Total thyroidectomy for cancer of the thyroid: significance of intraglandular dissemination.

Perioperative and postoperative morbidity and mortality were studied in a series of 3,008 thyroidectomies. Compressive symptoms, frequent in substernal and cancerous goiters, were present in 11.0% of the patients, although a low rate of dyspnea (2.7%) was observed. In large goiters, some orotracheal intubations were difficult. In such cases, the transtracheal approach can also be difficult, so failure should be anticipated. Postoperative causes of respiratory obstruction included local hemorrhages, bilateral recurrent nerve palsies, and laryngeal edema. A tracheal collapse was not observed. These respiratory obstructions led to repeat surgery in 11 patients, tracheostomy in 3, and temporary reintubation with steroid therapy in 1. The recurrent laryngeal nerve, which may have been affected preoperatively, was found to be damaged postoperatively in 0.5% of the patients with benign goiters, compared to 10.6% of the patients with thyroid cancer. In this last group a bilateral palsy was observed in 3 cases with prolonged or extensive surgery. After these short-term orotracheal intubations (114 minutes on average), injuries of the airway caused by the endotracheal tube were found in 4.6% of the patients.

Airway Complications in Thyroid Surgery

Transplantation of the Parathyroid Glands: Current Status

The incidences of hypothyroidism and its recurrence were studied in 791 patients at varying intervals after I/sup 131/ treatment of hyperthyroidism. Radiotherapy with I/sup 131/ tends to lead to hypothyroidism, both early and, especially, late. After a long remission, however, there is small likelihood of recurrence of hyperthyroidism. The influence of sex, age, type of goiter, and number of I/sup 131/ therapy doses administered on the incidence of hypothyroidism was studied. (auth)

Incidence of Hypothyroidism and Recurrences Following I131 Treatment of Hyperthyroidism

In a study of 328 cases of papillary adenocarcinoma of the thyroid treated surgically in the period 1940–1954, it was found that these adenocarcinomas are multicentric in at least 20 per cent of cases The multicentricity usually involves both lobes Given a papillary lesion in one lobe, one or more additional deposits occur in the same lobe in more than 10 per cent of cases, and in the opposite lobe in a like proportion of cases Further resection of the thyroid is advisable in cases in which partial lobectomy or partial thyroidectomy has been carried out previously because of a nodule that subsequently proves to be a papillary lesion Preservation of a remnant on the apparently uninvolved side together with the nodes in the tracheo-esophageal groove on that side is justified in order to avoid total parathyroidectomy

Multicentricity of papillary adenocarcinoma of the thyroid: influence on treatment.

The various complications of thyroid surgery have long been known to surgeons embarking on the surgical treatment of goiter. These complications may be severe enough to jeopardize the life of the patient or to create a physical or physiologic incapacity which will limit his normal activities. Because of the severity of these complications it becomes necessary that their incidence be reduced to an absolute minimum in this age of modern surgery. Moreover, if surgery is to continue to play a dominant role in the treatment of thyroid disease, the complications of this form of treatment must be less than those of other equally effective forms of treatment.

Complications of thyroid surgery

Malignant mucocele of the appendix; report of three cases.

In the current literature most authors agree that no completely satisfactory method exists for the preoperative diagnosis of parotid tumor. Blady and Hocker state that on sialography most malignant tumors show "infiltration" of the ducts, which they feel is diagnostic. The present study was undertaken to see whether such infiltrating lesions shed malignant cells which might be collected in the saliva and studied in the same manner as are bronchial washings. I t was felt that if positive results could be obtained with Papanicolaou smears, surgeons might be encouraged to adopt more radical initial surgical measures in the hope of improving the present discouraging results in the treatment of malignant lesions of the parotid gland. We have found no such study recorded in the English literature. This investigation was made on 33 patients who underwent surgical treatment of parotid tumors at the Mayo Clinic from July 1 to December 5, 1953. A total of 45 patients underwent such treatment during this period, but because of the nature of the previous operations and other factors, the remaining 12 were not considered suitable for study. On the night before operation, a specimen was collected from each parotid gland, the normal side thus serving as a control. In the first patients studied, Stensen's duct was cannulated, but in the remaining patients the simple but efficient device of Curby was used. Salivary flow was stimulated by unsweetened lemon juice. From 2 to 5 ml. of secretion was obtained in all cases, which was stained by a method previously described for bronchial washings. Three slides were made from each specimen. After the tumor was removed, fresh imprints were made in most cases and these were fixed and stained in the same manner as the secretions; these slides showed the appearance of known tumor cells stained by the same technic and served as further controls. All frozen-section diagnoses were confirmed by paraffin sections. Table 1 lists the diagnoses made on the basis of the tumors removed. All the smears showed a few scattered normal-appearing squamous cells and occasional columnar cells. No cells characteristic of the various benign tumors, as seen on the fresh imprints, were found. In the 7 cases in which the tumor was malignant, the slides made from the secretion in 1 of the cases of muco-epidermoid tumor were suggestive of malignancy, while those made in 1 of the cases of adenocarcinoma and in the case of undifferentiated carcinoma showed a few

Exfoliative cytology in the preoperative diagnosis of parotid tumors.

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Complications of thyroid surgery

Malignant mucocele of the appendix; report of three cases.

Exfoliative cytology in the preoperative diagnosis of parotid tumors.