Thyroidectomy: Microscopic Versus Conventional

NCT07488858 | Completed DMC

• 1 other identifier: Sheikh Zayed Hospital Lahore 1
• Study Type: interventional
• Target: 74
• Locations: 1 country
• Sites: 1

Brief Summary

Despite promising findings from international studies, the use of microscopic thyroidectomy remains limited in local surgical practice, where conventional thyroidectomy is traditionally followed. There is a scarcity of local data evaluating the benefits of MT, and inconsistencies in reported outcomes highlight the need for further research. The lack of standardized protocols and limited surgeon experience with microscopic techniques contribute to hesitation in its adoption. This study aims to address the research gap by providing comparative data on operative time, intraoperative blood loss, and postoperative complications in microscopic versus conventional thyroidectomy in our setting. The findings will aid in determining whether MT should be incorporated into routine surgical practice to improve patient outcomes and reduce postoperative complications.

Conditions

Thyroid Cancer; Thyroid Surgeries

Keywords

thyroidectomy; microscopic; laryngeal nerve palsy

Outcome Measures

Primary Outcomes (4)

• Mean intraoperative blood loss

  It will be defined as the mean total volume of blood lost during the surgical procedure, measured in milliliters (mL). Blood loss will be estimated using the difference between preoperative and postoperative suction canister volumes, accounting for irrigation fluids, and by weighing surgical sponges and gauze (1 g of blood = 1 mL).

  0 days

• Percentage of Transient Recurrent Laryngeal Nerve (RLN) Palsy

  postoperative unilateral or bilateral impairment of vocal cord mobility due to RLN dysfunction, confirmed by indirect laryngoscopy or videolaryngostroboscopy performed by an otolaryngologist. Diagnosis will be based on reduced or absent vocal cord movement compared to preoperative assessment. Patients exhibiting hoarseness, breathiness, or dysphonia with confirmed vocal cord dysfunction on laryngoscopic evaluation within one month postoperatively will be labeled as transient RLN palsy. Any patient showing full recovery of vocal cord mobility on follow-up laryngoscopy at one month will be classified as transient.

  one month

• Percentage of Permanent Recurrent Laryngeal Nerve (RLN) Palsy

  persistent postoperative unilateral or bilateral vocal cord paralysis confirmed by indirect laryngoscopy or videolaryngostroboscopy at one month postoperatively by an otolaryngologist. Diagnosis will require complete absence of vocal cord movement on objective examination at one month, without any signs of recovery. Patients with persistent hoarseness, dysphonia, or aspiration symptoms accompanied by vocal cord immobility at one month will be definitively classified as having permanent RLN palsy.

  one month

• percentage of Transient Hypocalcemia

  It will be labeled as transient hypocalcemia if the patient experiences symptoms such as perioral numbness, carpopedal spasms, or tetany within one month of surgery, with laboratory confirmation of serum calcium \< 8.0 mg/dL. Diagnosis will be based on serial calcium measurements, and resolution within one month without continued supplementation will confirm its transient nature.

  one month

Study Arms (2)

Microscopic Thyroidectomy

EXPERIMENTAL

Procedure: Microscopic Thyroidectomy

Conventional Thyroidectomy

PLACEBO COMPARATOR

Procedure: Conventional Thyroidectomy

Interventions

Microscopic Thyroidectomy PROCEDURE

The procedure was done under general anesthesia but with an endotracheal intubation. Transverse cervical incision (45 cm) was done along a natural skin line. Magnification (Zeiss Sensera, 3-5x magnification) was employed in order to make the recurrent laryngeal nerve (RLN), external branch of the superior laryngeal nerve (EBSLN), and parathyroid glands easier to dissect. The ligatures were done at the superior pole of the thyroid gland and not at EBSLN. The RN was determined on the entry site to the larynx and kept in perfect condition. The parathyroid glands were distinguished, frozen or remedied in the event of the devascularization. The thyroid gland had been removed according to the intended operation (lobectomy, sub-total, or the total thyroidectomy). The wound was closed in layers and hemodynamics was restored

Microscopic Thyroidectomy

Conventional Thyroidectomy PROCEDURE

A similar method was employed except that no microscopic magnification was employed. The standard visual techniques were used to identify RN and EBSLN and the process was accomplished according to the traditional approach. The traditional methods were used to identify and preserve parathyroid glands without any further magnification. The recovery room paid close attention to patients following surgery in case of any immediate complications such as bleeding or airway obstruction. Serum calcium levels were tested 24 hours after operation to determine whether they were hypocalcaemic and indirect laryngoscopy carried out prior to discharge to determine the functioning of the vocal cords

Conventional Thyroidectomy

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Both Male or female patients.
• Patients aged 18 to 65 years undergoing thyroidectomy for benign or malignant thyroid disease.
• Patients with multinodular goiter, Grave's disease, thyroid carcinoma indicated for surgery based on their workup.
• Candidates scheduled for unilateral lobectomy, subtotal thyroidectomy, or total thyroidectomy.
• Patients with preoperative normal vocal cord mobility confirmed by laryngoscopy.
• Hemodynamically stable patients without significant comorbidities affecting surgery or anesthesia based on ASA classification (Class I-III).
• Patients who provide informed consent to participate in the study.

You may not qualify if:

• Prior history of prior thyroid surgery.
• Patients with evidence of lateral lymph node metastasis or local invasion on preoperative imaging (ultrasonography or computed tomography).
• Patients with pre-existing hypocalcemia or parathyroid disorders.
• Patients with severe medical comorbidities, including uncontrolled diabetes (HbA1c \> 8%), chronic kidney disease (eGFR \< 30 mL/min/1.73m²), liver cirrhosis (Child-Pugh class B or C), or coagulopathy (INR \> 1.5 or platelet count \< 50,000/μL), will be excluded from the study.
• Pregnant or lactating women.
• Patients with invasive thyroid carcinoma, anaplastic thyroid carcinoma, or thyroid lymphoma requiring extensive radical surgery.

Sponsors & Collaborators

• Shahida Islam Medical Complex: lead

Study Sites (1)

Shaikh Zayed Hospital, Lahore

Lahore, Punjab Province, 60000, Pakistan

Location

MeSH Terms

Conditions

Thyroid Neoplasms

Condition Hierarchy (Ancestors)

Endocrine Gland Neoplasms; Neoplasms by Site; Neoplasms; Head and Neck Neoplasms; Endocrine System Diseases; Thyroid Diseases

Study Officials

• mudassar saeed pansota

  Assistant Professor of Urology, Shahida Islam Teaching Hospital, Lodhran, Pakistan

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor

Study Record Dates

• First Submitted: March 15, 2026
• First Posted: March 23, 2026
• Study Start: December 16, 2025
• Primary Completion: March 15, 2026
• Study Completion: March 15, 2026
• Last Updated: March 23, 2026

Record last verified: 2026-03

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)