Post-thyroidectomy Dysphagia: An International Multicentric CONSORT - Compatible RCT

NCT ID: NCT04410601

Last Updated: 2020-06-01

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

500 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-05-14

Study Completion Date

2021-06-30

Brief Summary

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The most common and feared complications of total thyroidectomy are vocal cord paralyses and hypocalcemia. However, post-thyroidectomy dysphagia is not uncommon and has important consequences on the quality of life (QoL). It should be taken seriously by all clinicians.

Detailed Description

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Dysphagia is a possible complication that can be observed in patients undergoing thyroidectomy, and can be related to superior and inferior laryngeal nerves dysfunction, but it usually appears after an uncomplicated surgical procedure. Aerodigestive symptoms, such as discomfort, tightness, lump, foreign body, difficulty or pain during swallowin, can also present before operation. If it appears or aggrevates after surgery, laryngeal nerve damage (superior laryngeal nerve - SLN, or inferior laryngeal nerve - recurrent, RLN), tracheo-malacia and postoperative fibrotic changes should be interrogated. However, in most of the cases, an anatomic and/or physiologic defect in the oro-pharngeal region is not easy to be detected. Therefore, a subjective feeling of dysphagia is more common.

Dysphagia has important consequences on the QoL in postoperative period, and should be addressed by the primary surgeon/clinician, regardless of whether it is objective or subjective.

The goal of the present study is to better understand the incidence of postoperative dysphagia symptoms among patients who have undergone total thyroidectomy for benign or malign thyroid disease. Besides, all possible risk factors (pre-intra-post-operative) are also going to be evaluated in detail, and the efficacy of a 6-week dysphagia-rehabilitation programme will also be employed and results will be shared.

Conditions

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Dysphagia, Esophageal Dysphagia, Oral Phase Dysphagia Comes and Goes Thyroiditis Thyroid Cancer Thyroid Neoplasms Thyroid Goiter Thyroid Nodule (Benign)

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Dysphagia among patients who have undergone total hyroidectomy for benign/malign thyroid disease. The preoperative factors (demographics; co-morbidities such as diabetes, multiple sclerosis, Parkinson's; body mass index; routine ear-nose-throat-ENT consultation), operative factors (over-manipulation, injury to larynx/neural plexus, easy/hard tracheal intubation, closure of strap muscles/stay open) and postoperative evaluation 1-No dysphagia, 2-Dysphagia with at least one other complication (nerve injury, hypocalcemia), 3-Dysphagia without any other surgical complications; ENT\&neurology consultations, survey.
Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

THE STUDY IS OPEN TO ALL SURGICAL CLINICS OVER THE WORLD EAGER TO JOIN; EXCEL WITH FORMS TO BE FILLED ARE AVAILABLE, please contact the principle/co-investigators by phone/e-mail.

Study Groups

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No dysphagia (after total thyroidectomy-TT)

Patients s/p post-thyroidectomy without complication

\*will NOT be enrolled to standard dysphagia-rehabilitation treatment

Group Type ACTIVE_COMPARATOR

Total thyroidectomy

Intervention Type PROCEDURE

DRT-diet modification, compensation strategies, oral motor exercises such as laryngeal elevation, masseters / tongue hold / exercise, bolus transition exercise; chin-down/up, head rotation, and other maneuvers with tactile stimulation.

Dysphagia (with at least one more complication of TT)

Patients s/p post-thyroidectomy with both dysphagia and other documented TT complication such as vocal cord paralysis/hypocalcemia/surgical site infection etc.

\*will be enrolled to standard dysphagia-rehabilitation treatment for 6-week.

Group Type EXPERIMENTAL

Total thyroidectomy

Intervention Type PROCEDURE

DRT-diet modification, compensation strategies, oral motor exercises such as laryngeal elevation, masseters / tongue hold / exercise, bolus transition exercise; chin-down/up, head rotation, and other maneuvers with tactile stimulation.

Dysphagia (the only complication after TT)

Patients s/p post-thyroidectomy dysphagia only.

\*will be enrolled to standard dysphagia-rehabilitation treatment for 6-week.

Group Type EXPERIMENTAL

Total thyroidectomy

Intervention Type PROCEDURE

DRT-diet modification, compensation strategies, oral motor exercises such as laryngeal elevation, masseters / tongue hold / exercise, bolus transition exercise; chin-down/up, head rotation, and other maneuvers with tactile stimulation.

Interventions

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Total thyroidectomy

DRT-diet modification, compensation strategies, oral motor exercises such as laryngeal elevation, masseters / tongue hold / exercise, bolus transition exercise; chin-down/up, head rotation, and other maneuvers with tactile stimulation.

Intervention Type PROCEDURE

Other Intervention Names

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Dysphagia rehabilitation treatment (DRT) programme

Eligibility Criteria

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Inclusion Criteria

* Patients with benign or malignant thyroid disorder (multinodular goitre, toxic goitre, thyroid carcinoma)
* Patients with total thyroidectomy (TT) indication
* Patients over 17 year-old

Exclusion Criteria

* Patients without thyroid disease
* Patients with thyroid disorder, but prepared for surgery other than TT
* Healthy volunteers
* Patients below 17 y/o
Minimum Eligible Age

17 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Umraniye Education and Research Hospital

OTHER_GOV

Sponsor Role lead

Responsible Party

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Ethem Unal, M.D., PhD, Associate Prof of Surgery & Surgic

Associated Professor of General Surgery and Surgical Oncology

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Sema YUKSEKDAG, MD

Role: PRINCIPAL_INVESTIGATOR

Instructor in General Surgery

Ethem UNAL, MD, PhD, ECFMG, IFSO & Board CSS

Role: STUDY_CHAIR

Assoc. Professor of General Surgery and Surgical Oncology

Locations

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Umraniye Education and Research Hospital, Health Sciences University

Istanbul, , Turkey (Türkiye)

Site Status RECRUITING

Countries

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Turkey (Türkiye)

Central Contacts

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Ethem UNAL, MD, PhD, USMLE, IFSO & Board CSS

Role: CONTACT

00 90 (216) 632 1818 ext. 1951

Sema YUKSEKDAG, MD

Role: CONTACT

00 90 (216) 632 1818 ext. 19511

Facility Contacts

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Ethem UNAL, MD, PhD, ECFMG, IFSO & Board CSS

Role: primary

00 90 (216) 632 1818 ext. 1951

Sema YUKSEKDAG, MD

Role: backup

00 90 (216) 632 1818 ext. 1951

References

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Rihn JA, Kane J, Albert TJ, Vaccaro AR, Hilibrand AS. What is the incidence and severity of dysphagia after anterior cervical surgery? Clin Orthop Relat Res. 2011 Mar;469(3):658-65. doi: 10.1007/s11999-010-1731-8.

Reference Type BACKGROUND
PMID: 21140251 (View on PubMed)

Hashemian M, Khorasani B, Tarameshlu M, Haghani H, Ghelichi L, Nakhostin Ansari N. Effects of Dysphagia Therapy on Swallowing Dysfunction after Total Thyroidectomy. Iran J Otorhinolaryngol. 2019 Nov;31(107):329-334. doi: 10.22038/ijorl.2019.36233.2193.

Reference Type BACKGROUND
PMID: 31857976 (View on PubMed)

Exarchos ST, Lachanas VA, Tsiouvaka S, Tsea M, Hajiioannou JK, Skoulakis CE, Bizakis JG. The impact of perioperative dexamethasone on swallowing impairment score after thyroidectomy: a retrospective study of 118 total thyroidectomies. Clin Otolaryngol. 2016 Oct;41(5):615-8. doi: 10.1111/coa.12547. Epub 2016 Feb 8. No abstract available.

Reference Type BACKGROUND
PMID: 26434490 (View on PubMed)

Shimizu M, Kobayashi T, Jimbo S, Senoo I, Ito H. Clinical evaluation of surgery for osteophyte-associated dysphagia using the functional outcome swallowing scale. PLoS One. 2018 Aug 1;13(8):e0201559. doi: 10.1371/journal.pone.0201559. eCollection 2018.

Reference Type BACKGROUND
PMID: 30067834 (View on PubMed)

Scerrino G, Tudisca C, Bonventre S, Raspanti C, Picone D, Porrello C, Paladino NC, Vernuccio F, Cupido F, Cocorullo G, Lo Re G, Gulotta G. Swallowing disorders after thyroidectomy: What we know and where we are. A systematic review. Int J Surg. 2017 May;41 Suppl 1:S94-S102. doi: 10.1016/j.ijsu.2017.03.078.

Reference Type RESULT
PMID: 28506421 (View on PubMed)

Related Links

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https://scholar.google.com.tr/citations?user=6bFlCZwAAAAJ&hl=tr

Ethem Unal, MD, PhD, ECFMG, IFSO, BCSS, Assoc. Professor of General Surgery \& Surgical Oncology, H-index:18 / i10-index:33

Other Identifiers

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12.05.2020/173

Identifier Type: REGISTRY

Identifier Source: secondary_id

B.10.1.TKH.4.34.H.GP.0.01/173

Identifier Type: -

Identifier Source: org_study_id

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