Benign Goiter Research Articles

Paediatric thyroidectomy: When and why? A 25-year institutional experience

ObjectiveThyroidectomy in paediatric patients is relatively uncommon. In this study, we reviewed our experience of thyroidectomy in children and identified risk factors associated with postoperative complications. MethodsWe performed a retrospective analysis of paediatric patients who had thyroidectomy in our institution between April 1995 and January 2021. Demographic data, preoperative cytological findings, indications of surgery, surgical complications and histological results were analysed. ResultsA total of 87 paediatric patients with 92 thyroidectomy were identified. The indications for surgery were Graves’ disease refractory to medical treatments (40.2%), benign thyroid nodules or multinodular goitre (26.4%), thyroid carcinoma (23.0%) and multiple endocrine neoplasm type 2A syndrome (10.3%). Patients presented with thyroid nodules or cervical lymph nodes had a 43.9% risk of malignancy.66 total thyroidectomy were done with median operation time of 134 min(102–170), while 26 hemi-thyroidectomy were performed (Right side 12/92, Left side 14/92) with median operation time of 65 min(49–102). The median postoperative hospital stay was 2 days(1–4). Intraoperative neck dissection (p = 0.003), drain insertion (p = 0.001) and hypocalcaemia requiring medical treatment (p = 0.004) were associated with longer hospital stay.The median follow-up was 11.3 years (3.0–16.8). 32% patients had immediate postoperative hypocalcaemia and 8% patients had permanent hypoparathyroidism. Transient vocal cord palsy was found in 3 patients(3%) and all resolved within 5-month time upon reassessment direct laryngoscopy. The use of intraoperative recurrent laryngeal nerve monitoring was associated with less vocal cord palsy (p = 0.022).The median disease-free survival was 13.7 years(7.4–17.7) for patients operated for well-differentiated thyroid carcinoma(WDTC). amongst the 9 patients who had prophylactic total thyroidectomy for MEN2A syndrome, 44% were found to have medullary thyroid microcarcinomas on pathology. ConclusionsSurgical management of paediatric thyroid disease can be complex. Postoperative hypocalcaemia and vocal cord palsy were usually transient after total thyroidectomy. The use of intraoperative recurrent laryngeal nerve monitoring had resulted in less vocal cord palsy. Long-term disease-free survival of patients with thyroid cancer had been achieved with multi-disciplinary management in our centre.Level of Evidence: Retrospective Comparative Study; Level III

BIOCHEMICAL AND CLINICAL CHARACTERIZATION OF IODINE DEFICIENCY DISORDERS IN CENTRAL INDIA

Background: Iodine (I) is a trace element that is required by both humans and animals. It can be found in a variety of chemical forms, including iodine, iodide (I), and iodate (IO3). It is widely distributed across the earth's ecology, with a concentration in the oceans. Iodine entered the natural cycle from the ocean, the atmosphere, and rainfall, as well as from rainfall into streams and rivers. Iodine is absorbed as iodide in human nutrition. Iodine is a necessary micronutrient and a component of thyroid hormones. Fish and seafood have a high iodine level. The amount of iodine in soil and drinking water varies depending on where it comes from. Iodine shortage produces a variety of negative health consequences, which are referred to as iodine deficiency illnesses (IDD). These conditions are caused by a lack of iodine, which causes insufficient thyroid hormone production.
 Aim: The aim of this study is to characterize the iodine deficiency disorder by biochemical and clinical assessment and to correlate the iodine status with thyroid disorder(s) in adults.
 Material and Method: The samples for this investigation were taken from patients at the Department of Endocrine Surgery. This study comprised a total of 100 hundred goiter patients, who had their urinary iodine excretion and thyroid hormone levels examined. For all goiter patients, the grading of goitre was established using the WHO/UNICEF/ICCIDD approved criteria. TSH, Free T4, Free T3 by using ELISA Method using commercial kits. Anti-microsomal antibody (AMA) or Thyroperoxidase antibody (TPO-Ab) by using ELISA Method using commercial kits. Anti-thyroglobulin antibody (ATG) estimated by using ELISA Method using commercial kits.
 Results: The data for each group were presented as Median and inter quarter range (IQR) The median and IQR of Urinary iodine excretion of the hypothyroid, hyperthyroid and Euthyroid goiter subjects were respectively and there was significant difference in the median urinary iodine excretion. The median and IQR of Urinary iodine excretion of the thyroiditis, thyrotoxicosis, cancer of thyroid and benign goiter respectively and there was significant difference in the median urinary iodine excretion.
 Conclusion: For ages, endemic goitre and cretinism have been recognised as public health issues, and iodine deficiency is thought to be the leading cause of preventable mental retardation. Most countries now include iodine deficiency control as part of their national nutrition policies. To eliminate iodine deficiency, several therapies with high efficacy have been employed, including iodized oil capsules (IOC) and universal salt iodisation (USI). Although some progress has been made, efforts to eliminate this devastating health problem must be hastened. Not only should iodine deficiency be monitored, but so should excessive iodine intake, as this is a problem in various areas, including the camps.
 Keywords: IDD, Goitre, TSH, IOC, USI, ATG, AMA, T4, T3.

Study the correlation of iodine nutrition and autoimmunity among Euthyroid goiter patient in a tertiary care hospital in Tamil Nadu

Background: Iodine is an essential micronutrient for the thyroid hormone synthesis. It is crucial for the growth and development of human life. Deficient or excessive iodine intake may affect thyroid gland size and functions. Despite the intake of iodized salt, the increasing occurrence of thyroid disorders in India.
 Aim and Objective: Aim of the present study is to analyse the nutritional status of iodine among Euthyroid goiter patient by measuring urinary excretion and correlate with thyroid hormone and auto antibodies
 Materials and Methods: one hundred and fifty Euthyroid goiter patients and one hundred and fifty age-matched normal adult were included in study. Urinary Iodine level and serum TSH, freeT4, freeT3, AMA and ATG were estimated both case and control groups.
 Results: The mean urinary iodine excretion concentration (UIC) in Euthyroid goiter patient was 244.39 µg/L and excess urinary iodine excretion was found in 48%. There were elevated serum AMA levels in Euthyroid goiter patient and that positive correlated with excess iodine.
 Conclusion: In this study we found that excess urinary iodine excretion among patients. This study we observed iodine excess associated complications, viz., benign goiter (49%), thyroiditis (24%), cancer of thyroid (21%) and thyrotoxicosis (6%).

Quality of Life in Patients with Benign Non-Toxic Goiter After Surgical Intervention: A Systematic Review and Meta-Analysis.

Prior studies evaluating health-related quality of life (HR-QoL) outcomes in patients undergoing surgery for benign non-toxic goiter have used different instruments and time points, leading to conflicting results. We sought to systematically review the differences in HR-QoL among patients with BNTG at baseline and 6months after surgery, using exclusively the ThyPRO questionnaire. A systematic search was performed using PubMed, Embase, Web of Science, Cochrane Central, CINAHL, and PsycINFO for papers reporting the assessment of HR-QoL utilizing ThyPRO. Data were meta-analyzed using a random-effects model, and pooled estimates were calculated using weighted mean differences (WMD) between baseline and 6months after surgery. We assessed the quality and risk of bias of the studies using the Robins-I tool and previously published minimally important change (MIC) values to assess clinical significance. Six papers met the predefined inclusion criteria, describing a total of 496 patients. Meta-analysis demonstrated improved QoL in all thirteen domains of ThyPRO six months post-surgical intervention compared to baseline. Specifically, the largest improvement in QoL was seen in the domains of overall QoL, WMD -25.84 (95% CI -29.70, -21.98, p < 0.001, I2 = 23%), goiter symptoms, 23.96 (95% CI -30.29, -17.64, p < 0.001, I2 = 91%), and tiredness, -16.20 (95% CI -19.23, -13.16, p < 0.001, I2 = 3%). The differences in scores 9 of 13 domains were clinically significant based on MIC. Disease-specific HR-QoL improved in all ThyPRO domains after surgery in patients with BNTG. Future studies of QoL in thyroid surgery patients will benefit from a standard questionnaire and improved reporting of covariates including complications to ensure comparability across studies.

Impact of thyroidectomy on quality of life in benign goitres: results from a prospective cohort study.

Benign thyroid diseases encompass a large spectrum of conditions that are chronic and subtle in nature. A majority of patients choose non-surgical management and continue living their daily lives with subconscious impairment of optimal functioning. We studied the effect of thyroidectomy on the quality of life (QoL) in patients with benign goitres. A prospective study was conducted on 50 patients between January 2017 and August 2018 using the ThyPRO 39 questionnaire. This is a disease-specific health-related questionnaire administered the day before surgery and 6 months following surgery. Data analysis was performed using EpiData Manager and EpiData Entry Client (v 3.1). The mean age of the cohort was 43.30 years ± 11.61, with a female preponderance (34:16). The most common indications for surgery were suspicion of malignancy and compressive symptoms in 34% and 30%, respectively. The most common histopathology reported was nodular/adenomatous hyperplasia (56%). Prior to surgery, the most common domains affected were emotional susceptibility and tiredness. Following surgery, a significant improvement in all domains of the ThyPRO 39 questionnaire were seen except for psychological well-being (p=0.126). In addition, the composite scores significantly improved (p<0.001). Younger age, female gender, and longer duration of goitre were the factors that significantly affected the outcomes in various domains. Patients with benign goitres have subtle impairment of QoL which showed significant improvement following thyroidectomy.

Is hemithyroidectomy sufficient in unilateral benign nodular goitre?

Multinodular goiter is a common disease. If only one thyroid lobe is affected, hemithyroidectomy may be preferred to reduce complication and hormone replacement therapy. However, completion thyroidectomy may be required later. The aim of the study was to evaluate the role of completion thyroidectomy in patients who develop nodules after hemithyroidectomy, and we aimed to find the ratio of patients who required hormone replacement for permanent hypothyroidism. Patients who underwent hemithyroidectomy for benign nodular goitre between January 2012 and June 2017 were analyzed. The age of the patients, gender, number of nodules and dimension of the largest nodule, preoperative fine needle aspiration biopsy results, and postoperative histopathology findings were recorded. The need for completion thyroidectomy and need for postoperative L-thyroxine treatment were based on these parameters. A total of 170 patients were included in the study. During the follow-up period new nodule or progression in existing nodule was observed in 23% (39 patients) of the cases. Permanent hypothyroidism requiring L-thyroxine treatment was observed in 31% (53 patients) of the cases. In this study, young age, multiple nodules and toxic nodular goitre diagnosis were noted to be independent risk factors that contributed to progression diseases in cases operated for benign nodular goitre. Due to low reoperation risk and acceptable permanent hypothyroidism rates, hemithyroidectomy is a viable option for benign goitre cases. The patients should be on follow-up for possible complications, especially hypothyroidism, for at least a year.

Benin Goitre in the General Surgery Department at Teaching Hospital Gabriel Tour&amp;amp;#233

Introduction: Goitre is an increase in the volume of the thyroid gland. Goiters may be congenital or acquired, diffuse or nodular, functional or non-functional, benign or malignant. Purpose: The objectives of this work were to study and determine the frequency of benign goitre in the general surgery department of CHU Gabriel Touré, and to study epidemiological, clinical and therapeutic aspects. Patients and Method: This was a retrospective and prospective study conducted in the general surgery department of CHU Gabriel Touré, from January 1999 to December 2019. Included in the study were all patients with benign goiter confirmed in histology, hospitalized and treated in the service. Patients with thyroid malignant tumours, strumite, thyroid tract cyst, cervical abscess and neck trauma were not retained. Socio-demographic, clinical, para-clinical, therapeutic and post-operative aspects were the study parameters. Word processing and tables were done with Microsoft Word and Excel 2016 software. Data analysis was performed with Epi info7 software, the statistical test used was the Khi2 test and a value of P 0.05 was considered statistically significant. Results: A total of 253 patient files were collected. Thyroidectomy represented 5.02% (253/5036) of surgical procedures. The average age was 42.5 years with a standard deviation of 15.6 and extremes of 13.9 and 76 years. The sex ratio was 8.7 in favour of the female sex. Anterior cervical swelling was the most common reason for consultation with 90.0% (230/253). There were 118/253 cases of euthyroid goiter (46.6%), 132/253 cases of hyperthyroid goiter (52.2%) and 3/253 cases of Basedow’s disease (1.2%). Histology revealed (178/253) cases of micro and macro follicular colloid adenoma (70.3%), (27/253) cases of micro and macro follicular vesicular adenoma (10.7%) and (48/253) cases of micro and macro vesicular hyperplasia. The most performed surgical techniques were subtotal thyroidectomy with a rate of 138/253 (54.5%) isthmo-lobectomy with a rate of 102/253 (40.3%), lobectomy with a rate of 11/253 (4.3%) and isthmectomy 1/253 (0.4%). One-month follow-up was marked by 4 cases of surgical site infection (1.6%), 2 cases of transient hypocalcemia (0.8%). One-year follow-up was simple in 98.4% of cases, we noted 4 cases of keloid. The average length of hospitalization was 3.31 ± 0.1 days. Conclusion: Goiter surgery is relatively common in the general surgery department of CHU Gabriel Touré. Good preparation and better post-operative monitoring could help minimize post-operative complications.

Spectrum of thyroid nodules in a tertiary care center in the Kingdom of Bahrain

Background: This study investigates and analyses the thyroid nodules in Bahrain, and correlates the diagnosis of cytopathology with a subsequent excision histopathology. Materials &amp; Methods: We conducted a retrospective study for all thyroid cases diagnosed at the Salmaniya Medical Complex during a 7-year period (January 2013 to December 2019). Results: A total of 1218 thyroid nodules were diagnosed during the study period. Among them, 1,037 (85%) of the patients were females and 181 were males (15%), with an average age of 48.2 years. Surgical excision was performed on 263 out of 1,037 (25%) of the cases. Conclusions: The study revealed that the prevalence of thyroid nodules is higher among females. The most common nodules are benign multinodular goiters. A statistically significant correlation was observed between fine needle aspiration cytology (FNA) and surgical excision of the thyroid nodule. Keywords: Thyroid, FNA, thyroid nodules, cytology, excision

HYPOCALCEMIA IN TOTAL VERSUS SUBTOTAL THYROIDECTOMY

Objective: To compare the occurrence of hypocalcemia in patients undergoing subtotal and total thyroidectomy.&#x0D; Study Design: Comparative prospective study.&#x0D; Place and Duration of Study: Surgical departments of Ayub Teaching Hospital, Abbottabad and Combined Military Hospital, Rawalpindi, from Mar 2018 to Feb 2020.&#x0D; Methodology: A total of 171 patients were selected for this study and they were divided into 2 groups. Group 1 consisted of 95 patients undergoing Total thyroidectomy whereas group 2 had 76 patients undergoing Subtotal thyroidectomy. It was a comparative prospective study and the groups were made by convenience sampling. The data was analyzed by SPSS-23.&#x0D; Results: In total thyroidectomy group Hypocalcemia was detected after 48 hours in 34 patients (35%) while in subtotal thyroidectomy group hypocalcemia was detected in 20 patients (28%). Tests for hypocalcemia were also done after two months of surgery and low levels were detected in 7 patients (7.5%) who had total thyroidectomy and in 2 patients (5%) in the group undergoing subtotal thyroidectomy. There was no significant difference in hypocalcemia after 48 hour (p=0.22) and 2 months postoperatively (p=0.6) between patients of Total Thyroidectomy and Subtotal Thyroidectomy.&#x0D; Conclusion: Total thyroidectomy is not associated with increased risk of permanent hypocalcemia as compared to Subtotal thyroidectomy. Because of its advantages Total thyroidectomy should be the preferred surgical procedure for patients presenting with benign euthyroid multi nodular goiter.

Comparison of the Outcome of Clamp-and-Tie with Ligasure Technique in Total Thyroidectomy

Objective: To compare the outcome of clamp-and-tie with Ligasure technique in total thyroidectomy patients. Material and Methods: A total 60 (30 in each group) patients undergoing near total thyroidectomy for benign goiter were included in this study. After taking informed consent, demographic data (age, gender, duration of goitre, place of living and BMI) were noted. All selected cases were be divided into group A &amp; B by lottery method. In group A patients total thyroidectomy was done by using ligasure while in group B patients, near total thyroidectomy was done by clamp-and-tie technique. Operation time and intra-operative blood loss were measured for each patient. Results: Mean age of patients was 45.60±12.1 years included in this study. Mean disease duration was 7.8±4.5 months. Mean BMI was 24.80±3.61 kg/m2. There were 43 (71.67%) females and 17 (28.33%) male patients. There were 13 (21.67%) patients were from rural area and 47 (78.33%) were from urban area. Mean operative time in group A was 61.33±5.98 hours versus 75.06±6.61 hours in group B (p-value &lt;0.001). Mean intra-operative blood loss was 53.40±6.11 ml in group A versus 81.47±9.29 ml in group B (p-value &lt;0.001). Conclusion: Thyroid surgery with Ligasure resulted in dramatically reduced mean operational time and postoperative blood loss compared to traditional approach. Keywords: clamp-and-tie technique, Ligasure, total thyroidectomy.

The Relationship Between the Serum Level of Vitamin D and Hypocalcemia After Total Thyroidectomy

Vitamin D plays a crucial role in calcium metabolism through the parathormone-dependent process. The deficiency of this important nutrient may be associated with hypocalcemia after thyroidectomy. To evaluate the role of vitamin D in predicting hypocalcemia following total thyroidectomy. In this study, sixty-two patients who underwent total thyroidectomy for benign or malignant thyroid disease were included in this prospective study. Preoperative vitamin D serum levels and parathormone (PTH) levels were determined. The association between preoperative vitamin D status and the development of hypocalcemia was investigated. In this study, 62 patients were evaluated. The mean age of the subjects was 47 years. Of the 62 patients studied, of which 9 were male patients (14.5%), and 53 were female (85.5%), the results of our study showed. In both groups with and without vitamin D deficiency, calcium levels decreased significantly (P=0.01). In our study, it was found that there was no significant relationship between postoperative hypocalcemia and vitamin D deficiency. (P=0.441). After reviewing the data and according to Spearman correlation statistical test, no significant relationship was observed between serum parathyroid hormone (PTH) and calcium after thyroidectomy (P=0.340). Vitamin D deficiency is a risk factor of hypocalcemia after total thyroidectomy for benign goiter. Although post thyroidectomy hypocalcemia is multifactorial, vitamin D deficiency, particularly severe form, is significantly associated with the development of biochemical and clinical hypocalcemia. Vitamin D supplementation can prevent this unwanted complication in such patients.

Value of Contrast-Enhanced Ultrasound in Partially Cystic Papillary Thyroid Carcinomas.

Partially cystic papillary thyroid carcinomas (PCPTCs) are rarely reported papillary thyroid carcinomas (PTCs) and are usually misdiagnosed as benign nodules. The objective of this study was to provide the various sonographic characteristics of partially cystic thyroid nodules for differentiation between malignant and benign nodules, including those for conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS). Twenty-three PCPTC patients and 37 nodular goiter patients were enrolled in this study. We evaluated the size, cystic percentage, solid echogenicity, calcification, vascularity, and CEUS parameters for each nodule. The final diagnosis of all patients was confirmed via surgery. Univariate analysis demonstrated that compared with benign nodular goiters, PCPTCs more frequently presented with calcification, hypoechogenicity of the solid part, hypoenhancement, heterogeneous enhancement, centrifugal perfusion, peak intensity index <1, time to peak index ≥1, and area under the curve index <1 on preoperative US and CEUS. Binary logistic regression analysis demonstrated that heterogeneous enhancement, centrifugal perfusion, and peak intensity index <1 are independent CEUS characteristics related to malignant PCPTCs and can be used for their differentiation from benign nodular goiters (all p < 0.05). Our study indicated that preoperative CEUS characteristics may serve as a useful tool to distinguish malignant PCPTCs from benign thyroid nodules.

The prevalence of hypoparathyroidism after thyroid surgery depending on the diagnosis, the extent of the procedure, and the presence of parathyroid glands in the postoperative examination.

Introduction Postoperative hypoparathyroidism can be one of the complications associated with total thyroid removal due to cancer or benign goitre. Purpose The paper aimed to evaluate the prevalence of hypoparathyroidism in patients operated on due to thyroid cancer and nodular goitre, including procedures performed between January 2015 and March 2019 at the Department of Oncological Surgery of the Medical University of Silesia in Katowice. Material and methods The studied group consisted of 595 patients operated on due to cancer and benign nodular goitres. Calcium and phosphate metabolism was assessed using PTH and ionised calcium tests four hours after the surgery. Ionised calcium was checked 30 days after the procedure. Patients who had borderline or below-normal PTH levels in the postoperative period were also subjected to PTH testing after 30 days. In patients with low PTH levels, supplementation with calcium and vitamin D3 was introduced after the surgery. Results Compared to patients operated on for benign goitres, persons diagnosed with cancer were significantly more likely to have PTH levels below 15 pg/ml and serum ionised calcium levels below 4 mg/dl after 30 days following the surgery. The recovery rate was 65.05% vs 82.6% (p < 0.003) and 64.2% vs 84.25% (p < 0.001). The results were similar among patients who underwent lateral and central lymphadenectomy - 33.3% vs 67.3% (p < 0.021) and 25.6% vs 67.6% (p < 0.018). In patients with mild goitres, no significant differences in the recovery rate were observed - 82.6% vs 92.8% (p < 0.327) and 84.25% vs 92.3% (p < 0.437). Patients in whom parathyroid glands were found in the postoperative material were significantly more likely to have decreased PTH and calcium levels after 30 days following the procedure. The recovery rate was 64.1% vs 78.9% (p < 0.027) and 58.06% vs 80.8% (p < 0.004). Conclusions Hypoparathyroidism is not an uncommon occurrence after thyroidectomy, even in facilities with extensive experience in this matter. Compared to total thyroid removal due to benign goitre, surgery for cancer with associated central and lateral lymphadenectomy significantly increases the risk of postoperative hypoparathyroidism. In surgical practice, it is reasonable to conduct routine Ca and PTH level checks after the procedure and 30 days following thyroidectomy.

Role of thyroxine in reducing the size of benign thyroid swellings and pre-treatment thyroid stimulating hormone as a predictor of response to therapy

Background: Conservative management for benign thyroid swellings which do not require surgery is a matter of controversy. There has been studies and trials on the role TSH suppression in reducing thyroid volume, but low dose thyroxine was never been properly studied. Being such a common disorder, more studies have to be undertaken to have an idea on managing the goitres conservatively.Methods: Patients with benign thyroid goitres without indications for surgery and who were on 50-100 µg of thyroxine per day was included in the study. Their initial thyroid hormone levels, volume on ultrasonogram, and fine needle aspiration cytology were collected along with biodata. They were reassessed after 6 months and 1 year for change in volume of thyroid.Results: Majority of patients showed a decreasing trend in volume of thyroid after 1 year of thyroxine therapy, even though the amount of reduction was not statistically significant. Rate of decrease in thyroid volume was significantly higher in patients with higher TSH values.Conclusions: Thyroxine therapy has got a role in reducing and arresting further growth of benign thyroid swellings which doesn’t require surgical management. Pre-treatment TSH can be used a predictor of response to thyroxine therapy.

Hypocalcemia following total thyroidectomy for benign goitre

Thyroidectomy has a complication rate lower than 5%. Most frequently, postoperative hypocalcemia has been observed. the aim of the present study was to assess Hypocalcemia following total thyroidectomy for benign goiter in head, neck, endocrine surgery unit at Alexandria main university hospital. Post-thyroidectomy hypocalcaemia (PTHC) is a recognised postoperative complication with potential wide-ranging implications and healthcare costs. Hypocalcaemia can be asymptomatic; however, clinical manifestations such as paraesthesia and muscle spasms can be distressing for the patient, while persistent untreated hypocalcaemia can be life threatening. Thyroid surgery (total or near total thyroidectomy) can lead to serious complications, including transient or permanent vocal cord palsy or severe bleeding. However, hypocalcemia is the most frequent complication after thyroid surgery. Transient hypocalcemia frequently complicates postoperative care of patients who have undergone thyroid surgery. Post-thyroidectomy hypocalcemia arises because of parathyroid removal, devascularization and damage which induce a state of transient (or permanent) hypoparathyroidism. Additional mechanisms, such as vitamin D deficiency, an acute increase in calcitonin serum levels (because of gland handling during surgery) or an “hungry bone syndrome” are believed to contribute to this process.

Non-neoplastic Lesions among Lateral Neck Mass Specimens in a Tertiary Care Center: A Descriptive Cross-sectional Study.

Lateral neck masses present clinically as neoplastic or non-neoplastic lesions of lymph nodes, salivary glands, and thyroid. Non-neoplastic lesions, if evaluated timely, may not transform into malignancy thus reducing clinical burden. A cytomorphological study using fine needle aspiration is a reliable method for the diagnosis of such masses. The aim of this study was to find out the prevalence of non-neoplastic lesions of lateral neck mass specimens received in the Department of Pathology in a tertiary care center. This descriptive cross-sectional study was carried out in the Department of Pathology among lateral neck mass specimens of a tertiary care center from January 2019 to December 2020 after obtaining ethical approval from the Institutional Review Committee (Reference no: 155/19). A convenience sampling method was used and data analysis was done in Microsoft Excel 2019. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Out of 300 lateral neck mass specimens, non-neoplastic lesions were found in 246 (82%) (77.7-86.3 at 95% Confidence Interval). The involvement of lymph nodes in 117 (47.6%) was the most common finding followed by thyroid 112 (45.5%). Among non-neoplastic lesions, the cytomorphological features of benign nodular goiter 93 (37.8%) was the most common lesion followed by reactive lymphoid hyperplasia 73 (29.7%). The study showed that the prevalence of non-neoplastic lesions was similar to that of other national and international studies.

P-204 Case report of cutaneous papillary thyroid carcinoma 16 years post total thyroidectomy for benign goiter

P-204 Case report of cutaneous papillary thyroid carcinoma 16 years post total thyroidectomy for benign goiter

Differences in Surgical Outcome in Near Total Thyroidectomy for Benign Nodular Goiter: A Comparison of LigaSure Vessel Sealer versus Conventional Clamp Knot Tie Technique

Objective: To compare the efficacy of LigaSure Vessel Sealer in Near Total Thyroidectomy versus Conventional Clamp Knot Tie Technique in terms of bleeding, operative time and postoperative drainage.&#x0D; Methodology: This comparative cross sectional study was conducted at Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro. Study duration was one year from November 2019 to October 2020. All patients of any age with benign multinodular goiter and either of gender were included. The study subjects were grouped into two categories by randomization (odd / even). The odd numbers were given to patients operated for ligasure and even numbers were given to patients operated with conventional clamp knot tie technique. Outcomes were observed with respect to post-operative calcium level, intra-operative bleeding, operative time, post-operative pain &amp; post-operative hospital stay. All the data was recorded via study proforma. Data was analyzed by using SPSS version 20.&#x0D; Results: Total 55 patients were observed. Mean age was 33.25±10.60 years in clamp knot tie procedure group and 35.16±07.96 years in ligasure technique group; without significant difference (p-0.448). Pre and post-operative calcium levels were statistically insignificant among both groups (p-0.358 and 0.163), while loss of blood, hospital stay, post-operative pain and operative duration were significantly greater in clamp knot tie technique group in comparison to ligasure technique group (p-&lt;0.001).&#x0D; Conclusion: LigaSure Vessel Sealer is a feasible and reliable surgical technique and significantly more effective as compared to conventional clamp knot tie technique in terms of post-operative bleeding, operative time, post-operative pain and post-operative hospital stay. However, calcium level was statistically insignificant.

Tiroidectomía y paratiroidectomía endoscópica transoral con abordaje vestibular (TOETVA TOEPVA): Experiencia inicial en el Hospital Universitario Austral

Background:Kocher’s cervicotomy has been the classic approach for thyroid and parathyroid surgery. The greater concern about neck scarring has generated an increasing interest in reducing scar size or leaving the scar in less visible places. In 2016 Anuwong published 60 cases of TOETVA/TOEPVA with optimal outcomes.Objectives: The aim of this study is to report the initial experience with transoral endoscopic thyroidectomy and parathyroidectomy vestibular approach in Hospital Universitario Austral.Material and methods: We conducted a retrospective analysis of 18 prospective procedures performed between May 2019 and March 2020. The procedures performed were 2 parathyroidectomies, 13 lobectomies, 4 total thyroidectomies, 1 with central lymph node dissection; one patient presented a parathyroid adenoma and a benign thyroid nodule. Cytology report according to the Bethesda system: category II in 7 cases, VI in 9 and indeterminate in 1.Results: 18 female patients. Median age: 41 years. Mean nodule size: 30 mm. Mean gland volume: 24 mL. Conversion. 1 case. Mean operative time: lobectomy, 260 minutes; total thyroidectomy, 262 minutes. Definite histology: papillary thyroid carcinoma,11; benign nodular goiter, 6; parathyroid adenoma, 2. Complications: mild ecchymosis, 12 patients; temporary hyperparathyroidism, 1 case; temporary recurrent laryngeal palsy, 1 case; temporary numbness of the mental region in 1 case.In the two cases undergoing total thyroidectomy due to cancer, thyroglobulin level 6 weeks after surgery was < 0.1 μIU/mL.Conclusions: 1) The transoral approach is a safe and feasible procedure that offers excellent cosmeticresults. 2) It can be implemented using conventional endoscopic equipment,

Occult Thyroid Carcinoma: A Tertiary Hospital Experience in Ibadan, Nigeria

Introduction: There is a dearth of knowledge on the proportion that occult thyroid carcinoma constitutes amongst patients with thyroid cancer in our practice. This study was therefore conducted to review the cases of occult thyroid carcinoma with a focus on the presentation, management, and the outcome of care in a low resource tertiary hospital setting. Materials and Methods: We conducted a retrospective cross-sectional descriptive study of 62 patients who were managed for thyroid cancer over a 15-year-period at the University College Hospital, Ibadan, Nigeria. The patients who had more than two follow-up visits to the Thyroid Clinic, over the preceding fifteen years were included in this study. The types of surgeries performed on the patients were noted. The data were analyzed using descriptive statistics. We also identified the various limitations that might have hindered the effective care of such patients. Results: Sixty-two consecutive patients, 12 male (19.4%) and 50 females (80.6%) with a median interquartile age range of 45 years, were diagnosed with thyroid cancer. The surgeries performed on the patients were total thyroidectomy, 48 (77.4%), completion-thyroidectomy, 14 (22.6%), near total thyroidectomy, etc. Occult thyroid cancer constituted 38 (61.3%) of the patients managed for thyroid cancer. The most common histology subtype was papillary carcinoma. We identified late presentation, inadequate oncologic surgery, financial constraint etc., as limitations of optimal care. Conclusions: In view of the proportion of occult thyroid cancer in this cohort of patients, the clinically benign goitres might contain carcinoma or micro-carcinoma. Therefore, an aggressive public health campaign to encourage early presentation of our patients and primary reduction through total thyroidectomy is recommended to improve the outcome of care.