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Thyroid isthmusectomy: a critical appraisal

Published online by Cambridge University Press:  11 December 2006

C Skilbeck ,
A Leslie  and
R Simo
C Skilbeck
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas' Hospital, London, UK
A Leslie
Affiliation:
Department of Radiology, University Hospital Lewisham, London, UK
R Simo
Affiliation:
Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas' Hospital, London, UK
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Abstract

Thyroid lobectomy with isthmusectomy is the standard surgical technique for removal of unilateral thyroid nodules, and it involves the exposure of the tracheoesophageal grooves. Thyroid isthmusectomy is a surgical procedure that excises only the thyroid isthmus. It allows excision of a lesion without the exposure of the tracheoesophageal grooves.

We aimed to demonstrate that isthmusectomy could be a safe alternative to thyroid lobectomy with isthmusectomy in patients with nodules confined to the isthmus or the pyramidal lobe.

This was a prospective study performed over a five year period from 1999 to 2004. Inclusion criteria for thyroid isthmusectomy were: patients with a single lesion located in the region of the thyroid isthmus or the pyramidal lobe; maximum lesion diameter of 30 mm; and cytological reports of non-diagnostic appearance, follicular cells or suspicion of malignancy.

Nine patients were identified with these criteria. Histology included two colloid nodules, three benign follicular adenomas, two Hurthle cell adenomas and two papillary thyroid carcinomas. There were no recorded complications.

Thyroid isthmusectomy is a safe alternative to thyroid lobectomy with isthmusectomy in patients who have nodules confined to the isthmus and pyramidal lobe. Leaving a cuff of normal thyroid tissue has the advantage of not exposing the tracheoesophageal grooves, thus minimising potential damage to the recurrent laryngeal nerves and parathyroids. Surgeons performing isthmusectomies should be experienced in more complex thyroid surgical procedures.

Keywords

Thyroid NoduleThyroid NeoplasmsThyroidectomy
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 121 , Issue 10 , October 2007 , pp. 986 - 989
Copyright
2007 JLO (1984) Limited

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Footnotes

Presented at the XVIII World Congress of the International Federation of Otorhinolaryngological Societies, 29th June 2005, Rome, Italy.