Total Thyroidectomy Research Articles

1234 Optimising Vitamin D and Calcium Management in Thyroidectomy Patients

Abstract Aim The study aimed to investigate the causes of temporary postoperative hypocalcemia and strategies for correction. Objectives included assessing the impact of preoperative trust guidelines on detecting and managing Vitamin D deficiency in thyroidectomy patients and analyzing its correlation with postoperative hypocalcemia at Northampton General Hospital. Method A three-cycle audit analyzed 16, 12, and 8 cases, respectively, encompassing total and completion thyroidectomies at NGH. Collaborative development of standardized trust guidelines involved the ENT Team, Endocrinology, and Pharmacists. Data collection covered various parameters, and departmental teachings were conducted to educate the team on the new guidelines. Results Thyroidectomy indications included Graves's disease, large Multinodular Goitre, and malignancy. In the third cycle, all patients underwent preoperative Vitamin D checks, aligning postoperative hypocalcemia with the national range. Our interventions increased preoperative Vitamin D checks from 56% to 100%, reducing deficiency from 25% to 0%. Postoperative hypocalcemia decreased from 56% in Cycle 1 to 8.3% in Cycle 2 and 12.5% in Cycle 3. Long-term hypoparathyroidism dropped to 0% in Cycle 3, with no correlation between surgeon technique or indication and postoperative hypocalcemia. Conclusions The introduction of preoperative guidelines significantly enhanced Vitamin D deficiency detection, substantially reducing postoperative hypocalcemia. This underscores the positive impact of standardized protocols on patient care. Future efforts involve re-auditing with the involvement of junior doctors to ensure continuous enhancement in clinical practice.

Effect of cranial base release and swallowing exercises in rehabilitation of post-operative total thyroidectomy patient. A case report

Thyroidectomy is a widely practiced surgical intervention with low mortality and morbidity rates; however, it can result in long-term complications impacting health and social well-being. Early physical rehabilitation programs have been shown to effectively address issues such as swallowing difficulties and motor function impairment in the neck and shoulders, thereby improving the overall quality of life for patients. This study aimed to assess the impact of cranial base release (CBR) in conjunction with swallowing exercises on the post-surgery recovery of patients undergoing total thyroidectomy. A 29-year-old male patient presented with swelling on the left side of the neck, along with pain during neck movements, speech difficulties, and swallowing issues. The patient's neck range of motion, swallowing impairment score, and neck pain and disability scale were measured both before and after treatment. The patient underwent a six-week rehabilitation program consisting of CBR, swallowing exercises, and conventional physiotherapy sessions twice daily. The combined approach of CBR and swallowing exercises resulted in significant improvements in neck range of motion, swallowing impairment score, and neck pain and disability scale for patients following total thyroidectomy. This study highlights the beneficial effects of integrating CBR with swallowing exercises in the rehabilitation of post-operative total thyroidectomy patient, offering promising outcomes for their recovery.

Risk Factors for Recurrent Laryngeal Nerve Palsy in Thyroid Surgery: A Single Center Experience of 1147 Procedures with Intermittent Intraoperative Neuromonitoring.

Recurrent laryngeal nerve (RLN) palsy is one possible complication during thyroid surgery. Intraoperative neuromonitoring and visualization of the nerve during surgery are standard procedures to reduce the risk of RLN palsy. This study aims to investigate new factors for RLN palsy and review ones that are already known in the literature to help surgeons prepare for the procedure. A retrospective study design was used to analyze the data of 1147 patients from a certified center for thyroid surgery. All patients underwent either total thyroidectomy or hemithyroidectomy from 2016 to 2020. The acquired information was analyzed descriptively. A logistic regression was used to analyze the independent variables of interest with the binary variable RLN palsy (yes/no). For the second aim of this study, a multiple logistic regression was applied to analyze the combined significant known and new risk factors. Surgery indication for Graves' disease (OR 14.34, p < 0.001), thyroid cancer (OR 2.39, p = 0.012), and recurrent goiter (OR 5.57, p < 0.001) increased the risk for RLN palsy significantly compared to nodular goiter in hemithyroidectomy. The duration of surgery correlated positively with a higher risk for RLN palsy (OR 1.009, p = 0.005). For gender, BMI, resection weight, left or right nerve at risk, and surgeon experience, no significant differences were found. Operations for Graves' disease, thyroid cancer, and recurrent goiter have the highest risk for RLN palsy and surgeons should be alerted. The longer the operation, the higher the risk of RLN palsy. The correlation between surgery method (hemithyroidectomy vs. thyroidectomy) and RLN palsy should be carefully considered due to possible bias.

Mucoepidermoid Carcinoma of the Thyroglossal Duct: Two Rare Entities in a Unique Case Report.

Mucoepidermoid Carcinoma (MEC) of the thyroid represents less than 0.5% of all thyroid neoplasms. Thyroglossal duct cyst carcinoma is a rare condition with only approximately 300 cases reported. A 34-year-old pregnant woman at 37 weeks gestation presented to an endocrinological center for primary autoimmune hypothyroidism. The thyroid ultrasound revealed a pseudonodular pattern. The patient was followed up after two years. She reported a full-term delivery without complications. A new thyroid ultrasound was performed, showing a cystic lesion in the median suprathyroid area, measuring 6 x 9 x 10 mm, not previously reported. After 4 months, the suprathyroid cystic lesion was confirmed by thyroid ultrasound, measuring 6 x 11 x 12 mm. The patient was referred for fine-needle aspiration cytology. Cytological examination showed lymphocytes, red blood cells, and some epithelial aggregates with large cytoplasm and nuclear polymetrism with oxyphilic aspects. The patient underwent the Sistrunk procedure for the suprathyroid lesion. The histological examination revealed lymphocytic thyroiditis in heterotopic thyroid tissue with solid cell nest, epidermoid epithelium, and mucus-secreting cells suggestive of low-grade mucoepidermoid carcinoma. The immunohistochemistry study was positive, exhibiting thyroid transcription factor 1 and cytokeratin-19. No positivity was observed for thyroglobulin, calcitonin, galectin-3, and Hector Battifora mesothelial antigen 1. The recent follow-up examination, 13 months after the surgery, has been found negative for disease recurrence. This is the first case of an MEC occurring within a thyroglossal duct. Considering the age of the patient, the histological diagnosis, and the absence of thyroid nodules and metastasis, we decided on the Sistrunk procedure without total thyroidectomy.

Resistant Graves’ Disease in Childhood, A Rare but Complicated Situation, through a Clinical Case

Graves’ disease is by far the most common cause of hyperthyroidism in children [1]. In this specific population, the hyperthyroidism is willingly biochemically overt and clinically severe [2]. Childhood hyperthyroidism may also cause accelerated growth and bone maturation, and eventually deterioration in academic performance, hence the need for a good screening and a better management. children with GD require prompt treatment, for the most of cases it’s initially medical. But once this fails or is not possible, a definitive treatment should be considered [3]. For the antithyroid drugs use, we currently consider no difference in biochemical control between DT and BR [2,4], unlike previous approaches which argue in favor of the use of bloc-replace method in children [5-6]. However, for a curative treatment, total thyroidectomy is the preferred option for GD patients younger than 10 years [3]. We report the case of a girl who was 2 and a half years old in the moment of diagnose, and whom we followed for Graves' disease for 1 and a half years. Ethical considerations: In accordance with the regulations in force, informed consent, written and verbal, was provided to the parents of the child before the publication of this work.

Postoperative parathyroid hormone (PTH) is equivalent to perioperative PTH drop in predicting postsurgical hypoparathyroidism.

Postoperative surgical hypoparathyroidism (PoSH) following thyroid surgery is an established complication. Several predictive factors have been identified including perioperative parathyroid hormone (PTH) levels. The aim of the study is to compare the drop in perioperative PTH to postoperative day 1 PTH in predicting hypocalcaemia and hypoparathyroidism. Records of consecutive patients who had either total or completion thyroidectomy with or without central neck dissection in a 3-year period in a single thyroid surgery unit were accessed to retrieve data on demographics, pathology, surgery, perioperative biochemistry and management. Of 295 included patients, there were 227 (76.9%) females. Forty-five (15.3%) had completion thyroidectomy, and the rest had total thyroidectomy. Seventy-eight (26.4%) had concomitant central neck dissection. Sixty-four (21.7%) had hypocalcaemia on the day after surgery. Hypoparathyroidism persisted in 10.5% of patients at 6 months. Both day 1 PTH and a drop in PTH predicted day 1 hypocalcaemia (p < 0.001) and 6-month hypoparathyroidism (p < 0.001). The area under the receiver operating characteristic (ROC) curves for day 1 PTH and drop in PTH for the prediction of day 1 hypocalcaemia (0.729 vs 0.726, respectively) and for 6-month hypoparathyroidism (0.964 vs 0.958, respectively) were similar, albeit slightly better for day 1 PTH. Day 1 PTH is equivalent to (if not better than) drop in PTH in predicting short- and long-term PoSH. Preoperative PTH measurements may not be needed in the detection and/or management of PoSH after thyroid surgery.

Assessing national trends in indications for pediatric total thyroidectomy

PurposeThe most common indications for total thyroidectomy (TT) in children are malignancy and thyrotoxicosis due to Graves' disease (GD). However, the incidence of patients with GD among patients undergoing TT is unknown. This study aims to examine trends in pediatric TT. Materials and methodsThe US Agency for Health Research and Quality Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) was queried to identify patients who underwent TT between 1997 and 2019. Weighted national estimates were obtained. Statistical analysis was completed using univariate logistic regression and one-sided Mann-Kendall Test. ResultsAn estimated 4803 pediatric patients underwent TT within the study years. GD was the indication in 25 % of cases. Mann-Kendall testing showed a trend toward an increasing proportion of TT for GD without reaching statistical significance (z = 1.3609, S = 12, p = 0.0688). Statistically significant univariate associations were found among those who underwent thyroidectomy for GD compared to other indications, as they were more likely to be female (β = 0.286, 95 % CI [0.058, 0.514], p = 0.014), Black, or Hispanic (β = 1.392 [1.064, 1.721], p < 0.001; and β = 0.562 [0.311, 0.814], p < 0.001, respectively). Additionally, they were less likely to have private insurance (β = −0.308 [−1.076, −0.753], p = 0.002) and more likely to live in a ZIP code associated with a median household income below the 50th percentile (β = 0.190 [0.012, 0.369], p = 0.036). The associations with the female sex, Black race, and Hispanic race persisted in multivariate analysis. ConclusionGD appears to be an increasingly prevalent indication for TT. Patient characteristics differ from those who undergo TT for other diagnoses.

Differential utilization of thyroid lobectomy after the 2015 American Thyroid Association guideline update.

The 2015 American Thyroid Association (ATA) guidelines added thyroid lobectomy (TL) as the appropriate treatment for low-risk differentiated thyroid cancer (DTC). We aimed to investigate the population-level factors that influence the utilization of TL. The Surveillance, Epidemiology and End Results (SEER) database was queried for all DTC patients fitting low-risk criteria as defined by the ATA. Trends in total thyroidectomy (TT) and TL were identified using a Cochrane-Armitage test. Multivariable logistic regression identified patient and socioeconomic characteristics associated with TL, and difference-in-difference analysis was used to control for secular trends over time. A total of 43,526 patients with low-risk DTC were identified in the SEER database; 39,411 pre-2015 and 4115 post-2015. After 2015, TT continued to outnumber TL (76.2% vs 23.8%), although the rate of TL increased significantly (11.6% to 23.8%, P < 0.001). However, difference-in-difference analysis found that age > 55 (OR 1.11, 95% CI 1.01-1.19, P < 0.001) and rurality (OR 1.16, 95% CI 1.05-1.28, P < 0.001) were independently associated with TT. TL was associated with T1 disease (OR 1.11, 95% CI 1.04-1.19, P = 0.001). Although the 2015 ATA guideline update led to an increase in TL for low-risk DTC, most patients still underwent TT. Age and neighborhood significantly impact the odds of receiving guideline-appropriate TL for low-risk DTC, especially for T2 disease.

Disease-free survival and response to therapy of clinically node- negative papillary thyroid cancer treated without central neck dissection: Retrospective study of 321 patients

Background and objectiveNodal metastases in the central compartment are frequent in papillary thyroid cancer (PTC). However, they are mostly micrometastases with no impact on survival and their relevance on the risk of locoregional relapse is controversial.There is no consensus regarding optimal management of the central neck in patients with PTC cN0. In our center, we do not perform prophylactic central neck dissection (pCND). The objective of this study is to review our long-term results and compare them with the most recent literature. Patients and methodsRetrospective review of patients with PTC who underwent total thyroidectomy (TT) without CND between 2005 and 2017. Primary result was disease-free survival in the neck (DFS). Results321 patients were identified, mostly T1-T2 tumors (94.1%). Median follow-up was 90 months. DFS in the central compartment was excellent (96.1% at 10 year’s follow-up). 19 patients had cervical recurrence, of which 15 underwent salvage surgery.On their last visit, including salvage surgery when appropriate, 77% of patients had excellent response, 18.7% had indeterminate response, 3.1% had biochemically incomplete response and 1.2% had morphologically incomplete response. Recurrent laryngeal nerve (RLN) paralysis after TT was transient in 4.7% of patients and permanent in 0.9% of patients. There were no RLN paralysis after salvage surgery. Permanent hypoparathyroidism occurred in 3.4% of patients. Only one patient had hypoparathyroidism after salvage surgery and it was permanent. ConclusionsBased on long-term results and low rate of complications associated with salvage surgery in our experience, we consider routine pCND is not justified.

The Oncologic Outcomes of Bilateral Central Lymph Node Dissection in Unilobar Papillary Thyroid Cancer and Its Risks: A Prospective Cohort Study.

Background Indications for performing a prophylactic central neck dissection (pCND) in papillary thyroid cancer (PTC) remain controversial. Thyroidectomy and central neck dissection (CND) are often recommended in all cases with proven differentiated thyroid cancer (DTC) and clinically positive lymph nodes (LNs), as well as in high risk for micro-metastasis patients with T3-T4 tumors or established metastatic nodes in the lateral compartments. Aims The aims of this study were to ascertain the role of performing bilateral central LN dissection in unilobar PTC in improving the oncological outcomes and outline the risks involved. Methods This was a department-based, prospective cohort study. We included all 20 patients who had unilobar PTC and underwent total thyroidectomy with bilateral CND. A postoperative histopathological analysis was used to identify metastatic central LNs. Results Twenty total thyroidectomies plus bilateral CNDs were performed, of which 10 were prophylactic bilaterally (those with N0), and all 20 were prophylactic on the contralateral side of PTC. Conventional risk factors (age, tumor size, and extrathyroidal extension)were notassociated with performing a pCND. The presence of unilobar PTC by preoperative FNAC was the only factor associated with performing bilateral CND. Positive ipsilateral LNs were retrieved in 55% of CNDs, while positive contralateral LNs were retrieved in only 15% of the patients. Conclusions The incidence of contralateral cervical LN metastasis in patients with unilateral PTC is low, while there is clear evidence of postoperative morbidity from routine contralateral CND in unilobar PTC. Contralateral CND in patients with unilobar PTC may be reserved for high-risk patients: males, those aged ≤45 years, tumors larger than 1.0 cm, and cases with extrathyroidal extension and micro-calcification on ultrasound.

Brain metastasis mimicking a cavernous angioma as initial presentation of papillary thyroid carcinoma.

Brain metastases as the first clinical presentation of a papillary thyroid carcinoma (PTC) are exceptional, while cavernous angiomas are common cerebral malformations. We report the case of a 36-year-old male with an incidental brain lesion mimicking a cavernous angioma on MRI. Gamma knife radiosurgery was performed, but after 6 months, the patient developed neurological symptoms, and a repeat brain MRI revealed a significant increase in the mass. The patient underwent neurosurgery, and the histological examination of the lesion revealed metastatic carcinoma of thyroid origin. PET-CT and neck ultrasound, subsequently performed, were concordant for the presence of a right lobe nodule and ipsilateral lymph nodes, both with ultrasound features suspicious of malignancy. Total thyroidectomy with central and right lateral neck dissection was performed, and histology confirmed an intrathyroidal multifocal PTC with lymph node metastases. Postoperative radioiodine was administered, and focal uptake within the thyroid bed, without distant metastases or brain remnants, was found on the post-therapeutic whole-body scan. At 2 years from diagnosis, the patient is in good health and undergoes clinical and imaging follow-up. Brain cavernous angiomas are common cerebral vascular malformations that are usually diagnosed by MRI. Despite the high accuracy of MRI, the exam is not pathognomonic, and misdiagnosis cannot be excluded. Brain metastases from PTC are very rare; however, they can mimic a cavernous angioma. Therefore, the differential diagnosis should always be considered.

Trial of thyroid auto-transplantation after total thyroidectomy in benign thyroid diseases

Trial of thyroid auto-transplantation after total thyroidectomy in benign thyroid diseases

Role of Postoperative Intact Parathyroid Hormone Levels in Predicting Hypocalcaemia after Thyroidectomy.

To determine the sensitivity and specificity of intact parathyroid hormone (iPTH) levels in predicting hypocalcaemia after thyroidectomy. A descriptive cross-sectional study. Place and Duration of the Study: Department of General Surgery, Shifa International Hospital and Shifa Foundation, Islamabad, from May 2021 to 2022. The sample size was calculated to be 205 with consecutive non-probability sampling. Serum iPTH levels and serum calcium levels were measured postoperatively at 6 hours and 24 hours and recorded in a proforma for analysis. After collection, the data were entered and analysed using SPSS version 24.0. Among 205 patients, 157 (76.6%) were females and 48 (23.4%) were males. At 6 hours postoperatively, 121 (59%) patients had normal iPTH levels and 123 (60%) patients had normal serum calcium levels (p = 0.15). At 24-hour, 130 (63.4%) patients had normal iPTH levels and 92 (44.9%) patients had normal serum calcium levels (p = 0.001). Overall, 8 (3.9%) patients developed symptomatic hypocalcaemia (p = <0.001). The sensitivity and specificity of iPTH levels at ≤15 pg/ml were 100% and 70%, respectively, but at 24 pg/ml cut-off level, the specificity increased to 90% with sensitivity of 100%. Low serum iPTH levels at 6 hours after surgery can predict hypocalcaemia in patients undergoing thyroidectomy, even if serum calcium levels appear normal at that time. Parathyroid hormone, Serum calcium, Hypocalcaemia, Total thyroidectomy, Calcium homeostasis.

Incidence of Persistence and Recurrence of Differentiated Thyroid Cancer in Post-surgical Cases From a Tertiary Care Hospital in Dubai, United Arab Emirates.

Background Despite the excellent prognosis of differentiated thyroid carcinoma, recurrence remains a major concern. However, the persistence of thyroid cancer post-thyroidectomy is not uncommon. We aimed to characterise patients who underwent re-operative surgery for differentiated thyroid carcinoma and analyse the percentage of re-operations that truly were for "recurrent" disease versus the management of persistent disease. Methods We conducted a retrospective review of the hospital database, analysing patients who visited the nuclear medicine department at Mediclinic City Hospital, a tertiary care hospital in Dubai, United Arab Emirates, between 2015 and 2022. The study included patients with differentiated thyroid carcinoma who underwent re-operations after total thyroidectomy. Recurrence was defined as the development of disease after a patient had undetectable thyroglobulin and negative radiological scans within one year of the first surgery. Cases were categorised as "recurrent", "persistent", or "unable to classify" in the event of missing data. Results Out of 836 patients diagnosed with differentiated thyroid carcinoma who visited the nuclear medicine department, 71 underwent re-operations. The mean age of these patients was 44.4 years (CI 41.7-47.0), of whom 78.9% were females. Almost half (46.5%) underwent re-operations within the first year, and 98.6% were diagnosed with papillary thyroid carcinoma. We were able to classify 63.4% of cases (n=45) as persistent disease, while 24 cases were categorised as "unable to classify". Only two cases met the criteria for recurrent disease. Conclusion The majority of cases previously classified as "recurrent" in differentiated thyroid carcinoma were found to be a persistent disease, possibly indicating inadequate therapy. Further research may be required to explore the reasons behind this eye-opening rate of disease persistence. This highlights an area for improvement in the management and future outcomes of differentiated thyroid carcinoma patients.

815 A Retrospective Audit of the Management of Calcium Following Total or Completion Thyroidectomy, a Two Cycle Audit

815 A Retrospective Audit of the Management of Calcium Following Total or Completion Thyroidectomy, a Two Cycle Audit

Life-threatening amiodarone-induced thyrotoxicosis – Personalized approach to radical treatment

ObjectiveAmiodarone is an iodine-rich molecule and an effective antiarrhythmic drug. It is a first-line treatment for patients with life-threatening ventricular arrhythmias and for prevention in patients at high risk. The use of amiodarone may cause serious adverse effects such as pharmacotherapy-resistant, life-threatening amiodarone-induced thyrotoxicosis (AIT)leading to rapid deterioration of the patient's condition.According to the European Thyroid Association (ETA) guidelines, emergency thyroidectomy is the first-line treatment option in these cases. ; however, is not always feasible in the clinical setting due to the high anesthetic risk.We aimed to assess the clinical course and results of urgent thyroidectomy and 131-I therapy in patients with severe AIT with worsening of cardiac status. MethodsRetrospective analysis of the clinical course and outcomes of life-threatening AIT refractory to pharmacotherapy in patients hospitalized at a tertiary endocrinology center between 2014 and 2022. ResultsAn electronic database search identified 75 patients hospitalized for severe AIT. At the time of AIT diagnosis, median Thyroid-stimulating hormone (TSH) concentration was 0.001 mIU/L (range 0.001–0.35), fT4 63.2 pmol/L (range 9.0 - >100), and fT3 10.2 pmol/L (range 3.8–49.3). All patients received optimal conservative treatment. Among them, 20 required urgent radical therapy due to worsening arrhythmias and/or AIT-related heart failure. In this group, 6 patients died before any radical treatment was applied, 6 underwent total thyroidectomy, while 8 patients were successfully treated with 131-I (in 6 cases after rhTSH stimulation). The median dose of 131-I used for the therapy was 784MBq (range 627–860). The decision to treat with 131-I despite low but detectable 131-I uptake (median value 6 %) was made in cases of significant contraindications to anesthesia due to refractory ventricular arrhythmias, exacerbation of severe heart failure unresponsive to cardiac treatment, myocardial infarction during AIT course, massive pulmonary embolism. ConclusionThe decision regarding the optimal time and type of radical treatment of AIT refractory to pharmacotherapy is critical for patients management and should not be delayed. Urgent therapy with 131-I may be an effective therapeutic option in patients who are unsuitable for thyroidectomy due to the high risk of anesthesia.

Suppressed thyroid stimulating hormone levels after initiation of a subcutaneous glucagon-like peptide-1 receptor agonist in a post-thyroidectomy patient managed with levothyroxine case report

ObjectivesGlucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy has demonstrated an increased risk of thyroid C-cell hyperplasia and C-cell tumors in rodents. Due to this risk, a boxed warning for this drug class exists for people with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2. There is a lack of data regarding any possible effect of GLP-1 RA therapy on serum thyroid levels. The objective of this case report is to describe a case of suppressed thyroid stimulating hormone levels after initiation of a subcutaneous semaglutide in a post-total thyroidectomy patient managed with levothyroxine in order to highlight the need for closer monitoring of these patients and further research in this area. Case SummaryThe patient described in the case underwent a total thyroidectomy in 2015 with stable thyroid hormone replacement requirements with levothyroxine for 5 years until the initiation and titration of subcutaneous semaglutide. The reduction in thyroid stimulating hormone (TSH) after starting GLP-1 RA therapy necessitated a 25 percent dose reduction of levothyroxine from her original dose. Practice implicationsThis patient experienced suppressed TSH levels following initiation and titration of subcutaneous semaglutide. The etiology of these changes may be related to the direct effects of GLP-1 RA therapy on TSH levels, changes in absorption related to delayed gastric emptying rates, secondary to GLP-1 RA-associated weight loss, or a combination of these proposed mechanisms. It may be prudent to exercise more frequent monitoring of medications that require weight-based dosing and those with a narrow therapeutic index when initiating and titrating GLP-1 RA-based therapies and is an area of potential study.

Pediatric thyroid cancer in Saudi Arabia: a literature review of current trends in management and outcomes.

Pediatric thyroid cancer is on the rise, especially among adolescents. It is more aggressive than adult thyroid cancer and often presents with advanced features. This review aims to examine the current trends in the management and outcomes of pediatric thyroid cancer in Saudi Arabia. A comprehensive literature search was conducted to identify relevant studies on pediatric thyroid cancer in Saudi Arabia. PubMed and Google Scholar were searched from inception until December 2023. Extracted information included study identifiers, patient demographics, clinicopathological features, treatment modalities, complications, surveillance practices, recurrence patterns, and survival outcomes. The literature search identified ten eligible studies on pediatric thyroid cancer in Saudi Arabia. Pediatric thyroid cancer in Saudi Arabia often presents with advanced features, including higher rates of lymph nodes and distant metastases at diagnosis compared to adults. Fine-needle aspiration remains accurate, correlating well with final histopathology. Treatment primarily involves surgery, with total thyroidectomy being common, followed by radioactive iodine therapy for high-risk patients or those with positive iodine uptake. Survival rates exceed 95%, indicating a generally favorable prognosis. Recurrence rates can reach up to 30% in some studies, particularly with larger tumors or distant metastases. Hypocalcemia and recurrent laryngeal nerve injury are common postoperative complications, highlighting the need for experienced surgeons and meticulous technique. Genetic alterations in pediatric thyroid cancer are being investigated, but their impact on prognosis and treatment response is unclear. Limited data on management and outcomes in other regions of Saudi Arabia calls for multicenter studies to address healthcare disparities. Pediatric thyroid cancer in Saudi Arabia has unique characteristics compared to its adult counterpart, mandating specialized management approaches. More research is needed on early detection, risk stratification, personalized treatment, and addressing regional disparities to improve outcomes for this vulnerable population.

The Impact of Thyroidectomy and Lobectomy on Patients' Health-Related Quality of Life, Eastern Region, Saudi Arabia.

The thyroid gland is a crucial endocrine organ that can be susceptible to various pathological conditions, often necessitating total thyroidectomy or lobectomy. It is a common surgical procedure in Saudi Arabia. Thus, it is essential to recognize the impact of thyroid surgery on patients' health-related quality of life (HRQoL). The aim of this study was to evaluate HRQoL among patients with benign and malignant thyroid diseases who underwent thyroidectomy in the eastern region of Saudi Arabia. This cross-sectional study was conducted at King Fahad Hospital of University in Khobar, Kingdom of Saudi Arabia from January 2018 to May 2018. The data collection method used was divided into two parts. Part I included the patients' socio-demographic characteristics and the clinical characteristics of their thyroid surgery. Part II was a HRQoL questionnaire (SF-36, version 1.0). The sample included 100 thyroidectomy patients ≥18 years. The study findings revealed that the overall scores for post-thyroidectomy patients showed a significant improvement in HRQoL, and HRQoL was not significantly associated with benign or malignant thyroid diseases. Especially when the surgery is performed by a high-volume endocrine surgeon, thyroidectomy may lead to significant improvements in HRQoL among patients, including the elderly and younger adults, with benign and malignant thyroid disorders. There was no difference in HRQoL between patients who underwent total thyroidectomy or thyroid lobectomy. Also, HRQol among thyroidectomy patients is associated with their educational and occupational statuses.

The role of intraoperative central lymph node biopsy in the treatment of clinically low-risk PTMC.

To evaluate the role of intraoperative frozen biopsy of central lymph nodes in central neck dissection and thyroidectomy in patients of unilateral, clinically negative nodes (cN0) papillary thyroid microcarcinoma (PTMC) without extra-glandular invasion. The clinical data of 465 patients were collected retrospectively. Part of prelaryngeal, pretracheal and ipsilateral paratracheal lymph nodes were taken for frozen pathological examination during the operation. Then the thyroid lobe on the tumor side and isthmus were excised, and central neck dissection of the affected side was performed in all patients. The number of metastases in entire central lymph nodes of the affected side can be obtained by postoperative paraffin pathology. If the number of positive lymph nodes during surgery is ≥3, contralateral gland resection was performed. In this group of 465 patients, there were 186 cases with central lymph node metastasis. The Kappa coefficient of consistency between frozen pathology and paraffin pathology in central lymph nodes was 0.605. The ROC curve for the number of intraoperative frozen metastases-postoperative pathological metastases over 5 showed that the AUC of the curve was 0.793, while the maximum Youden index was 0.5259, whose corresponding number of positive lymph nodes was 3. Intraoperative central lymph nodes biopsy can be used as an important indicator for the status of central lymph node metastasis in unilateral cN0 PTMC patients without extra-glandular invasion and a determinant for central lymph node dissection. While the number of positive lymph nodes intraoperatively is ≥3, total thyroidectomy should be considered.