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Studies Examine Safety, Cosmetic Outcomes of Thyroidectomies

Two Oral Presentations will highlight studies looking at cosmetic outcomes and the safety of outpatient surgery related to thyroidectomies. “Scientific Oral Presentations—Endocrine Surgery” will be presented from 1:00 pm-2:00 pm today in Trinity Ballroom 1 of the Omni Dallas Hotel.

Outpatient Thyroidectomies Safe for Elderly Patients

Thyroidectomies are increasingly being performed as an outpatient procedure, but the safety of the surgery for the elderly has not been demonstrated before now. A Scientific Oral Presentation shows that following established protocols for outpatient thyroidectomy in the geriatric population is a safe and appropriate option.

“As the American population is getting older, we are going to see more of these elderly patients. We wanted to determine if these patients are good surgical candidates not just for thyroidectomies, but for outpatient thyroidectomies,” said Jamie M. Segel, MD.

Dr. Segel is the lead author of “Outpatient Thyroidectomy Is Safe in the Elderly and Super-elderly,” which will be presented from 1:12 pm-1:17 pm today in Trinity Ballroom 1 of the Omni Dallas Hotel. She is a Resident Physician at Georgia Regents University Department of Otolaryngology-Head and Neck Surgery, Augusta, GA.

The seven-year study of 1,429 patients compared the safety of outpatient thyroidectomies in two groups—elderly, over age 65, and super-elderly, over age 80—with a control group, ages 21-40.

“We compared these groups and assessed their outcome measures,” Dr. Segel said. “We looked at readmission and common complications in thyroidectomy surgery, such as hematoma, vocal cord paralysis, and hypocalcemia. We were surprised that the rates are similar, if not lower, than the control population.”

The key is a refined protocol established for all patients considered for outpatient thyroidectomies. This excludes patients with severe medical comorbidities, and includes intra-operative techniques, such as the use of laryngeal nerve monitoring, advanced hemostatic devices, and single-point strap muscle closure. Postoperatively, patients are evaluated using a flexible laryngoscopy after total or completion thyroidectomies, and follow a calcium regimen, she said.

“Rates of successful procedures in the elderly, at a minimum, are comparable with the control group because of the implementation of the protocol,” Dr. Segel said. “Older patients tend to be sicker, so not all of them qualify for outpatient surgery. When they meet the selection protocol, they do just as well as any patient who meets the protocol selection criteria.”

Study Shows Patients Prefer Smaller Thyroidectomy Scars

A study confirms that patients prefer the appearance of minimally invasive thyroidectomy scars over the longer scars associated with conventional thyroid surgery.  The study, “Cosmetic Outcomes after Thyroidectomy: The Patient Perspective,” will be presented from 1:24 am-1:29 am today in Trinity Ballroom 1, Omni Dallas Hotel.

“Thyroid surgery has traditionally been associated with a big anterior neck scar, but recently, minimally invasive and remote access techniques have been developed to approach the thyroid,” said William S. Duke, MD, a lead author of the study. “One of the controversies about the minimally invasive techniques that has emerged is whether the size of the incision really matters to patients. Some people have even published papers that—in their experience—their patient populations don’t care how big their incisions are.”

Questions about the validity and applicability of those findings to larger patient populations guided the design of the study, said Dr. Duke, Assistant Professor and Associate Surgical Director of the GRU Thyroid Center, Georgia Regents University Department of Otolaryngology-Head and Neck Surgery. Medical illustrators at the university created computer-generated thyroidectomy scars of varying lengths that mimic several types of minimally invasive surgical incisions, as well as the conventional thyroidectomy incision.

The six illustrations were added to photos and shown to patients who have had thyroidectomy or sinus surgeries, to eliminate any bias, he said. The appearances of those scars were then measured using a validated instrument.

“We found shorter scars scored better than long scars, and thin scars scored better than wide scars. We now have objective data,” Dr. Duke said. “All patients preferred the appearance of shorter scars, and this preference transcends gender, age, race, and bias about whether a patient is going to get a neck scar.”