Navegando por Palavras-chave "tireoidectomia"
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- ItemSomente MetadadadosDosagem do paratormônio: predizendo o risco de hipocalcemia sintomática após tiroidectomia total(Universidade Federal de São Paulo (UNIFESP), 2014-05-28) Vanderlei, Felipe Augusto Brasileiro [UNIFESP]; Abrahão, Marcio [UNIFESP] ; Universidade Federal de São Paulo (UNIFESP)Hypocalcemia is the most frequent complication after total thyroidectomy. We developed a method, using peri-operative parathyroid hormone (PTH) measure, which can identify patients with increased risk of developing symptoms of hypocalcemia. The purpose of this study is to validate our method evaluating the development of hypocalcemia symptoms after total thyroidectomy in patients treated or not with calcium and vitamin D based on the PTH value measured one hour after the surgery. Methods: Two hundreds ninety eight total thyroidectomy patients with or without central neck dissection were evaluated prospectively. PTH was measures one hour after the surgery (PTH1). If the value of PTH1 ? 12.1 pg/mL the patient was observed, if PTH1 < 12,1 pg/mL the patient was treated with calcium and vitamin D supplementation. All the patients were evaluated for symptoms of hypocalcemia. Results: One hundred ninety six patients had PTH1 ? 12.1 pg/mL and among them 183 (94,4%) had no symptoms. Our test managed right all but eleven patients (96,3%). None of these eleven patients had severe symptoms nor needed further hospitalization demonstrating the security of the test. Our rate of transient hypocalcemia among the patients studied was 31.5% and 6.5% for persistent hypocalcemia. The value of PTH1 ? 9.5 pg/mL had a sensitivity of 78% and specificity of 100% for the non-development of persistent hypoparathyroidism. Conclusion: PTH measured one hour after surgery is safe, reliable and can successfully identify patients most likely to develop symptoms of hypocalcemia after total thyroidectomy.
- ItemAcesso aberto (Open Access)Identificação do ramo externo do nervo laríngeo superior na tireoidectomia minimamente invasivo vídeo-assistida(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2005-06-01) Dedivitis, Rogério Aparecido [UNIFESP]; Guimarães, André V.; Universidade Federal de São Paulo (UNIFESP); Universidade Metropolitana de SantosThe minimally invasive video-assisted thyroidectomy (MIVAT) without gas infusion is considered safe and has advantages in terms of cosmetic results compared to the conventional approach. AIM: to present our findings regarding the identification of the external branch of the superior laryngeal nerve (EBSLN) during MIVAT. STUDY DESIGN: Transversal cohort study. MATERIAL AND METHOD: twelve patients underwent hemithyroidectomy for thyroid nodular disease through MIVAT method. The upper pedicle of the thyroid was dissected under the magnified view at 0-degree five-millimeter endoscope in order to achieve the identification of EBSLN in all cases. RESULTS: We identified 10 (83.3%) EBSLN out of 12 cases. The nerve ran medially to the branches of the superior thyroid artery in 8 cases (80%) and crossed anteriorly in 2 (20%). CONCLUSIONS: We identified the EBSLN in 83.3% of the cases, whose course was medial to the branches of the superior thyroid artery in 80% and crossing anteriorly in 20%. The ligation of the upper pedicle of the thyroid can be performed under direct view of the EBSLN.
- ItemSomente MetadadadosQualidade vocal de pacientes submetidos à tireoidectomia com monitorização do nervo laríngeo inferior(Universidade Federal de São Paulo (UNIFESP), 2014-06-25) Takimoto, Roberto Massao [UNIFESP]; Cervantes, Onivaldo Cervantes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: An attempt was made to estimate the inferior laryngeal nerves monitoring impact on thyroidectomized patient?s vocal quality. Study Design: Prospective clinic randomized double-blind trial. Methods: Eighty-five patients were evaluated, men and women, median age 48,19 yrs., with no thyroid hormone dysfunctions. They were operated without (group A ? 40 patients) or with (group B ? 45 patients) inferior laryngeal nerves monitoring. The groups were controlled by gender, age, tobacco, thyroid volume, surgery extent, post-op hypoparathyroidism, type of disease (benign or malignant), TNM classification, ASA classification, laryngeal trauma and difficulty during the intubation. Patients were excluded because: severe alteration in grade (perceptive evaluation) before surgery, previous neck surgery, previous laryngoscopic alterations , previous neck radiotherapy , neck dissection and the ones that did not come to the post-op appointment. All the patients went through perceptive evaluation (Grade, Roughness, Breathiness, Asthenia, Strain and Instability), laryngoscopy, acoustic vocal analysis (F0, jitter, shimmer, GNE and hoarseness diagram) and voice-related quality of life (V-RQOL). These evaluations were performed before and after surgery (1st and 4th week). Results: Group A had 8.57% of paralysis versus 7.5% in group B in the first week post-op (p=1.000) and 4.29% versus 6.25% in the fourth week post-op (p=0.865). In the perceptive evaluation, only breathiness in the fourth week post-op, showed significant difference between the groups (25% of altered evaluations in group A versus 6.7% in group B, p=0,041). However, when the patients were compared with themselves, evaluating the status before versus after the surgery, none of the evaluated parameters, not even the breathiness showed any significant difference. Twenty seven (27.05%) percent of all patients (both groups) showed worse grade (perceptive evaluation) in the first week post-op and 28.23% in the fourth week postop. In the vocal acoustic analysis, none of the parameters showed significant difference between the groups. The median F0 (Hz) in women was 202.62 (before surgery), 198.19 (1st week post-op) and 191.90 (4th week post-op) in group A, and 193.48 (before surgery), 190.63 (1st week post-op) and 186.81 (4th week post-op) in group B. In the V-RQOL, there was not any significant difference, nether between the groups nor before versus after surgery. The median total scores were 91.25 (before surgery), 91.69 (1st week post-op) and 92.19 (4th week post-op) in group A, and 93.78 (before surgery), 96.22 (1st week post-op) and 98.39 (4th week post-op) in group B. Conclusion: At the present study, there was no impact, nether improvement nor worsening, in vocal quality of thyroidectomized patients under inferior laryngeal nerves monitoring.