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ABSTRACT: Abstract We evaluated dehydroepiandrosterone-sulfate (DHEA-S) levels in premature ovarian failure (POF) patients with and without Hashimoto's thyroiditis, and the impact of DHEA supplementation on thyroid autoantibodies. In a retrospective case series, we included 67 women with spontaneous POF who received estrogen/gestagen replacement with or without DHEA (30mg/day) for 3 months. Women who were seropositive for thyroglobulin-antibodies and/or thyroperoxidase-autoantibodies (n=30) revealed lower pretherapeutic DHEA-S levels (1.2µg/ml; range, 0.4-2.9; vs. 1.9µg/ml; range, 0.2-3.9; p<0.001). DHEA-S showed an inverse correlation with both thyroglobulin-antibodies (r=-0.426, p<0.001) and thyroperoxidase -autoantibodies (r=-0.362, p=0.002). When treated with additional DHEA, significant decreases were found for peroxidase-autoantibodies (median 85.0 IU/ml, range 41-600 vs. median 51.0 IU/ml, range 20-589; p=0.005) but not for thyroglobulin-antibodies.
Climacteric 05/2013; · 1.99 Impact Factor
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ABSTRACT: BACKGROUND: It has been claimed by non-scientific sources that operations carried out at waxing moon are associated with a
higher risk of complications. We aimed to evaluate if the lunar cycle influenced the incidence of postoperative haemorrhage
(PH) after thyroid surgery in our large database. METHODS: We retrospectively evaluated 424 patients requiring surgery for
thyroid disease and suffering from PH from the years 1979 to 2006 for whom the precise operation date and hour were known.
The lunar phase at the time of skin incision was calculated with an online-calculator. RESULTS: PH was somewhat less prevalent
in the waning phase (54.7% waxing, 45.3% waning moon; p = 0.052). If the incidence of PH is plotted for each day of the lunar cycle only a random fluctuation was observed: A linear
regression does not yield any significant correlation (r
2 = 0.0046). CONCLUSIONS: Patients need not worry about the lunar cycle when deciding on elective surgery.
GRUNDLAGEN: Nichtwissenschaftliche Quellen behaupten, dass Operationen, die bei zunehmendem und vor allem bei vollem Mond
durchgeführt werden, ein höheres Risiko für postoperative Komplikationen tragen. Ziel war es, in unserem großem Krankengut
zu evaluieren, ob der Mondzyklus die Inzidenz an Nachblutungen nach Schilddrüsenoperationen beeinflusste. METHODIK: In einer
retrospektiven Kohortenstudie wurden alle 424 Patienten mit Revisionsoperation wegen Nachblutung nach Schilddrüsenoperation
im Zeitraum von 1979 bis 2005, für die Datum und Zeitpunkt der Erstoperation genau vorlagen, inkludiert. Die Mondphase zum
Zeitpunkt des Hautschnittes der Erstoperation wurde mittels eines Internet-basierten Programms berechnet. ERGEBNISSE: Nachblutungen
waren etwas seltener bei abnehmendem Mond (54,7 % bei zunehmendem Mond, 45,3 % bei abnehmendem Mond; p = 0,052). Trägt man jedoch die Inzidenz der Nachblutungen gegenüber den einzelnen Mondtagen auf, wird eine zufällige Fluktuation
ersichtlich: Das lineare Regressionsmodell zeigt keinerlei signifikante Korrelationen (r
2 = 0,0046). SCHLUSSFOLGERUNGEN: Die Patienten müssen sich im Rahmen der Terminisierung elektiver Operationen keine Sorgen
um die Mondphase machen.
KeywordsHaemorrhage-Lunar phase-Moon-Thyroid surgery-Surgery
SchlüsselwörterNachblutung-Mondphase-Mond-Schilddrüsenoperationen-Chirurgie
European Surgery 04/2012; 42(2):72-76. · 0.28 Impact Factor
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ABSTRACT: Postoperative bleeding after thyroid surgery is a feared and life-threatening complication. The aim of the study was to identify risk factors for postoperative bleeding, with special emphasis on the impact of the individual surgeon and the time to diagnosis of the complication.
Data on consecutive thyroid operations were collected prospectively in a database over 30 years and analysed retrospectively for potential risk factors for postoperative bleeding.
There were 30,142 operations and postoperative bleeding occurred in 519 patients (1·7 per cent). Risk factors identified were older age (odds ratio (OR) 1·03 per year), male sex (OR 1·64), extent of resection (OR up to 1·41), bilateral procedure (OR 1·99) and operation for recurrent disease (OR 1·54). The risk of complications among individual surgeons differed by up to sevenfold. Postoperative bleeding occurred in 336 (80·6 per cent) of 417 patients within the first 6 h after surgery. Postoperative bleeding was diagnosed after 24 h in ten patients (2·4 per cent), all of whom had bilateral procedures. Nine patients required urgent tracheostomy. Three patients died, giving a mortality rate of 0·01 per cent overall and 0·6 per cent among patients who had surgery for postoperative bleeding.
Observation for up to 24 h is recommended for the majority of patients undergoing bilateral thyroid surgery in an endemic goitre area. Same-day discharge is feasible in selected patients, especially after a unilateral procedure. Quality improvement by continuous outcome monitoring and retraining of individual surgeons is suggested.
British Journal of Surgery 03/2012; 99(3):373-9. · 4.61 Impact Factor
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ABSTRACT: To present the case of a postmenopausal woman, who was suspected of having an ovarian cyst. Instead, a cystadenoma of the appendix was discovered during laparoscopy.
A 64-year-old postmenopausal nulliparous woman was admitted to our hospital because of a cystic lesion, which had been detected in the course of a routine gynecological examination. The patient underwent vaginal ultrasound, magnetic resonance tomography, and laparoscopy.
During vaginal ultrasound, a dumbbell-shaped anechogenic cystic structure 70 x 32 x 22 mm in diameter was found in the region of the right adnexa. Magnetic resonance tomography revealed no additional information. During diagnostic laparoscopy, the cystic lesion was found to be a distended appendix. A laparoscopic appendectomy was performed. Subsequent histological analysis revealed a villous mucinous cystadenoma of the appendix with low-grade intraepithelial neoplasia.
Gynecologists should routinely consider this disease in the differential diagnosis of right lower dumbbell abdominal cysts. Eleven percent to 20% of mucoceles are caused by mucinous cystadenocarcinomas, which carry the risk of peritoneal tumor implantation caused by rupture or laparoscopic resection. Therefore, it should be mandatory that a general surgeon be involved in the laparoscopic procedure and the conversion to laparotomy for resection of the structure.
JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons 01/2010; 14(2):296-8. · 0.98 Impact Factor
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ABSTRACT: Hypocalcaemia after thyroidectomy is thought to result from surgical damage to the parathyroid glands. This study analysed postoperative outcomes related to perioperative parathyroid hormone (PTH) levels.
Some 402 consecutive patients undergoing thyroid surgery were studied prospectively to monitor perioperative changes in serum PTH and Ca2+ levels, and clinical symptoms of hypocalcaemia.
Transient symptomatic hypocalcaemia and persistent hypoparathyroidism occurred in 61 (15 per cent) and six (1.5 per cent) of 402 patients respectively. The intraoperative decline in PTH was 20.2 per cent; the trough (63.8 per cent of preoperative value) was reached 3 h after surgery. Before surgery, PTH levels were correlated inversely with serum Ca2+ concentration. The correlation remained positive from 3 h after surgery until postoperative day 14. Thus, PTH secretion was reduced, but remained sufficient to prevent symptomatic hypocalcaemia in most patients. A low serum PTH level was predictive of persistent hypoparathyroidism (sensitivity and negative predictive value 100 per cent, but poor specificity of 54.1 per cent).
Thyroid surgery impairs hormone secretion by the parathyroid glands resulting in postoperative latent parathyroid insufficiency. Normal PTH levels 3 h after surgery and a normal serum calcium level on the first postoperative day rule out persistent hypoparathyroidism.
British Journal of Surgery 01/2009; 95(12):1480-7. · 4.61 Impact Factor
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ABSTRACT: BACKGROUND: Hypoparathyroidism still remains an underestimated complication after thyroidectomy; the kinetics of parathyroid
hormone (PTH) are poorly understood. It is generally assumed that careful surgical preparation reduces the risk for postoperative
persistent hypocalcaemia, but the standard of surgical care is illdefined. METHODS: We designed three protocols in order to
(i) define the perioperative PTH- and Ca2+-kinetics, (ii) delineate intraoperatively the anatomic location of the parathyroid glands, (iii) correlate the temporal evolution
of clinical symptoms of hypocalcaemia with the plasma levels of Ca2+ and PTH. RESULTS: The objective is to define perioperative parameters that may be predictive of persistent hypocalcemia.
We tested the feasibility of our approach in a patient undergoing thyroidectomy for multinodular goitre: during surgery, PTH
declined from 36.1 pg/ml to only 8.3 pg/ml (i.e. 23%). Two parathyroid glands were detected by the surgeon and carefully preserved,
2 glands remained invisible. However, parathyroid function recovered within 14 days. Calcium-levels fell from 2.21 mmol/l
to a minimum of 1.98 mmol/l on the first postoperative day, but hypocalcaemia-related symptoms were not observed. CONCLUSIONS:
Parathyroid gland function can be markedly impaired by surgical manipulation during thyroidectomy but this does not necessarily
translate into postoperative clinical symptoms. Our protocols are suitable for collection of large prospective data series
to better understand the mechanism of long-lasting or persistent hypocalcaemia.
GRUNDLAGEN: Der Hypoparathyreoidismus ist eine unterschätzte Komplikation nach Schilddrüsenoperation. Die Erkennung der zugrundeliegenden
Störung des Parathormon (PTH)- und Kalziummetabolismus erfordert prospektive Langzeitstudien. Es besteht die Annahme, dass
die sorgfältige Präparation der Nebenschilddrüsen das Risiko der permanenten Hypokalzämie reduziert. Prospektive evidenzbasierte
Daten zur Erstellung von Leitlinien fehlen. METHODIK: Wir stellen drei Studienprotokolle vor und erläutern sie anhand eines
Fallbeispiels: (i) das Monitoring der perioperativen Parathormon- und Kalziumkinetik, (ii) die genaue Beschreibung des intraoperativ-topographischen
Nebenschilddrüsensitus und (iii) die Erfassung der Hypokalzämie-typischen Symptome. ERGEBNISSE: Studienziel ist die Definition
von prognostischen Parametern (PTH cut-off Wert) für die Vorhersage des permanenten Hypoparathyreoidismus anhand der intra-
und postoperativen PTH-Kinetik. Bei unserem Indexpatienten fielen die intraoperativen Parathormonwerte von 36,1 pg/ml auf
8,3 pg/ml (23 %). Zwei Nebenschilddrüsen wurden vom Operateur gesehen und sorgfältig erhalten, zwei blieben unerkannt. Die
Funktion der Nebenschilddrüsen erholte sich innerhalb von vierzehn Tagen. Am ersten postoperativen Tag fielen die Kalziumwerte
im Serum von 2,21 mmol/l auf einen Tiefstwert von 1,98 mmol/l, ohne dass die Patientin Hypokalzämie-typische Symptome entwickelte.
SCHLUSSFOLGERUNGEN: Trotz eines klinisch unauffälligen postoperativen Verlaufes kann eine beträchtliche Störung der Parathormonsekretion
– bedingt durch die Schilddrüsenoperation – vorliegen. Unsere Protokolle stellen die Basis zur prospektiven Analyse des Mechanismus
der postoperativen Nebenschilddrüseninsuffizienz dar.
European Surgery 09/2006; 38(5):368-373. · 0.28 Impact Factor
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European Surgery-acta Chirurgica Austriaca - EUR SURG. 01/2006; 38(5):368-373.
