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In this paper, a case report of acute pulmonary oedema following thyroidectomy in a 51-year-old male patient is reported. The aetiological factor was vigorous inspiratory effort against an obstruction of the upper airway occurring immediately after extubation. The patient was transferred to intensive care unit and treated with CPAP ventilation. He recovered completely after 48 hours. The pathogenesis of both laryngospasm and an unexpexted but potentially serious complication such as negative-pressure pulmonary oedema is discussed.

The aim of the study was to draw up a management protocol in thyroid surgery promoted by the Italian Association of Endocrine Surgery Units (Club delle UEC), shared by the experts and applied by the operators in the sector. The management protocols already presented in February 2002 and drawn up by the first Author of the present publication on the occasion of the current review were examined by the I Consensus Conference called on the topic by the Italian Endocrine Surgery Units. The conference comprised two distinct sessions, the first on 18 June 2005 within the framework of the 4th National Congress of the Club delle UEC in Naples, and the second on 17 September 2005 within the framework of the 8th Multidisciplinary Scanno Prize Meeting. A selected board of endocrinologists and endocrine surgeons, chaired by Aldo Pinchera and comprising the first nine Authors of this paper, examined the individual chapters in close collaboration with the other Authors, comparing their findings with the opinions of the experts cited in the text and submitting the consensus text for the approval of all those present. The diagnostic, therapeutic and healtcare management protocols in thyroid surgery approved by the I Consensus Conference are officially those proposed by the Italian Association of Endocrine Surgery Units (Club delle UEC) and are subject to review by October 1, 2007.

Transient and definitive hypoparathyroidism represent a frequent complication after thyroid surgery. Recently some authors proposed the use of intraoperative parathyroid hormone assay for the rapid detection of this complication. In this paper the authors describe the data obtained from 42 total thyroidectomies with intraoperative measurements of parathyroid hormone. When parathormone decrement was over 75% during thyroidectomy, the hypocalcemic symptomatology was found in all cases during postoperative observation. The authors emphasize intraoperative PTH dosage for immediate identification of patients at risk for postoperative hypoparathyroidism. In this cases parathyroid autotransplantation is suggested to prevent postoperative hypoparathyroidism.

On the basis of their experience acquired in the field of thyroid surgery the authors examine the problems related to extracapsular lobectomy from a tactical and technical point of view, starting with its principal indications: benign monolobar thyroid disease in a single or multiple nodular form. The validity of extemporary histological tests is also assessed on the basis of their experience of rare false negatives and the relative successive totalization programme. Lastly, the paper underlines the fundamental identification of the recurrent nerve as the central point of the operation, before which the authors emphasize that nothing should be cut or ligated apart from the superior vascular peduncle and vena media.

In this paper, the authors discuss the risks of lesions to the external branch of the superior laryngeal nerve during surgical procedures on the thyroid gland. These lesions result in significant functional impairment consisting on the patients' impossibility of emitting high-pitched sounds, an easy tiredness in vocalizing, huskiness, or a combination of these symptoms. Recently, in effect, with the increasing use pre and postoperatively of newer diagnostic tools such as electromyography (EMG) of the cricothyroid muscle, a fairly high incidence of permanent or temporary, including single or bilateral lesions to this nerve was demonstrated. The necessity of using appropriate surgical techniques with the objective of avoiding or markedly reducing the incidence of lesions to the superior laryngeal nerve is discussed in detail by the authors.