Musculoskeletal Diseases

Nervous System Diseases

Symptoms and General Pathology

All Conditions

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Gland and Hormone Related Diseases

Respiratory Tract (Lung and Bronchial) Diseases

Ear, Nose, and Throat Diseases

Nutritional and Metabolic Diseases

Rare Diseases

Muscle Weakness

Thyroid Neoplasms

Thyroid Diseases

Paralysis

Paresis

Thyroid Nodule

Hypoparathyroidism

Vocal Cord Paralysis

Goiter

Thyroid Cancer, Papillary

Hypocalcemia

Endocrine System Diseases

Endocrine Gland Neoplasms

Head and Neck Neoplasms

Neurologic Manifestations

Parathyroid Diseases

Metabolic Diseases

Calcium Metabolism Disorders

Water-Electrolyte Imbalance

Laryngeal Diseases

Respiratory Tract Diseases

Otorhinolaryngologic Diseases

Vagus Nerve Diseases

Cranial Nerve Diseases

Adenocarcinoma

Adenocarcinoma, Papillary

Carcinoma

Neoplasms, Glandular and Epithelial

Neoplasms by Histologic Type

Control (status/post-s/p total thyroidectomy-TT, without complication- demographics and BMI matched)

Experimental (s/p TT, with only vocal cord paralysis-VCP, uni or bilateral)

Experimental (s/p TT, with only hypocalcemia-H, transient or permanent)

Experimental (s/p TT, with both vocal cord paralysis-VCP and hypocalcemia-H);

Subgroups:

4.1. VCP (Permanent) + H (Permanent) 4.2. VCP (Transient) + H (Transient) 4.3. VCP (Permanent) + H (Transient) 4.4. VCP (Transient) + H (Permanent)

Please answer:

* Improvement in hypocalcemia also make a positive effect on voice? (any objective sign? Ca? PTH?)
* Return of voice is parallel with the improvement in hypocalcemia? (any objective sign? Ca? PTH?

Patients with thyroid diseases either benign (e.g. multinodular goitre) or malign (e.g. thyroid carcinoma) will be prepared for total thyroidectomy procedure and will be enrolled.

Total thyroidectomy

Ethem UNAL, MD, PhD, USMLE & IFSO-Certified, Board CSS

Kadir YILDIRAK, MD

Ethem UNAL, MD, PhD, USMLE & IFSO- Certified Board CSS

Kadir M YILDIRAK, MD

Sema YUKSEKDAG, MD

In the present study, the severity of recurrent laryngeal nerve injury (RLNI) and hypocalcemia (H) will be followed-up and the probable interrelation between them will be proposed considering the clinical situation of patients, e.g. improvement in hypocalcemia also make a positive effect on voice? (any objective sign? Ca? PTH?), return of voice is parallel with the improvement in hypocalcemia? Postoperative calcium (Ca), parathyroid hormone (PTH), regular vocal cord evaluations by ear-nose-throat (ENT) exams, deterioration-stability-improvement of clinical symptoms regarding both Ca metabolism and vocal cord function will be noted at regular intervals (postoperative day 1-3-first, weekly control/first month, monthly/first 6-month, 3-monthly/6-12 months) at outpatient controls. Serum Ca, PTH, ENT evaluation of vocal cords-noted.

Total thyroidectomy is currently the preferred surgical treatment modality for both thyroid carcinomas and benign disorders such as multinodular goitre, since it minimizes the risk of recurrence and eliminates the complication risks of repeat or completion surgery. Vocal cord paralysis due to injury to recurrent laryngeal nerve (RLN) is the most dreaded complication of total thyroidectomy. The reported incidence of temporary RLN injury (RLNI) varies between 0 and 12 %, while the incidence of permanent RLNI has been reported to be much lower (0-3.5 %). In case of bilateral RLNI, respiratory distress and aspiration can develop rapidly and may result in mortality. Therefore, all precautions including close monitoring and tracheostomy should be undertaken without any delay. The best known technique to avoid injury to RLN is meticulous dissection of the nerve throughout its anatomic pathway. However, functional impairment of RLN is not visible macroscopically and intraoperative nerve monitoring (IONM) has been developed to monitor the nerve to avoid unnecessary dissection. Meticulous hemostasis can be achieved with harmonic sealing instrument, since improper hemostasis is known to increase the risk of RLNI. Despite the lack of evidence to support an advantage of IONM over the standard anatomic dissection of RLN, surgeons have adopted it in increasing ratios. The second most feared compliation of thyroidectomy is iatrogenic hypocalcemia. Transient symptomatic hypocalcemia after total thyroidectomy occurs in approximately 7% to 25% of cases, but permanent hypocalcemia is less common (0.4% to 13.8%). Size and invasion of tumor, operative trauma and vascular compromise determines the severity of symptoms.

Post-thyroidectomy Vocal Cord Paralysis Along With Hypocalcemia: STROBE - Guided Prospective Cohort

Post-thyroidectomy Vocal Cord Paralysis Along With Hypocalcemia: Prospective, Matched-randomized Observational Cohort Compatible With STROBE Guidelines

Study is open to high-volume INTERNATIONAL endocrine surgery centers, eager to join to present STROBE compatible observational study

Available upon email requests@drethemunal@gmail.com

Any improvement recorded? VCP? H? vice versa

Umraniye Education and Research Hospital

MD, PhD, USMLE & IFSO-Certified, BCSS, Associated Professor of General Surgery and Surgical Oncology

Spots Global Cancer Trial Database for iatrogenic hypocalcemia