (p=0.0003) was higher than in the total thyroidectomy group (68.4% vs. 19.7% postoperative day 1, 31.5% vs. 4.2% postoperative day 30). Conclusions. The risk of morbidity concerning the recurrent nerve injury and postoperative hypoparathyroidism increases with the extent of surgery. Extensive surgery may achieve proper oncologic outcomes but increases the risk of postoperative morbidity and decreases quality of life. In deciding for extensive surgery, both patient and medical team need to understand these risks.

Background. The recurrent paralysis is the most important complication after total thyroidectomy. Vocal dysfunction can have multiple causes. Based on strict clinical criteria, the follow-up of patients who underwent a thyroidectomy may lead to wrong conclusions concerning possible recurrent nerve injury. Purpose. The aim of this study was to evaluate recurrential complications after total thyroidectomy by an ENT endoscopic examination. Method. We prospectively analyzed 100 cases of thyroid operations with a total number of 190 recurrent laryngeal nerve with lesional risk. Fourteen patients were operated for malignant disease. The patients were divided into two groups: group A (patients with high risk of recurrential injury) and group B (patients with low risk of recurrential injury). The operations were performed by one surgical team. The surgical interventions were followed in the 2nd postoperative day by an ENT endoscopic examination in order to assess vocal cords mobility. In patients with voice changes, ENT examination was repeated as many times was needed. At the same time a clinical examination of the quality of phonation was carried out. Results. From the total number of 100 patients examined with 190 nerves at risk, there were 7 patients with recurrent temporary paralyses (3.7%). After 6 months postoperative, there was a single patient with recurrent paralysis (0.5% ). Regarding permanent recurrent paralysis, there was no patient with paresis after one postoperative year (0%). There was no significant difference regarding the recurrent paralysis between patients with high or low risk of recurrential injury. Conclusions. The damage function of the recurrent nerve is recovered in 30 days in most cases and almost 100% in six months. Belonging to a low or high risk group is not associated with the development of motility disorders. The simple following of the clinical manifestations can lead to erroneous conclusions.

Introduction. Retrosternal goitre enlargement can cause compression of several mediastinal structures, especially the trachea and the superior vena cava. Retrosternal goitre as a cause of superior vena cava syndrome is a rare occurrence. We report the case of a middle aged man that underwent surgery for retrosternal goitre with compression of both innominate veins presenting as superior vena cava syndrome. Case Presentation. A 50 year old man presented with a 2 year history of cyanosis of the upper limbs, head and neck, marked facial edema, plethora, dyspnea on exertion and choking sensation. Pemberton’s sign was present. Computer tomography diagnosed retrosternal goitre at the level of the aortic arch, tracheal compression and important collateral circulation. Endocrine evaluation showed normal thyroid function (fT4 15.8 pmol/L) with low-normal TSH (0.5mU/L), normal calcitonin (<2 pg/mL). The patient underwent successful total thyroidectomy with cervical approach and his symptoms dramatically improved. The facial oedema persisted for the next 3 weeks. Discussion. Less than 3% of superior vena cava syndromes are secondary to a variety of benign causes. Superior vena cava syndrome caused by slow growing retrosternal goitres is very rare and can be asymptomatic for a long period due to venous collateral development. Conclusion. Superior vena cava syndrome secondary to retrosternal goitres, a very rare occurrence, is an indication for total thyroidectomy, with low postoperative morbidity and dramatic resolution of symptoms.