Bilateral Total Thyroidectomy Research Articles

Hybrid minimal invasive esophagectomy for esophageal cancer: a single center experience with 14 cases

AIM: To perform a retrospective evaluation of morbidity, early postoperative mortality rates, and the safety of the procedure in patients who underwent hybrid minimally invasive esophagectomy in our clinic. MATERIAL AND METHOD: The records of 14 patients with esophageal cancer operated using the minimally invasive esophagectomy technique in the general surgery clinic of the XXX Hospital between November 2015 and November 2022 were analyzed retrospectively. RESULTS: The mean age of the 14 cases was 55 ± 11.96 years (32-71). Ten patients (71%) were men and four (29%) were women. The tumor was located in the lower esophagus in 12 cases, in the middle esophagus in one, and in the upper esophagus in one. Near total esophagectomy – cervical anastomosis was performed in 13 cases. Pharyngogastric anastomosis was performed after total esophagectomy, bilateral total thyroidectomy, and laryngectomy in one patient with upper esophageal tumor. The mean operative time was 319.64 ± 76.28 (188-452) min. Mean intraoperative bleeding was 109.64 ± 58.58 (40-220) ml, and the mean length of hospital stay was 13.71 ± 3.72 (7-21) days. No early postoperative mortality was observed in any case. CONCLUSION: Our early postoperative results in cases in which we performed hybrid minimally invasive esophagectomy are consistent with the previous literature.

Comparison of Surgical Outcomes of Transoral Versus Open Thyroidectomy for Graves Disease.

The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a safe alternative to thyroidectomy for thyroid goiter and provides the benefit of being scarless. However, the data on the use of TOETVA in patients with Graves disease are limited. This retrospective study compared the outcomes of Graves disease patients who underwent TOETVA versus those who underwent open thyroidectomy (OT). Patients with Graves disease who received TOETVA or OT for bilateral total thyroidectomy between September 2017 and October 2022 were included. Patient demographics and surgical outcomes, including operation time, blood loss, length of stay, and complications, were compared. There were 15 patients in each group. The mean age in the TOETVA group was 35.80±8.13 years, which was significantly younger than that in the OT group, which was 51.53±14.22 years. Females predominated in both groups. The other demographic characteristics were similar in both groups. The operation time and intraoperative blood loss were also comparable. The postoperative stay and complications, including hypoparathyroidism, recurrent laryngeal nerve injury, surgical site infection, postoperative hemorrhage, and recurrence of hyperthyroidism, were not different between the 2 groups. There were 11 patients in the TOETVA group and 10 in the OT group who had thyroglobulin levels <0.1ng/dL, indicating the completeness of total thyroidectomy in the 2 groups. There was no conversion of TOETVA to an open procedure. For carefully selected Graves patients, TOETVA offers a safe, scarless, and feasible alternative to conventional open thyroidectomy.

Bilateral axillo-breast approach robotic total thyroidectomy without isthmectomy: a case report

Bilateral axillo-breast approach robotic total thyroidectomy without isthmectomy: a case report

P-82 Riedel's thyroiditis: three-year follow-up under steroid, rituximab and mycophenolate mofetil treatment

Abstract Introduction Riedel's thyroiditis (RT) is an uncommon thyroiditis characterized by fibrosis, macrophage, and eosinophil infiltration and is assumed to be the primary cause of autoimmunity in the pathogenesis. Invasion of the surrounding tissues, particularly the trachea, occurs. RT is also regarded as thyroid involvement in IgG4-related systemic illness. Because there is no conventional medical treatment protocol for RT, this paper aims to highlight the problems we had in diagnosing and our approach throughout therapy. Clinical Case In the last 1.5 years, a 44-year-old female patient on levothyroxine replacement diagnosed with hypothyroidism developed bilateral swelling in the eyes, double vision, drooping eyelids, shortness of breath, and feeling something lodged in the throat. A diffusely enlarged and stiff thyroid gland was palpated in her physical examination. Neck CT revealed a diffusely enlarged thyroid gland 7cm in diameter and constricted trachea. She did not have any constitutional symptoms. According to physical and radiologic exams, preliminary differential diagnoses were anaplastic thyroid carcinoma and IgG4-related thyroiditis. In laboratory tests, TSH: 4.5 mIU/L, st3-4: normal, Anti TPO: +++ TRAB: 0.15 U/L, ANA: Negative, IgG4: 0.52 g/L (0.03-2.01), ACE:21.39. Since the thyroid fine needle aspiration biopsy reported a hypocellular smear, a lacrimal gland biopsy was performed for systemic involvement of IgG4 related disorder's. Her dyspnea was becoming critical; therefore, she was administered 0.5 mg/kg steroid for two weeks before the scheduled bilateral total thyroidectomy, and a considerable decrease in dyspnea, swallowing sensations, and regression in compression findings were seen. Lacrimal biopsies demonstrated persistent inflammation with plasma cells and severe fibrosis, consistent with late-stage IgG4-related illness. Both thyroid lobes were enlarged in neck T1 and T2-weighted MRI images (right lobe was 34×25×68 mm, the left lobe was 35×26×69 mm), diffuse hypointensity was noted, contrast uptake decreased in the thyroid parenchyma following IVCM, and the data was determined to be compatible with RT. The thyroid gland grew markedly on PET-CT, narrowing the air column, with increased FDG absorption in a heterogeneous character (SUVmax: 4.9), and mild-moderate involvement in bilateral lacrimal and parotid glands.The decision was made to continue steroid treatment at 1 mg/kg for one month. Rituximab was given twice every six months while the steroid was lowered. Mycophenolate mofetil (MMF) (2×500 mg) was introduced as a maintenance immunosuppressive medication. The initial radiologic findings regressed in the control neck MRI and PET-CT in the first year. The MRI findings were also steady in the second and third years of MMF. Conclusion Immunosupression therapy with steroid, rituximab and MMF was effective in our RT patient for the long term without significant complications. Clinical and radiological responses similar to surgery can be obtained with immunosuppressive agents.Figure 1.PET-CT and MRI images at diagnosis and third year

O-10 Lymph node ACTH washout determined the source of ACTH secretion in a patient with Cushing's Syndrome due to medullary thyroid cancer

Abstract Introduction Ectopic ACTH syndrome constitutes 18% of Cushing's syndrome cases, and in rare cases, ACTH secretion from medullary thyroid cancer cells is the source of ectopic ACTH production. Here we report a catastrophic Cushing's syndrome case owing to medullary thyroid cancer in which the source of ACTH production was demonstrated by lymph node ACTH washout. Clinical Case A 23 year-old male was admitted to other clinics with complaints of inability to lose weight despite diet and exercise, and weight gain of approximately 40 kg, which had been going on for the last two years. At his application, his weight was 160 kg and his body mass index was 42.51 kg/m2. On physical examination, clinical stigmata suggesting Cushing's syndrome such as moon face, buffalo hump, supraclavicular fat deposition, acanthosis nigricans, centripedal obesity, purple striae on the abdomen were noted. The biochemical and hormonal evaluation confirmed ACTH-dependent Cushing's syndrome (Table 1). To establish the source of excess ACTH, first, a pituitary MRI was performed which revealed a 4×2 mm adenoma on the left side of the gland. In PET-CT, a 24×20 mm hypoechoic nodule in the inferior of the right thyroid lobe, and several pathological lymph nodes at the right side of the neck were detected. Serum calcitonin levels were high (6528 ng/L) and fine-needle aspiration biopsy from the thyroid nodule documented medullary thyroid cancer. The patient underwent bilateral total thyroidectomy and right cervical lymph node dissection. The pathology report was compatible with metastatic medullary thyroid cancer. After surgery, the remission of hypercortisolemia was not achieved and the patient was started on metyrapone treatment before the permanent treatment plan. Postoperative Gallium-68 DOTA PET-CT indicated residual disease and increased uptake in retropharyngeal, bilateral cervical level 2-4, right level 3, bilateral central, and bilateral lower cervical lymph nodes. The persistence of hypercortisolemia after surgery was most likely attributed to residual disease, however, it was considered that pituitary adenoma may also be the cause of ACTH secretion. Therefore, to confirm the source of ACTH secretion, ACTH washout samples were taken from the cervical lymph nodes and were found to be high as 958 ng/L. Reoperation was performed for recurrent mass and lymph node metastases. Conclusion Medullary thyroid cancer should definitely be considered in cases of ectopic ACTH syndrome. ACTH washing from the suspected lymph node may be an option for diagnostic purposes. In addition to the patient's primary tumor, hypercortisolism should also be treated.Table 1.Cushing's assessment tests

Effect of early intravenous calcium replacement after total thyroidectomy

Aim: This study was to evaluate the need for postoperative calcium replacement in patients undergoing total thyroidectomy, to evaluate the effect of intravenous calcium therapy given in the early postoperative period regardless of serum calcium level and physical examination on the length of stay of the patients, parathormone levels, and the need for oral calcium after discharge. Materials and Methods: The files of 73 patients who underwent bilateral total thyroidectomy between January 2018 and July 2023 were retrospectively reviewed, and the demographic characteristics, anti-TG, anti-TPO, postoperative calcium, parathormone, thyroid gland weight of the patients were recorded. The effect of intravenous calcium replacement on calcium requirement, parathormone levels, and length of hospitalization was evaluated independently of calcium levels. Results: It has been observed that replacement is associated with long-term calcium requirement in patients who underwent bilateral total thyroidectomy and received intravenous calcium in the early period. The length of stay was found to be longer in patients who underwent calcium replacement. Conclusion: Various treatment methods are used to prevent hypocalcemia. One of these treatment methods is early intravenous calcium replacement. In clinical practice, treatments given to prevent the development of complications and to discharge patients early may sometimes lead to the occurrence of complications that are tried to be prevented. The purpose of calcium replacement is to prevent the development of hypocalcemia, to reduce the complication rate and to provide early discharge. It was evaluated that intravenous calcium replacement therapy, which was applied in the early period to prevent postoperative hypocalcemia, caused patients to need longer-term calcium replacement and prolonged hospitalization. It is important to avoid calcium replacement in the early period and to evaluate the physical examination findings along with the serum calcium level of the patients for replacement.

Minimally Invasive Open Bilateral Total Thyroidectomy Using Unilateral Neck Incision in Thyroid Cancer: Preliminary Surgical and Quality of Life Outcomes

Minimally Invasive Open Bilateral Total Thyroidectomy Using Unilateral Neck Incision in Thyroid Cancer: Preliminary Surgical and Quality of Life Outcomes

Can the risk of hypocalcemia be detected with intact parathyroid hormone level after total thyroidectomy?

Objective: Nowadays, thyroidectomy is performed in patients with various indications. However, transient or permanent hypocalcemia occurs after surgery. In this case, the duration of hospitalization of the patients is prolonged. In this study, we aimed to detect hypocalcemia in the early phase with intact parathyroid hormone (iPTH), a biochemical marker. &#x0D; &#x0D; Method: Hospital records of patients who had undergone standard bilateral total thyroidectomy for thyroid disease were retrospectively analyzed between September 2018 and April 2019 at the Department of General Surgery, Gaziantep University.&#x0D; &#x0D; Results: Of the 114 patients included in the study, 91 were female (79.8%), and 23 were male (23%). Calcium levels of ≤8.5 mg/dL were found in 49 of 114 patients. Clinical symptoms of hypocalcemia were observed in 19 of these 49 patients. There was a significant correlation between the patients’ iPTH levels at 3-6 hours postoperatively and the calcium values at 24 hours postoperatively (p

Unpredictable nightmare in thyroid surgery: Incidental Parathyroidectomy

Background: Incidental removal of the parathyroid gland is an unwanted minor complication of thyroidectomy and would occur even in experienced centers. The purpose of this study was to evaluate our clinic’s outcomes, incidence, and risk factors for incidental parathyroidectomy. &#x0D; Methods: A total of 627 patients with an average age of 50.74±12.68 years were included in the study. Seventy-eight point nine percent of the patients had bilateral total thyroidectomy, 11.2% had a total lobectomy with isthmectomy, 4.8% had completed thyroidectomy, 4% had bilateral total thyroidectomy with bilateral central dissection and 1.1% had bilateral subtotal thyroidectomy. Incidental parathyroidectomy was observed in 6.4% (n=40) of all patients.&#x0D; Results: There was a significant correlation between incidental parathyroidectomy and bilateral total thyroidectomy and bilateral central neck dissection. There were no statistically significant differences between the incidental and nonincidental parathyroidectomy group with respect to age and gender. While the preoperative diagnosis of hyperthyroidism (20.6% vs 7.5%) was significantly higher in the non-incidental parathyroidectomy group than in the incidental parathyroidectomy group, and the diagnosis of malignancy was significantly higher in the incidental parathyroidectomy group (32.5% vs. 11.6%, p=0.001). Regarding parathyroid localization, our incidental parathyroidectomy rate was higher in intrathyroidal localized cases. Postoperative transient hypocalcemia (62.5%) was higher in the incidental parathyroidectomy group than in the non-incidental parathyroidectomy group (34.4%, p

Transoral endoscopic and robotic thyroidectomy for thyroid cancer: the mid-term oncological outcome.

Traditional open thyroidectomy is the surgical standard for thyroid cancer; however, it inevitably leaves a visible scar on the neck and affects the patient's quality of life. Therefore, to avoid making a neck incision, the transoral endoscopic thyroidectomy vestibular approach (TOETVA) and transoral robotic thyroidectomy (TORT) have been developed recently, and the surgical outcomes of these techniques are as favorable as open surgery for benign disease. Additionally, positive short-term surgical outcomes have also been achieved in a few patients with thyroid cancer. However, no data on the mid-to-long-term recurrence and survival rates of transoral thyroidectomy in thyroid cancer are available. Therefore, in this study, we analyzed the surgical outcomes and mid-term oncological results of the TOETVA and TORT in patients with thyroid cancer. We reviewed patients who had received TOETVA or TORT between July 2017 and November 2021 and followed up on their oncological outcomes until December 2022. Perioperative surgical and mid-term oncological outcomes were analyzed. The 115 patients underwent 122 operations (57 TOETVAs and 65 TORTs), including seven complete thyroidectomies for differentiated thyroid cancer (DTC), Stage I-II, including T1-T3, N0-N1a, and initial low- to high-risk groups. There was no conversion from transoral to open surgery. TORT required a longer operating time (median [interquartile range]) than TOETVA (lobectomy: 279 [250, 318] vs. 196 [173, 253] min, p < 0.001; bilateral total thyroidectomy: 375 [309, 433] vs. 279 [238, 312] min, p < 0.001); however, no difference was found between the two groups regarding perioperative complications. Complete thyroidectomy with a second transoral approach was safe. TOETVA and TORT achieved favorable oncological outcomes with 100% survival and 98.2% acceptable response (excellent and indeterminate response) during a mean 37.88 ± 12.42months mid-term follow-up. Transoral endoscopic and robotic thyroidectomy was safe and achieved favorable mid-term oncological outcomes in a selected cohort of patients with early-stage DTC.

Risk factors for hypocalcemia and correlation between thyroid volume and incidental parathyroidectomy after total thyroidectomy: single center experience

Aim: We aimed to investigate correlation between the effects of age, sex, disease, pathologic diagnosis, parathyroid autotransplantation, presence of parathyroid in the pathology specimen and clinicopathological variables and thyroid volume, postoperative hypocalcemia after bilateral total thyroidectomy.&#x0D; Material and Method: A retrospective study planned in tertiary university hospital on patients undergone bilateral total thyroidectomy and neck dissection when necessary surgery for thyroid pathologies. Minimum calcium values in the postoperative period were recorded as transient or permanent hypocalcemia. The cases were statistically analyzed for the relationship between the volume of the thyroid gland removed and hypocalcemia. The effects of sex, pathological diagnosis, preoperative hyperthyroidism, anatomical retrosternal extension, number of parathyroid glands seen and preserved intraoperatively, parathyroid gland autoimplantation, parathyroid gland removal in the pathological specimen, nerve monitoring, bilateral total thyroidectomy and central and lateral neck dissection were analyzed for postoperative hypocalcemia.&#x0D; Results: Totally 763 patients were included in the study. The mean age of the patients was 50.6 years (SD:12.8) and the sex of 575 (75.4%) patients was female. Hypocalcemia was more common in women than in men (31% vs 17%; p

Incidental Papillary Microcarcinoma and Papillary Thyroid Carcinoma in Multinodular Goiter.

This study aimed to examine the incidence of incidental papillary microcarcinoma (PMC) and papillary thyroid carcinoma (PTC) in patients with benign multinodular goiter (MNG) and to compare their relationship with some prognostic factors from a new perspective. Bilateral total thyroidectomy (BTT) was used to evaluate the data of 716 patients who underwent a surgery for MNG. The prognostic data for these tumors and the relationship between patients with bilateral and multifocal tumors were evaluated using statistical tests. Papillary carcinomas were detected in 201 patients, PMC in 134 of them, and PTCs in 67. Bilaterality was more common in patients with PTCs than in those with PMC. The incidence of bilaterality in male patients with PTC was statistically more common. The presence of intra-tumoral lymphocytes was higher in multifocal PTC cases than in unifocal PTC cases. The results revealed that the number of PMC s was high in incidental tumors, and patients with PTC with male sex, bilaterality, multifocality, and tumor capsule invasion were associated with poor prognosis.

Effect of intraoperative active exploration of parathyroid glands to reduce the incidence of postoperative hypoparathyroidism, and risk factors of hypoparathyroidism after total thyroidectomy: a single-center study.

The risk factors for hypoparathyroidism after thyroid surgery have not been fully identified. This study analyzes the risk factors of hypoparathyroidism before and after total thyroidectomy. We retrospectively collected the clinical data of 289 patients who underwent total thyroidectomy at the Thyroid Surgery Center of Lishui Central Hospital from June 2018 to June 2020. For the anatomy and protection of parathyroid glands during the operation, one group of patients used the parathyroid avoidance method, and the other group used the active exploration method. Various risk factors affecting parathyroid dysfunction were studied using logistic regression models. A total of 289 patients were included in this study. The average age of patients was 47.21 ± 11.78 years, including 57 males (19.7%) and 232 females (80.3%). There were 149 (51.6%) patients with transient hypoparathyroidism and 21 (7.3%) with permanent hypoparathyroidism. The main risk factors of hypoparathyroidism were parathyroid avoidance method (P = 0.005), parathyroid autotransplantation (P = 0.011), bilateral central neck lymph node dissection (CND) (P = 0.001), lymphatic metastasis (P = 0.039), and parathyroid in the specimen (P = 0.029). The main risk factors associated with permanent hypoparathyroidism were bilateral CND (P = 0.038), lymphatic metastasis (P = 0.047), parathyroid hormone (PTH) < 1.2 pg/ml within three days after surgery (P = 0.006). Hypoparathyroidism is common but mostly transient after bilateral total thyroidectomy. Compared with parathyroid avoidance method, the active exploration method during operation may reduce the incidence of postoperative hypoparathyroidism. PTH <1.2 pg/ml within three days after surgery was predictive in patients with permanent hypoparathyroidism.

Lodine-131 uptake in a patient with cholelithiasis on post-therapeutic scan

A 71-year-old male patient was diagnosed with papillary carcinoma follicular variant after bilateral total thyroidectomy and radioactive iodine treatment was applied. The post-therapeutic whole-body scan demonstrated a focal 131I uptake in the right lobe of the liver in the right upper quadrant of the abdomen. Single-photon emission computed tomography/computed tomography (SPECT/CT) was performed to determine the precise localization of 131I uptake. It was understood that the identified focal 131I activity was due to cholelithiasis. In the same period, free-floating gallstones in the lumen and the gallbladder neck were observed on the abdominal ultrasonography

Predictive Factors Indicative of Hemithyroidectomy and Close Follow-Up versus Bilateral Total Thyroidectomy for Aggressive Variants of Papillary Thyroid Cancer.

Simple SummaryThis study evaluated the need for additional surgical treatment in patients diagnosed with aggressive variants of papillary thyroid cancer after lobectomy. With the increase in the frequency of early diagnosis, the detection of papillary thyroid cancer pathologically belonging to the aggressive variant is also increasing. Therefore, there is growing concern regarding the aggressive treatment of encapsulated aggressive variants of papillary thyroid cancer without invasive features. We suggest that close follow-up can be performed without any additional surgical treatment in patients with low-risk aggressive variants of papillary thyroid cancer incidentally detected after hemithyroidectomy. The patients should be provided sufficient consultation with clinicians.The diagnostic and treatment rates of early thyroid cancer have been increasing, including those of aggressive variants of papillary thyroid cancer (AVPTC). This study aimed to analyze the need for completion total thyroidectomy after lobectomy for clinically low-to-intermediate-risk AVPTC. Overall, 249 patients who underwent hemithyroidectomy (HT, n = 46) or bilateral total thyroidectomy (BTT, n = 203) for AVPTC between November 2005 and December 2019 at our single institution were examined. The average follow-up period was 14.9 years, with a recurrence rate of 4.3% and 10.8% in the HT and BTT groups, respectively. Multivariate Cox analysis revealed that palpable tumor on the neck during evaluation (HR, 2.7; 95% CI, 1.1–6.4; p = 0.025), clinical N1b (HR, 8.3; 95% CI, 1.1–63.4; p = 0.041), tumor size (cm) (HR, 1.3; 95% CI, 1.0–1.7; p = 0.036), gross extrathyroidal extension (HR, 3.1; 95% CI, 1.4–7.0; p = 0.007), and pathologic T3b (HR, 3.4; 95% CI, 1.0–11.4; p = 0.045) or T4a (HR, 6.0; 95% CI, 1.9–18.8; p = 0.002) were associated with an increased risk of recurrence. Incidentalomas identified during diagnosis had a significantly lower risk of recurrence (HR, 0.4; 95% CI, 0.2–0.9; p = 0.033). Close follow-up may be performed without completion total thyroidectomy for AVPTC found incidentally after HT.

Establishing a predictive model of hypoparathyroidism after total thyroidectomy and central lymph node dissection for postoperative calcium supplementation selectively.

BackgroundThe core goal of this article is to find some meaningful risk factors that can affect the postoperative hypoparathyroidism of thyroid cancer, create an effective prediction model on this basis, and use it to selectively implement routine prophylactic calcium supplementation for patients after thyroid carcinoma surgery.MethodsThe clinicopathological characteristics of patients with papillary thyroid carcinoma (PTC) who underwent conventional bilateral total thyroidectomy (TT) + bilateral central lymph node dissection from January 2020 to August 2021 in the Affiliated Hospital of Nantong University were retrospectively analyzed. Firstly, this study analyzed the relationship between postoperative hypocalcemia and hypoparathyroidism. Then, we included many potential risk factors such as gender, age, body mass index (BMI), lateral lymph node dissection (LLND) and so on and also performed univariate and multivariate analysis of the independent risk factors for postoperative hypoparathyroidism in patients, and established a predictive scoring model.ResultsAmong the 401 patients with PTC, 50.1% developed postoperative hypoparathyroidism. There was significant difference in serum calcium concentration between normal parathyroid group and hypoparathyroidism group after thyroid carcinoma surgery. BMI <24 kg/m2, lateral lymph node dissection, multifocality, and extrathyroidal extension (ETE) were all identified as independent risk factors for postoperative hypoparathyroidism. Based on these independent risk factors, a nine-point risk scoring model was created to firstly assess the postoperative parathyroid function status of patients and then to determine whether routine prophylactic calcium supplementation is needed. Importantly, the area under the curve (AUC) of the risk scoring model is equal to 0.979.ConclusionsAt present, prophylactic calcium supplementation after thyroid carcinoma surgery is a controversial postoperative treatment. It should be selectively implemented for high-risk patients with hypoparathyroidism after surgery. Routine prophylactic calcium supplementation is recommended for PTC patients with a score greater than or equal to 5, although there are no clinical symptoms of postoperative hypocalcemia caused by hypoparathyroidism. However, prophylactic calcium supplementation is not recommended for patients with PTC with a score of less than 5; if the patient develops hypocalcemia at the later stage, therapeutic calcium supplementation can then be implemented.

The Effects of Thyroid Gland Volume and Weight on Surgical Approach Selection and Anesthesia Management in Retrosternal Goiter

Background: Retrosternal goiter surgery is a technically challenging procedure. Selecting the appropriate surgical approach is critical in preventing surgical and anesthesia complications. Objectives: This retrospective clinical study aimed to investigate the role of thyroid volume and weight in the development of retrosternal goiter and the importance of special anesthesia management in patients with retrosternal goiter, which is a potentially difficult airway candidate. Methods: Retrosternal goiter was detected in 125 patients through ultrasonography. Patients were divided into cervical surgery (CA) and sternotomy (ECA) groups. Volumetric measurements were performed ultrasonographically. Patients' demographics, preoperative thyroid ultrasonography features, American Society of Anesthesiologists (ASA) classifications, Mallampati classifications, intubation characteristics, perioperative and postoperative patient data, and postoperative thyroid specimen weights were recorded. Results: A total of 106 patients (32 male and 74 female) were operated on for bilateral total thyroidectomy. Total thyroidectomy was performed with CA in 98 (92.5%) patients and with ECA in 8 (7.5%) patients. Malignancy was detected in 4 (3%) of 106 operated cases. All of the malignant cases were seen in patients with a cervical approach. When the volumetric measurements of both groups were compared, the volume values were significantly higher in the ECA group (P=0.032). 67 patients were ASA I and 39 patients were ASA II. 64 patients were defined as Mallampati Class I, 36 patients as Mallampati Class II, and 6 patients as Mallampati Class III. Intubation was performed on the third attempt for 5 patients and 8 patients with Mallampati I and Mallampati II, respectively. The rate of difficult intubation was statistically significant in the ECA group (P=0.019). Conclusion: Predicting ECA requirement in the preoperative period is closely related to the preoperative volumetric analysis of the thyroid gland with three-dimensional ultrasonography. In addition, since anesthesia management is difficult in patients who need ECA, volumetric analysis has become even more critical.

Impact of RET Screening on the Management of Multiple Endocrine Neoplasia Type 2A: 10 Years Experience and Follow-Up in Three Families.

Multiple endocrine neoplasia type 2A (MEN 2A) is mainly caused by germline RET codon C634 mutation and is characterized by Medullary Thyroid Carcinoma (MTC), pheochromocytoma (PHEO), and hyperparathyroidism (HPTH). The early diagnosis and initial normative treatment are helpful for the long-term outcome of MEN2A. Three index cases and their 29 relatives from three families with MEN2A were included in this study. Genetic screening was performed on all participants. Demographic, clinical profiles, tumor histopathologic features, and follow-up records were systematically analyzed. In total, RET C634Y mutation was identified in 10 individuals (10/32, 31.3%). Among them, 5 presented with MTC symptoms, whereas the other 5 did not show apparent clinical manifestation, and all were subjected to thyroidectomy with varying neck dissection. Compared to individuals in the former, the latter benefited greatly from RET screening with significantly younger age at diagnosis of MTC and surgery (18.1 ± 13.8 years vs. 39.0 ± 14.1 years, P =0.045), and lessaggressive MTC behavior (size: 0.74 vs. 2.82 cm, P =0.026; LN+/resected: 20.0% vs. 100.0%, P =0.048) and also lower recurrence rate of MTC (20.0% vs. 100.0%, P =0.048). The PHEO was identified in 6 of the 10 carriers (60.0%), and all had undergone adrenal-sparing surgery. During the 10 years of follow-up, one (16.7%) developed recurrence of PHEO. Integrated RET screening, serum calcitonin, and plasma metanephrine/ normetanephrine levels can facilitate the early diagnosis and standardized MTC/PHEO surgery to improve the prognosis of MEN2A. Laparoscopic adrenal-sparing surgery prior to the bilateral total thyroidectomy is a preferred surgical approach for PHEO.

Serum Calcitonin-Negative Medullary Thyroid Carcinoma: A Case Series of 19 Patients in a Single Center.

IntroductionMedullary thyroid carcinoma (MTC) is a rare cancer that accounts for 5% of thyroid cancers. Serum calcitonin is a good biomarker for MTC, which is used for diagnosis, prognosis, and monitoring of recurrence. Calcitonin-negative MTC (CNMTC) is rare but confounds diagnostic and prognostic directions. This study introduces 19 cases of CNMTC in a single center.MethodFrom 2002 March to 2020 July, more than 76,500 patients had undergone thyroid surgery due to thyroid cancer at the Severance Hospital, and a total of 320 patients were diagnosed with MTC (0.4%). Serum calcitonin levels were obtained from every patient who was suspected with MTC. These patients had undergone either bilateral total thyroidectomy or unilateral thyroidectomy with central compartment lymph node dissection, and additional modified radical lymph node dissection if lateral lymph node metastasis was positive. Postoperative monitoring and out-patient clinic follow-up were performed with obtaining the serum calcitonin levels.ResultNineteen patients tested negative for calcitonin preoperatively (6%). The mean preoperative calcitonin level was 5.1pg/mL if undetectable level is regarded as 0pg/mL. Only two patients were males, and the female bias was significant (p = 0.017). No one except two patients with modified radical neck dissection showed central compartment lymph node metastasis. Every patient’s postoperative calcitonin level remained low. The median follow-up period was 71 months. There was no recurrence and only one fatality, and the overall survival rate was 95%.ConclusionSince incidence of CNMTC is not negligible, MTC should not be ruled out in the diagnostic phase even if serum calcitonin is negative in preoperative examination. We presented 19 cases of CNMTC whose prognosis in general were favorable. Markers of serum and immunohistochemical samples other than calcitonin should be actively examined.

New approach of prediction of recurrence in thyroid cancer patients using machine learning.

Although papillary thyroid cancers are known to have a relatively low risk of recurrence, several factors are associated with a higher risk of recurrence, such as extrathyroidal extension, nodal metastasis, and BRAF gene mutation. However, predicting disease recurrence and prognosis in patients undergoing thyroidectomy is clinically difficult. To detect new algorithms that predict recurrence, inductive logic programming was used in this study.A total of 785 thyroid cancer patients who underwent bilateral total thyroidectomy and were treated with radioiodine were selected for our study. Of those, 624 (79.5%) cases were used to create algorithms that would detect recurrence. Furthermore, 161 (20.5%) cases were analyzed to validate the created rules. DELMIA Process Rules Discovery was used to conduct the analysis.Of the 624 cases, 43 (6.9%) cases experienced recurrence. Three rules that could predict recurrence were identified, with postoperative thyroglobulin level being the most powerful variable that correlated with recurrence. The rules identified in our study, when applied to the 161 cases for validation, were able to predict 71.4% (10 of 14) of the recurrences.Our study highlights that inductive logic programming could have a useful application in predicting recurrence among thyroid patients.