The Relationship Between the Serum Level of Vitamin D and Hypocalcemia After Total Thyroidectomy

Vitamin D plays a crucial role in calcium metabolism through the parathormone-dependent process. The deficiency of this important nutrient may be associated with hypocalcemia after thyroidectomy. To evaluate the role of vitamin D in predicting hypocalcemia following total thyroidectomy. In this study, sixty-two patients who underwent total thyroidectomy for benign or malignant thyroid disease were included in this prospective study. Preoperative vitamin D serum levels and parathormone (PTH) levels were determined. The association between preoperative vitamin D status and the development of hypocalcemia was investigated. In this study, 62 patients were evaluated. The mean age of the subjects was 47 years. Of the 62 patients studied, of which 9 were male patients (14.5%), and 53 were female (85.5%), the results of our study showed. In both groups with and without vitamin D deficiency, calcium levels decreased significantly (P=0.01). In our study, it was found that there was no significant relationship between postoperative hypocalcemia and vitamin D deficiency. (P=0.441). After reviewing the data and according to Spearman correlation statistical test, no significant relationship was observed between serum parathyroid hormone (PTH) and calcium after thyroidectomy (P=0.340). Vitamin D deficiency is a risk factor of hypocalcemia after total thyroidectomy for benign goiter. Although post thyroidectomy hypocalcemia is multifactorial, vitamin D deficiency, particularly severe form, is significantly associated with the development of biochemical and clinical hypocalcemia. Vitamin D supplementation can prevent this unwanted complication in such patients.

Regrowth of Thyroid Gland: Is This Possible????

Introduction: Adult Thyroid gland which derived from primitive pharynx and neural crest is considered a non-regenerative organ. In this nature, partial or total thyroidectomy is considered a curative treatment for compressive non-malignant goiter. While there is a potential regrowth from stimulating by pituitary thyroid stimulating hormone (TSH), such growth is rarely significant and suppressive TSH therapy is currently indicated only for thyroid malignancy. We present an unusual case of rapid regrowth of normal thyroid tissue that expanded both of the lobes from a single unilateral remnant. Case: 58-year-old male with prior history of multinodular goiter status post subtotal thyroidectomy due to compressive symptoms in 2006 present to our clinic for follow up. Post-operatively, case was complicated with Iatrogenic Hypoparathyroidism thus on replacement of calcium and calcitriol. Follow up neck ultrasound (US), showed no thyroid gland with minimal residual tissue in the right fossa and pathology was benign. In 2011, patient complained of new onset globus sensation, and voice changes which initially concern for gastroenterology issue as the etiology. A neck US unexpectedly revealed normal right thyroid lobe of 5.7 cm without any tissue on the left and no nodule. FNA subsequently performed which was benign tissue. Due to high risk of complication for repeat surgery, annual US was planned for monitoring. In 2013 there was a significant new growth of left thyroid of 1.7 cm in size, no nodules. A repeat US six months later revealed an increase in size in the right from 5.7 to 6.1 cm as well as 1.7 to 2.1cm on the left. Patient denied any compressive symptoms, so we continue with neck US surveillance. By 2020, the right lobe was 6.4 cm and left lobe at 2.4 cm. Within both lobes, now multiple nodules start appearing. FNA were performed on several of those nodules with a benign cytopathology in all of them. Of note, other than regrowth of his thyroid, it is also physiologically functional as patient is euthyroid without levothyroxine replacement since 2013. Discussion: When patient underwent thyroidectomy for benign multinodular goiter, thyroid function test is the only routine test for follow up without additional further images. While it is considered a curative treatment, some regeneration or recurrence is still a possibility which is shown in our case. This is one of the few cases in the literature that we could found about normal thyroid tissue regrowth. It is still unclear how the mechanism for this phenomenon occurs. Further studies may need to be pursued with regards to suppressive TSH therapy or even radioactive iodine ablation for benign goiter that have regrowth potential. It is crucial that physicians become aware of such occurrence may happen since new thyroid nodules can also develop in the new thyroid tissue and fine needle aspiration should be performed accordingly.

Hypoglossal nerve palsy after gasless trans-axillary endoscopic thyroidectomy: a case report

Background Gasless trans-axillary endoscopic thyroidectomy (GTAET) has satisfactory cosmetic effects for the patients who have benign goiter and small thyroid carcinoma, however the complications of this surgical procedure have not been fully documented. Ipsilateral hypoglossal nerve palsy (IHNP) associated with GTAET has never been reported before. Case presentation A 33-year old male patient presented with a 4 × 5 mm solid thyroid nodule in the right lobe. Papillary thyroid carcinoma was confirmed by the fine needle aspiration. He had strong cosmetic demand, therefore GTAET for right lobectomy and central cervical lymphadenectomy was performed in a supine position with cervical extension. Six hours after the operation, he developed tongue deviation to the right side, speech and swallowing difficulties, indicating IHNP. Head and cervical MRI showed no abnormality. The intravenous steroid was used for three days, and oral vitamin B1 and mecobalamin was prescribed for 1 month. Nine days after surgery, he was discharged. Three months after the operation, all the symptoms were completely resolved. Conclusions To the best of the authors’ knowledge, this is the first case of IHNP after GTAET, which will be valuable to add our knowledge to diagnose and treat rare complications of GTAET.

Appraisal of Thyroidectomy in Outlying Tertiary Care Hospital

Objective: To find out the prevalence, presentation, disease patterns, operations of the thyroid gland and facilitate the prevention of complications and a risk factors for it. Study design: Cohort retrospective study. Setting: Academic tertiary care hospital. Subject and Methods: A total of 173 euthyroid benign and malignant goiter patient’s demographic data, diagnosis, operations, complications, and management options collection and analyzed who attended in the department of Otolaryngology and Head-Neck Surgery, Comilla Medical College, and Comilla Medical Centre, concern Clinic of Central Medical College, Comilla, Bangladesh from 01 July 2016 to 31 June 2019. Results: Incidence of euthyroid benign and malignant Goiter among outpatient was 0.12%, and the yearly prevalence of 33.34%. Out of 173, the male was 20 (11.56%), and the female 153 (88.44%), 30-39 years patients have the highest presentation was 60 (88.44%), 20-29 years 40 (23.12%), and 40-49 years 38 (21.97%), euthyroid benign goiter was 142 (82.08%), and malignant 31 (17.92%).

The Serum Level of Vitamin D and Hypocalcemia in Thyroidectomy Candidate Patients Referred to a Tertiary Care Hospital in the North of Iran

Objective: Vitamin D plays a crucial role in calcium metabolism through the Parathyroid hormone (PTH) dependent process. The deficiency of this important nutrient may be associated with hypocalcemia after thyroidectomy. To evaluate the role of vitamin D in predicting hypocalcemia following total thyroidectomy.Results: sixty-two patients who underwent total thyroidectomy for benign or malignant thyroid disease were included in this prospective study. Preoperative vitamin D serum levels and PTH levels were determined. The results of our study showed In both groups with and without vitamin D deficiency, calcium levels decreased significantly (P = 0.01). In our study, it was found that there was no significant relationship between postoperative hypocalcemia and vitamin D deficiency. (P = 0.441). After reviewing the data and according to Spearman correlation statistical test, no significant relationship was observed between serum PTH and calcium after thyroidectomy (P = 0.340).Vitamin D deficiency is a risk factor of hypocalcemia after total thyroidectomy for benign goiter. Although post thyroidectomy hypocalcemia is multifactorial, vitamin D deficiency, particularly severe form, is significantly associated with the development of biochemical and clinical hypocalcemia vitamin D supplementation can prevent this unwanted complication in such patients.

Tracheomalacia due to trachea compression related to benign goiter

Introduction: Tracheomalacia can result from long-standing compression by a large goiter. The cartilaginous rings of the trachea may be weakened or destroyed by long-standing compression, causing loss of structural support. Tracheomalacia after resectioning of benign goiter compressing trachea was an important issue. It has extended the time of mechanical ventilation, increased the risk of failure extubating and mortality. Materials and Methods: Descriptive and prospective study. From November 2014 to January 2017, we have collected 102 patients who had benign goiter compressing trachea and had thyroidectomy. Tracheomalacia was diagnosed and managed intra and postoperatively. Results: Recognition of women accounted for the majority of 81.4%. The average age was 54.5 years old and the average duration of goiter was 5 years. The patients were hospitalized with the main symptom of dysphagia accounting for 21.6% and difficulty breathing when lying down was 16.7%. On CT scan, the average Goiter was 270g, the average narrow airway diameter was 8.4 mm, of which 12.7% of patients had narrow tracheal diameter <5mm. The rate of tracheomalacia was 4.9%. There were statistically significant differences between the 2 groups with and without tracheomalacia: elderly patients (p = 0.041); goiter long-standing time (p = 0.07); symptoms of positional dyspnea on lying (p = 0.003) and tracheal diameter compressed (p = 0.001). Conclusion: Tracheomalacia should be noted in patients older than 65 years old, goiter exist longer than 5 years and goiter is over 200g.