Endocrine Abstracts

Introduction: Thyroid surgery was initially considered as “horrid butchery” due to associated high morbidity and mortality, however with the advent of safe surgical techniques and improved understanding of thyroid physiology, thyroid surgery has become safer. Still there are certain intra-operative factors, as described in Difficulty Thyroidectomy Scale (DTS)which are thought to be associated with adverse outcome. However anatomical parameters also need to be addressed to make it more reliable and effective. So, aim of this study was to use Modified thyroidectomy difficulty scale (MTDS) and to know if anatomical variations also contribute.

Material and Methods: Prospective study on patients who underwent thyroidectomy at Department of Endocrine Surgery, SGPGIMS. We designed a MTDS (4 itemed thyroidectomy difficulty scale with various anatomical parameters like location & branching of recurrent laryngeal nerve, type of external branch of superior laryngeal nerve, parathyroid glands, grade of tubercle of Zuckerkandl (TZ), and retrosternal extension). It was filled by two endocrine surgeons blinded to each other at the end of operation. Analysis was done to look for inter-observer variability and also to compare surgical outcome in terms of operating time and complication rates.

Results: Total 30 patients were assessed on Modified thyroidectomy difficulty score. Cohort included 15 (50%) euthyroid goiters, 12 (40%) toxic goiters, 2 (6.67%) malignant and 1 (3.33%) patient of thyroiditis. Among both trainees, total and individual parametric scores exhibited a high degree of correlation, which rules out any observational bias. DTS correlates significantly with operating time P<0.01, hypoparathyroidism P=0.05 and nerve palsy P<0.01, where MTDS correlates more strongly with operating time<0.01, hypoparathyroidism P=0.02 and nerve palsy P<0.01. In difficulty score gland size (P=0.00) and fibrosis (P=0.04) were significant factors. In modified score TZ grading (P=0.003) was the only factor.

Conclusion: Modified thyroidectomy score correlates more strongly with the operative time and complication rates.