Endocrine Abstracts

Background

Thyroidectomy is the common most common endocrine surgical procedure varies from Scalpel to Robotic transoral thyroidectomy. Colloid nodules are common and easily operable without any difficulty. We report a phenomenon where in the surgery becomes difficult and lead to complications if not thought with this phenomenon – colloid leak.

Material and method

The endocrine surgeon (Associate Professor) has been involved in training of over 25 superspeciality endocrine trainers over a period of nine years in a tertiary referral high volume center. He has participated in 700 Thyroidectomies of which 250 thyroidectomies for colloid goiter. We have observed this phenomenon in 5 patients over 5 years in a tertiary referral centre in north India

Result

5 male patients (46.7 ± 12.1 years) had this colloid leak. Mean BMI was (22.4 ± 2.9). FNAC was colloid in all patients. 3 had colloid leak in all planes. 2 had only per thyroidal leak. All patients had Recurrent Laryngeal nerve identified. In 1 patient only 1 parathyroid gland could be identified. Mean duration of surgery was 120 ± 12 min. Mean blood less was 10 ml ± 2.5 ml. Mean duration of stay after surgery was 48. ± 12 h. No permanent complication was observed. All patients operated within 2 weeks of FNAC. All HPT was colloid. Immunohistochemistry revealed IgG4 stained plasma cell aggregates in the line of colloid leak.

Discussion

This phenomenon was observed in muscular males in the colloid goiters where in there is leak of colloid after FNAC and this colloid elicited an inflammatory response in the surrounding tissues as evidenced by IgG4 positive immunohistochemistry staining for plasma cells. This phenomenon was more pronounced 5 to 7 days after FNAC. The planes were stuck and mobilization of gland was difficult in one patient a small cuff of muscle had to be removed. This fact of colloid leak causing chronic inflammation may be a harbinger of chronic changes and may a role in tumorogenesis

Conclusion

Astute Endocrine Surgeon should be aware of this colloid leak phenomenon and when found the dissection should be very careful to present complications during thyroidectomy.