Transient Hypocalcemia Research Articles

Study of the incidence of hypocalcemia in patients undergoing bilateral thyroid surgery

Background: Thyroid surgery are among the most common operations performed all over the world. Hypocalcemia following total thyroidectomy is a fairly common complication. Occurrence of acute hypocalcemia can be predicted in patients undergoing thyroid surgery, based on serial calcium measurement and this helps in early prediction of hypocalcemia. The aim of present study was to assess the incidence of post thyroidectomy hypocalcemia and factors which might play a role in its occurrence.Methods: A total 30 patients who underwent bilateral thyroidectomy were analysed. The study period was from June 2017 to March 2019. The incidence of hypocalcemia was analysed with serial calcium estimation in immediate post-operative period, 4 hours and 24 hours after surgery and on 5th post-operative day. The factors analysed included pre-operative and post-operative serum calcium levels, clinical features, the disease type and factors related to surgery. The ethical approval was taken from the ethical committee of the institute. At the end of the study data was collected and analysed by using student t-test and chi square test. A p-value of less than 0.05 was considered significant.Results: Post-operative transient hypocalcemia developed in 21 patients out of 30 (70%). Of them six patients (28.75%) developed severe hypocalcemia and 15 (71.42%) developed mild to moderate hypocalcemia. Out of six patients, five patients were histopathologically diagnosed as malignant thyroid disease. 15 patients who developed mild to moderate hypocalcemia were diagnosed to be having benign thyroid conditions.Conclusions: Patients underwent thyroid surgery for malignant conditions showed higher incidence and severity hypocalcemia as compared to cases where surgery was performed for benign thyroid disease. This complication can be prevented with meticulous perioperative dissection, prompt identification of parathyroid glands and frequent postoperative monitoring of serum calcium levels.

Intraoperative identification of parathyroid glands by autofluorescence on total thyroidectomy – Does it really reduces post-operative hypocalcemia?

Abstract Background Intraoperative identification of parathyroid glands which remains largely dependent on the surgeon's expertise, is a major challenge in endocrine surgery and the most efficient way to reduce postoperative hypocalcemia and its important morbidity. Since the description on autofluorescence of parathyroid glands by Paras et al. in 2011, other works had confirmed the utility of this property in the identification of the glands but its efficacy in reducing hypocalcemia is not completely stated. In this study we evaluate the utilization of a low-cost device in total thyroidectomy. Methods In a before and after controlled study we compared patients submitted to total thyroidectomy by the same surgeon in two periods: From January 2017 to February 2018 (visual identification of parathyroid glands) and from February 2018 to December 2019 (with utilization of the near infrared system). Main outcomes included postoperative hypocalcemia and hypoparathyroidism, parathyroid identification and incidental resection. Results Patients in the study group displayed significantly lower postoperative hypoparathyroidism (p = 0.044). In spite of the reduction observed in study group absolute values of calcium and number of hypocalcemic patients didn't achieve statistical significance. There were no patients with permanent hypocalcemia in study group comparing with 3 in the control group. Number of parathyroid glands identified was significantly higher in study group (p Near infrared autofluorescence device was able to identify accurately inadvertently removed parathyroid glands, with a sensivity of 100% and a specificity of 87.5%. Conclusions Event though we couldn't demonstrate significant improvement in transient postoperative hypocalcemia, the reduction of permanent hypocalcemia and the improvement in surgeon's ability and confidence in the identification of parathyroid glands could make near infrared autofluorescence an useful tool in surgery of thyroid gland.

Post-Thyroidectomy Hypocalcemia: Clinical Study at Tertiary Care Center.

A recent review by the American association of clinical Endocrinologist (AACE) and American College of Endocrinology discussed definations and management of post-surgical hypocalcemia. In term of post-surgical hypocalcemia a total serum calcium of less than 8.5mg/Dl(2.125mmol/L) or ionised calcium less than 1.15mmol/L were considered as cut off levels. The aim of the study is to evaluate & compare 30 operated cases of thyroid surgery based on its gender, age distribution, pre-operative indication & nature of surgery, post-thyroidectomy hypocalcemia. This prospective study was conducted in the Department of Otorhinolaryngology, head, neck surgery department sir T hospital, and government medical college Bhavnagar. All patients undergoing thyroidectomy surgeries were included in the study. Data collected from the patients undergoing thyroidectomise by meticulous history taking, careful clinical examination, appropriate radiological, haematological investigations including serum calcium and serum albumin, operative findings and follow-up of the cases was done after surgery for post- in association with nature of thyroid surgery. Post-thyroidectomy transient hypocalcemia is a frequent complication which can be prevented with pre-operative preparation of patients with extreme caution and pre-operative meticulous dissection, prompt identification of parathyroids and post-operative frequent monitoring of serum calcium and early treatment can prevent significant morbidity. operative hypocalcemia. The study was conducted to know the incidence of hypocalcemia after thyroid surgery.

Parathyroid Hormone Reduction Predicts Transient Hypocalcemia after Total Thyroidectomy: A Single-Center Prospective Study.

Objective We performed this study to investigate the risk factors for postoperative hypocalcemia after total thyroidectomy with central lymph node dissection (CLND). Study Design. This was a single-center prospective study based on 176 consecutive patients who underwent total thyroidectomy for papillary thyroid carcinoma. Setting. Patients were recruited between January 2016 and June 2018. Subjects and Methods. Patients who underwent bilateral (n = 155, bilateral group) and ipsilateral CLND (n = 21) after total thyroidectomy were included. The preoperative and postoperative parathyroid hormone (PTH) and calcium levels were detected. The risk factors for transient hypocalcemia were identified using logistic regression analysis and receiver operating characteristic (ROC) curve analysis. Results Fifty-one (28.98%) patients developed transient hypocalcemia, and 2 patients (1.14%) developed permanent hypoparathyroidism. There was no difference in the gender ratio or the morbidity of hypocalcemia between the patients who underwent bilateral and ipsilateral CLND. On postoperative day 1, PTH decrease was a risk factor for transient hypocalcemia in the whole cohort (β = 0.043, OR = 1.044, 95% CI 1.023–1.065, p < 0.001), bilateral group (β = 0.042, OR = 1.043, 95% CI 1.022–1.064, p < 0.001), and female patients (β = 0.049, OR = 1.050, 95% CI 1.026–1.075, p < 0.001). Tumor diameter was a risk factor for transient hypocalcemia in female patients (β = 0.499, OR = 1.647, 95% CI 1.003–2.704, p=0.049). The ROC curve analysis illustrated that 65.58%, 71.00%, and 71.00% PTH level reduction had high accuracy in predicting transient hypocalcemia in the whole cohort, bilateral group, and female patients, respectively (AUC = 0.986, 0.987, and 0.987). Conclusion Asymptomatic female patients with bilateral CLND and a 71.00% PTH level reduction were at a high risk of transient hypocalcemia.

Extended Level IV Neck Dissection for Limited Prophylactic Clearance of Level V in Node-Positive Papillary Thyroid Carcinoma: a Homogenous Study Population.

There is near consensus that prophylactic lateral neck dissection has no role in the management of differentiated thyroid cancer, but the extent of lateral neck dissection in differentiated thyroid cancer remains controversial, especially whether level V should be addressed or not. There is lot of heterogeneity in reporting of the management of level V in papillary thyroid cancer. We at our Institute address the lateral neck positive papillary thyroid cancer with selective neck dissection involving levels II-IV, performing extended level IV dissection with inclusion of the triangular area delineated by the sternocleidomastoid muscle, the clavicle, and the perpendicular line drawn to the clavicle from the point where the horizontal line at the level of cricoid cuts the posterior border of sternocleidomastoid muscle. Retrospective analysis of the departmental data set related to thyroidectomy with lateral neck dissection from 2013 to mid-2019 for papillary thyroid cancer, was carried out. Patients with recurrent papillary thyroid cancer were excluded as were patients with involvement of level V. Data related to the demography of patients, histological diagnosis, and postoperative complications were compiled and summarized. Note was made of the incidence of ipsilateral neck recurrence and the neck level involved with recurrence noted. Data was analyzed for fifty-two patients of non-recurrent papillary thyroid cancer who had undergone total thyroidectomy and lateral neck dissection involving levels II-IV, with extended dissection at level IV. It should be noted that none of the patients had clinical involvement of level V. Only two patients had lateral neck recurrence, both the recurrences were in level III, one on the ipsilateral side and the other on the contralateral side. Recurrence in the central compartment was noted in two patients, with one of these patients also having ipsilateral level III recurrence. One of the patients had distal metastasis to the lungs. Transient paresis of the unilateral vocal cords was noted in seven patients which got resolved within 2months in all of them. Transient hypocalcemia was noted in four patients. Although our series has a small sample size with limited follow-up, it is one of the few studies in which prophylactic level V dissection has been studied in a homogenous study population of non-recurrent papillary thyroid cancer. Our study has shown that prophylactic dissection of level V may have a limited role, but further large multi-institutional studies need to be carried out to come up with a definite answer.

Parathyroid hormone response in treatment of subclinical hypocalcemia in postpartum dairy cows

The aim of this study was to evaluate different treatments of postpartum subclinical hypocalcemia in dairy cows with emphasis on PTH response. Twenty four cows with subclinical hypocalcemia (Ca 1.4–2.0 mmol/L), out of 180 Holstein cows tested, were assigned in one of three equal groups: (1) CON received no Ca supplementation, (2) PO-Ca received 1000 mL of oral Ca suspension, immediately after establishing hypocalcemia, and 500 mL of the suspension 12 h after, (3) IV-Ca intravenously received 500 mL of Ca immediately after establishing hypocalcemia. The blood samples were taken up to 48 h after initial treatment for determination of Ca, iP, Mg and PTH concentrations. Urine pH was also evaluated up to 48 h after initial treatment. Compered to CON cows that were hypocalcemic up to the 48 h, Ca concentrations were significantly higher in PO-Ca up to hour 8 and IV-Ca up to hour 24. At first 2 h, PTH concentrations were significantly lower, compared to CON, only in IV-Ca, while at hour 4 PTH concentrations were significantly lower in both treated groups. At hours 24 and 48, PTH concentrations were significantly lower only in PO-Ca compared to CON group. Urine pH values in CON indicate alkalosis and were significantly lower both in PO-Ca and IV-Ca group, up to 12 h and 24 h respectively. In conclusion, both treatments mitigated hypocalcemia in cows, but with significantly different PTH response. Due to adequate PTH response, normocalcemia is established in CON and expected transient hypocalcemia is avoided in IV-Ca cows.

Redo thyroid surgery without drains.

Redo thyroid surgery is associated with higher risk of hematoma than the initial thyroid surgery. We report a single surgeon's experience of performing redo thyroid surgery without drains. This retrospective single-institutional study evaluates the safety and efficiency of redo thyroid surgery without drains by comparing three groups of patients: those who underwent primary bilateral thyroidectomy (Group 1), those who underwent completion thyroidectomy (Group 2); and those who underwent thyroidectomy for recurrent thyroid diseases (Group 3). The demographic characteristics did not differ among the groups. Substernal extension and hyperthyroidism were more frequent in group 1, whereas the weight of the resected thyroid gland was lower in groups 2 and 3. Hematoma occurred in 5%, 4%, and 4% of patients in Groups 1, 2, and 3, respectively. Postoperative transient hypocalcemia occurred in 19%, 16%, and 21% of patients in Groups 1, 2, and 3 respectively. The postoperative incidence of transient recurrent laryngeal nerve (RLN) paralysis in Groups 1, 2, and 3, was 6%, 7%, and 8%, respectively. The incidence of permanent unilateral RLN paralysis in Groups 2 and 3 was 1%. The postoperative length of stay was 1day in 92% of the patients from all groups. Avoiding the routine use of drains in redo thyroid surgery is safe and effective, it does not increase overall surgical morbidity, and it reduces the overall length of stay in hospital.

The impact of near infrared fluorescence imaging on parathyroid function after total thyroidectomy.

Compared withconventional thyroidectomy, hypocalcemia rate was reported to be lower after total thyroidectomy (TT) utilizing near infrared fluorescence imaging (NIFI). The aim of this study is to evaluate the impact of NIFI on postoperative parathyroid function after TT. This was a retrospective institutional review board-approved study comparing 100 patients who underwent TT with NIFI guidance and 200 patients without, by the same surgeon. Clinical parameters were compared using χ2 and t test. Average number of parathyroid glands identified intraoperatively was similar between twogroups. However, rate of incidental parathyroidectomy was higher in conventional (14%) versus NIFI group (6%) (P = .039), despite similar (4% vs 6%, respectively) autotransplantation rates (P = .562). Incidences of transient (6.5% vs 5.0%) and permanent (0.5% vs 0%) hypocalcemia were not statistically different between conventional and NIFI groups (P = NS). The use of NIFI during thyroidectomy may decrease the rate of incidental parathyroidectomy by increasing the ability of the surgeon to recognize parathyroid glands with fluorescent contrast distinction. Nevertheless, in contrary to recent reports in literature, postoperative hypocalcemia rate was not altered compared with conventional technique, suggesting that preservation of parathyroid vasculature, rather than an augmented ability to detect the glands, may dominantly affect postoperative function.

Preoperative Vitamin D Levels as a Predictor of Transient Hypocalcemia and Hypoparathyroidism After Parathyroidectomy

Hypocalcemia is a common problem after parathyroidectomy and/or thyroidectomy. The complication may be transient or permanent. Most cases occur as a result of removal of the parathyroid glands or damage to the glands during neck surgery. The purpose of this study was to evaluate the effect of preoperative vitamin D deficiency in predicting transient hypocalcemia and hypoparathyroidism after parathyroidectomy.Retrospective evaluation was made of 180 patients with primary hyperparathyroidism in respect of serum 25(OH)D, calcium and parathyroid hormone before and after parathyroidectomy. Transient hypocalcemia was defined as corrected calcium ≤ 8.4 mg/dL, and these cases were then evaluated for preoperative 25(OH)D values. Transient hypoparathyroidism has been described as low PTH level immediately after surgery before beginning any supplementation. Permanent hypoparathyroidism is accepted as the need for medical treatment is necessary over 12 months.Both transient hypocalcemia and hypoparathyroidism developed at statistically significantly higher rates in patients with preoperative vitamin D deficiency and vitamin D insufficiency.Vitamin D deficiency is an independent contributor to transient hypocalcemia and hypoparathyroidism following parathyroidectomy.

Predictors of post-thyroidectomy hypocalcaemia: a systematic and narrative review.

Hypocalcaemia is the most common complication after total or completion thyroidectomy. This study assesses recent evidence on predictive factors for post-thyroidectomy hypocalcaemia in order to identify the patients affected and aid prevention. Two authors independently assessed articles and extracted data to provide a narrative synthesis. This study was an updated systematic search and narrative review regarding predictors of post-thyroidectomy hypocalcaemia using the Ovid Medline, Embase, Cochrane and Cinahl databases. Results were limited to papers published from January 2012 to August 2019. Sixty-three observational studies with a total of 210 401 patients met the inclusion criteria. The median incidence was 27.5 per cent for transient biochemical hypocalcaemia, 12.5 per cent for symptomatic hypocalcaemia and 2.2 per cent for permanent hypocalcaemia. The most frequent statistically significant predictor of hypocalcaemia was peri-operative parathyroid hormone level. Symptomatic hypocalcaemia and permanent hypocalcaemia were seen more frequently in patients undergoing concomitant neck dissection. Many factors have been studied for their link to post-thyroidectomy hypocalcaemia, and this study assesses the recent evidence presented in each case.

P1429EVALUATION OF PARATHYROIDECTOMY IN PERSISTENT HYPERARATHYROIDISM AFTER RENAL TRANSPLANTATION: A SINGLE-CENTER RETROSPECTIVE STUDY

Abstract Background and Aims To investigate the efficacy of parathyroidectomy (PTX) in the treatment of persistent hyperparathyroidism (PHPT) after renal transplantation and the effect of PTX on renal allograft function. Method This single-center retrospective study enrolled 31 patients who underwent PTX for the treatment of PHPT after renal transplantation in the Kidney Disease Center of the First Affiliated Hospital of Zhejiang University from May 2010 to Oct. 2018. The changes of serum calcium, serum phosphorus, alkaline phosphatase, parathyroid hormone(PTH), serum creatinine, and estimated glomerular filtration rate (eGFR) in the preoperative and postoperative periods (1w, 1m, 3m, 6m,12m) were compared. The operative successful rate (12 m) and postoperative complications were calculated. Results The serum calcium before PTX was (2.78±0.18) mmol/L, which decreased significantly to (2.19±0.34) mmol/L at 1 week postoperatively (P&amp;lt;0.01). The serum phosphorus before PTX was (0.76±0.16) mmol/L, which decreased significantly to (0.97±0.26) mmol/L at 1 week postoperatively (P&amp;lt;0.01). The PTH before PTX was (276.00±200.60) pg/mL, which decreased significantly to (46.62±104.36) pg/mL at 1 week postoperatively (P&amp;lt;0.01). The alkaline phosphatase before PTX was (261.59±236.95) U/L, which decreased significantly to (154.90±117.37) U/L at 3 months postoperatively (P&amp;lt;0.01). No significant difference was found in postoperative serum creatinine or eGFR levels compared with the baseline. The operative successful rate was 90.3% at 12 months postoperatively. The incidence rates of postoperative transient hypocalcemia, persistent hypoparathyroidism, and hoarseness were 35.5%, 3.2% and 3.2% respectively. No persistent hypocalcemia, incision hemorrhage, incision infection, or surgery-related death happened. Conclusion PTX can quickly and effectively alleviate high calcium, low phosphorus, high PTH and high alkaline phosphatase after renal transplantation. PTX is effective and safe in the treatment of PHPT after renal transplantation, and has no effect on renal allograft function.

A Comparative Study of Clinicopathological Profile and Surgical Outcomes of Endoscopic (Bilateral Axillo-Breast Approach) Versus Conventional Total Thyroidectomy for Thyroid Tumors

Surgical techniques are evolving more rapidly than ever. Minimal access endocrine surgery is the latest amalgamation of technology and surgical skills. Endoscopic thyroid surgery is usually demanded by young patients to avoid neck scar. The aim of this study was to review our experience and compare outcomes of endoscopic total thyroidectomy (ETT) using bilateral axillo-breast approach (BABA) with conventional open total thyroidectomy (COT), performed during January 2015–December 2018. Patients were divided into 2 groups: group A, through ETT, and group B, through COT. A total of 40 patients underwent ETT and 121 COT. There was no difference in both group in terms of age (median 38 years in group A vs 42 years in group B; p = 0.209) and gender (M:F = 1, 12.33 in group A vs 1:8.31 in group B; p = 0.763). Mean tumor size was significantly less in group A (3.90 cm in group A and 4.55 cm in group B; p = 0.048). Forty-five percent of patients developed transient hypocalcemia in group A, and 12.5% required IV calcium, whereas in group B, 52.89% of patients developed transient hypocalcemia, and 17.36% of patient required IV calcium. There was no permanent hypocalcemia in both groups. One (2.5%) patient had permanent voice change in ETT group. Increased postoperative stay (5.18 days in group A and 4.03 days in group B; p = <0.001) and operating time (median 195 min in group A and 165 min in group B; p = <0.001) in group A. A total of 11 patients had surgery for differentiated thyroid carcinoma in group A and 29 in group B. Postoperative parameters were comparable in both groups. Endoscopic procedures can be safely applied in various thyroid disease, even in larger goiter and malignant diseases. Although operating time, drainage, and hospital stay are longer in ETT, but perioperative outcomes are comparable with open surgeries.

Medical Management of Primary Hyperparathyroidism in Pregnancy: A Case Report and Brief Literature Review

There is no established standard of care for the medical management of primary hyperparathyroidism in pregnancy for those patients who are not surgical candidates. We present a case of primary hyperparathyroidism in the third trimester that was managed with cinacalcet and a literature review on the various modalities for the medical management of primary hyperparathyroidism in pregnancy. The primary aim of this case report is to document a case of hyperparathyroidism in pregnancy that was managed medically and to perform a brief systematic review of the literature available on the medical management of primary hyperparathyroidism in pregnancy. The secondary aim is to contribute to the literature available on the use of cinacalcet in pregnancy. A 37-year-old woman with untreated primary hyperparathyroidism presented at 32 weeks of gestation with hypercalcemia that was not amenable to surgical intervention. We treated her with increasing doses of cinacalcet with improvement in her serum calcium until developing pre-eclampsia which prompted emergent cesarean delivery of the infant. The neonate developed respiratory distress after delivery but did not develop hypocalcemia after birth. The neonate became transiently hypercalcemic in the setting of calcium gluconate infusions given to prevent hypocalcemia. The patient underwent surgical removal of a parathyroid adenoma and required calcium supplementation for 1 month afterwards. Hypercalcemic crisis during pregnancy is associated with significant maternal and fetal morbidity. There is limited information regarding the medical management of primary hyperparathyroidism due to the lack of high-powered studies and prospective studies owing to the relative rarity of the condition. No serious adverse maternal events were reported for either bisphosphonate or cinacalcet use. Adverse neonatal events include transient hypocalcemia of the infant with cinacalcet use and possibly low birth weight, infantile hypocalcemia, and shortened gestational periods with bisphosphonate use. J Endocrinol Metab. 2020;10(2):49-53 doi: https://doi.org/10.14740/jem624

Preoperative Vitamin D Supplementation in Patients With Vitamin D Deficiency Undergoing Total Thyroidectomy

Transient hypocalcemia due to parathyroid gland or vessel manipulation is a common complication following thyroidectomy. Considering the role of 25-hydroxyvitamin D (25(OH)D) in calcium hemostasis, this study aimed to evaluate the effect of preoperative vitamin D supplementation on hypocalcemia incidence in thyroidectomy patients. In this randomized clinical trial, 100 patients scheduled for total thyroidectomy and suffering from preoperative moderate or severe vitamin D deficiency were enrolled. Patients were randomly allocated to either study or control groups using the sealed envelope method. Patients in the study group received vitamin D3 50,000-unit pearl weekly for 4 weeks prior to the operation. The control group received placebo. Total and ionized serum calcium levels were checked before surgery, the day after surgery, and 2 weeks postoperatively. No significant difference was observed in terms of demographic data. During serial total calcium checks (5 episodes), total calcium levels changed significantly in patients who had received vitamin D supplements compared to the control group (P=0.043). Symptomatic hypocalcemia incidence was significantly lower in patients supplemented with 25-hydroxyvitamin D (25(OH)D) (P=0.04). Also, the requirement for intravenous calcium administration in order to treat the hypocalcemia symptoms was significantly lower in the study in comparison to the control group (P=0.03). Vitamin D supplementation in patients with vitamin D deficiency might lead to a lower incidence of early-onset symptomatic hypocalcemia; hence, requiring less calcium supplementation for the management of hypocalcemia.

Transoral Vestibular Thyroidectomy: Is the New Era Already Here?

Minimally invasive thyroidectomy sounds non-familiar to the general surgeon. Since conventional open approach has been widely adopted, surgeons in their effort to further improve their skills passed to the new era of the Natural Orifice Transluminal Endoscopic Surgery (NOTES). The widespread adoption of robotics has led to the inevitable usage of robotic technology in simple and more complicated procedures. Although cervical area is limited and difficult to handle the necessary instruments, many efforts have been noted and the new era in minimal invasive thyroidectomy is coming. Transoral vestibular thyroidectomy promises excellent cosmetic results, in accordance with the elimination of complications, such as recurrent laryngeal nerve injury. The safety of the procedure has to be the main thought for the surgeon who perform the technique. A comprehensive search of PubMed Database was conducted for English-language studies using a list of key words. All transoral vestibular thyroidectomies that had intraoperative and postoperative complications were included from January 2000 till December 2018. A total of 11 studies, including 428 patients that underwent transoral thyroidectomy via vestibular approach, were analyzed. Postoperative data and complications were gathered among these studies. Recurrent laryngeal nerve injury was more likely to be discovered during the first postoperative days as transient hoarseness. Small hematomas were noticed, and most of them were definitively treated at the hospital where the injury occurred. Transient hypocalcemia was treated with per os supplements. Transoral vestibular thyroidectomy is a safe and adequate alternative to conventional open approach, with excellent cosmetic results. On the other hand, surgeons must be already experienced and familiar with robotic or endoscopic techniques, so as to overcome the problem of the eliminated space in the central neck area.

Causes of hypocalcemia after thyroid surgery

Aim. To identify the causes affecting hypocalcemia and its frequency of causing after thyroidectomy.&#x0D; Methods. The study included 402 patients after thyroidectomy, 361 (89.8%) women and 41 (10.2%) men, for the period 20152019. The patients were between the ages of 14 and 77 years (average 4527.2 years). Patients were tested for the presence of hyperthyroidism, the volume of tissue removed and type of thyroidectomy, presence of repeated thyroid operations and accidental parathyroidectomy, the results of parathyroid autotransplantation and pathohistological reports. To determine the effect of these factors on hypocalcemia, patients were divided into three groups. The first group included patients (n=51, 12.7%) were underwent surgery for Graves disease, the second (n=335, 83.3%) for nodular goiter, and the third (n=16, 4%) for recurrent goiter. Statistical data analysis was performed with IBM SPSS 16.0. The results were analyzed by one-way analysis of variance or KruskalWallis test and the median test. Results were considered statistically significant at p 0.05 (two-sided criterion).&#x0D; Results. In the early postoperative period, 20 (5%) of 402 patients had hypocalcemia, of which 12 (3%) had transient hypocalcemia, and 8 (2%) had permanent hypocalcemia. Postoperative hypocalcemia was detected in 9 (17.6%) patients the first group, 8 (2.4%) patients in the second group, and 3 (18.8%) patients of the third group. Patients hypocalcemia was characterized based on the types of underwent operations as follows: in 14 (5.3%; p 0.05) patients after total thyroidectomy, in 1 (3.2%) patient after close to total thyroidectomy, in 1 (16.7%) patient after total thyroidectomy with central lymphatic dissection, in 1 (20%) patient after total thyroidectomy with central and lateral lymphatic dissection, in 3 (18.8%) patients after repeated surgery. Postoperative hypocalcemia was identified in 5 of 44 patients of the second group with thyroid carcinoma, as well as in 1 patient of the third group with the same pathology (p=0.246).&#x0D; Conclusion. Incidence of hypocalcemia was more frequent after surgery for hyperthyroidism, especially after total thyroidectomy; in 40% of cases, transient hypocalcemia was identified in patients with autotransplantation of the parathyroid gland after an accidental parathyroidectomy.

Comparison of safety and efficacy between total endoscopic resection and conventional open surgery for malignant thyroid tumors: a meta-analysis.

BackgroundEndoscopic thyroidectomy (ET) has been widely accepted as a surgical option for benign thyroid lesions, yet remains controversial in the treatment of malignant thyroid because of concerns with the safety and efficacies. This paper aims at systematically evaluating the advantages and disadvantages of ET in malignant thyroid tumors through meta-analyses.MethodsMeta-analysis was conducted by retrieving all studies on the treatment of malignant thyroid carcinomas released in database, including PubMed, Web of Science, Cochrane and Google scholar, from January 2005 to January 2019. Then the safety and efficacies were compared between the two surgical modalities based on current reports.ResultsTotally, 3,482 cases were included in 11 related studies. Most adverse outcomes by ET were involved in transient or permanent recurrent laryngeal nerve paralysis (RLN) and hypocalcemia, postoperative total complications, hemorrhage, hematoma at the incision, and total relapse rate following surgery. Besides, ET led to higher incidence of transient RLN palsy, yet significantly lower transient hypocalcemia than conventional open thyroidectomy (COT). The difference was insignificant regarding transient or permanent RLN and hypocalcemia, total postoperative complications, postoperative hemorrhage, incisional hematoma and total recurrent rate between the two procedures. Secondary outcomes consisted of operative time, hospital stay and cosmetic results, by which COT was superior to ET, yet cosmetic incision was better by ET than by COT. There was no significant difference in hospital stay.ConclusionsET can be feasible and safe surgical option for malignant thyroid lesions, with better cosmetic effect.

Surgery for retrosternal goiter: cervical approach.

Retrosternal goiter refers to when the thyroid gland extends from the neck to the substernal portion, descending below the thoracic inlet into the mediastinum. It is typically accompanied by compressive symptoms, and most patients need to undergo surgery. This retrospective study set out to analyze the surgical approach to retrosternal goiter and to evaluate perioperative complications, with the aim of recommending best surgical technique. We carried out retrospective analysis of 115 patients with retrosternal goiter treated at our center between May 4, 2011 and March 19, 2019. We analyzed patient characteristics, surgical methods, and perioperative complications using SPSS. Of the 115 patients in our study, 112 underwent thyroidectomy by cervical approach, with only 3 requiring an extracervical approach. The median age of the patients was 52.3 years, and the majority were female (81.74%). Most of the patients (73.91%) experienced no symptoms but were diagnosed with tracheal compression during surgery or preoperative imaging examination. Ninety-eight (85.22%) of our patients underwent preoperative evaluation of their condition by CT imaging. No obvious surgical contraindications were found before thyroid function tests. The mean operation time was 115.11 min, and the average amount of bleeding during surgery was 54.43 mL. The mean postoperative hospital stay was 5.38 days. In 109 cases (94.78%), the goiter was found to be benign, and malignancy was diagnosed in 6 patients (5.22%). Of the 112 patients who were treated with the cervical approach, 7 (6.25%) experienced recurrent laryngeal nerve palsy; 6 of these cases were transitory and 1 was permanent. The number of patients treated by cervical and extracervical approach who experienced transient hypocalcaemia was 23 (20.54%) and 2, respectively. Transient hypoparathyroidism affected 16 patients (14.29%) treated by cervical approach. Two patients had tracheomalacia phenomenon and one patient had pleural effusion after surgery. No cases experienced permanent hypocalcemia, permanent hypoparathyroidism, postoperative hematoma, tracheostomy, or death. Retrosternal goiter surgery is challenging for surgeons. The best surgical approach for the patient should be based on CT scan evaluation. In our study, based on preoperative CT imaging and in-operation evaluation, 50% of the tumor volume was located below the thoracic inlet and 50% of the tumor volume was located above the thoracic inlet in almost all of the patients. Both sections could be successfully removed via a cervical incision, and no obvious complications were observed during the perioperative period. With careful planning and execution before surgery and meticulous operation during surgery, most retrosternal goiters can be safely treated by cervical approach.

Parathyroid glands verification using the auto-fluorescence identification tool

In the clinical cases, one of the methods of intraoperative verification of the parathyroid glands (PTG) by visualization of the autofluorescence is considered. PTG have a unique ability for near-infrared autofluorescence, using endogenous fluorophores that are not yet fully characterized. Intraoperative imaging of PTG autofluorescence is possible using a camera that provides laser excitation of near-infrared light and visible white LED light. Without the introduction of any contrast agent, the spontaneous fluorescence of PTG to near-infrared light allows accurate identification of unchanged PTG in almost all cases. Angiography using ICG fluorescence is performed to patients after thyroidectomy to visualize the blood supply of identified PTGs and assess their viability. In clinical cases, patients were described: 2 with diagnosed with papillary thyroid cancer, 1 with a diagnosis of primary hyperparathyroidism. Adenoma of the lower right PTG. In all cases, the specified method of imaging of the thyroid gland was used, first without contrast agent at the stage of PTG extraction, then with the introduction of indocyanine green solution (ICG) at the final stage of the operation. This greatly improved the imaging of unchanged thyroid glands, the assessment of their viability and the prognosis of possible hypocalcemia in the early postoperative period. This clinical cases suggest that the use of the effect of autofluorescence with intravenous intraoperative administration of iodine-containing contrast agent ICG, enables a clear visualization of the parathyroid glands and the evaluation of the vascular trophism of the latter. This is especially important in cases of total thyroidectomy with extensive neck dissections, since the risk of damage to the thyroid gland, especially when the latter within the thymus, is quite high. In addition, the laboratory tests performed in the postoperative periods peak in favor of the effect of autofluorescence, since it provides data for analysis and prevention of postoperative transient hypocalcaemia.

Clinicopathological study of thyroid swelling and its management

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; There is high prevalence of thyroid lesions in India. In this study, an attempt is made to find out the clinical spectrum of thyroid swellings in central India, diagnostic accuracy of fine needle aspiration cytology (FNAC), appropriate surgical management and to compare it with postoperative histopathological diagnosis so as to determine its role in surgical management.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In this prospective study, 100 subjects presenting to ENT OPD of GMC, Nagpur during the period from September 2017 to August 2019 with thyroid swelling who were fit to undergo surgery and willing to participate in the study were selected. After detailed evaluation and routine investigations, thyroid function test (TFT), FNAC, ultrasonography (USG) neck, all the subjects underwent required thyroidectomy. The postoperative histopathological examination (HPE) report was correlated with cytological report. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In 100 subjects, majority of subjects were from 4th decade (32%) with female: male ratio=6.14:1. FNAC findings were colloid goiter (61%), nodular goiter (19%), follicular neoplasm (10%), and papillary carcinoma (9%). On HPE, colloid goitre (57%) was most common non-neoplastic lesion and papillary carcinoma (65.21 %) was most common malignant lesion. Hemithyroidectomy (70%) was most common procedure done. Transient hypocalcemia (5%), recurrent laryngeal nerve (RLN) paresis (2%) were the postoperative complications encountered. Sensitivity, specificity, accuracy, positive and negative predictive values of FNAC to diagnose malignancy were 55.6%, 100%, 91%, 100% and 90% respectively.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; FNAC is an easy, rapid, reliable, cost-effective, minimally invasive and readily repeatable technique for diagnosis of thyroid swellings. The common false negative diagnosis is seen in follicular pattern cases, cystic papillary thyroid carcinoma (PTC) and papillary microcarcinoma. &lt;/p&gt;