Total Thyroidectomy Research Articles

A case of bilateral chylothorax after a total thyroidectomy and left sided modified radical neck dissection for papillary thyroid cancer

A case of bilateral chylothorax after a total thyroidectomy and left sided modified radical neck dissection for papillary thyroid cancer

Extent of surgery in the surgical treatment of graves' disease: subtotal vs. total thyroidectomy and comparison of the long-term results

Extent of surgery in the surgical treatment of graves' disease: subtotal vs. total thyroidectomy and comparison of the long-term results

Serum anti-thyroglobulin antibody levels following total thyroidectomy are related to the recurrence of papillary thyroid carcinoma

Serum anti-thyroglobulin antibody levels following total thyroidectomy are related to the recurrence of papillary thyroid carcinoma

Early detection and management of hypocalcaemia after total thyroidectomy

Early detection and management of hypocalcaemia after total thyroidectomy

Comparing total thyroidectomy and subtotal thyroidectomy for benign thyroid disorders: A retrospective cohort study

Comparing total thyroidectomy and subtotal thyroidectomy for benign thyroid disorders: A retrospective cohort study

Challenges for a perioperative physician – A choking thyroid planned for total thyroidectomy

A large retrosternal goiter is a nightmare for an anesthesiology and a surgeon. A comprehensive history, a thorough clinical examination, pre-operative planning and a close working relationship among multidisciplinary medical teams are prerequisites to prevent adverse events intra-operatively and postoperatively. This case report is about a geriatric patient who presented with progressively enlarged anterior neck swelling for past 30 years associated with orthopnea and dysphagia. Patient underwent awake fibreroptic intubation under topical anesthesia. Thyroidectomy combined with sternotomy was done. Intra-operative and postoperative was uneventful.This case report suggests the use of AFOI in anticipated difficult airway and it’s success.

An innovative way of administration of radioactive iodine in an 11 years' old girl with intellectual disability after total thyroidectomy for differentiated thyroid cancer

An innovative way of administration of radioactive iodine in an 11 years' old girl with intellectual disability after total thyroidectomy for differentiated thyroid cancer

Comparison of the Outcome Between Ligasure and Conventional Suture tie Techniques in Patients Undergoing Thyroidectomy

Objective: To compare the outcome between ligasure and conventional suture tie techniques in patients undergoing thyroidectomy. Study setting and duration: This study was conducted in the department of general surgery, DHQ hospital Dera Ghazi Khan, over a period of one year from September 2022 to September 2023. Subject and methods: This randomized controlled study was conducted on 60 patients divided in two groups, group a (ligasure technique and group b (conventional suture technique) having age 30-65 years either male or female gender presented to undergo thyroidectomy. Patients undergoing chemotherapy, recurrent cases and bleeding diathesis (INR > 1.5) were excluded. The participants were randomly assigned to group A and group B through draws method using sealed opaque envelopes. All the surgical procedures were performed as per institutional protocol by consultant surgeon with ? 5-year post-fellowship experience. All the patients received anesthesia as per hospital protocol. Results: This study was conducted on 60 patients divided in two groups equally, group a (ligasure technique) and group b (conventional technique). The mean age in group A was 47.80±11.54 years and 44.83±10.38 years in group B. among patient in group A 10 (33.3%) patients had total thyroidectomy while 20 (66.7%) patients had subtotal thyroidectomy and in group B 12 (10%) patients had total thyroidectomy while 18 (60%) patients had subtotal thyroidectomy. Group A had significantly shorter operative time (62.07±3.09 mins vs 69.70±3.18 mins, P = 0.0001) as compared to group B. According to the comparison of total blood loss between both groups, group A had significantly lower blood loss (56.27±2.50 ml vs 68.57±2.92) as compared to group B. Conclusion: It can be concluded that ligasure technique had better outcomes as compared to conventional suture tie technique. The mean operative time and blood loss was significantly lower in ligasure technique as compared to conventional suture technique. Keywords: Conventional technique, ligasure, mean operative time, post-operative blood loss, thyroidectomy

Pediatric Papillary Thyroid Carcinoma: Outcomes After Surgery Without Adjuvant Radioactive Iodine.

Pediatric papillary thyroid carcinoma (PTC) is usually treated with total thyroidectomy followed by radioactive iodine (RAI). Recently, RAI is being used more selectively based on surgical pathology and postoperative dynamic risk stratification (DRS). To describe patients with pediatric PTC not initially treated with RAI and their disease outcomes. This was an ambispective study at a tertiary cancer center of patients < 19 years diagnosed from 1/1/1990 to 12/31/2021 with stage I PTC who intentionally were not treated with RAI within a year of diagnosis. We assessed clinical characteristics, management, and disease outcomes using DRS. Of 490 PTC patients, we identified 93 eligible patients (median age at diagnosis 16y; 87% female), including 46 (49%) with cervical lymph node metastases. Initial management included: total thyroidectomy ± neck dissection (n=69, 75%), lobectomy ± neck dissection (n=20, 21%), or a Sistrunk procedure for ectopic PTC (n=4, 4%). After a median follow-up of 5.5 years (range 1-26), most patients (85/93; 91%) remained disease-free with no further therapy. Persistent (n=5) or recurrent (n=3) disease was found in 9% of the entire cohort. Four patients ultimately received RAI, of which only one clearly benefited, and additional surgery was performed or planned in four patients, two of whom had an excellent response at last follow-up. Selected pediatric PTC patients, even those with lymph node metastases, may not require therapeutic 131I and can avoid the unnecessary risks of RAI while still benefitting from the excellent long-term outcomes that are well-described for this disease.

Preliminary results of thyroid surgery from a tertiary comprehensive children's hospital

BackgroundThyroid nodules are rare in children and the risk of malignancy rate is considerably higher than in adults. In this study, we aimed to evaluate the patients who admitted to our hospital with thyroid nodules and underwent thyroid surgery examine the distributions of pathologies, changes in treatment protocols and results. MethodsPediatric patients < 18-year-old, who presented with thyroid nodules and underwent thyroid surgery at our clinic between 2005 and 2018, were retrospectively examined. Demographic characteristics, complaints at presentation, ultrasonography findings, surgical method, histopathological results, and postoperative complications were evaluated. Data were compared between two time periods: before and after 2014. ResultsA total of 52 thyroid surgeries were performed on 45 patients with a female/male ratio of 3:1 and an average age of 14.1 ± 2.6 years. Differentiated thyroid carcinoma was detected in 12 (26.7 %) of the patients. The incidence of malignant tumors increased from 18.2 % to 26.7 % after 2014. Transient hypocalcemia was detected in 11 (21.1 %) patients. The risk of postoperative hypocalcemia was significantly increased in patients with bilateral resection (p < 0.01). Parathyroid hormone level measured at 6–12 h postoperatively is useful in predicting hypocalcemia (p = 0.001). No significant relationship was found between high body mass index and thyroid malignancy. Fine needle aspiration biopsy results were found to be significant in predicting malignancy (p = 0.041). ConclusionWe assert the critical importance of vigilant postoperative monitoring for hypocalcemia, particularly following total thyroidectomy and completion thyroidectomy. Since the incidence of thyroid pathologies requiring surgical intervention in children is relatively low, we think that such cases should be performed in comprehensive pediatric hospitals where a multidisciplinary approach is adopted.

Risk and Protective Factors of Postoperative and Persistent Hypoparathyroidism after Total Thyroidectomy in a Series of 1965 Patients.

Postoperative hypoparathyroidism (HypoPTH) is the most common complication following total thyroidectomy. Several risk factors have been identified, but data on postoperative follow-up are scarce. The study focused on 1965 patients undergoing surgery for benign and malignant thyroid diseases at a tertiary-level academic center. Anamnestic, biochemical, surgical, pathological, and follow-up data were evaluated. HypoPTH was defined by a serum concentration of PTH < 10 pg/mL on the first or the second post-operative day. Persistent HypoPTH was defined by the need for calcium/active vitamin D treatment > 12 months after surgery. Postoperative HypoPTH occurred in 542 patients. Multivariate analysis identified the association of central lymph-nodal dissection, reduced preoperative PTH levels, a lower rate of parathyroid glands preserved in situ, and longer duration of surgery as independent risk factors. At a median follow-up of 47 months, HypoPTH regressed in 443 patients (more than 6 months after surgery in 7%) and persisted in 53 patients. Patients receiving a lower dose of calcium/active vitamin D treatment at discharge (HR 0.559; p < 0.001) or undergoing prolonged, tailored, and direct follow-up by the operating endocrine surgeon team had a significantly lower risk of persistent HypoPTH (2.4% compared to 32.8% for other specialists) (HR 2.563; p < 0.001). Various patient, disease, and surgeon-related risk factors may predict postoperative HypoPTH. Lower postoperative calcium/active vitamin D treatment and prolonged, tailored follow-up directly performed by operating endocrine surgeons may significantly reduce the rate of persistent HypoPTH.

Data-Driven Thyroglobulin Cutoffs for Low- and Intermediate-Risk Thyroid Cancer Follow-Up: ITCO Real-World Analysis.

The utility of thyroglobulin (Tg) in the follow-up of differentiated thyroid cancer (DTC) patients has been well-documented. Although third-generation immunoassays have improved accuracy, limitations persist (interfering anti-Tg antibodies and measurement variability). Evolving treatment strategies require a reevaluation of Tg thresholds for optimal patient management. To assess the performance of serum Tg testing in two populations: patients receiving total thyroidectomy and radioiodine remnant ablation (RRA), or treated with thyroidectomy alone. Prospective observational study. Setting. Centers contributing to the Italian Thyroid Cancer Observatory (ITCO) database. We included 540 patients with 5 years of follow-up and negative anti-Tg antibodies. Serum Tg levels assessed at 1-year follow-up visit. Detection of structural disease within 5 years of follow-up. After excluding 26 patients with structural disease detected at any time point, the median Tg did not differ between patients treated with or without radioiodine. Data-driven Tg thresholds were established based on the 97th percentile of Tg levels in disease-free individuals: 1.97 ng/mL for patients undergoing thyroidectomy alone (lower than proposed by the MSKCC protocol and ESMO Guidelines, yet demonstrating good predictive ability, with a negative predictive value (NPV) of 98%) and 0.84 ng/mL for patients receiving post-surgical RRA. High sensitivity and NPV supported the potential of these thresholds in excluding structural disease. This real-world study provides evidence for the continued reliability of 1-year serum Tg levels. The data-driven Tg thresholds proposed offer valuable insights for clinical decision-making in patients undergoing total thyroidectomy with or without RRA.

The current role of adjuvant radiotherapy in management of medullary thyroid carcinoma: A single institute analysis.

Medullary thyroid carcinoma (MTC) accounts for only about 5% of total thyroid cancers. It usually presents as an advanced disease carrying a poor prognosis than well-differentiated thyroid cancers. While the treatment of choice is surgery, the role of adjuvant radiotherapy is still unclear. This retrospective study aims to understand the role of adjuvant radiotherapy in MTC and its effect on survival. We did a retrospective two study to estimate the effect of adjuvant external beam radiotherapy (EBRT) on survival outcomes in MTC. A total of 30 patients who were diagnosed with nonmetastatic MTC during the period 2015 to 2020 were included in the study. Fifteen patients underwent only total thyroidectomy with cervical lymph node dissection. Rest 15 patients received adjuvant EBRT following surgery. A median dose of 60 Gy in 30 fractions, 2 Gy per fraction, 5 days per week, was given by conventional radiotherapy technique. Survival outcomes were estimated using Kaplan-Meier method. A univariate analysis using log rank test was performed to estimate the association of various prognostic factors including age, sex, tumor size, nodal involvement, and surgical resection status on survival outcomes. Median age of presentation in our study is 47 years (inter quartile range: 36-55 years). Median follow-up time is 4 years. Male to female ratio is 2:3-70% of patients presented with T3 lesions and 77% with N1b disease. There was no significant difference in overall survival (OS) in patients who received adjuvant RT following surgery in comparison to patients who underwent only surgery (92.9% vs. 71.4% P value = 0.202). Similarly, there was no improvement in locoregional recurrence-free survival (LRFS) (100% vs. 85.7%, P value-0.157), Distant metastasis-free survival (DMFS) (64.3% vs. 71.4%, P value = 0.725), and Disease-free survival (DFS) (64.3% vs. 64.3%, P value = 0.91). Age, gender, nodal involvement, and surgical resection status (R0, R1, R2) did not have any effect on survival outcomes. DFS (100% vs. 63.6% P value = 0.008), LRFS (100% vs. 94.7% P value = 0.002), and DMFS (100% vs. 63.2% P value = 0.006) were significantly better in T2 lesions compared to advanced lesions. Adjuvant EBRT failed to show any significant improvement in survival outcomes and locoregional control in MTC. Further prospective randomized clinical trials are needed to validate the role of EBRT in MTC. Clinicians should proceed with caution before advising adjuvant radiotherapy in MTC and make an informed decision after weighing the pros and cons of giving adjuvant EBRT.

Incidence and risk factors for recurrent laryngeal nerve injury after thyroid surgery

ObjectivesInjury to the recurrent laryngeal nerve (RLNI) is a known possible morbidity after thyroid surgery. The clinical presentation varied in severity, from changes in voice quality and swallowing in unilateral cases to airway compromise in bilateral cases. In minor cases, vocal fold paralysis (VFP) may occur unnoticed. Although many intraoperative measures have been implemented to minimize nerve injury, the risk remains, either transient or permanent. This study evaluated the incidence and potential risk factors of recurrent laryngeal nerve injury after thyroidectomy.MethodsRetrospective data analysis was conducted on 1368 patients who underwent thyroidectomy at the National Guard Hospital, King Abdul-Aziz Medical City, Jeddah, Saudi Arabia, between January 2008 and December 2021. Evaluations were conducted on the pathological features, surgical procedure type, and state of the recurrent laryngeal nerve during surgery as contributing to recurrent laryngeal nerve injury. All patients underwent preoperative and postoperative indirect laryngoscopy examinations with or without videostroboscopy. Physiological testing of the RLN using neurostimulation and laryngeal palpation (NSLP) or intraoperative neuromonitoring (IONM) was performed in all cases. VFP was considered present when vocal fold mobility was absent or significantly reduced.ResultsA total of 1368 patients (2177 nerves at risk) who underwent thyroidectomy and fulfilled the inclusive criteria (809 bilateral, 559 unilateral) were evaluated. A total of 62% of patients were more than 45 years old, and the mean age was 48.36 ± 13.03 with a male-to-female ratio of 1:3.6. Eight-hundred one (58.6%) patients underwent total or subtotal thyroidectomies (1602 nerves at risk). Two-hundred seventy-six patients underwent hemithyroidectomy (276 nerves at risk), and 291 patients underwent completion or redo surgeries (299 nerves at risk). Of these 1368 patients, post-surgery laryngoscopy showed reduced or absent vocal fold mobility in 47 (3.4%) patients. Forty-three out of 47 patients had unilateral vocal fold paralysis, and 4 had bilateral VFP. When we analyzed the three risk factors statistically significant for postoperative RLN palsy, age (OR, 1.01; 95% CI, 0.98–1.05; p = 0.365) became non-significant. The other risk factors (extent of surgery and histopathological diagnosis) remained statistically significant (p = 0.004 and 0.031). After adjustment, the extent of surgery, including total thyroidectomy and revision surgery, was strongly associated with a higher risk of odds of postoperative RLN palsy. Physiological RLN stimulation was performed in all cases with NSLP or INOM, and no significant association was observed in the incidence of VFP (p = 0.365). In most cases, symptoms were spontaneously resolved with recovery of vocal fold movement within a few months.ConclusionIn this study, 3.4% of the recurrent laryngeal nerve showed postoperative dysfunction either transient or permanent VFP. Intraoperative identification of the nerve remains the gold standard of care during thyroidectomy. Neuromonitoring aids in detecting the nerve, particularly in severe cases, but does not reduce the nerve injury compared to NSLP.

Simultaneous occurrence of papillary thyroid carcinoma, medullary thyroid carcinoma, and lymphoma: A case report.

Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, the coexistence of PTC and medullary thyroid carcinoma (MTC) is uncommon. While the simultaneous occurrence of both cancers with small lymphocytic lymphoma (SLL) in lymph nodes with PTC metastasis is very rare. This study presents a unique case of concurrent PTC, MTC, and SLL, highlighting the exceptional rarity of these coexisting tumors. A 75-year-old female with a thyroid tumor underwent total thyroidectomy, bilateral central neck lymph node dissection, and right radical neck lymph node dissection. Histopathological examination revealed a low-grade medullary thyroid carcinoma (MTC) in the left lobe and classical papillary thyroid carcinoma (PTC) in the right lobe, with PTC metastasis in the cervical lymph nodes and concurrent SLL in the affected lymph nodes. Coexistence of PTC, MTC and SLL in the same patient is rare, there are currently no standardized treatment guidelines due to the limited literature. However, it is essential to consider not only the treatment for each type of tumor but also the potential risks or conflicts associated with the treatments. In the case reported in this paper, the papillary carcinoma invaded the capsule of the right lobe of the thyroid and metastasized to the cervical lymph nodes, warranting radioactive iodine therapy. However, considering the potential negative impact of radioactive iodine on the pre-existing lymphoma, the radioactive iodine therapy was postponed. Meanwhile, constant monitoring of calcitonin and thyroid globulin should be performed to monitor tumor recurrence as was performed in the present case. Since MTC, PTC, and SLL may coexist, patients with PTC deserve careful surveillance for the other disease entities. This case underscores the need for heightened awareness among clinicians, radiologists, and pathologists regarding the possibility of concurrent thyroid tumors and abnormal lymph nodes, guiding comprehensive pre-operative evaluations and postoperative monitoring strategies. This study aims to provide a warning for routine pathological diagnosis and contribute data for related research.

The use of artificial intelligence to detect parathyroid tissue on ex vivo specimens during thyroidectomy and parathyroidectomy procedures using near-infrared autofluorescence signals

In thyroidectomy and parathyroidectomy procedures, diagnostic dilemmas related to whether an index tissue is of parathyroid or nonparathyroid origin frequently arise. Current options of frozen section and parathyroid aspiration are time-consuming. Parathyroid glands appear brighter than surrounding tissues on near-infrared autofluorescence imaging. The aim of this study was to develop an artificial intelligence model differentiating parathyroid tissue on surgical specimens based on near-infrared autofluorescence. With institutional review board approval, an image library of exvivo specimens obtained in thyroidectomy and parathyroidectomy procedures was created between November 2019 and April 2023 at a single academic center. Exvivo autofluorescence images of surgically removed parathyroid glands, thyroid glands, lymph nodes, and thymic tissue were uploaded into an artificial intelligence platform. Two different models were trained, with the first model using autofluorescence images from all specimens, including thyroid, and the second model excluding thyroid, to prevent the effect of specimen size on the results. Deep-learning models were trained to detect autofluorescence signals specific to parathyroid glands. Randomly chosen 80% of data were used for training, 10% for validation, and 10% for testing. Recall, precision, and area under the curve of models were calculated. Surgical procedures included 377 parathyroidectomies, 239 total thyroidectomies, 97 thyroid lobectomies, and 32 central neck dissections. For the development of the model, 1151 images from a total of 678 procedures were used. The dataset comprised 648 parathyroid, 379 thyroid, 104 lymph node, and 20 thymic tissue images. The overall precision, recall, and area under the curve of the model to detect parathyroid tissue were 96.5%, 96.5%, and 0.985, respectively. False negatives were related to dark and large parathyroid glands. The visual deep-learning model developed to identify parathyroid tissue in exvivo specimens during thyroidectomy and parathyroidectomy demonstrated a high sensitivity and positive predictive value. This suggests potential utility of near-infrared autofluorescence imaging to improve intraoperative efficiency by reducing the need for frozen sections and parathyroid hormone aspirations to confirm parathyroid tissue.

Increased risk of chronic kidney disease after total thyroidectomy: A nationwide matched cohort study.

Development of hypoparathyroidism (hypoPT) after total thyroidectomy (TT) may increase the risk of kidney-related morbidity. We aimed to examine the risk of hypoPT and chronic kidney disease (CKD) in patients undergoing TT in Denmark over a 20-year period. Using population-based registries, we identified all Danish individuals with TT between January 1998 and December 2017. We included a matched comparison cohort by randomly selecting 10 citizens for each patient, by sex and birth year. We calculated cumulative incidence and hazard ratio (HR) of CKD by Cox regression in patients with TT compared with the comparison cohort. Further, CKD risks were stratified by indications for TT and comorbidity groups according to Charlson Comorbidity Index. We included 2421 patients with TT and 21.5% had hypoPT. After 10 years, the risk of developing CKD for hypoPT patients was 13.5% (95% CI:9.8-17.7), 11.6% (95% CI: 9.7-13.7) for patients without hypoPT, and 5.8% (95% CI: 5.3-6.2) for the comparison cohort. When compared with the matched comparison cohort, the adjusted HR for CKD in hypoPT patients was 3.23 (95% CI: 2.37-4-41) and 2.27 (1.87-2.75) for patients without hypoPT. For patients without previous comorbidities, the adjusted HR of CKD was higher than in patients with several comorbidities. HypoPT was a frequent complication after TT and was associated with an increased risk of CKD. We also found an increased risk of CKD in patients with a normal parathyroid function after TT, which needs to be further evaluated.

Association of Free Thyroxine with Progression-Free Survival in Intermediate and High Risk Differentiated Thyroid Cancer.

Supraphysiologic thyroxine (T4) doses are used in intermediate and high-risk patients with differentiated thyroid cancer (IR/HR-DTC) to suppress tumor progression by thyrotropin (TSH). However, preclinical data suggest that T4 can also act as a growth stimulus for cancer, but there is no clinical evidence supporting this claim. We analyzed the association between free T4 (FT4) and progression-free survival (PFS) in patients with IR/HR-DTC. This longitudinal cohort study, approved by multi-institutional review board, included patients with IR/HR-DTC treated uniformly with total thyroidectomy, radioiodine (RAI), and TSH suppression therapy, with at least three TSH and FT4 values available. Association between FT4 and PFS at landmarks 6, 12, and 18 months was assessed by Kaplan-Meier survival curves, while competing risks were assessed through Cox proportional hazards model. From 739 screened patients 382 met the inclusion criteria and were characterized by a median age of 46 (34-59) years, 64.1% women, treated with a median RAI dosage of 159 (110-410) mCi. During follow up of 7.1 (3.4-12.7) years 34.6% experienced disease progression.Elevated FT4, observed in 29.3% of patients, was not associated with worse PFS (HR 0.9, CI 0.54-1.5, p=0.69), while age (HR 1.02, CI 1.004-1.04, p=0.01), tumor size (HR 1.15, CI 1.04-1.28, p=0.01), and metastases to the lateral neck lymph nodes (HR 2.9, CI 1.7-4.74, p<0.001), bones (HR 4.87, CI 1.79-13.3, p=0.002), and brain (HR 5.56, CI 2.54-12.2, p<0.001) were associated with shorter PFS. Contrary to preclinical evidence, elevated FT4 levels do not affect PFS in patients with IR/HR-DTC.

HYPERTHYROIDISM AND GRAVES' DISEASE: OPHTHALMOLOGICAL MANIFESTATIONS AND SURGICAL TREATMENT.

Introduction: Hyperthyroidism, characterized by the excessive production of hormones by the thyroid gland, can lead to various systemic complications, including ophthalmological manifestations such as Graves' Orbitopathy (GO). Graves' Disease, one of the main causes of hyperthyroidism, is often associated with these ocular complications, which include ocular protrusion, diplopia, and periorbital swelling. Surgical treatment, including total or subtotal thyroidectomy, emerges as an option to control the progression of hyperthyroidism and improve associated ophthalmological symptoms. **Objective**: To analyze the ophthalmological manifestations of hyperthyroidism and Graves' Disease, as well as evaluate the effectiveness of surgical treatment in managing these complications. **Methodology**: The review followed the PRISMA checklist to ensure rigor and transparency. Searches were conducted in PubMed, Scielo, and Web of Science databases using five descriptors: "Hyperthyroidism," "Graves' Disease," "Graves' Orbitopathy," "Surgical Treatment," and "Ophthalmological Manifestations." Inclusion criteria encompassed articles published in the last 10 years, studies focused on surgical treatment for GO, and works explicitly addressing the ophthalmological manifestations of Graves' Disease. Exclusion criteria included studies that did not discuss surgical treatment, non-peer-reviewed articles, and publications older than a decade. **Results**: The analysis revealed that Graves' Orbitopathy frequently manifests with symptoms such as ocular protrusion, diplopia, and periorbital edema, significantly impacting patients' quality of life. Thyroidectomy proved effective in reducing hormone levels, resulting in symptomatic improvements for many patients. However, outcomes varied, and surgical intervention was not always associated with complete resolution of ophthalmological manifestations. **Conclusion**: Surgical treatment of hyperthyroidism and Graves' Disease can provide significant relief from ophthalmological manifestations, though it does not guarantee complete resolution of symptoms. Surgery should be considered within a multidisciplinary context, taking into account the severity of ocular symptoms and response to conservative treatment. The review highlighted the need for integrated treatment strategies to optimize outcomes for patients with ophthalmological complications associated with hyperthyroidism and Graves' Disease.

Machine Learning-Based Algorithm for the Early Prediction of Postoperative Hypocalcemia Risk After Thyroidectomy.

We used machine learning to develop and validate a multivariable algorithm allowing the accurate and early prediction of postoperative hypocalcemia risk. Postoperative hypocalcemia is frequent after total thyroidectomy. An early and accurate individualized prediction of the risk of hypocalcemia could guide the selective prescription of calcium supplementation only to patients most likely to present with hypocalcemia after total thyroidectomy. This retrospective study enrolled all patients undergoing total thyroidectomy in a single referral center between November 2019 and March 2022 (derivation cohort) and April 2022 and September 2022 (validation cohort). The primary study outcome was postoperative hypocalcemia (serum calcium under 80mg/L). Exposures were multiple clinical and biological variables prospectively collected and analyzed with various machine learning methods to develop and validate a multivariable prediction algorithm. Among 610/118 participants in the derivation/validation cohorts, 100 (16.4%)/26 (22%) presented postoperative hypocalcemia. The most accurate prediction algorithm was obtained with random forest and combined intraoperative parathyroid hormone measurements with 3 clinical variables (age, sex, and body mass index) to calculate a postoperative hypocalcemia risk for each patient. After multiple cross-validation, the area under the receiver operative characteristic curve was 0.902 (0.829-0.970) in the derivation cohort, and 0.928 (95% CI: 0.86; 0.97) in the validation cohort. Postoperative hypocalcemia risk values of 7% (low threshold) and 20% (high threshold) had, respectively, a sensitivity of 92%, a negative likelihood ratio of 0.11, a specificity of 90%, and a positive of 7.6 for the prediction of postoperative hypocalcemia. Using machine learning, we developed and validated a simple multivariable model that allowed the accurate prediction of postoperative hypocalcemia. The resulting algorithm could be used at the point of care to guide clinical management after total thyroidectomy.