ORIGINAL ARTICLE   

Chirurgia 2021 December;34(6):259-64

DOI: 10.23736/S0394-9508.20.05247-X

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Surgical and clinicopathologic implications of the pyramidal lobe of the thyroid gland

Andreas KIRIAKOPOULOS ¹ ✉, Spyridon NTELIS ², Athanassios PETRALIAS ², Dimitrios LINOS ^{3, 4}

¹ School of Medicine, Department of Surgery, Fifth Surgical Clinic, Evgenidion Hospital, National and Kapodistrian University of Athens, Athens, Greece; ² Institute of Preventive Medicine, Environmental and Occupational Health Prolepsis, Maroussi, Greece; ³ Department of Surgery, Hygeia Hospital, Maroussi, Greece; ⁴ National and Kapodistrian University of Athens, Athens, Greece

BACKGROUND: The pyramidal lobe (PL) represents an upward extension of the thyroid gland with remarkable variability in terms of presence, location and size. This prospective study analyzes the significance of the PL.
METHODS: From January 2013 to September 2015, 538 patients were prospectively enrolled in the study. Descriptive statistics, differences of patients with and without PL, differences in PL size (Kruskal-Wallis/ANOVA tests) and correlations of PL size with age, BMI and thyroid weight were computed. Odds ratios for the probability of observing PL size above the median value were analyzed using multivariate analysis.
RESULTS: Out of 538 patients, 272 (50.6%) had pyramidal lobe, average size 1.82 cm. Statistically significant higher proportion of patients with PL was observed for patients with Delphian node presence (P=0.017). PL size was significantly larger for patients with greater thyroid weight (P=0.014); male gender (P=0.011) and Delphian node presence (P=0.021). No difference was found regarding age or BMI. Patients with multifocal papillary thyroid cancer (PTC)>10 mm had smaller PL size than patients with minimal multifocal PTC (<10 mm). After adjusting for age, gender, BMI, and thyroid weight, the odds of observing PL size above the sample median was significantly lower for patients with Multifocal PTC>10 mm (P=0.023) and for patients with cervical LN malignancy (P=0.014).
CONCLUSIONS: PL occurs in 50.6% of patients. Larger size correlates strongly with big thyroids, male gender and Delphian nodes presence. Thorough anatomic knowledge and meticulous surgical technique are required for PL excision and a truly “total thyroidectomy.”

KEY WORDS: Endocrine surgical procedures; Thyroid gland; Surgical procedures, operative