Unilateral Thyroid Lobe Research Articles

Retrospective analysis of prognostic factors in patients of papillary thyroid microcarcinoma.

We performed a retrospective chart review of 245 patients with papillary thyroid microcarcinoma (PTMC) to define factors linked to central lymph node metastasis and thus prognosis. Univariate and multivariate analyses showed that being male (p < 0.001), age <45 years at diagnosis (p = 0.045), maximum tumor size > 5 mm (p = 0.030), multifocal tumor (p = 0.040) and tumor envelope invasion (p < 0.001) were all independent risk factors for central compartment lymph node metastasis. Unifocal lesions at the thyroid gland’s upper pole, middle and lower pole, had lymph node metastasis rates of 22.7%, 14.0% and 35.0%, respectively (p = 0.048). The rate of central lymph node metastasis was much higher when there was bilateral thyroid involvement than with multifocal unilateral lesions (58.6% vs 37.5%; p = 0.040). These results suggest that for patients at low risk of central lymph node metastasis, unilateral thyroid lobe and isthmus resection is sufficient. However, for patients at high risk of central lymph node metastasis, central lymph node dissection increases the likelihood of complete tumor excision.

Long-term outcome of thyroid lobectomy for unilateral multifocal papillary carcinoma.

The National Comprehensive Cancer Network (NCCN) guidelines recommend completion thyroidectomy for patients with multifocal papillary thyroid carcinoma (PTC) diagnosed by paraffin pathology after lobectomy. However, studies for the influence of surgical range on prognosis of unilateral multifocal carcinoma are scarce. We analyzed the clinicopathological characteristics and long-term outcomes of patients with unilateral multifocal PTC to identify risk factors for recurrence and disease-related death.The clinical and pathological data of 123 cases with multifocal lesions in the unilateral thyroid lobe were retrospectively collected, including sex, age, stage, surgical range, histopathology characteristics, and follow-up data. The prognostic factors were analyzed by means of the Kaplan–Meier method.The recurrence in the contralateral residual thyroid was observed in 6 cases. The 10-year cumulative recurrence rate of the remnant thyroid was 7.0%. Extrathyroidal extension (ETE) was a significant prognostic factor, with χ2 equal to 4.043 and a P value of .044. One patient died from progression of pulmonary metastasis during the follow-up. The 10-year disease-specific survival rate was 96% and 14 cases experienced recurrences and underwent a second surgery (11.4%), and thus the 10-year recurrence-free survival rate was 83.2%. Multivariate analysis showed that the pathologic tumor (pT) stage was an independent prognostic factor for the recurrence-free survival rate (P <.0001, hazard ratio 2.871, 95% confidence interval 1.783–4.624).ETE is a significant prognostic factor for the recurrence of the remnant thyroid and pT stage is an independent prognostic factor for tumor recurrence-free survival. Lobectomy (with isthmectomy) is effective for most patients with unilateral multifocal PTC.

Postotic and preotic cranial neural crest cells differently contribute to thyroid development

Thyroid development and formation vary among species, but in most species the thyroid morphogenesis consists of five stages: specification, budding, descent, bilobation and folliculogenesis. The detailed mechanisms of these stages have not been fully clarified. During early development, the cranial neural crest (CNC) contributes to the thyroid gland. The removal of the postotic CNC (corresponding to rhombomeres 6, 7 and 8, also known as the cardiac neural crest) results in abnormalities of the cardiovascular system, thymus, parathyroid glands, and thyroid gland. To investigate the influence of the CNC on thyroid bilobation process, we divided the CNC into two regions, the postotic CNC and the preotic CNC (from the mesencephalon to rhombomere 5) regions and examined. We found that preotic CNC-ablated embryos had a unilateral thyroid lobe, and confirmed the presence of a single lobe or the absence of lobes in postotic CNC-ablated chick embryos. The thyroid anlage in each region-ablated embryos was of a normal size at the descent stage, but at a later stage, the thyroid in preotic CNC-ablated embryos was of a normal size, conflicting with a previous report in which the thyroid was reduced in size in the postotic CNC-ablated embryos. The postotic CNC cells differentiated into connective tissues of the thyroid in quail-to-chick chimeras. In contrast, the preotic CNC cells did not differentiate into connective tissues of the thyroid. We found that preotic CNC cells encompassed the thyroid anlage from the specification stage to the descent stage. Finally, we found that endothelin-1 and endothelin type A receptor-knockout mice and bosentan (endothelin receptor antagonist)-treated chick embryos showed bilobation anomalies that included single-lobe formation. Therefore, not only the postotic CNC, but also the preotic CNC plays an important role in thyroid morphogenesis.

Frequency and pattern of central lymph node metastasis in papillary carcinoma of the thyroid isthmus.

The purpose of this study was to evaluate the frequency and pattern of central lymph node metastasis in isthmic papillary thyroid carcinoma (PTC). We compared the clinical and pathological data of 45 patients with a single isthmic PTC and 149 patients with a single PTC located in the unilateral thyroid lobe, all of whom underwent total thyroidectomy and bilateral central neck dissection. The rates of clinical, pathologic, and occult central lymph node metastasis were higher in the isthmus group than the non-isthmus group. Central lymph node metastasis in the pretracheal and bilateral paratracheal lymph nodes was more frequent in the isthmic PTC group than in the non-isthmus group. On multivariate analysis, isthmic location of the tumor was an independent risk factor for central lymph node metastasis. Complete bilateral central neck dissection should be considered for isthmic PTC because of the high rate of bilateral central lymph node metastasis, especially to pretracheal and bilateral paratracheal lymph nodes. © 2015 Wiley Periodicals, Inc. Head Neck 38: E412-E416, 2016.

Thyroid Gland Tumours in the Horse: Clinical Diagnostic, Treatment and Histological Characterisation

Reasons for performing studyTumours of the thyroid gland are rare in the equine species. In literature varying clinical signs and diagnostic findings are described in single reports and case series. Reported clinical signs are related to upper airway compression or thyroidal metabolic activity. A considerable risk of laryngeal hemiplegia is described when horses were treated with hemithyroidectomy [1].ObjectivesTo review 11 horses referred with a unilateral thyroid neoplasia in order to describe clinical presentation, diagnostic findings, treatment and outcome. Histopathology was performed on all resected thyroid lobes.Study designRetrospective case series.MethodsRecords from horses with histologically confirmed thyroid tumours treated with unilateral thyroid lobe resection were reviewed (2003–2013). Short‐term outcome was defined for 2 weeks after surgery. Owners’ questionnaire was performed for evaluation of long‐term outcome defined as a minimum of 6 months.ResultsAffected horses were aged between 6 and 21 years. In contrast to literature the majority of tumours were adenocarcinomas (9/11), mainly found in mares (8/9). Histology revealed follicular and parafollicular (C‐cell) mixed growth pattern of the carcinomas. Tumour size, growth rate and sonographic appearance did not correlate to histological characteristics. Ventral displacement of the thyroid lobe and close preparation along the thyroid capsule during surgical resection are inevitable to avoid damage to laryngeal nerves. Seroma formation was the only observed short‐term complication. No long‐term complications occurred.ConclusionsHemithyroidectomy is regarded the treatment of choice in horses with a unilateral thyroid lobe neoplasia with excellent long‐term prognosis. High incidence of malignant tumours particularly in mares has to be considered. Tumour characteristics can only be derived from histopathology and immunhistochemistry.Ethical animal research: Ethical committee oversight not currently required by this congress: retrospective study of clinical records. Explicit owner informed consent for participation in this study was not stated. Sources of funding: None. Competing interests: None.

Recurrent laryngeal nerve palsy during surgery for benign thyroid diseases: Risk factors and outcome analysis

We investigated the risk factors for postoperative recurrent laryngeal nerve (RLN) palsy and related outcomes in patients with benign thyroid diseases. From 2008 to 2010, 844 thyroidectomies for benign thyroid diseases (benign nodules in 447; Graves' disease in 377; huge goiter attributable to Hashimoto thyroiditis in 20) were performed at Noguchi Thyroid Clinic and Hospital Foundation. The otolaryngologists screened all patients for the presence or absence of RLN palsy by laryngoscope, both pre- and postoperatively. When RLN palsy was present, the patients were checked periodically by laryngoscopy without additional drug therapy until the recovery of vocal cord palsy or loss of contact. A total of 1,374 nerves were at risk during the thyroid surgery (bilateral risk in 530, unilateral risk in 314). No patient exhibited a bilateral RLN palsy. Unilateral postoperative RLN palsies were found in 45 patients (benign nodules in 25, Graves' disease in 19, and Hashimoto thyroiditis in 1). The RLN was involuntarily amputated in five patients during the operation. The incidence of RLN palsy was 5.3% per patient and 3.3% per nerve. The incidence of RLN palsy was greater in patients who underwent complete unilateral thyroid lobe resection compared with partial resection of the lobe (P = .04). The occurrence of RLN palsy was associated with the need for reoperation caused by postoperative bleeding and the reduced weight of the thyroid remnant in Graves' disease (P = .04 and P = .03, respectively). Among 40 patients with RLN palsy and excluding 5 amputated patients, the RLN palsy resolved in 34 patients (85%) within 12 months after the procedure. The remaining 6 patients (15%) were considered to have permanent RLN palsies. Complete resection of the thyroid lobe and reoperation for postoperative bleeding are the risk factors for postoperative RLN palsy in patients with benign thyroid nodules. In Graves' disease, smaller weight of the residual thyroid tissue contributes to the occurrence of RLN palsy. Most RLN palsies that do not require amputation of the nerve resolve spontaneously within 12 months after surgery. In this study, the palsy remained in 1.3% (11/844) of patients.

A young fit man presenting to the emergency department with a painful neck due to a thyroid abscess

### Learning Point for Clinicians This case exemplifies the need to consider less common diagnoses if a patient’s presentation is non-classical, such as in our patient who had an erythematous neck, unilateral thyroid lobe enlargement and grossly elevated white cell count and C-reactive protein (CRP) that would not be expected to occur with viral thyroiditis. A 38-year-old Caucasian man presented to our emergency department with a week’s history of sore throat, dysphagia, neck swelling and fever. One month prior, he experienced a respiratory tract infection, for which he had not sought medical advice and which had resolved without antibiotics. He had no history of trauma or procedures involving the neck. He had no notable past medical or family history. He was a non-smoker and drank 15 U of alcohol per week. On examination, he was a young fit man, slightly sweaty and flushed but otherwise looked …

Hydatid cyst of the thyroid gland: report of three cases

Cystic Echinococcosis is a parasitic infestation that is distributed world-wide. It may be found in nearly any part of the body, most often in the liver and the lungs, but occasionally in other structures such as the thyroid gland. The present study reports three cases of hydatid cysts of the thyroid gland, in patient ranging from 18 to 25 years of age. Two patients had concomitant hydatid disease involving organs other than the thyroid gland (secondary disease), and one had, sole, involvement of the thyroid gland itself (primary disease). Moreover, an occult papillary thyroid carcinoma was detected incidentally in one case, involving the unilateral thyroid lobe as the hydatid cyst. While several surgical procedures including left lobectomy and isthmectomy were undertaken in one patient, two patients underwent total thyroidectomy. No disease recurrence was observed in any of the three patients during the postoperative follow-up period. No study reporting the concomitance of hydatid cyst and neoplasia of the thyroid gland has been previously published. This concomitance indicates the importance of the differential diagnosis of lesions characterized by calcifications in the thyroid gland, especially in endemic regions.

Massive Chronic Organizing Thyroid Abscess Masquerading Thyroid Cancer

We present here a case of a 65-year-old male with atypical presentation of long standing chronic thyroid abscess, which initially mimicked malignancy, with a brief discussion of the presentation, diagnosis and possible risk factors for chronic thyroid abscess confined to unilateral thyroid lobe. doi:10.4021/jem8w

Massive Chronic Organizing Thyroid Abscess Masquerading Thyroid Cancer

We present here a case of a 65-year-old male with atypical presentation of long standing chronic thyroid abscess, which initially mimicked malignancy, with a brief discussion of the presentation, diagnosis and possible risk factors for chronic thyroid abscess confined to unilateral thyroid lobe. J Endocrinol Metab. 2011;1(2):90-91 doi: https://doi.org/10.4021/jem8w

Endoscope-assisted thyroidectomy by chest approach with good cosmetic results

To explore the feasibility, safety, and cosmetic efficacy of endoscope-assisted thyroidectomy (EAT) by chest approach. Fifty-one patients with single benign thyroid nodule < or = 4.0 cm in diameter, and without history of neck surgery or irradiation, 8 males and 43 females, aged 33.9 (18-64), underwent endoscope-assisted thyroidectomy by chest approach: a skin incision with the length of 4 cm was made in the chest, an endoscope was inserted, and subtotal or total thyroidectomy with the technique similar to that in conventional surgery was performed with naked eyes. Subtotal thyroidectomy was performed in 49 patients, and total excision of unilateral thyroid lobe plus isthmus lobectomy and contralateral partial lobectomy was performed on the other 2 patients. No patient was transferred to traditional surgery. Only one case showed palsy of recurrent nerve. Most patients expressed with the cosmetic results. EAT is a feasible and safe procedure with rather good cosmetic

Parathyroid carcinoma: clinical presentation and treatment

Carcinoma of the parathyroid gland is a rare cause of primary hyperparathyroidism, with incidence of less than 1%. Parathyroid carcinomas usually grow slowly, with a tendency for local invasion. The preoperative differential diagnosis between carcinoma and adenoma of parathyroid gland is often difficult because many of the signs and symptoms are similar. Patients with parathyroid carcinoma have a generally higher serum calcium level and PTH level, and incidence of renal and bone diseases, pancreatitis, peptic ulcer, and anemia. The most effective therapy for parathyroid cancer is complete resection of the tumor together with the ipsilateral thyroid lobe.We reviewed the case of a 64-year-old woman with parathyroid carcinoma, who had severe hypercalcemia, hypertension, asymptomatic nephrolithiasis, fracture of the neck of the right femur, hypertension, and anemia. A hard mass was palpable on the right side of her neck. The tumor was resected and blocked by the unilateral thyroid lobe. Histopathological examination showed parathyroid carcinoma. The patient was given adjuvant radiation therapy and there was no evidence of recurrence 32 months after surgery.