Transient Hypocalcemia Research Articles

Sutureless FOCUS harmonic scalpel versus clamp-and-tie techniques for thyroidectomy: A meta-analysis of 43 randomized controlled trials

Background: One of the most important surgical steps during thyroidectomy is the safe ligation of vessels. In fact, it is crucial to avoid postoperative bleeding and nerves’ injury. The “clamp and tie” technique was first introduced in the 19th century. Since then, a lot of other techniques have been adopted to facilitate the safe ligation and sectioning of thyroidal vessels; however, one of the most relevant advances is the introduction of energy-based devices (EBDs), which occurred three decades ago. Purpose: The aim of this systematic review and meta-analysis is to evaluate the safety and effectiveness of sutureless FOCUS harmonic scalpel (second generation EBDs) versus conventional clamps-and-tie technique) in total thyroidectomy. Results: This systematic review and meta-analysis represent the largest comparison in literature between the thyroidectomy procedure with the second-generation Advanced Harmonic Scalpel Ultrasonic Focus (UAS FOCUS) versus the conventional Clamp-and-Tie (CT) technique: as a matter of fact, it includes 43 randomized controlled trials (RCTs) and a total of 10.361 patients. The incidence of transient recurrent laryngeal nerve was statistically lower in patients undergoing UAS (3.99%) rather than CT (5.23%) (RR 0.79, 95% CI 0.63 to 0.99). The incidence of transient hypocalcemia was 11.3% in patients who underwent thyroidectomy with UAS FOCUS and 15.4% in those who underwent thyroidectomy with CT. Conclusion: Sutureless EBD is associated with a lower risk of damage to the laryngeal nerves and parathyroid glands. The rate of hypocalcemia and nerve paresis is indeed lower due to less thermic damage. Sutureless EBD can also diminish the rate of postoperative bleeding and cervical hematoma, a rare but potentially fatal complication.

Predictors of hypocalcemia and hypoparathyroidism in patients undergoing thyroidectomy for benign and malignant pathologies

Objective To analyse the risk factors of hypoparathyroidism and hypocalcemia after total thyroidectomy. Methods Clinical data of patients who underwent total thyroidectomy in a tertiary care hospital from the southern part of India was collected retrospectively from January 2021 to May 2023. Multivariate logistic regression was used to analyse the risk factors associated with transient hypoparathyroidism and hypocalcemia separately. Results A total of 300 patients who underwent total thyroidectomy were enrolled. The median age of the study population was 41 years, and 70% were females. Histopathological examination showed 80.3% had thyroid cancer. The incidence of postoperative transient hypoparathyroidism was 26.7%, while postoperative transient hypocalcemia was 12.3%. Multivariate analysis showed that presence of hypothyroidism before surgery (OR 3.230,95%CI:1.368–7.624,p=0.007), performing central compartment neck dissection (CCND) (OR 2.196,95%CI:1.133-4.257,p=0.02) and parathyroid gland in surgical specimen (OR 5.547, 95%CI:3.065–10.036,p<0.0001) were independent predictors of postoperative transient hypoparathyroidism. Female gender (OR 2.689,95%CI:1.049-6.895,p= 0.039), presence of parathyroid in the surgical specimen (OR 1.067,95%CI:0.367-8.438,p=0.004) and performing CCND (OR 2.192,95%CI:0.990-4.850,p=0.05) were independent predictors of postoperative transient hypocalcemia. Conclusion Hypoparathyroidism and hypocalcemia after thyroid surgery are common, and most of them are transient. Independent predictors of hypoparathyroidism and hypocalcemia differs. Hypoparathyroidism appears to be a better predictor for patients who will develop postoperative hypocalcemia.

ThP2.8 - Reducing postoperative length of stay after thyroidectomy through a standardised multidisciplinary postoperative care protocol does not compromise patient safety

Abstract Aims Our unit had a significantly longer length of stay after thyroid surgery. We introduced change of practice through a standardised multidisciplinary postoperative care protocol. We analyse the effect of the protocol on postoperative length of stay and any impacts on patient safety. Methods A multidisciplinary protocol was implemented and embedded into clinical practice. Data was collected prospectively on consecutive patients undergoing thyroid surgery. Outcomes with reference to adverse events, length of stay and readmissions were audited. Comparisons were made with unit's pre-protocol data and national figures published in BAETS (British Association of Endocrine and thyroid Surgeons) audit report. Results A total of 78 patients underwent 37 total thyroidectomies and 41 lobectomies. Three (8.3%) of the total thyroidectomies had transient hypocalcaemia but none were permanent. None had voice changes or recurrent laryngeal nerve palsy. Three patients were reviewed few days after discharge with mild hypocalcaemia symptoms treated with calcium supplements. One was re-admitted 5 days post discharge with wound infection. Twenty-seven (75%) were discharged on 1st postoperative day as opposed to 0% pre-protocol (BAETS audit report 66%). Thirty-seven (90%) of lobectomies were discharged on 1st postoperative day (Units pre-protocol 42%, BAETS audit 81%). There was no postoperative bleed or hypocalcaemia. One patient with a large recurrent retrosternal goitre had transient recurrent laryngeal nerve palsy that recovered subsequently. There were no readmissions or adverse events directly related to early discharge. Conclusion A well embedded dedicated postoperative care protocol can significantly reduce postoperative hospital stay after thyroid surgery without compromising patient safety.

Incidental parathyroidectomy after thyroid surgery and relationship with postoperative hypocalcemia: a single tertiary center analysis.

Incidental parathyroidectomy (IP) is a complication seen at varying rates after thyroid surgery, and its relationship with postoperative hypocalcemia has not been clarified. In this study, our goal was to identify the frequency and risk factors for IP in a large patient cohort and assess its correlation with postoperative hypocalcemia. A total of 4052 patients who underwent thyroid surgery between 2008 and 2020 were reviewed retrospectively. The patients were divided into two groups, the IP and non-IP groups, and compared in terms of demographics, surgical procedures, pathological diagnosis, and specimen weight. The relationships between IP and hypocalcemia were also evaluated. There were 587 (14.5%) IPs out of 4052 cases. In these patients, mostly one gland was removed (84.6%), and 23.2% of these glands were intrathyroidal. The rate of transient hypocalcemia was 39.9%, and that of permanent hypocalcemia was 1.7%. Female gender, malignancy, lower preoperative thyroid volume, presence of central lymph node dissection, lower specimen weight, presence of autotransplantation and capsule invasion in malignant cases were determined to be risk factors for IP. After excluding hemithyroidectomy and autotransplantation, transient and permanent hypocalcemia were found to be significantly higher in cases with IP (p < 0.001). Multivariate analysis showed that female sex, no multinodular goiter, central dissection, and low thyroid volume were risk-adjusted independent variables. Our findings highlight the significant role of IP in postoperative hypocalcemia. Given that most IPs are located in the perithyroidal region, precise surgical dissection is vital to preserve parathyroid gland function and prevent IP and subsequent hypocalcemia.

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.

Endoscopic assisted parathyroid surgery via a subclavian approach

Objective:To explore the safety and efficacy of airless endoscopic surgery in the treatment of parathyroid diseases. Methods:By retrospective comparison, clinical treatment of 26 patients with primary hyperparathyroidism admitted to the Department of Otolaryngology and Head and Neck Surgery of the Hospital, Sun Yat-sen University from January 2018 to January 2023 were collected. They were divided into traditional group（13 cases） and endoscopic group（13 cases） according to the surgical method. The traditional group underwent traditional open parathyroid surgery, and the endoscopic group underwent airless endoscopic surgery through the subclavian approach. The efficacy, postoperative incision pain, incidence of adverse events, and aesthetic effects of the two groups were evaluated. Results:A total of 26 patients were included, including 13 patients in the traditional group and 13 patients in the endoscopic group. There was no significant difference in the incidence of hypocalcemia and transient hypoparathyroidism on the first day after surgery between the two groups（P>0.05）. No patients with incision pain（>3 points） or swallowing pain were found in both groups after the operation, and they were afraid or unwilling to cough and expel phlegm. There were no significant differences in the amount of blood loss, duration of operation, incidence of temporary recurrent laryngeal nerve palsy and transient hypocalcemia, and postoperative pain score between the two groups. The endoscopic group's scar evaluation score and aesthetic effect satisfaction score at 6 months after surgery were higher than those of the traditional group（P<0.01）. Conclusion:Airless Endoscopic parathyroid surgery via the subclavian approach has good effectiveness and safety, which did not significantly increase the risk of surgery. It can safely remove the lesion and leave no surgical scar on the anterior neck, which has the advantage of a good cosmetic effect. It is a safe and feasible endoscopic parathyroid surgery and can be used as a new choice for patients undergoing parathyroid surgery.

Initial versus Staged Thyroidectomy for Differentiated Thyroid Cancer: A Retrospective Multi-Dimensional Cohort Analysis of Effectiveness and Safety.

The optimal surgical approach for differentiated thyroid cancer remains controversial, with debate regarding the comparative risks of upfront total thyroidectomy versus staged completion thyroidectomy following the initial lobectomy. This study aimed to assess the complication rates associated with these two strategies and identify the optimal timing for completion thyroidectomy using a multi-dimensional analysis of four cohorts: an institutional series (n = 148), the National Surgical Quality Improvement Program (NSQIP) database (n = 39,992), the TriNetX repository (n > 30,000), and a pooled literature review (10 studies, n = 6015). Institutional data revealed higher overall complication rates with total thyroidectomy (18.3%) compared to completion thyroidectomy (6.8%), primarily due to increased temporary hypocalcemia (10% vs. 0%, p = 0.004). The NSQIP analysis demonstrated that total thyroidectomy was associated with a 72% increased risk of transient hypocalcemia (p < 0.001) and a 25% increased risk of permanent hypocalcemia (p < 0.001). TriNetX data confirmed these findings and identified obesity and concurrent neck dissection as risk factors for complications. A meta-analysis showed that total thyroidectomy increased the rates of transient (RR = 1.63) and permanent (RR = 1.23) hypocalcemia (p < 0.001). Institutional and TriNetX data suggested that performing completion thyroidectomy between 1 and 6 months after the initial lobectomy minimized permanent complication rates compared to delays beyond 6 months. In conclusion, for differentiated thyroid cancer, total thyroidectomy is associated with higher risks of transient and permanent hypocalcemia compared to staged completion thyroidectomy. However, performing completion thyroidectomy within 1-6 months of the initial lobectomy may mitigate the risk of permanent complications. These findings can inform personalized surgical decision-making for patients with differentiated thyroid cancer.

Do extremely large goiters carry a higher risk of malignancy or complications? A case control study

IntroductionThe definition of thyroid goiter remains ambiguous, yet size may impact both malignancy rate and surgical complications' rate. MethodsAll patients with thyroid goiter who underwent thyroidectomy between 1/2015–1/2023 were included. Goiter was defined as lobe ≥4 cm. For analysis purpose, goiters measuring 4–8 cm and ≥8 cm were defined as large and extremely large goiters, respectively. For malignancy definition, tumor<1 cm in their largest diameter were excluded from study. Collected data included demographics, cytology, histology and postoperative complication. Results144 goiters from 111 patients were included. The most common indication for surgery was symptoms (55 %). Compared with large goiter, extremely large goiters demonstrated a trend for tracheal narrowing on pre-operative CT findings (23 % vs. 45 %, p = 0.07 respectively). Overall differentiated thyroid carcinoma (DTC) rate was 17 % (25/144) without statistical difference between groups (p = 0.89). Within goiters with pre-operative benign cytology, the DTC rate was 17 % (7/43). Follicular variant of papillary thyroid cancer was the most common type for both groups. Nodular hyperplasia was significantly associated with extremely large goiters (53 % vs. 73 %, p = 0.03). No significant difference was found in transient hypocalcemia (48 % [15/31] vs. 41 % [5/12], p = 0.6) and other complications' rate between extremely large goiters and the control group. ConclusionWhen discussing management options for patients with goiters, the size of the goiter should not regarded as a higher risk for complications or malignancy, yet the relatively high malignancy rate found should be taken under consideration for resection.

Further delineation of phenotype and genotype of Kenny-Caffey syndrome type 2 (phenotype and genotype of KCS type 2).

Kenny-Caffey syndrome type 2 (KCS2) is an extremely rare inherited disorder characterized by proportionate short stature, skeletal defects, ocular and dental abnormalities, and transient hypocalcemia. It is caused by variants in FAM111A gene. Diagnosis of KCS2 can be challenging because of its similarities to other syndromes, the absence of clear hallmarks and the deficient number of genetically confirmed cases. Here, we aimed to further delineate and summarize the genotype and phenotype of KCS2, in order to get a better understanding of this rare disorder, and promote early diagnosis and intervention. We present clinical and genetic characteristics of eight newly affected individuals with KCS2 from six families, including one family with three individuals found to be a father-to-daughter transmission, adding to the limited literature. Furthermore, we performed a review of genetically confirmed KCS2 cases in PubMed, MEDLINE and CNKI databases. There were six females and two males in our cohort. All the patients presented with short stature (100.0%). Clinical manifestations included ocular defects such as hypermetropia (5/8), dental problems such as defective dentition (3/8) and dental caries (3/8), skeletal and brain anomalies such as delayed closure of anterior fontanelle (6/8), cerebral calcification (3/8), cortical thickening (3/8) and medullary stenosis (4/8) of tubular bones. Endocrinologic abnormalities included hypoparathyroidism (5/8) and hypocalcemia (3/8). One male patient had micropenis and microorchidism. All cases harboured missense variants of FAM111A, and nucleotides c.1706 arose as a mutational hotspot, with seven individuals harbouring a c.1706G>A (p.Arg569His) variant, and one child harbouring a c.1531T>C (p.Tyr511His) variant. Literature review yielded a total of 46 patients from 20 papers. Data analysis showed that short stature, hypoparathyroidism and hypocalcemia, ocular and dental defects, skeletal features including cortical thickening and medullary stenosis of tubular bones, and seizures/spasms were present in more than 70% of the reported KCS2 cases. We provide detailed characteristics of the largest KCS2 group in China and present the first genetically confirmed instance of father-to-daughter transmission of KCS2. Our study confirms that Arg569His is the hot spot variant and summarizes the typical phenotypes of KCS2, which would help early diagnosis and intervention.

Surgical Management and Predictors of Postoperative Complications of Retrosternal Goiters: A Retrospective Study.

The preferred standard treatment for retrosternal goiter (RSG), a slow-growing, often benign tumor, remains thyroidectomy. An alternative strategy may be required when the goiter is intrathoracic. Data on the results of RSG procedures are rarely reported. Careful patient selection and assessment are critical to avoiding an unexpected sternotomy during surgery and postoperative complications. This study aims to examine the clinical findings and treatment outcomes of RSG and to identify the variables affecting postoperative complications in a resource-limited setting. A retrospective study was conducted at Al-Thawra Modern General Hospital in Sana'a, Yemen, on 69 patients diagnosed with RSG and undergoing thyroidectomy between April 2019 and February 2023. Initial clinical characteristics, radiological and laboratory findings, treatment approach, and outcome were collected from the patient's medical profile and analyzed. To determine the variables influencing postoperative complications, a bivariate analysis was carried out. The mean age was 51.0 ± 13.6 years, and 45 (65.2%) were female. The most commonly reported symptoms were palpable masses (66; 95.7%), difficulty breathing (45; 65.2%), and neck discomfort (20; 29.0%), with 7 (10.1%) patients being asymptomatic. Previous thyroid surgery was reported in 10 (14.5%) cases. According to the grading classification, grade 1 was the most prevalent (42; 60.9%). Total thyroidectomy was the predominant surgical procedure in 59 (85.5%) cases. Using a cervical approach, all patients underwent thyroidectomy, and a sternotomy was required in one case. Histopathological analysis revealed benign multinodular goiter in 79.7%, followed by papillary thyroid cancer in 10.1% and thyroiditis in 6.7%. The postoperative complication occurred in 22 (31.9%), and the most common complication was transient hypocalcemia (11, 15.9%). There was no mortality during or after the surgery. In bivariate analysis, advanced age, difficulty swallowing, tracheal deviation, large RSG mass, advanced RSG grade, previous surgery, and malignant histopathology were associated with postoperative complications and were statistically significant (all p<0.05). RSG is a rare disease that may require challenging surgical intervention. In this study, the cervical approach was the most practical and least intrusive surgical method. In addition, postoperative complications were associated with advanced age, difficulty swallowing, tracheal deviation, large RSG mass, advanced RSG grade, previous surgery, and malignant histopathology. Low postoperative complication rates can be achieved by understanding the surgical architecture of the neck, essential clinical RSG presentation, thyroid pathology, and necessary surgical treatment.

Preventive central neck lymph node dissection as a stage in the treatment of papillary thyroid cancer

Relevance: The need of prophylactic cervical lymph node dissection for the detection of low grade thyroid cancer remains debatable since preoperative examination does not always allow determining the involvement of a group VI regional lymph collector.Objective: to evaluate the frequency of group VI nodes involvement with clinical N0–Nx based on the results of a morphological examination after performing a preventive central neck lymph node dissection.Materials and methods: the study included 295 patients who underwent surgery from 2016 to 2022 for papillary thyroid cancer with cT1–T2, N0–Nx. There were 11.5 % of men included (n = 34) and 88.5 % of women (n = 261). Of these, 40.7 % (n = 120) were less than 55 years old. All patients underwent surgical treatment which included thyroidectomy or hemithyroidectomy with cervical lymph node dissection.Results: The study included 295 patients with cT1 — 247 (83.7 %) and cT2 — 48 (16.3 %). Pathomorphological examination changed the T index in some patients: pT1 was found in 80.3 % of cases (n = 237); рТ2 — in 9.2 % (n = 27); рТ3 — in 10.5 % (n = 31). Central neck lymph nodes involvement was detected in 77 (26.1 %) out of 295 patients. There was a correlation between the frequency of metastases detection and the size of the primary tumor: 22.8 % (n = 54) of metastases with pT1, 33.3 % (n = 9) with pT2, and 45.2 % (n = 14) with pT3. Transient hypocalcemia was found in 32 % of patients with pT1, 69 % with pT2, and 84 % with pT3. Two patients had unilateral transient paresis of the larynx.Conclusions: Our analysis demonstrates that the preventive central neck lymph node dissection in patients with low grade thyroid cancer is an important component of surgical treatment, which allows to improve the treatment results with a possible subsequent reduction in the risk of distant progression. In this study 77 (26.1 %) of 295 patients had metastases in the lymph nodes of the central neck. The number of postoperative complications affecting the quality of life of patients was acceptable with 0.67 % of paresis of the larynx and 39 % of mild hypocalcemia.

Complications after Thyroidectomy; a Comparison Among Seven Different Surgical Procedures and the Impact of Central Compartment Lymph Nodes Sampling: a Cohort Study

Introduction: Thyroid nodules are commonly encountered in medical practice. The relation between the magnitude of thyroid surgery and its complications is not settled.&#x0D; Objectives: Our aim is to examine the incidence of recurrent laryngeal nerve injury and hypoparathyroidism after thyroid surgery in different thyroid procedures including local lymph nodes control.&#x0D; Methods: The records of 345 patients who underwent thyroidectomy at the Jordan University Hospital from January 2010 to December 2016 were reviewed. They were divided into seven groups (total thyroidectomy, near-total thyroidectomy, hemithyroidectomy, completion thyroidectomy, redo surgery, hemithyroidectomy with completion, and near-total thyroidectomy with completion). A comparison among the groups was done. Ninety-one patients who underwent central lymph nodes biopsy were identified. They were divided into three groups (pre-tracheal lymph nodes excision, central neck dissection, and central neck sampling) and then compared.&#x0D; Results: Transient hypocalcemia was significantly higher with total thyroidectomy in comparison to near-total thyroidectomy and hemithyroidectomy with or without completion. All groups were comparable regarding permanent hypocalcemia and recurrent laryngeal nerve palsy. No significant relationship between the type of dissection and complication rate was found.&#x0D; Conclusion: Near-total thyroidectomy is a safe alternative to total thyroidectomy with a lower early complication rate. Redo surgery and central dissection are not associated with higher morbidity.

Complications of thyroidectomy: Insights from a single-centre study in northeast India

To study and compare the frequency of post-operative complications associated with thyroid surgeries indicated for various benign and malignant pathologies and assess the outcome of management of such complications in a tertiary care hospital in Northeast India. An analytical study was done at a tertiary care hospital in Assam over a period of 1 year from May 2022 to June 2023. Data was collected from 53 patients who underwent surgery at this hospital. Hemithyroidectomy, subtotal, near-total, and total thyroidectomies were performed in 31(58.4%), 2 (3.7%), 6 (11.3%) and 14 (26.4%) cases respectively. The overall rate of complications was 39.6%. Permanent hypocalcaemia was observed to be the most common complication, followed by transient hypocalcaemia and transient recurrent laryngeal nerve palsy. The complications were found to be more frequent in surgery for malignant thyroid disease. There was no mortality in our study. A better understanding of thyroid gland anatomy, meticulous haemostasis and Identification of Recurrent laryngeal nerve and parathyroid glands lead to favourable post-operative outcomes. Appropriate post-operative care with early identification and management of complications plays an essential role in reducing the duration of postoperative hospital stay and limiting patient morbidity.

14. “TEXTBOOK OUTCOMES” IN SURGICAL APPROACH OF DIFFERENTIATED THYROID CANCER

Abstract Introduction The textbook outcome (TO) is a composite quality measure used to define the achievement of multiple ideal surgical results. There is a lack of studies regarding TO in differentiated thyroid carcinoma (DTC). The aim of the study is to define the TO in DTC surgery and determine the factors that avoid its achievement. Methods Retrospective study of consecutive patients undergoing surgery for DTC between 01/01/2021 and 31/03/2023. The TO is defined by the absence of complications (hematoma, recurrent laryngeal nerve palsy, hypocalcemia, seroma, surgical site infection (SSI)), prolonged hospital stay (exceeding the 75th percentile), readmission, and 90-day mortality. Results Fifty-nine patients were included (median age 53 years (43-61), 43 women (72,9%)) with a median follow-up of 17 months (14-20). The majority presented with unilateral nodules (32; 54,2%), Bethesda VI (24; 44,4%), with a median size of 21mm (11,75-35,0). Thirty-one patients (52,5%) underwent total thyroidectomy, 28(47,5%) lobectomy, 15 unilateral CCL (25,4%), 10 bilateral CCL (16,9%) and 10 unilateral LCL (16,9%). The median hospital stay was 1 day (1-1). Fourteen patients (23,7%) had complications: 1 hematoma (1,7%), 5 hoarseness (8,5%), 4 transient recurrent nerve palsy (6,8%) and 2 permanent (3,4%), 7 transient hypocalcemia (11,9%) and 4 permanent (6,8%), 2 SSI (3,4%) and 3 seroma (5,1%). Two patients were readmitted because of SSI (one requiring emergency surgery). In total, 69,5% (41) patients achieved TO. Risk factors that avoided its consecution were: total thyroidectomy [OR7,81 IC95%(1,95-31,25); p=0,004)] and unilateral LCL [OR4,63 IC95%(1,12-19,20); p=0,035)]. Conclusion Most of the patients achieved TO. The predictors associated to the absence of TO achievement were total thyroidectomy and unilateral LCL, meaning that the more aggressive the surgery is, the greater the chances are of surgical complications.

INCIDENCE OF HYPOCALCEMIA FOLLOWING NEAR TOTAL THYROIDECTOMY AND TOTAL THYROIDECTOMY

Objective:Our study was conducted at ESIC Medical College and Hospital, Kalaburagi, aimed to evaluate the incidence of hypocalcemia following near-total and total thyroidectomy over a 2-year period from November 2021 to November 2023. Methods: A total of 120 patients above 12 years undergoing thyroidectomy were included. Pre-operative assessments, including clinical history, examination, fine needle aspiration cytology, thyroid function tests, ultrasound neck, and indirect laryngoscopy, were conducted. Blood samples were collected pre-operatively and post-operatively. Hypocalcemia was defined as serum calcium below 8 mg/dL and ionized calcium below 4.4 mg/dL, with transient hypocalcemia lasting less than 6 months and permanent hypocalcemia persisting beyond 6 months. Biochemical and laboratory tests, including thyroid function tests, were performed, and management involved calcium supplementation with or without vitamin D. Results: The study revealed an overall incidence of hypocalcemia at 21.6%, with 7.5% progressing to permanent hypocalcemia. Malignancy was more prevalent in males (60%), while benign disorders were common in females (60% in the age group 20-50 years). Conclusion: Postoperative hypocalcemia, though a frequent complication after near-total and total thyroidectomy, can be mitigated through proper planning, meticulous surgical techniques, and the use of advanced technologies. Regular monitoring and early intervention are imperative for patient well-being, emphasizing the importance of attention to surgical details in minimizing complications.

A modified, single-incision, gasless, endoscopic thyroidectomy and bilateral central neck dissection via axillary approach technique for bilateral papillary thyroid microcarcinoma: A preliminary report

BackgroundOur objective was to assess the viability and oncological security of a gasless, transaxillary single-incision endoscopic procedure for performing total thyroidectomy and bilateral central neck dissection (TT + BCND). This study focused on patients diagnosed with bilateral papillary thyroid microcarcinoma (PTMC). MethodBetween April 2020 and November 2021, 22 patients with bilateral PTMC underwent single-incision, gasless, transaxillary endoscopic TT + BCND. The patients’ clinicopathologic characteristics, surgical completeness and complications were analyzed. ResultSingle-incision, gasless, transaxillary endoscopic TT + BCND was successful performed in all patients. The median (IQR) total surgical time was 143 (85–160) min. Only two patients experienced transient unilateral RLN palsy or transient hypocalcemia. All these complications resolved within 1 month after surgery. The median duration of hospital stay after surgery was 4 (3–4.5) days. The median hospitalization expense for these patients was 3848 (3781–4145) USD. The median number of lymph node yielded was 10.5 (8–15). The cosmetic outcomes were well-received by all individuals. ConclusionIn certain cases, gasless, transaxillary endoscopic TT + BCND procedure performed through a single incision proved to be a secure alternative for managing bilateral PTMC.

Improvement in Central Neck Dissection Quality in Thyroid Cancer by Use of Tissue Autofluorescence.

Risk of postoperative transient or permanent hypoparathyroidism represents one of the most common complications following total thyroidectomy. This risk increases if a cervical lymphadenectomy procedure must also be performed, as is usually the case in thyroid carcinoma patients. Parathyroid autofluorescence (AF) is a non-invasive method that aids intraoperative identification of parathyroid glands. In this prospective study, 189 patients with papillary thyroid cancer who underwent total thyroidectomy with central neck dissection were included. Patients were randomly allocated to one of two groups: NAF (no AF, surgery was performed without AF) and the AF group (surgery was performed with AF-Fluobeam LX system, Fluoptics, Grenoble, France). The number of excised lymph nodes was significantly higher in the AF compared to the NAF group, with mean values of 21.3 ± 4.8 and 9.2 ± 4.1, respectively. Furthermore, a significantly higher number of metastatic lymph nodes were observed in the AF group. Transient hypocalcemia recorded significantly lower rates in the AF group with 4.9% compared to 16.8% in the NAF group. AF use during total thyroidectomy with central neck dissection for papillary thyroid carcinoma patients, decreased the rate of iatrogenic parathyroid gland lesions, and increased the rate of lymphatic clearance.

Relationship between hypocalcemia immediately after calving with metabolic disorders and body condition score in Holstein cows.

Hypocalcemia is one of the most common transition period disorders that affects dairy cows and has been divided into clinical and subclinical types. This study aimed to investigate the relationship between postpartum serum calcium (Ca) concentrations with metabolic disorders and body condition score (BCS) in Holstein dairy cows. Two hundred and seventy-one Holstein cows were blocked from two commercial dairy herds based on parity (primiparous and multiparous) and serum Ca concentrations on calving day, 1 and 2 days postpartum were allocated to 1 of 3 groups: 1) Serum Ca concentration >8.5 mg/dl at the calving day, 1 and 2 days postpartum (normocalcemic); 2) serum Ca concentration ≤8.5 mg/dl on the calving day and 1 or 2 day postpartum (transient subclinical hypocalcemia (TSCH)); and 3) serum Ca concentration ≤8.5 mg/dl on the calving day, 1 and 2 days postpartum (persistent subclinical hypocalcemia (PSCH)). The results showed that the primiparous and multiparous cows had the highest TSCH and PSCH percentages, respectively. Ca status after calving did not affect the BCS changes, incidence of milk fever, hypomagnesemia and hyperketonemia, and clinical and subclinical endometritis. The incidence of retained placenta, metritis, and subclinical mastitis was affected by Ca status after calving, so PSCH cows experienced 6.28, 6.43, and 5.9 times more retained placenta, metritis, and subclinical mastitis than normocalcemic cows, respectively. The culling rate within the first 60 days in milk for PSCH cows was 4.61 times more than for normocalcemic cows. Overall, the results of the study showed that cows with PSCH had a higher incidence of retained placenta; uterine infections, subclinical mastitis, and culling rate, but cows with TSCH were similar to healthy cows in terms of metabolic disorders and culling rate.

Feasibility and safety of modified en-bloc resection in endoscopic thyroid surgery via bilateral areolar approach - long-term institutional analysis ten years after surgery.

This study aimed to introduce a new modified en-bloc resection method and evaluate its feasibility and safety in endoscopic thyroid surgery via bilateral areolar approach (BAA). Papillary thyroid carcinoma (PTC) patients who underwent lobectomy and ipsilateral central node dissection (CND) via the BAA approach were retrospectively reviewed. Their clinical characteristics and outcomes were evaluated, including operative duration, lymph node yield (LNY), surgical complications, recurrence rate, and metastasis rate, over a ten-year follow-up period. Simultaneous lobectomy and CND were performed in the modified en-bloc group, whereas lobectomy was performed first, followed by CND in the conventional group. The study included 108 patients in the modified en-bloc group and 213 in the conventional group. There were no significant differences in gender, age, tumor locations, tumor dominant nodule size, or the incidence of concomitant Hashimoto thyroiditis when comparing clinicopathologic characteristics. The comparison of operative duration (P = 0.14), blood loss (P = 0.13), postoperative hospital stay (P = 0.58), incidence of transient vocal cord paralysis (P = 0.90) and hypocalcemia (P = 0.60) did not show any differences. The mean LNY achieved in the central compartment of the modified en-bloc group (7.5 ± 4.5) was significantly higher than that in the conventional group (5.6 ± 3.6). Two patients in the modified en-bloc group and two in the conventional group experienced metastasis after surgery during the ten-year follow-up (1.8% vs. 0.9%, P = 0.60). The learning curve analysis showed a significant decrease in operative duration after the 25-35th cases for modified en-bloc resection. The modified en-bloc resection method in endoscopic thyroid surgery via BAA is a technically feasible and safe procedure with excellent cosmetic outcomes for selective PTC patients.

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

Thyroid cancer incidence has increased in recent decades, and thyroid surgery is continuously evolving in response to demands for postoperative comfort and cosmesis. This study aimed to introduce a new surgical method for minimally invasive open bilateral total thyroidectomy (MI-BTT) using a unilateral 2.5-3.0 cm neck incision. Furthermore, we reported the surgical outcomes and postoperative quality of life (QoL) using a validated Korean translated Dermatology Life Quality Index (DLQI) questionnaire. We retrospectively evaluated 41 Asian patients who underwent MI-BTT for low-risk papillary thyroid cancer by a single surgeon from March 2019 to December 2021. A total of 4 male and 37 female patients were included. The mean age and body mass index were 46.2±10.1 years and 23.3±3.3 kg/m², respectively. The average tumor size was 1.1±0.6 cm, and 36 patients (87.8%) had bilateral cancer. Twenty-three (56.1%) patients had occult central lymph node (CLN) metastasis in the final pathologic report, with the mean number of dissected CLNs being 7.2±6.5. Gross capsular extension was found in 6 patients (14.6%). Moreover, 28 patients (68.3%) received additional treatment after surgery with low or high doses of radioactive iodine. The average serum-stimulated thyroglobulin value identified during treatment was 1.57±2.30 ng/mL. The mean operation time was 78.0±13.9 minutes, and postoperative complications included transient hypocalcemia (36.6%), transient hoarseness (24.4%), and seroma (2.4%). The mean total DLQI score was 2.73±0.78, indicating a small effect on QoL. MI-BTT is a novel, safe, and feasible technique to improve patient satisfaction for surgical scars and QoL.