الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Nowadays, TT is considered the mainstay treatment for bilateral nodular goiter and some cases of Graves’ disease being safe and easy as reported by many experienced authors and preventing reoperation in the neck in cases of recurrence of the original pathology or completion thyroidectomy in patients who had undergone STT and had postoperative pathology of thyroid carcinoma. This procedure is routinely followed by life-long administration of postoperative L-T4 replacement therapy, which requires strict compliance to drug intake and regular follow-up of thyroid function tests.
Auto-transplantation of heterotopic fresh thyroid tissue into the rectus femoris muscle could help providing the patient with normal thyroid hormone under the control of his own auto-regulatory mechanism and avoiding the need for postoperative life-long L-T4 replacement therapy. Previous animal studies and few human studies were done regarding this issue and all proved survival and variable degree of function of the implanted thyroid tissue.
The aim of this study was to determine the survival and functional capacity of heterotopic transplantation of fresh thyroid tissue done in the same session of TT for benign goiters to achieve a postoperative euthyroid state without the need for administration of life-long L-T4 replacement therapy.
The present study was carried out on 20 patients; 13 with SMNG, four with Graves’ disease and three with TNG. Patients with thyroiditis or any form of thyroid malignancy or suspicion of malignancy were all excluded. There were 15 women (75%) and five men (25%), their ages ranged between 20 and 66 years.
Preoperatively, all patients were subjected to careful history-taking and thorough clinical examination of the neck. Laboratory investigations including thyroid function tests (FT3, FT4 and TSH), thyroid antibodies (anti-TPO and anti-Tg) and total calcium level were done for all patients. Chest and neck x-ray and dedicated neck US were done for every patient. For any dominant or suspicious thyroid nodule if present, US-guided FNAC was done.
Intraoperatively, 10-15 g of the healthiest looking non-nodular part of the excised gland was minced into 1-2 mm slices after stripping of its fibrous capsule. The tissue was then made into an emulsion of 20 ml lactated Ringer’s solution and injected through the rectus femoris muscle in 6-8 different directions using a specially designed wide bore needle.
The final postoperative pathology detected the presence of follicular variant of PTC in two patients in whom preoperative pathology missed their diagnosis. The two patients had their graft excised and were excluded from the study.
Follow-up of 18 patients was done to report the survival and function of the heterotopic transplanted thyroid tissue through 99mTc uptake at 2-month postoperatively and thyroid function tests (FT3, FT4 and TSH) at two, four, six, eight, ten and twelve-month postoperatively. Results confirmed that all implants survived and showed variable