• Korean Journal of Head & Neck Oncology
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• v.15 no.1
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• pp.52-60
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• 1999

Objectives: For investigation of the differentiation between transient and permanent hypocalcemia, we focused on a postoperative calcium requirement and an interval of normalization in serum hypocalcemic level and studied for the causes of postoperative hypocalcemia. Material and Method: Postthyroidectomy hypocalcemia was studied in 193 patients who were admitted from January, 1991 to December, 1998 and underwent lobectomy, subtotal thyroidectomy or total thyroidectomy. We compared postoperative serum calcium, phosphate and ionized calcium levels among three groups which were lobectomy, subtotal thyroidectomy and total thyroidectomy, respectively. Result: All patients revealed postoperative decline in serum calcium and ionized calcium, especially, the lowest serum calcium level was seen in 48 hours after surgery. Serum calcium level was returned to normal in five to six postoperative days in most patients. But 24 patients required calcium supplementation due to symptomatic hypocalcemia. In this series, we discovered that the important period for monitoring of serum calcium level was 24 to 96 hours after surgery. If the calcium replacement therapy was not required in the first 72 hours after surgery, it would not be needed during the remainder of the patient's hospital course. Symptomatic transient hypocalcemia was 22 cases(11.4%) and permanent hypocalcemia was 2 cases(1%). Conclusion : We found that hypoalbuminemia, preoperative hyperthyroidism and impairment of blood supply to parathyroid were the main causes of postthyroidectomy hypocalcemia. We also thought that the interval from initial medication to normalization in serum calcium level, and the increase of requirement in calcium and vitamin D were the important factors for differentiation between transient and permanent hypocalcemia.

• Korean Journal of Head & Neck Oncology
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• v.13 no.2
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• pp.241-246
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• 1997

It has become evident in recent years that parathyroid adenoma and well differentiated thyroid cancer occur together more than would be expected by chance alone. However, the association between them is not well understood. We have experienced 4 cases of coexistent parathyroid adenoma and well-differentiated thyroid cancer during the past 16 years. None of them had a familial incidence or a history of radiation exposure. Three cases showed symptomatic hypercalcemia(including renal stones, bone pain, joint pain) and in two of them(patient 1 and patient 2), thyroid abnormalities were detected preoperatively by neck ultrasonography or neck CT for evaluation of parathyroid lesions. However, in patient 3, a parathyoid humor was identified and removed incidentally during the course of thyroidectomy. In 3 cases, surgeries for thyroid carcinoma and parathyroid adenoma were performed during the same exploration of the neck, but in patient 4, thyroidectomy preceded parathyroidectomy; The interval between thyroidectomy and subsequent parathyroidectomy was 11 yeras. The thyroid tumors in 3 cases were papillary carcinoma, the sizes of which ranged from 1.0 cm to 1.5 cm in greatest diameter. The remaining case(patient 4) was minimal invasive follicular carcinoma. Total or near-total thyroidectomy with various types of cervical lymphnode dissection and bilateral neck exploration for the parathyroid lesion was performed in 3 cases with papillary carcinoma. Ipsilateral lobectomy and contralateral partial thyroidectomy with consequent unilateral neck exploration for the parathyroid tumor was performed in the case of follicular cancer. In our experience, parathyroid adenoma and well-differentiated thyroid carcinomas can be coexistent and we felt that the attention to the hypercalcemic patients would be needed for detection of this rare condition.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.21 no.1
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• pp.37-41
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• 2010

Background and Objectives : Transient minor voice changes after thyroidectomy are not infrequent complaints even in cases without any evidence of recurrent laryngeal nerve damage. However, clinical course, diagnosis and management of such voice changes are not fully understood. This study aimed to evaluate the clinical characteristics of minor voice changes after thyroidectomy. We also tried to assess the significance and feasibility of superior laryngeal nerve monitoring and to find out the optimal evaluation tools for such voice changes after thyroidectomy. Materials and Method : Nine adult patients who received total thyroidectomy without evidence of recurrent laryngeal nerve injury were enrolled for this prospective study. Voice evaluations were performed preoperatively and 3 months postoperatively ; acoustic analyses including voice range profile, aerodynamic study, stroboscopic evaluation and subjective voice assessment with questionnaires. The external branch of superior laryngeal nerve was monitored by nerve stimulator after ligation of superior thyroidal vessels. Results: Four of nine patients complained their voice change at 3 months after the surgery. Three of them reported complete recovery of their voice at 6 months after the surgery. Acoustic analysis revealed significant decrease in their phonatory range especially with high tone loss. Questionnaires related to singing was more sensitive than previously well-known "voice handicap index". Stimulation of the superior laryngeal nerve was feasible in most of the cases (94.4%), but it failed to show any correlation with minor voice changes after thyroidectomy. Conclusion : Minor voice changes were not rare events during the first 6 month after thyroidectomy. Decrease in phonatory range with high tone loss and therefore, discomfort in singing was the most common finding. Superior laryngeal monitoring was feasible but it was not a sensitive tool for the prediction of minor voice change after thyroidectomy.

• Korean Journal of Radiology
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• v.23 no.10
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• pp.1019-1027
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• 2022

Objective: Thyroidectomy bed lesions frequently show suspicious ultrasound (US) features after thyroid surgery. Fine-needle aspiration (FNA) may not provide definitive pathological information about the lesions. Although core-needle biopsy (CNB) has excellent diagnostic performance in characterizing suspicious thyroid nodules, no published studies have evaluated the performance of CNB specifically for thyroidectomy bed lesions. Therefore, we aimed to evaluate the diagnostic performance and safety of CNB for characterizing thyroidectomy bed lesions. Materials and Methods: A total of 124 thyroidectomy bed lesions in 113 patients (79 female and 34 male; age, 23-85 years) who underwent US-guided CNB between December 2008 and December 2020 were included. We reviewed the US imaging features of the target lesions and the histories of previous biopsies. The pathologic results, diagnostic performance for malignancy, and complications of CNB were analyzed. Results: All samples (100%) obtained by CNB were adequate for pathological analysis. Pathological analysis revealed inconclusive results in two lesions (1.6%). According to the reference standard, 50 lesions were ultimately malignant (40.3%), and 72 were benign (58.1%), excluding the two inconclusive lesions. The performance of CNB for diagnosing malignant thyroidectomy bed lesions in the 122 lesions had a sensitivity of 98.0% (49/50), a specificity of 100% (72/72), positive predictive value of 100% (49/49), and negative predictive value of 98.6% (72/73). Eleven lesions were referred for CNB after prior inconclusive FNA results in thyroidectomy bed lesions, for all of which CNB yielded correct conclusive pathologic diagnoses. According to the pathological analysis of CNB, there were various benign lesions (58.9%, 73/124) besides recurrence, including benign postoperative lesions other than suture granuloma (32.3%, 40/124), suture granuloma (15.3%, 19/124), remnant thyroid tissue (5.6%, 7/124), parathyroid lesions (4%, 5/124), and abscesses (1.6%, 2/124). No major or minor complications were associated with the CNB procedure. Conclusion: US-guided CNB is accurate and safe for characterizing thyroidectomy bed lesions.

• Korean Journal of Head & Neck Oncology
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• v.17 no.1
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• pp.38-41
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• 2001

Background and Objectives: Thyroid nodules can be diagnosed by FNAB, neck sonography, CT scan, or frozen section with relative accuracy. But some cases, which show no malignancy with those methods, are proved differentiated carcinomas on permanent sections. These false negative results of those diagnostic methods pose difficulties in the surgeon's decision-making process. We analyzed completion thyroidectomies retrospectively in order to make a treatment guideline for thyroid nodules. Materials and Methods: During the last six years, we performed 243 thyroid lobectomies, no evidence of malignancy with preoperative or intraoperative diagnostic methods at the Department of Otolaryngology-Head and Neck Surgery, Ansan and Anam Korea University Hospital. Among these cases, 23 patients (male 6, female 17, mean age 33.4 year old) were proved differentiated thyroid carcinomas on permanent section and we performed completion thyroidectomies. Results: Preoperative FNAB showed seven cases of nodular hyperplasia, 11 cases of follicular adenoma, and five cases of inadequate specimen. Among total 15 cases on frozen section, five cases were nodular hyperplasias, and 10 cases were follicular adenomas. Pathologic results of the permanent section were six cases of papillary cell carcinoma and 17 cases of follicular cell carcinoma. Completion thyroidectomy was performed on all these cases. Conclusion: FNAB and frozen section cannot be sufficient to make the diagnosis of thyroid nodule, we consider that completion thyroidectomy should be performed at the moment with malignant evidence on permanent section.

• Korean Journal of Head & Neck Oncology
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• v.13 no.2
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• pp.206-212
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• 1997

H$\"{u}$rthle cell neoplasm of the thyroid gland is an uncommon, but potentially malignant lesion. However, in many instances, the malignant potential of the H$\"{u}$rthle cell neoplasm is very difficult to judge histologically. For this reason, the biologic behavior of this tumor and its optimal treatment have come under considerable debate in recent years. In order to review the clinicopathologic features of the H$\"{u}$rthle cell neoplasm and to determine its optimal treatment modalities, we studied 26 patients with path logical proof of H$\"{u}$rthle cell tumor from January 1987 to September 1997. We also performed an immunohistochemical study using the monoclonal antibodies against antigen CD34 for the angiogenic activity of this tumor and evaluated the differences of microvessel density(MVD) between benign and malignant tumors. The age of the patients ranged from 1 to 71 years with a mean of 44.2 years. There were 6 males and 20 females(M : F= 1 : 3.3). The accuracies of fine needle aspiration biopsy and frozen section were very low; 6.3% and 34.8%, respectively. There were 20 benign tumors and 6 malignant tumors(23.1%). All the malignant tumors were microinvasive(intermediate) type which had minimal capsular invasion and most of them(5 cases) were diagnosed postoperatively. Any specific clinicopathologic differences were not seen between benign and intermediate groups. Most of the cases had conservative surgeries(15 ipsilateral lobectomy-isthmusectomy, 7 subtotal thyroidectomy) while total thyroidectomy was performed in 4 cases. Of the cases with malignant tumor, 2 had ipsilateral lobectomy-isthmusectomy, 3 had subtotal thyroidectomy and the remaining 1 had total thyroidectomy. Mean size of the tumors was 3.0 cm(0.1- 8.5 cm) in the greatest diameter and multiple tumors were seen in 6 cases(23.1 %). During the follow-up period, only one recurrence(3.8%) of benign tumor occurred but distant metastasis or cause-specific death was seen in the benign or intermediate groups. Mean MVDs of the benign(n=13) and intermediate(n=6) groups were $121.7{\pm}35.3$ and $114.3{\pm}31.7$, respectively and there was no statistical significance between them. In conclusion, because of the low accuracies of fine needle aspiration biopsy and frozen section for the H$\"{u}$rthle cell neoplasm, the extent of surgery could be individualized based on permanent pathologic examination; Conservative surgery would be adequate for patients with benign or intermediate H$\"{u}$rthle cell neoplasm and total or near-total thyroidectomy for those with definite malignancy.

• Korean Journal of Head & Neck Oncology
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• v.27 no.1
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• pp.38-41
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• 2011

Background and Objectives : Although it is well established that patients with papillary thyroid microcarcinoma (PTMC) have a highly favorable prognosis, the extent of thyroid surgery for PTMC remains unclear. According to the 2011 revised Korean Thyroid Association guideline, the choice of surgical strategy(total thyroidectomy versus lobectomy) for PTMC depends on solely preoperative diagnostic scrutinies-ultrasonography and fine needle aspiration cytology. We want to know how accurately these preoperative diagnostic scrutinies define the choice of surgical strategy for PTMC. Materials and Methods : For 119 patients who underwent total thyroidectomy with central neck dissection for PTMC, retrospectively, we compared the choice of surgery according to preoperative work up and postoperative pathologic findings. Results : Overall accuracy of the choice of surgery by preoperative work up was 61%. Among patients recommended lobectomy on preoperative work up, completion thyroidectomy on postoperative pathology might be necessary for 60% of patients and hidden central node metastasis was revealed in 31% of patients. Conclusions : The results of this study compel us to reinvestigate the current treatment guideline for PTMC. On current guideline according to the sonography and fine needle aspiration cytology, it might be thought to be better to choose more aggressive surgical strategy.

• Korean Journal of Head & Neck Oncology
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• v.32 no.1
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• pp.7-11
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• 2016

Background and Objectives: Quality of voice may be deteriorated after thyroidectomy without any injury to recurrent laryngeal nerve. While there have been several studies showing the change of acoustic parameters after thyroidectomy, factors related to deteriorated voice quality have been rarely studies. In this study, we sought to analyze the factors associated to deteriorated voice quality after thyroidectomy. Materials and Methods: We made a retrospective review of 35 patients who underwent thyroidectomy for papillary thyroid carcinoma. Voice analysis including acoustic analysis, voice handicap index 10 (VHI-10), and GRBAS score was conducted before and 3 months after surgery. Patients were grouped according to the amount of increase in VHI-10 after surgery ; group A (${\Delta}VHI<7$) and group B (${\Delta}VHI{\geq}7$). Clinicopathologic factors associated to patients of group B were analyzed and changes of parameters from acoustic analysis in each group were evaluated. Results : Patients of group B were associated with age ${\geq}45$ years (p=0.025) and showed borderline association to total thyroidectomy (p=0.075) and tumor size ${\geq}1cm$ (p=0.086). Multivariate analysis demonstrated that those with age ${\geq}45$ years were independently associated to deteriorated quality of voice (p=0.014, HR=18.38). Patients of group B were also associated to significant deterioration of high pitch (p<0.001) and Grade score with borderline significance (p=0.054). Conclusion: Patients older than 45 years may have higher risk of deterioration of quality of voice after thyroidectomy based on increase of VHI-10 score (${\Delta}VHI{\geq}7$). Association with deterioration of high pitch should also be considered in these patients.

• Korean Journal of Head & Neck Oncology
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• v.28 no.2
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• pp.114-117
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• 2012

Background and Objectives : To assure the surgical completeness of the gasless endoscopic thyroidectomy via single incision axillary approach using flexible videoscope which provide wide angle and working space, we compared single incision axillary approach and axillo-areolar approach by means of clinical, surgical outcomes. Materials and Methods : From March 2011 to July 2012, 24 patients who had underwent endoscopic thyroidectomy via transaxillary approach were enrolled. Of total, 17 patients underwent single incision axillary approach(group I) and the other 7 underwent axillo-areolar approach(group II). Results : Patient demographics, surgical indications were similar between the two groups. The operating time(group I 144.6min, group II 153.6 min ; p=.29), blood loss(group I : 55.4cc, group II : 35.7cc : p=.64), hospital stay(group I : 4.2days, group II : 4.4 days ; p=.65) were similar in the two groups. Overall, two patients in group I(2/17, 11.8%) experienced postoperative complications, including one hematoma and one seroma. Due to narrow working space, one patient was change to axillo-areolar approach during single incision axillary approach with $30^{\circ}$ rigid endoscope. Conclusion：Single incision axillary approach is safe and effective similar to other endoscopic thyroidectomy methods using flexible videoscope. Different with $30^{\circ}$ rigid endoscope, 10-mm flexible videoscope can put inside the axillary inicision site in different axis with endoscopic instruments. This difference in endoscopic axis help to prevent crash with endoscopic instrument.

• Korean Journal of Otorhinolaryngology-Head and Neck Surgery
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• v.61 no.12
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• pp.697-701
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• 2018

Background and Objectives The aim of this study was to evaluate surgical completeness in endoscopic total thyroidectomy with central neck dissection via unilateral axillo-breast approach (UABA) compared with bilateral axillo-breast (BABA) and open approach (OA) by means of the radioactive iodine uptake (RAIU) ratio and thyroglobulin (Tg) of remnant thyroid. Subjects and Method From July 2010 to March 2013, 82 patients who had underwent total thyroidectomy with central neck dissection and postoperative radioactive iodine (RAI) ablation for papillary thyroid carcinoma were enrolled. Of these patients, 27 patients underwent UABA, 24 patients BABA, and 31 patients OA. Clinicopathologic data, surgical outcome, stimulated Tg and RAIU ratio on the first postoperative RAI ablation scan were compared among 3 groups. Results Patients in the endoscopic surgery groups (UABA, BABA) were younger than those in the OA groups. Invasiveness such as operation time, postoperative pain, and drain amount in UABA was less than that in BABA and severer than that in OA. Other variables regarding clinicopathologic and surgical data were not significantly different. Stimulated Tg and RAIU ratio did not show significant differences among 3 groups (p=0.659 and p=0.664). Conclusion The completeness of UABA was comparable with that of BABA and OA. The UABA may be a safe option for patients who need endoscopic thyroidectomy for papillary thyroid carcinoma.