Cervical Thyroid Research Articles

Residual Retrosternal Goiter and Thymolipoma After Cervical Thyroid Resection

Residual Retrosternal Goiter and Thymolipoma After Cervical Thyroid Resection

The Clinical Application of Superb Microvascular Imagingin Evaluating Thyroid Related Diseases: ASystematic Review.

This article reviews all published articles on the application of superb microvascular imaging (SMI) technique in thyroid related diseases before December 31, 2023. SMI, a recently developed ultrasound imaging modality, could display microvascular information by eliminating clutter and preserving low flow signals. Most studies used SMI to help diagnose malignant thyroid nodules and concluded that SMI performed better than color Doppler imaging and power Doppler imaging. At present, there is no consensus when depicting the morphology of vascularity of thyroid nodules (TNs). This problem may be solved by quantitative SMI which makes it possible to quantitatively evaluate the vascularity of TNs. SMI is also applied to evaluate cervical lymph node or thyroid inflammatory diseases. Although, SMI has some limitations, such as no standard for the normal perfusion patterns, and it has a broad application prospect in the diagnosis and management of thyroid related diseases.

8159 Single Nuclei RNA-Sequencing Reveals Novel Cellular Diversity in Human Neck Adipose Tissue

Abstract Disclosure: H. Camara: None. S.D. Kodani: Employee; Self; Hoxton Farm. S. Yang: None. V. Efthymiou: None. K. An: None. A. Gupta: None. F. Shamsi: None. A. Streets: None. M.E. Patti: Advisory Board Member; Self; Fractyl Laboratories. Consulting Fee; Self; AstraZeneca, Hamni, MBX Biosciences. Grant Recipient; Self; Dexcom. Y. Tseng: Consulting Fee; Self; LyGenesis. Other; Self; BioHaven. Adipose tissue plays a crucial role in maintaining metabolic health. It fulfills distinct functions through two types of fat: white adipose tissue (WAT), the primary site of triglyceride storage, and brown adipose tissue (BAT) along with related beige fat, specializing in thermogenic energy expenditure. Despite the scarcity of BAT in humans, these thermogenic adipocytes efficiently utilize glucose and triglycerides and act as an endocrine organ by secreting batokines. Hence, increased BAT activity is associated with improved metabolic health in humans. In adults, thermogenic adipose tissue is localized in deep neck planes, exhibiting a gradient from white to beige/brown from superficial to deep layers. Mounting evidence suggests the diverse cell types within the adipose tissue and their dynamic interactions play an important role in its versatile functions. To understand the cellular compositions of human adipose tissue and directly compare the differences between human BAT vs. WAT, we collected 30 paired samples of superficial, intermediate and deep human neck adipose tissue from 15 participants who underwent anterior cervical discectomy fusion or thyroid surgery and subjected the frozen tissues to single-nucleus RNA sequencing (snRNA-seq). The integration of the samples yielded 41,337 good-quality nuclei. As expected, white adipocytes (WAd) were the dominant cell type, comprising 38% of the total cells captured. Further analysis of the WAd cluster revealed increased expression of brown adipocyte-associated genes, such as EBF2 and COBL, and enrichment of oxidative phosphorylation pathway score in cells from deep neck samples, indicating increased thermogenic potential. Bona fide brown adipocytes (BAds), marked by the expression of PPARGC1A, were predominantly located in the deep neck samples (>80%) but comprised less than 2% of the dataset. Despite their low numbers, cell-cell communication analysis by CellChat predicted that BAds account for most of the communication events within this niche, highlighting their endocrine importance. snRNA-seq also captured non-adipocyte cells, including adipocyte progenitors, smooth muscle, immune, Schwann and neuron-associated cells. Among these, a novel Neuron-Associated Cell-1, marked by the expression of CNTNAP2, emerged as the second most abundant in the dataset (∼10% of total). Another neuron-associated cell population marked by expression of DNAH11, though less abundant (∼1%), was enriched in deep neck samples, potentially regulating the high levels of thermogenic potential in this region. Taken together, the identified subpopulations and their gene expression profiles offer new insights into the tissue's role in metabolic regulation. This knowledge could be pivotal for developing targeted therapies for obesity and related disorders. Presentation: 6/1/2024

Personalized Management of Malignant and Non-Malignant Ectopic Mediastinal Thyroid: A Proposed 10-Item Algorithm Approach.

We aimed to analyze the management of the ectopic mediastinal thyroid (EMT) with respect to EMT-related cancer and non-malignant findings related to the pathological report, clinical presentation, imaging traits, endocrine profile, connective tissue to the cervical (eutopic) thyroid gland, biopsy or fine needle aspiration (FNA) results, surgical techniques and post-operatory outcome. This was a comprehensive review based on revising any type of freely PubMed-accessible English, full-length original papers including the keywords "ectopic thyroid" and "mediastinum" from inception until March 2024. We included 89 original articles that specified EMTs data. We classified them into four main groups: (I) studies/case series (n = 10; N = 36 EMT patients); (II) malignant EMTs (N = 22 subjects; except for one newborn with immature teratoma in the EMT, only adults were reported; mean age of 62.94 years; ranges: 34 to 90 years; female to male ratio of 0.9). Histological analysis in adults showed the following: papillary (N = 11/21); follicular variant of the papillary type (N = 2/21); Hürthle cell thyroid follicular malignancy (N = 1/21); poorly differentiated (N = 1/21); anaplastic (N = 2/21); medullary (N = 1/21); lymphoma (N = 2/21); and MALT (mucosa-associated lymphoid tissue) (N = 1/21); (III) benign EMTs with no thyroid anomalies (N = 37 subjects; mean age of 56.32 years; ranges: 30 to 80 years; female to male ratio of 1.8); (IV) benign EMTs with thyroid anomalies (N = 23; female to male ratio of 5.6; average age of 52.1 years). This panel involved clinical/subclinical hypothyroidism (iatrogenic, congenital, thyroiditis-induced, and transitory type upon EMT removal); thyrotoxicosis (including autonomous activity in EMTs that suppressed eutopic gland); autoimmune thyroiditis/Graves's disease; nodules/multinodular goiter and cancer in eutopic thyroid or prior thyroidectomy (before EMT detection). We propose a 10-item algorithm that might help navigate through the EMT domain. To conclude, across this focused-sample analysis (to our knowledge, the largest of its kind) of EMTs, the EMT clinical index of suspicion remains low; a higher rate of cancer is reported than prior data (18.8%), incident imagery-based detection was found in 10-14% of the EMTs; surgery offered an overall good outcome. A wide range of imagery, biopsy/FNA and surgical procedures is part of an otherwise complex personalized management.

Single-sEV profiling identifies the TACSTD2 + sEV subpopulation as a factor of tumor susceptibility in the elderly

BackgroundAging is a very complex physiological phenomenon, and sEVs are involved in the regulation of this mechanism. Serum samples from healthy individuals under 30 and over 60 years of age were collected to analyze differences in sEVs proteomics.ResultsBased on PBA analysis, we found that sEVs from the serum of elderly individuals highly express TACSTD2 and identified a subpopulation marked by TACSTD2. Using ELISA, we verified the upregulation of TACSTD2 in serum from elderly human and aged mouse. In addition, we discovered that TACSTD2 was significantly increased in samples from tumor patients and had better diagnostic value than CEA. Specifically, 9 of the 13 tumor groups exhibited elevated TACSTD2, particularly for cervical cancer, colon cancer, esophageal carcinoma, liver cancer and thyroid carcinoma. Moreover, we found that serum sEVs from the elderly (especially those with high TACSTD2 levels) promoted tumor cell (SW480, HuCCT1 and HeLa) proliferation and migration.ConclusionTACSTD2 was upregulated in the serum of elderly individuals and patients with tumors, and could serve as a dual biomarker for aging and tumors.

Next-Generation-Sequencing on fine needle aspirates in neck recurrence of thyroid cancers.

Tumor molecular genotyping plays a key role in improving the management of advanced thyroid cancers. Molecular tests are classically performed on Formalin-Fixed Paraffin-Embedded (FFPE) carcinoma tissue. However alternative molecular testing strategies are needed when FFPE tumoral tissue is unavailable. The objective of our study was to retrospectively assess the performance of targeted DNA and RNA-based Next Generation Sequencing (NGS) on the fine needle aspirate from thyroid cancer cervical recurrences to determine if this strategy is efficient in clinical practice. A retrospective study of 33 patients who had had DNA and/or RNA-based NGS on ultrasound (US)-guided fine needle aspirates of cervical thyroid cancer recurrences in our Department from July 2019 to September 2022. In total, 34 DNA and 32 RNA-based NGS analyses were performed. Out of the 34 DNA-based NGS performed, 27 (79%) were conclusive allowing the identification of an oncogenic driver for 18 patients (53%). The most common mutation (n = 13) was BRAF c.1799T>A. Out of the 32 RNA-based NGS performed, 26 were interpretable (81%) and no gene fusion was found. The identification of a BRAFV600E mutation was decisive for one patient in our series, who was prescribed dabrafenib and trametinib. NGS performed on fine needle aspirates of neck lymph node metastases enabled the identification of an oncogenic driver alteration in 53% of the cases in our series of advanced thyroid cancer patients and could significantly alter patient management.

Thyroid Localization of Breast Cancer: About a Case and Literature Review

Introduction: Thyroid localization of breast cancer is rare and has a poor prognosis. Common metastatic sites of mammary carcinoma are pulmonary, hepatic and bone. Clinical diagnosis of thyroid metastasis from malignancy is difficult. We report a case of thyroid metastasis of mammary origin. We then discuss the diagnostic methods and their peculiarities in the identification of such lesions. Observation: This was a 47-year-old patient who underwent a left mastectomy with ipsilateral axillary lymph node dissection in 2014 and was presented 9 years later following the onset of a thyroid mass and right spinal lymphadenopathy. Cervical imaging revealed cervical lymphadenopathy of spinal site and nodular goiter classified as EU-TIRADS 4. A cytopuncture of the cervical lymphadenopathy and thyroid nodule is performed. Cytology revealed thyroid metastasis from mammary carcinoma and metastatic cervical lymphadenopathy. The patient underwent surgery (total thyroidectomy) confirming the diagnosis. Conclusion: The diagnosis of thyroid metastasis should be suspected in patients with a history of neoplasia prior to nodular goiter. The treatment for these metastases is that of primary cancer.

A Case of Malignant Struma Ovarii with Cervical Papillary Thyroid Carcinoma

A Case of Malignant Struma Ovarii with Cervical Papillary Thyroid Carcinoma

RET/PTC rearrangement in papillary thyroid carcinoma arising in malignant struma ovarii with abdominal wall metastasis and cervical thyroid gland: a case report and review of the literature

BackgroundStruma ovarii refers to rare mature cystic teratomas containing at least 50% of thyroid tissue, and malignant transformation is known to be even rarer. The synchronous development of malignant struma ovarii and cervical thyroid carcinoma are also scarce and poorly understood due to limited data about molecular features. Here, we present the first report of RET/PTC 1 rearrangement in synchronous metastatic malignant struma ovarii to the abdominal wall and cervical thyroid cancer.Case presentationWe described a 47-year-old multigravida woman with bilateral adnexal and lower abdominal wall masses detected during the evaluation of abnormal uterine bleeding. The patient underwent a hysterectomy, bilateral salpingo-oophorectomy, and surgical removal of abdominal wall mass. Then, the pathological evaluation revealed papillary thyroid carcinoma (PTC) within struma ovarii and metastatic PTC in the abdominal wall fibro adipose tissue. Further, cervical thyroid gland physical examination and ultrasound illustrated a nodule within the left lobe. Subsequently, a total thyroidectomy was performed, and a histological examination revealed PTC. Furthermore, all affected tissue, i.e., struma ovarii, abdominal wall metastasis, and cervical thyroid gland tested for BRAF and RAS mutations and RET/PTC 1 rearrangement. RET/PTC 1 rearrangement was identified among all three different sites. Finally, after six years of follow-up, the patient had no evidence of recurrence or distant metastasis.ConclusionsIn light of these findings, malignant struma ovarii might yield a clue to cervical thyroid carcinoma, and the molecular analysis could provide valuable information for understanding the underlying mechanism, tumor clinicopathological behaviors, and prognosis.

An Anaplastic Thyroid Carcinoma of the Giant-Cell Type from a Mediastinal Ectopic Thyroid Gland.

Anaplastic thyroid carcinoma is a rare, aggressive form of thyroid carcinoma with a mean survival of less than 6 months. Ectopic thyroid tissue can be present in the mediastinum due to faulty embryogenesis with improper descent. Primary thyroid malignancies may arise from this ectopic tissue. A 90-year-old male with a history of prostatic adenocarcinoma, hypothyroidism, and occupational and therapeutic exposure to radiation presented with a rash on his chest. A review of the dermatopathology and excised mediastinal specimen revealed rare papillary foci that tested positive for thyroid markers from a background of poorly differentiated components. Molecular analysis confirmed a BRAF V600E mutation in the specimen. The final diagnosis was anaplastic thyroid carcinoma of the giant-cell type. Given the atrophic cervical thyroid tissue in the patient's neck with no evidence of previous surgery, this carcinoma was believed to arise from ectopic mediastinal tissue associated with cutaneous and bony metastasis. In conclusion, anaplastic thyroid carcinoma is an aggressive and rare thyroid malignancy that can arise from ectopic thyroid tissue in the mediastinum and should be considered in the differential diagnosis of primary undifferentiated mediastinal malignancies with bony involvement.

A rare case of both primary and secondary intrathoracic goiters

Primary intrathoracic goiter is a very rare entity representing only 1% of all intrathoracic goiters. It arises from mediastinal ectopic thyroid, without tissue connection with cervical thyroid and its blood supply is entirely derived from intrathoracic vessels.

Radiofrequency Ablation of Cervical Thyroid Cancer Metastases-Experience of Endocrinology Practices in the United States.

Radiofrequency ablation (RFA) is used in the United States to treat benign thyroid nodules; however, experience with treating cervical recurrence/persistence of papillary thyroid cancer (PTC) is limited. To evaluate the efficacy RFA for the treatment of cervical recurrence/persistence of PTC in the United States. This is a retrospective, multicenter study of 8 patients who underwent RFA of 11 cervical metastatic PTC lesions between July 2020 and December 2021. The volume reduction (VR) of the lesions, thyroglobulin (Tg) levels and complications following RFA were assessed. Energy applied per unit volume (E/V) during RFA was also determined. Nine out of 11 (81.8%) lesions had initial volume under 0.5 mL and showed a complete (n = 8) or near-complete (n = 1) response. The 2 lesions with initial volume over 1.1 mL had a partial response, 1 of which had regrowth. There was a median VR of 100% (range 56.3-100%) after a median follow-up period of 453 days (range 162-570 days), with corresponding decline in Tg levels from a median of 0.7 ng/mL (range 0-15.2 ng/mL) to a median of 0.3 ng/mL (range 0-1.3 ng/mL). All patients with an E/V of at least 4483 J/mL or higher had a complete or near-complete response. There were no complications. RFA performed in an endocrinology practice is an efficacious treatment option for selected patients with cervical metastases of PTC, particularly those who cannot or do not want to undergo further surgery.

Beta thalassemia revealing hypothyroidism: A case report

Thalassemia is a condition that affects hemoglobin synthesis and is one of the most Common hereditary illnesses in the world. Patients with thalassemia major require several blood transfusions. Multiple blood transfusions cause thyroid dysfunction, which leads to iron excess. We report the case of 35-year-old, followed in hematology for deep iron deficiency anemia who has benefited from a transfusion repeatedly diagnosed with beta thalassemia. At the interrogation, the patient reports a moderate gain of weight not quantified, hair loss and sensations of chills, chronic constipation, without other associated signs including no other signs of hypersecretion or anterior pituitary hyposecretion, no tumor SD. The physical examination finds a conscious patient, Normocardium, normal build, dysmorphic SD, palpable thyroid not increased in size. Microcytic hypochromic anemia, TSH at 10 mIU/l (0.35 -5.1) mIU / l, T4 at 10.6 pmol / l (10.6-19.4) pmol / l T3 to 2.88 pmol / l (3.8-8.4) pmol / l. Objective cervical ultrasound thyroid gland increased in size at the expense of the thyroid lobe with thyroid nodules classified EU-TIRADS 2 and 3. The patient was put on levothyrox 75ug/d. Thyroid disorders are common in β-thalassemia patients who have been transfused multiple times.

Multimodal imaging of congenital pyriform fossa fistula in children.

Our aim was to explore the clinical value of multimodal imaging examinations in the diagnosis of congenital pyriform fossa fistula in children, so as to provide clues for the early diagnosis and treatment of congenital pyriform fossa fistula. The clinical and imaging data of 55 children with pyriform fossa fistula diagnosed surgically in our hospital from 2015 to 2018 were analyzed retrospectively. All 55 patients underwent a CT scan. Of those patients, contrast enhancement CT was performed in 47 cases, MRI was performed in 2 cases, and barium esophagography was performed in 41 cases. Among the 55 cases, there were 24 male patients and 31 female patients. The age ranged from 11 months to 13 years old, and the median age was 3.8 years old. The lesions of 49 cases (89.1%) were located on the left side, and the imaging of CT showed soft tissue mass in the anterior cervical region blurred boundary. There was ipsilateral thyroid involvement in 50 cases (90.9%), trachea and/or carotid sheath extension in 43 cases (78.2%), abscess formation in 39 cases (70.9%), and pneumatosis in 25 cases (45.5%). The CT examination of 22 children after treatment showed a linear or tubular low-density shadow in the thyroid gland, gas accumulation in the anterior cervical region or thyroid, and residual contrast medium, partly. A total of 24 cases underwent barium esophagography during the acute phase, and 15 cases (62.5%) showed sinus formation from the pyriform fossa downward or punctate high-density shadow in the anterior cervical region. The 2 cases where MRI was performed showed abscess formation in one side of the neck and thyroid involvement. Pyriform fossa fistula is most common in the left anterior cervical region, and it is closely related to the thyroid gland. The plain and enhanced-contrast CT scan can be used as the first choice during the infection stage. It helps to understand the location, extent, and structure of the surrounding tissue. The preliminary diagnosis of pyriform sinus fistula was according to the imaging features. It provided an important basis for clinical diagnosis and reduced the pain caused by repeated infection or surgical incision and drainage.

A Personalized 3D-Printed Model for Preoperative Evaluation in Thyroid Surgery.

The anatomic structure of the surgical area of thyroid cancer is complex. It is very important to comprehensively and carefully evaluate the tumor location and its relation with the capsule, trachea, esophagus, nerves, and blood vessels before operation. This paper introduces an innovative 3D-printed model establishment method based on computerized tomography (CT) DICOM images. We established a personalized 3D-printed model of the cervical thyroid surgery field for each patient who needed thyroid surgery to help clinicians evaluate the key points and difficulties of the surgery and select the operation methods of key parts as a basis. The results showed that this model is conducive to preoperative discussion and the formulation of operation strategies. In particular, as a result of the clear display of the recurrent laryngeal nerve and parathyroid gland locations in the thyroid operation field, injury to them can be avoided during surgery, the difficulty of thyroid surgery reduced, and the incidence of postoperative hypoparathyroidism and complications related to recurrent laryngeal nerve injury reduced too. Moreover, this 3D-printed model is intuitive and aids communication for the signing of informed consent by patients before surgery.

A rare cause of diagnostic pitfall in cases with differentiated thyroid carcinoma: Lateral cervical ectopic thyroid

Ektopik tiroit genellikle boyun orta hatta izlenmekle birlikte, nadir olarak lateral yerleşimli de olabilir. Bu çalışmada diferansiye tiroit karsinomu nedeniyle total tiroidektomi uygulanan ve lateral ektopik tiroit dokusu saptanan 4 olgu sunulmaktadır. Operasyon sonrası evreleme için Tc99m perteknetat ile yapılan sintigrafi incelemesinde olguların 3’ünde submandibuler bölgede artmış tutulum izlenen alanda, ultrasonografik incelemede tiroit bezi ile eş ekojenite homojen iç yapıda ektopik tiroit dokusu saptanırken, diğer olguda alt juguler bölgede izlenen heterojen iç yapıda nodüler lezyon, yapılan santral-lateral boyun diseksiyonu sonucunda ektopik tiroit dokusu tanısı almıştır. Metastatik lenf bezi ile primer lateral ektopik tiroit dokusu ayrımı primer tiroit karsinomlu olgularda oldukça önemli olup, laboratuvar verileri, sintigrafi ve ultrasonografiyi içeren tanısal çalışma evrelemede kritik rol oynamaktadır. Oldukça nadir olmakla birlikte ektopik tiroit, lateral boyun kitlelerinin ayırıcı tanısında akılda bulundurulmalıdır.

Needs Assessment of Essential Anatomy: A Perspective from Anesthesiology, Emergency Medicine, ObGyn and Orthopedics Resident

IntroductionCurricular development begins with identifying a problem, followed by a needs assessment of curricular components. Changes in pedagogical approaches and reductions in curricular time for gross anatomy have been identified as problems in undergraduate medical education. The objective of this study was to conduct a needs assessment of the most essential anatomy for residents in Anesthesiology (AN), Emergency Medicine (EM), Ob/Gyn (OB), and Orthopedics (OR) at Beaumont Health in Royal Oak, MI (the teaching hospital for Oakland Univ. William Beaumont School of Medicine).MethodsResidents completed a survey to assess the clinical importance of 907 anatomical structures for the back, upper limb (UL), lower limb (LL), thorax (Thx), abdomen (Abd), pelvis and perineum (P&P), and head and neck (H&N) on a 1‐4 Likert‐scale (1=not important; 4=essential). Kruskal‐Wallis analyses with a Bonferroni correction (p<0.007) were used to assess differences of top‐level items for each region between residency groups. The 3 and 4 rating response frequencies for each structure formed a basis for classifications of importance: structures rated 3 or 4 by ≥75.0% were essential, 50.0‐74.9% more important, 25.0‐49.9% less important, 0.0‐24.9% not important.ResultsFifty‐five residents (AN, N=6; EM, N=l5; OB, N=13; OR, N=21) completed the survey. Ratings by OR residents were significantly higher for the limbs than AN, ER, and OB, and higher for the back than EM and OB. Ratings by OB residents were significantly higher for P&P than by AN and ER residents. No ratings differences were found for Thx, Abd, or H&N. Classifications of essential and more important for all structures across body regions were: AN, 71.8%; EM, 64.5%, OB: 52.0%, OR: 99.9%. Individual regions with ≥70% of structures essential or more important were: AN (Back, Thx, Abd, H&N), EM (UL, Thx, H&N), OB (Abd, P&P), OR (all regions). Regions with ≥20% of structures as not important were: AN (UL, P&P), EM (Back), OB (UL). With few exceptions, the following were classified as essential or more important: surface anatomy, meninges, heart, great vessels, respiratory tract, thoracic skeleton, peritoneum, diaphragm, abdominal veins, skull, cervical fascial spaces, cranial nerves, thyroid and parathyroid glands, and the lumbar and brachial plexuses.ConclusionsThis study conducted a needs assessment of anatomy curricular content solely from the perspective of selected non‐primary care residents at a single clinical site. Significant differences in ratings were found between residents for body regions in which residents would be expected to focus their clinical (surgical) activity (notably, OR and OB).SignificanceThis data provides insight into the importance that non‐primary care residents placed on specific anatomical structures. The authors suggest that the classifications of importance for specific anatomy by these residents were informed by their clinical perspective, and can serve as a guide for curricular development in the context of reduced contact hours, new pedagogies, and vertical integration.

Substernal Goiter: From Definitions to Treatment.

The enlargement of multinodular goiter into the mediastinum through the thoracic inlet or ectopic thyroid tissues directly in the mediastinum is defined as Substernal Goiter (SG). However, there is no clear consensus in the literature on this definition. There are many definitions for SG in the literature. Most definitions are similar or overlapping. Since the thyroid is located in the neck above the thoracic inlet in its normal anatomical position, the simplest clinical definition should be preferred among the definitions regarding its descent below the thoracic inlet and adjacent to the mediastinal organs. In the American Thyroid Association guideline, SG is defined as clinical or radiological protrusion of the thyroid gland over the sternal notch or clavicle in a patient with a slightly extended neck in the supine position. SGs can be classified as primary or secondary according to their origins. In addition, there are combined SGs resulting from the enlargement of the primary SG, which is the growth of the cervical thyroid gland toward the mediastinum, and the secondary SG, which is defined as an ectopic mediastinal mass, together. We find it appropriate to define such SGs as mixed SGs. In this disease, which has the same etiology and etiopathogenesis as cervical goiter, the descent of the thyroid gland into the mediastinum due to some anatomical factors explains the physiopathology. Compression symptoms of mediastinal major vascular structures, trachea, and esophagus cause the symptoms and findings of SGs due to its localization. In addition, the relationship of SGs with possible malignancy risk and hyperthyroidism affecting the indications and methods of treatment has been discussed for a long time. In this study, we aimed to evaluate the definitions, classification, physiopathology, laboratory and imaging methods used for diagnosis, the relationship of SG with hyperthyroidism and malignancy, and briefly the treatment methods, according to the current studies from literature.

Surgical Treatment of Substernal Goiter Part 1: Surgical Indications, Pre-Operative, and Peroperative Preparation.

Surgery is one of the most appropriate treatment options for many patients with substernal goiter (SG). However, SG surgery has some technical difficulties and a higher risk of complications compared to normal cervical thyroid surgery. Due to these technical difficulties and complication risks, which we also mentioned in our study, SG surgery should be performed by experienced and high-volume endocrine surgeons in centers with a large team and technical equipment. Pre-operative clinical and radiological evaluation and definitions in SG were evaluated in detail in our previous study. Detailed pre-operative evaluation, pre-operative risk assessment, surgical anatomy, anesthesia, appropriate surgical planning and estimation of surgical width are extremely important in SG surgery, where surgical technical difficulties and increased complication risks compared to cervical thyroid surgery come to the fore. In this study, we aimed to evaluate these preoperative and peroperative preparations in detail.

Highly differentiated follicular thyroid-type carcinoma of the ovary reconsidered

More than a decade ago, Roth and Karseladze1 first described the entity of highly differentiated follicular thyroid carcinoma of ovarian origin (HDFCO) and reassessed the previously applied term peritoneal strumosis....