European Journal of Molecular & Clinical Medicine

Background: Hypocalcaemia is a common complication following thyroid surgery,
cause of which is multifactorial. The aim of this study was to identify risk factors for
development of post-operative hypocalcaemia in cases of total thyroidectomy, near total
thyroidectomy, and completion thyroidectomy with or without neck dissection.
Materials and Methods: From 1st November 2020 to 31st October 2021, 40 consecutive
patients undergoing total thyroidectomy, near-total, sub-total or completion
thyroidectomy at Govt Medical College & Hospital, Suryapet were enrolled in this
prospective study, longitudinal, cohort study. The primary endpoints were the
occurrence of post-operative hypocalcaemia as by defined as a nadir corrected serum
calcium less than 8.0 mg/dL or symptomatic hypocalcaemia.
Results: 40 patients were analyzed. The average age was 42.53±15.86 years with 86.7%
female. The most common indications for surgery were benign thyroid disease (80%).
27 patients (67.5%) experienced postoperative hypocalcaemia with 14 (35 %) requiring
intravenous calcium infusion. Risk factors for postoperative hypocalcaemia included
inadvertent parathyroid removal during surgery further exemplified by the fact that
there is lesser incidence of post-operative hypocalcaemia in patients undergoing near
total thyroidectomy.
Conclusion: Patients undergoing total thyroidectomy and in whom parathyroid could
not be identified and preserved or auto transplanted may benefit from more vigilant
pre-operative preparation and postoperative calcium and vitamin D supplementation.

Background:The postoperative consequences of thyroid surgery have long been
recognisedbygoitre surgeons. These problems may be serious enough to endanger the
patient's life or cause physical or physiological limitations. Given the severity of the
consequences, they must be kept to a minimum in this age of contemporary surgery.
Moreover, for surgery to remain a dominating treatment option for thyroid illness, its
complications must be less than other effective treatments. Aim: objectives of this study
is to investigate preoperative factors that influence complication rates, complication
rates linked with thyroid surgery type, problem types, complication onset time,
complication duration, complication management.
Materials and Methods: The current study lasted 18 months from January 2019 to July
2020. Princes Esra Hospital, Deccan College of Medical Sciences, Hyderabad. The study
included a prospective analysis of 80 goitre surgeries. These cases were clinically
investigated and recorded using the attached proforma.
Results: A study of 80 goitres having surgery(cases that underwent goiter surgery)
revealed Thyroid problems affect women more than men. The hospital saw the most
patients in their third decade. Multinodular Goitre in Euthyroid Status was the most
common clinical diagnosis. The most prevalent histology diagnosis was Nodular Colloid
Goitre. Subtotal thyroidectomy was the most common procedure for goitre.
Complications after surgery included wound infection. This trial had no fatality and
little morbidity. It is possible to do thyroid surgery with little morbidity and mortality
for a wide range of thyroid illnesses if done gently with thorough attention to hemostasis
and structural features.

Background: Thyroid swelling is a condition commonly encountered by General Surgeons. Some patients need only Medical Management, whereas others need Surgical management in the form of Hemi or Total Thyroidectomy. Compared to RLN the EBSLN is less studied in terms of course and relation to thyroid gland intraoperatively. In our study we observed the course and relation of EBSLN with respect to the thyroid gland during surgery.
Materials and Methods: A prospective analysis of 60 patients who underwent thyroidectomy in General Surgery department in Rajah Muthiah Medical College was done. Intraoperatively, the EBSLN was visually identified and preserved before proceeding to ligate the superior thyroid vessels. The nerve was classified according to the Cernea classification.
Results: In 60 patients, 95 nerves were planned to be identified. The nerve was type 1 in 28/95 (29.5%), Type 2a in 46/95 (48.5%), and Type 2b in 11/95 (11.5%) patients. The nerve could not be identified in 10/95 (10.5%) patients.
Conclusion: The course and relation of EBSLN with respect to thyroid gland varies in different thyroid pathologies.

Background: Unrecognized transection of the recurrent laryngeal nerve (RLN) or its motor branch could result in an unexpected permanent palsy. So, for a safe thyroid operation, intraoperative assurance of anatomical and functional RLN integrity is a necessity. Aim of work: To evaluate the recognition and protection of RLN by staining the RLN intraoperatively with methylene blue (MB) in one side and comparing it with the identification alone in the other side visually during total thyroidectomy. Subjects and methods: A case control study (retrospective study) carried out in the department of surgical oncology Zagazig university hospitals and Ismailia teaching oncology hospital during the period from November 2018 to August 2019. The study included 112 patients with bilateral thyroid disease who will do total thyroidectomy. The patients were subdivided into two groups depending on the MB use. Complete history taking was taken from all subjects. General examination of all body systems and local examination of the neck were done. We also did full lab investigations, neck U/S then the operations were performed. Results: We detected transient vocal cord palsy 10 sides (8.6%) of visual  identification alone, while in MB sides no case was detected with the same lesion. Conclusion: Recognition of RLN intraoperatively by MB staining is cheap and widely available technique and can decrease the stress during thyroidectomy, especially when Intra Operative Nerve Monitoring (IONM) is absent.

Background: Thyroid nodules are extremely common and are usually benign. 4%-6.5% from thyroid nodulesaremalignant. Among Thyroid cancer investigations manydiagnostic molecular biomarkers were found to have applications in thyroid nodules managment and avoid unnecessary thyroidectomy.(1)
This study aims:To detect value of micro-RNA 221 expression in sera of Patients with thyroid nodules and its relation to outcome after surgery.
Patients and Methods: Forty-five adult subjects aged between 18 to 70-years old who were diagnosed with suspicious thyroid nodules that required total thyroidectomy were offered participation in the study. In addition, five healthy Subjects, were included as a control group, based on the patient’s history, physical examination, US and FNAB findings. Patients who had thyroid nodules with U/S pattern suggestive of malignant potential (TIRADS score ≥ 3),also with indeterminate FNAB results (Bethesda III, IV)were selected. Samples of human plasma were collected from selected patients visiting outpatient clinics. Results was correlated with postoperative pathology results.
Results: In our study there was no significant difference regarding outcome in patients (benign or malignant) with respect to serum microRna 221. There was a significant difference between benign and malignant outcomes regarding size of dominant nodules by ultrasound with a mean value equals 4.6 cm in largest dimension in patients with malignant thyroid nodules and p value equals 0.027 indicating increased size of nodule may be associated with increased risk of malignancy.