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Status unknownNCT04410601Dysphagia-TTUpdated Jun 1, 2020

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

An interventional study of Total thyroidectomy in Dysphagia, Esophageal, Dysphagia, Oral Phase and Dysphagia Comes and Goes, sponsored by Umraniye Education and Research Hospital. Status unknown at 1 site in Turkey. Open to participants aged 17 Years and older. Per ClinicalTrials.gov, last updated 2020-06-01.

Sponsored by Umraniye Education and Research Hospital · Not applicable, Interventional, and Diagnostic

The sponsor has not verified this record recently (last verified May 2020), so the status shown — last known as Recruiting — may be out of date.
Phase
Not applicable
Study type
Interventional
Enrollment
500
Allocation
Randomized
Ages
17 Years and older
Sex
All
01

Study summary

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.

Read the detailed description

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.

02

Conditions studied

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

Keywords

  • Thyroidectomy
  • Total thyroidectomy
  • Post-thyroidectomy
  • Post-thyroidectomy dysphagia
  • International
  • Multi-centric
03

Who can participate

Ages eligible
17 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

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

Exclusion Criteria:

  • Patients without thyroid disease
  • Patients with thyroid disorder, but prepared for surgery other than TT
  • Healthy volunteers
  • Patients below 17 y/o
04

Study design

Phase
Not applicable
Primary purpose
Diagnostic
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
500 participants (estimated)

Study arms

  • Active comparator
    No dysphagia (after total thyroidectomy-TT)

    Patients s/p post-thyroidectomy without complication \*will NOT be enrolled to standard dysphagia-rehabilitation treatment

    Procedure: Total thyroidectomy

  • Experimental
    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.

    Procedure: Total thyroidectomy

  • Experimental
    Dysphagia (the only complication after TT)

    Patients s/p post-thyroidectomy dysphagia only. \*will be enrolled to standard dysphagia-rehabilitation treatment for 6-week.

    Procedure: Total thyroidectomy

Interventions

  • ProcedureTotal 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.

    Also known as: Dysphagia rehabilitation treatment (DRT) programme

05

What researchers measure

Primary outcomes

  1. Evaluation of Dysphagia-Subjective Survey Form

    Subjective survey form to be filled- a self-evaluation questionnaire-to evaluate 'Change from baseline postoperative (po) day 1-3 to week 2, po week 6, po week 16, po week 24, po week 36 and po week 48 (last). A new form will be filled in for each outpatient clinic control. assessing common dysphagia symptoms- includes 6 items scored within a range of 0 (without swallowing alterations) to 24 (maximum swallowing dysfunction).

    Time frame: 12 months

  2. Evaluation of Dysphagia-Objective Functional Outcome Swallowing Score (FOSS)

    Objective survey form to be filled- a clinician-oriented questionnaire assessing the swallowing function objectively, from stage I (normal function) to stage V (no oral intake). To evaluate change in dysphagia from baseline po day 1-3 to .po week 2, po week 6, po week 16, po week 24, po week 36 and po week 48 (last). A new form will be filled in for each outpatient clinic control.

    Time frame: 12 months

  3. Evaluation of Dysphagia- ENT Consultation

    Flexible fiberoptic laryngoscopy (any anatomic explanation for dysphagia? YES or NO? To evaluate change in dysphagia from baseline at postoperative (po) week 6 to po week 24, po week 48 (last).

    Time frame: 12 months

  4. Evaluation of Dysphagia- Neurology Consultation

    EMG-electromyography test (any anatomic and/or physiologic dysfunction? YES or NO? To evaluate change in dysphagia from baseline at postoperative (po) week 6 to po week 24, po week 48 (last).

    Time frame: 12 months

  5. Evaluation of Dysphagia- Esophago-gastro-duodenoscopy (EGD)

    Any anatomic defect? EGD will be performed once at Postoperative (po) week 6.

    Time frame: 6 weeks

Secondary outcomes

  1. Evaluation of Standard Dysphagia Rehabilitation

    6-week treatment, starting from po week 6, for all patients with dysphagia- ending at po week 12. Any improvement after 6-week treatment? evaluate at po week 12 and please answer: Any improvent in dysphagia symptom? -YES or NO?

    Time frame: 12 weeks

06

Study locations

1 of 1 sites recruiting
  • Umraniye Education and Research Hospital, Health Sciences University
    Istanbul, 34764, Turkey
    • Ethem UNAL, MD, PhD, ECFMG, IFSO & Board CSS · Contact · drethemunal@gmail.com · 00 90 (216) 632 1818
    • Sema YUKSEKDAG, MD · Contact · drsemayuksekdag@gmail.com · 00 90 (216) 632 1818
    • Kadir M YILDIRAK, MD · Sub investigator
    • Sema YUKSEKDAG, MD · Principal investigator
    Recruiting
07

References and documents

Publications

  • 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. PubMed 21140251 ↗
  • 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. PubMed 31857976 ↗
  • 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. PubMed 26434490 ↗
  • 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. PubMed 30067834 ↗
  • 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. PubMed 28506421 ↗

Individual participant data

Plan to share: Yes — Excel documents including data (patient ID and protocol # will be shaded) available upon request

Supporting information: Study protocol, Sap, Icf, Csr, Analytic code

08

Registry details

Key details

Study ID
NCT04410601
Lead sponsor
Umraniye Education and Research Hospital
Responsible party
Ethem Unal, M.D., PhD, Associate Prof of Surgery & Surgic (Associated Professor of General Surgery and Surgical Oncology, Umraniye Education and Research Hospital) — Principal investigator
First posted
Jun 1, 2020
Start date
May 14, 2020
Primary completion
Jun 2021 (estimated)
Completion
Jun 2021 (estimated)
Last update
Jun 1, 2020

Study contacts

Ethem UNAL, MD, PhD, USMLE, IFSO & Board CSS
Contact
drethemunal@gmail.com
00 90 (216) 632 1818 ext. 1951
Sema YUKSEKDAG, MD
Contact
drsemayuksekdag@gmail.com
00 90 (216) 632 1818 ext. 19511
Sema YUKSEKDAG, MD
principal investigator · Instructor in General Surgery
Ethem UNAL, MD, PhD, ECFMG, IFSO & Board CSS
study chair · Assoc. Professor of General Surgery and Surgical Oncology

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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This study is status unknown, as verified in May 2020. You cannot join it, but the record below documents what was studied.

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