Thyroidectomy

Background: The purpose of this study is to evaluate the suitability of lobectomy with isthmusectomy (LwI) in treatment of Follicular Thyroid Neoplasms (FTN), considering malignancy incidence and postoperative complications. Methods: 192 patients (165 females; 27 males) who underwent LwI for FTN from 01/2005 to 12/2007 were retrospectively evaluated: clinical and pathological features, surgical complications and five year outcome of the remnant lobe. Inclusion criteria were cytological Bethesda category III and IV or histological follicular architecture. Patients with metastatic follicular carcinoma or previous thyroid surgery were excluded. Results: Mean age was 48,68±14,93yrs. Overall malignancy occurred in 88 patients (45,83%) and 80 (41,67%) underwent thyroidectomy completion (TC), mainly by index lesion's malignancy. Forty-one (21,35%) in LwI and 31 (38,75%) in TC specimens had associated malignancy, mainly papillary microcarcinomas. High preoperative Thyroid-Stimulating Hormone (TSH), histological multinodularity and, in cytology category IV, younger age, were significantly associated to malignancy. Permanent recurrent laryngeal nerve lesion occurred in 0,58% in Lwl and 1,52% in TC, and temporary dysphonia occurred in 9,25% and 6,06% (LwI and TC respectively). No LwI patients presented hypoparathyroidism and 3,03% in TC had temporary symptoms. In LwI, 36,70% developed hypothyroidism. Higher preoperative TSH was associated with hypothyroidism development. Conclusions: LwI was inappropriate in 40,10% patients with malignancy who required TC and 23,12% had no functional benefit because post-LwI hypothyroidism. Nodular relapse was reported in at least 23/113 LwI patients (20,35%). We propose total thyroidectomy for patients with FTN preoperative TSH higher than 2,16 mU/L and, in Bethesda category IV, less than 39,5yrs.

Long non-coding RNAs (lncRNAs) regulate pathological processes, yet their potential roles in papillary thyroid carcinoma (PTC) are poorly understood. To profile transcriptionally dysregulated lncRNAs in PTC and identify lncRNAs associated with clinicopathological characteristics. We performed RNA sequencing of 12 paired PTC tumors and matched noncancerous tissues and correlated the expression of lncRNAs with clinical parameters. The 2 most significantly dysregulated lncRNAs were studied in an Ohio PTC cohort (n=109) and in PTC data (n=497) from TCGA. A combination of laboratory-based studies and computational analysis using clinical data and samples and a publically available database. Correlation between expression values and clinical parameters. We identified 218 lncRNAs showing differential expression in PTC (fold change ≥2.0, p value <0.01). Significant correlation was observed between the expression of two lncRNAs (XLOC_051122 and XLOC_006074) and (i) lymph node metastasis (...

Recurrent laryngeal nerve (RLN) palsy is a devastating complication of thyroidectomy. Although neurapraxia is thought to be the most common cause, the underlying mechanisms are poorly understood. The objectives of this study were to examine the differential palsy rates between the left and right RLNs, and the role of intraoperative nerve swelling as a risk factor of postoperative palsy. Thyroidectomy data were collected, including demographics, change in RLN diameter, and RLN electromyographic (EMG) reading. Left and right RLNs, as well as bilateral and unilateral subgroup analyses were performed. A total of 5,334 RLNs were at risk in 3,408 thyroidectomies in this study. The overall RLN palsy rate was 1.5%, greater on the right side than the left for bilateral cases (P = .025), and greater on the left side than the right for unilateral cases (P = .007). In a subgroup of 519 RLNs, the diameter and EMG amplitude were measured. The RLN diameter increased by approximately 1.5-fold (P &l...

The most common cause of hyperthyroidism in Australia is Graves disease, caused by a defect in immunoregulation in genetically predisposed individuals, leading to production of thyroid-stimulating antibodies. Each of the three modalities of therapy for Graves disease--thionamide drugs, subtotal or total thyroidectomy, and radioactive iodine ablation--can render the patient euthyroid, but all have potential adverse effects and may not eliminate recurrences. Hypothyroidism occurs in about 5% of the adult population; most present with "subclinical" hypothyroidism (mild thyroid failure), characterised by raised levels of serum thyroid stimulating hormone (TSH) but normal free thyroxine (T(4)). The most common cause of hypothyroidism in Australia is autoimmune chronic lymphocytic thyroiditis, characterised by raised circulating levels of thyroid peroxidase antibody. Symptoms and signs of hypothyroidism are often mild or subtle and, when there is clinical suspicion, thyroid func...

Parathyroid hormone (PTH) levels are often measured after thyroid surgery and are used to detect patients at risk for postoperative hypoparathyroidism. However, there is a lack of consensus in the literature about how to define the recovery of parathyroid gland function and when to classify hypoparathyroidism as permanent. The goals of this study were to determine the incidence of low postoperative PTH in total thyroidectomy patients and to monitor their time course to recovery of parathyroid gland function. We identified 1054 consecutive patients who underwent a total or completion thyroidectomy from January, 2006-December, 2013. Low PTH was defined as a PTH measurement <10 pg/mL immediately after surgery. Patients were considered to be permanently hypoparathyroid if they had not recovered within 1 y. Recovery of parathyroid gland function was defined as PTH ≥10 pg/mL and no need for therapeutic calcium or activated vitamin D (calcitriol) supplementation to prevent hypocalcemic ...

We report a 39-year-old female who underwent a total thyroidectomy as treatment for a thyroid papillary cancer. She suffered several episodes of mild angioedema in lips and tongue, after using different commercial Levothyroxine formulations, with and without excipients. Given the need to use this drug, the patient was admitted in our hospital and we proceeded to desensitize her with oral Levothyroxine. The patient fasted throughout the whole procedure, was properly monitored and had an adequate peripheral venous access. On the first day of the procedure, a 15-step protocol was performed, first administering placebo and then, compounded formulations of Levothyroxine starting from 0.01 ug, followed by doubling doses every 15 minutes until the cumulative dose of 111.95 ug was completed, corresponding to the daily dose of Levothyroxine her endocrinologist prescribed (112 ug). The patient was monitored at baseline, between each dose and up to 3 hours after the procedure was completed. Th...

Diabetes insipidus is a clinical entity that is often seen in neurosurgical patients either during or immediately after transsphenoidal hypophysectomy. Rarely, diabetes insipidus can manifest as a new entity months later in patients who have previously had an intracranial injury or operation.

Purpose This study was done to compare quantitative elastosonography and ultrasound analysis in the characterisation of thyroid nodules. Materials and methods From July 2009 to September 2011, 123 patients with 147 thyroid nodules were included in our study. All patients enrolled had to undergo thyroidectomy because of nodular thyroid disease (goitre or nodules). After preliminary examination with conventional ultrasound (US) and colour Doppler US, the patients were examined with elastosonography, using high-level equipment (Toshiba Aplio XG) and quantitative software (Elasto-Q). Each lesion was characterised using an US score (echogenicity, borders, microcalcifications and colour Doppler pattern), and then by elastosonographic strain ratio. Each patient subsequently underwent thyroidectomy. Histological results were used as the gold standard. Results Histological examination demonstrated 89 benign and 58 malignant lesions. On average, the strain ratio value was 2.84±2.69 (range, 0.05–14.5; p=0.001). Sensitivity and specificity of the US score were about 56% and 72%, respectively, whereas those of the strain ratio were 93% and 89%, using a cut-off of 2 obtained with receiver operating characteristic (ROC) curve analysis. Elastosonography was more accurate than US and colour Doppler US in characterising thyroid nodules (p=0.002). Conclusions Quantitative elastosonography is a useful diagnostic tool in the evaluation of thyroid lesions, and can be used to limit fine-needle aspiration cytology and improve the selection of patients for thyroidectomy. Obiettivo Scopo del presente lavoro è stato confrontare elastosonografia quantitativa ed analisi ecografica nella caratterizzazione del nodulo tiroideo. Materiali e metodi Tra luglio 2009 e settembre 2011 sono stati arruolati 123 pazienti con 147 noduli candidati all’intervento di tiroidectomia totale per la presenza di patologia nodulare tiroidea. Dopo valutazione preliminare con ecografia e color Doppler, i pazienti sono stati sottoposti ad elastosonografia, mediante software quantitativo Elasto-Q con apparecchiatura Toshiba Aplio XG. Ogni nodulo è stato caratterizzato mediante ecoscore (ecogenicità, margini, microcalcificazioni, pattern color Doppler) e indice di deformabilità (strain ratio). I risultati istologici sono stati utilizzati come gold standard. Risultati I noduli esaminati sono risultati benigni in 89 casi e maligni in 58. Alla valutazione elastosonografica la media dei valori di strain ratio è stata 2,84±2,69 (p=0,001). Si sono ottenuti valori di sensibilità e specificità rispettivamente 56% e 72% per l’eco-score e 93% e 89% per lo strain ratio, utilizzando un cut-off pari a 2, con un valore predittivo positivo del 55% e dell’82% rispettivamente. La tecnica elastosonografica ha mostrato maggiore accuratezza dell’ecografia e del color Doppler nella caratterizzazione delle lesioni tiroidee (p=0,002). Conclusioni L’elastosonografia quantitativa è uno strumento valido per la caratterizzazione dei noduli tiroidei, utile per ridurre il ricorso all’agoaspirato, in particolare nei casi incerti.

The external branch of the superior laryngeal nerve (ELN) is intimately associated with the superior thyroid artery (STA) in relation to the superior pole of the thyroid gland, rendering it vulnerable to injury during the ligation of this vessel during thyroidectomy. Although most texts acknowledge the fact that the nerve is in close relation to the STA, there has not been an anatomical study to relate the position of the ELN to the superior pole of the thyroid gland. The aim of this study was to determine the shortest distance, from the most superior point of the thyroid gland, to the ELN. Bilateral micro-dissection on 43 adult cadavers, excluding those with thyroid pathology and previous thyroidectomies, was undertaken. The most superior point of the superior pole of the thyroid gland was identified and the shortest distance to the ELN was measured with a digital calliper (accuracy 0.01 mm). The metric study indicated a mean distance from the ELN to the superior pole of a normal sized thyroid gland of 5.76 mm (range: 2.00-11.26) on the right, and 6.17 mm (range: 2.78-13.48) on the left. From the literature, it is clear that the ELN may even be closer to the superior pole of an enlarged thyroid gland. The recommendation to stay on the substance of the superior pole of the thyroid gland when ligating the STA remains valid, as the nerve is extremely close in relation to the superior pole of the normal thyroid gland.

A retrospective study of 1534 consecutive biopsies Aim of study > To assess the value of intraoperative frozen-section diagnosis in thyroid surgery and determine its limitations. Methods > This retrospective study examined the results of 1534 frozen sections of thyroid specimens analyzed over the 11-year period from 1995 through 2005 and their correlations with the final histological examination. Deferred responses were not taken into account for statistical calculations. Results > In our series, frozen-section diagnosis was concordant with subsequent histopathological examination in 92% of cases, discordant in 3%, and deferred in 5%. The global specificity of frozen section analysis for all histological subtypes was 99.8% and its sensitivity 67%. Its sensitivity for thyroid cancer was lower in follicular (42%) and papillary carcinoma (64%) than medullary (100%), anaplastic (100%), secondary (100%), mixed (100%), and insular carcinomas (86%). Conclusion > In our series, as in the literature, most of the discordances between frozen-section and definitive diagnosis were associated with microfollicular lesions, which explain the low tome 37 > n86 > juin 2008 > cahier 1

Thyroid eye disease (TED) is the most frequent extrathyroidal manifestation of Graves' disease. In most instances it is mild and non-progressive, but in 3%-5% of cases it is severe. Non-severe TED requires only supportive measures, such as eye ointments, sunglasses and prisms. By contrast, severe TED requires aggressive treatment, either medical (high-dose glucocorticoids, orbital radiotherapy) or surgical (orbital decompression). The choice of treatment relies on the assessment of both TED severity and activity. Removal of controllable risk factors, especially cigarette smoking, is important to improve the course and the therapeutic outcome. A coordinated approach to the treatment of hyperthyroidism and TED is also required. Novel promising treatments, to be verified in large series of patients, include somatostatin analogues and cytokine antagonists.

Amiodarone-induced hyperthyroidism has on most instances been reported as mild, and thyroid functions return to normal after discontinuation of the drug. Nevertheless, life-threatening amiodarone-induced thyrotoxicosis has also been described. Conventional treatments such as antithyroid drugs (thionamide) and corticosteroids are essentially ineffective or fail to alter the dramatic course of the thyroid crisis. This limited effectiveness of medical therapy, particularly in patients with previously neglected or unknown thyroid disease, prompted us to intervene surgically. We report a series of nine patients who underwent total or near-total thyroidectomy as a first-line therapy for five of them. Surgery resulted in rapid resolution of thyrotoxicosis with an uneventful postoperative course. This approach has the advantage of immediate effectivity, low risk of relapse, and appears to be the only treatment that permits continued therapy with amiodarone when the drug appears needed to control a life-threatening arrhythmia.

Thyroid eye disease (TED) is newly diagnosed at a rate of approximately 2.9 men and 16 women per 100,000 people every year. 1 This relatively rare disease mainly affects patients who have been diagnosed with Graves hyperthyroidism (90%). However, up to 5% of patients with TED are euthyroid, and another 3% of TED patients have Hashimoto's thyroiditis. Current research to elucidate the pathophysiology of TED has focused mainly on the autoimmune component of anti-thyroglobulin and its effects on intraorbital fibroblasts. The predominant features of TED include exophthalmos related mainly to increased adipose tissue and intraorbital muscle enlargement. This tissue expansion within the limited orbital space provided by the rigid bony orbit causes most of the pathology related to TED.

The findings in hyperthyroid patients with Graves' orbitopathy (GO) of antibodies against antigens shared between the thyroid and orbit, such as the TSHreceptor (TRAb) and a novel protein G2s (G2sAb), suggested a possible common therapeutic strategy. However, the gold therapeutic standard for hyperthyrodism in these patients remains still unsettled and is mainly based on personal experience. Studies on the effect of total thyroidectomy (TT) alone or followed by radioiodine ablation (RAI) of thyroid remnants showed often conflicting results. This longitudinal study was aimed at evaluating the influence of TT alone or followed by post-surgical RAI with respect to methimazole treatment on the activity and severity of GO in patients with hyperthyroidism and GO. Sixty consecutive patients with Graves' disease and mild/ moderate GO were studied and grouped as follows: group 1, including 25 patients (16F, 9M) undergoing TT alone; group 2, including 10 patients (8F, 2M) undergoing TT followed by RAI for histological evidence of differentiated thyroid cancer; group 3, including 25 patients (18F, 7M) euthyroid under methimazole therapy, studied as controls. Clinical study of ophthalmopathy and measurements of TRAb and G2sAb were performed in all patients at start of the study (time of TT for group 1 and RAI after TT for group 2 and of the first finding of euthyroidism under methimazole treatment for group 3) and after 6, 12, 24 months. Patients of both groups 1 and 2 showed an early significant decrease and a further progressive reduction of the activity and severity of GO with a disappearance of TRAb and a decrease of G2sAb levels during the followup, without statistically significant differences between the two groups. Patients in group 3 showed a much later and less marked improvement of GO with persistence of TRAb and G2sAb positivity, even if with reduction of TRAb levels at 12 and 24 months. Our results suggest that in Graves' patients with large goiter or relapse of hyperthyroidism and mild/moderate GO, TT alone could be an advisable choice to treat hyperthyroidism also improving GO with reduction of cost/benefit ratio.

Background: Advanced vessel sealing devices provide an alternative to conventional ligation techniques for thyroidectomy. To date, most studies have been inadequately powered to explore differences in the infrequent post-operative complications following thyroidectomy. This study is designed to compare the outcomes of sutureless thyroidectomy and conventional thyroidectomy for recurrent laryngeal nerve (RLN) injury, permanent hypoparathyroidism, and haematoma formation. Methods: A cohort study of consecutive patients undergoing total thyroidectomy using conventional versus sutureless techniques was performed. Sutureless thyroidectomy was performed using either Ligasure Precise (Covidien) or Harmonic Focus (Johnson and Johnson) devices. The primary outcome measures were post-operative haemorrhage, permanent RLN injury and hypoparathyroidism. Secondary outcome measures were operative time, temporary hypoparathyroidism and vocal cord dysfunction. A cost minimization analysis comparing the two techniques was performed. consecutive patients underwent total thyroidectomy. Of these, 772 underwent conventional thyroidectomy and 1163 were performed using a sutureless technique. The mean operative time was significantly lower in the sutureless group (71 versus 86 min, P = 0.02). There was no difference in the post-operative complications of haematoma (0.78% conventional versus 1.12% sutureless, P = 0.46), permanent hypoparathyroidism (1.30% conventional versus 0.52% sutureless, P = 0.06) or permanent RLN injury (0.26% conventional versus 0.52% sutureless, P = 0.39). There was an overall cost saving of AUD$14 300 per 100 total thyroidectomy cases performed using the sutureless technique. Conclusions: Sutureless thyroidectomy is a safe and efficient way of performing total thyroidectomy and has the potential to reduce operating room costs.

In the last decades, a surprising increased incidence of differentiated thyroid cancer (DTC), along with a precocious diagnosis of ''small'' tumors and microcarcinomas have been observed. In these cases, better oncological outcomes are expected, and a ''tailored'' and ''less aggressive'' multimodal therapeutic protocol should be considered, avoiding an unfavorable even if minimal morbidity following an ''overtreatment.'' In order to better define the most suitable surgical approach, its benefits and risks, we discuss the role of surgery in the current management of DTCs in the light of data appeared in the literature. Even if lymph node metastases are commonly observed, and in up to 90 % of DTC cases micrometastases are reported, the impact of lymphatic involvement on longterm survival is still argument of intensive research, and indications and extension of lymph node dissection (LD) are still under debate. In particular, endocrine and neck surgeons are still divided between proponents and opponents of routine central LD (RCLD). Considering the available evidence, there is agreement about total thyroidectomy, therapeutic LD in clinically node-positive DTC patients, and RCLD in ''high risk'' cases. Nevertheless, indications to the best surgical treatment of clinically node-negative ''low risk'' patients are still subject of research. Considering on the one hand, the recent trend toward routine central lymphadenectomy, avoiding radioactive treatment, and on the other hand, the satisfactory results obtained reserving prophylactic LD to ''high risk'' patients, we think that further prospective randomized trials are needed to evaluate the best choice between the different surgical approaches.

Background. Identification of recurrent laryngeal nerve (RLN) has decreased the rates of permanent RLN palsy during thyroid operations; however, unexpected RLN palsy still occurs, even though the visual integrity was assured and most nerve injuries were not recognized intraoperatively. The aim of this study is to determine the causes of RLN palsy and to identify potentially reversible causes of RLN injury during the operation with the application of intraoperative neuromonitoring (IONM). Methods. One hundred and thirteen patients with 173 nerves at risk were enrolled in this study. All operations were performed by the same surgeon. The 4-step procedure of IONM was designed to obtain electromagnetic (EMG) signals from the vagus nerve and RLN before and after resection of thyroid lobe. Results. Sixteen nerves had loss of EMG signals after thyroid dissection, and the causes of nerve injuries were well elucidated with the application of IONM. One nerve injury was caused by inadvertent transection, which led to permanent RLN palsy. Among the remaining 15 nerves, 1 injury was caused by a constricting band of connective tissue, which was detected precisely and released intraoperatively, 2 by inadvertent clamping of the nerve, and 12 by apparent overstretching at the region of Berry's ligament. (Five nerves regained signals before closing the wound, but 1 showed impaired cord movement. Another 7 nerves did not regain signals before closing the wound, and all developed temporary RLN palsy.) Conclusions. Our 4-step procedure of IONM is useful and helpful in elucidating the potential operative pitfalls during dissection near the RLN. Although the rates of RLN palsy were not decreased in this study, the use of neuromonitoring provided instructive information for future operations by ascertaining where and how the RLN has been injured. (Surgery 2008;143:743-9.) From the

Objective: This study evaluates the incidence and risk factors of complications in patients submitted to thyroidectomy for differentiated thyroid carcinoma in a cancer hospital with residency training. Study Design: A retrospective chart and complications review of 316 consecutive patients who underwent thyroidectomy for differentiated thyroid carcinoma. Results: Of the 316 patients, the main postoperative complications were transient hypocalcemia in 87 (27.5%), permanent hypocalcemia in 16 (5.1%), transient vocal cord palsy in 4 (1.2%), and permanent vocal cord palsy in 2 (0.6%). Neck dissection and paratracheal lymph node dissection when associated with total thyroidectomy were significantly related to transitory and permanent hypocalcemia. Conclusion: Thyroid surgery can be performed safely in a hospital with medical residency training program under direct supervision of an experienced surgeon with acceptable morbidity. Hypocalcemia is the most significant complication. Neck and paratracheal lymph node dissections were the most significant predictors of hypocalcemia in patients submitted to total thyroidectomy. (Am J Otolaryngol 2004;25:225-230.

In order to examine the relationship between thyroid status, the circadian system, and antidepressant drug response, the antidepressant drug clorgyline, a monoamine oxidase inhibitor (MAOI), was administered chronically to sham-operated or thyroparathyroidectomized rats. Wheel-running was monitored continuously in a light-dark (LD) cycle, and then in constant dim light. In LD, MAOI treatment increased levels of running. This effect was delayed in hypothyroid rats relative to euthyroid rats. In constant light, the MAOl-induced increase in running was diminished in euthyroid but not hypothyroid animals. Hypothyroid animals were less responsive to the change in lighting than were euthyroid animals, and this was more apparent in hypothyroid rats given MAOI. The daily pattern of running differed with lighting condition as well as with treatment group. MAOI-treatment of hypothyroid animals phase-ad. vanced the pattern of wheel-running. MAOl-treatment of control animals increased the amplitude of wheel-running particularly in the LD cycle. These results indicate that thyroid status, lighting, and MAO! treatment interact to alter the behavioral response to chronic drug treatment.

There is currently a lack of consensus to support the proper timing for postoperative laryngoscopy that is reliable to diagnose recurrent laryngeal nerve palsy (RLNP) after thyroid surgery. The purpose of this study was to investigate the impact of different time intervals of fiber-optic nasolaryngoscopy (FNL) on the diagnosis of RLNP. FNL was performed postoperatively at day 0 (T1), at second day post-op (T2), and +2 weeks (T3). For patients with RLNP, repeated examinations were performed at +2 (T4), +6 (T5), and +12 months (T6). Four hundred thirty-four patients appear for postoperative FNL, providing 825 nerves at risk. Permanent RLNP occurred in 0.7%, temporary RLNP in 6.7%. RLNP rate was 6.4% at T1, 6.7% at T2, 4.8% at T3, 2.5% at T4, 0.8% at T5, and 0.7% at T6. Full recovery of vocal cord function was confirmed after rehabilitation in 87.5% of cases at T5 and 89% in T6. T2 was significantly superior to T3 in terms of diagnosis of RLNP (P < 0.05). Of patients at T2, 10.7% did not see any reason to FNL because of their normal voice register. FNL is essential for the detection of vocal cord paralysis after thyroidectomy. We report different time evaluation criteria of vocal cord motility with great and significant variability of results. Second day post-op inspection of the larynx (T2) is suggested. Symptomatic voice assessment is insufficient.

The aim of this review is to analyse anaesthesiologic preoperative assessment, intraoperative management and postoperative complications of patients with thyroid disease. A special care is paid to difficult airway recognition and resolving this situation. Anaesthetist's and surgeon's point of view of perioperative and postoperative complications is both discussed with special interest on early surgical complications and the need for urgent anaesthetic treatment. Particularly total intravenous anaesthesia and recurrent laryngeal nerve monitoring actually are two end-points in the thyroid surgery.

La gammagrafía con tecnecio 99 (Tc99) sestamibi y la biopsia por aspiración permiten predecir de forma relativamente segura el resultado histopatológico de un nódulo tiroideo.Determinar la utilidad diagnóstica de la gammagrafía tiroidea con tecnecio 99 sestamibi para detección de malignidad en pacientes con nódulo tiroideo, confirmado por resultado histopatológico definitivo posterior a tiroidectomía.Se estudió un total de 69 pacientes con diagnóstico de nódulo tiroideo solitario que contaban con punción por aspiración con aguja fina y que fueron sometidos a tiroidectomía total ante sospecha de cáncer con análisis patológico posterior en todos.Cincuenta y cuatro pacientes con gammagrafía tiroidea positiva para malignidad; 25 pacientes con un histopatológico final de cáncer y 29 con un histopatológico negativo al mismo. Quince pacientes con gammagrafía tiroidea negativa para neoplasia tiroidea, con 3 presentando un diagnóstico de cáncer confirmado por patología y 12 confirmados con ausencia de malignidad.En el presente estudio se realizó un análisis estadístico para determinar la certeza diagnostica del Tc99 sestamibi para detectar malignidad en los nódulos tiroideos. El estudio con gammagrafía tiroidea con Tc99 sestamibi para cáncer de tiroides, tuvo una sensibilidad de 89,28%, con una especificidad de 29,25%. El Tc99 sestamibi mostró un valor predictor positivo de 46,29% y un valor predictor negativo de 80%.Consideramos que la práctica de la gammagrafía tiroidea con Tc99 sestamibi debe ser una técnica diagnóstica que se utilice de forma rutinaria en todo aquel paciente con un nódulo tiroideo que presente una punción aspiración con citología tiroidea indeterminada; siendo su mayor utilidad para descartar malignidad en aquellos que presentan captación baja en el estudio de medicina nuclear.99mTc sestamibi scanning and aspiration biopsy can predict the histopathological result of a thyroid nodule fairly accurately.To determine the accuracy of 99mTc sestamibi scanning in detecting malignancy in patients with thyroid nodule confirmed by definitive histopathological report after thyroidectomy.A total of 69 patients with a solitary thyroid nodule were studied. In all patients, fine needle aspiration, total thyroidectomy for suspected thyroid cancer, and histological analysis of the surgical specimen were performed. There were 54 patients with a positive 99mTc sestamibi scan; of these, malignancy was confirmed by histological analysis in 25 and excluded in 29. There were 15 patients with a negative 99mTc sestamibi scan; of these, three had a final diagnosis of cancer and 12 were confirmed as cancer-free.The diagnostic accuracy of 99mTc sestamibi scanning in detecting malignancy in thyroid nodules was determined through a statistical analysis. 99mTc sestamibi scan for thyroid cancer had a sensitivity of 89.28% and a specificity of 29.25%. The positive predictive value was 46.29% and the negative predictive value was 80%.We believe that 99mTc sestamibi scan should be routinely used in all patients with a thyroid nodule and an indeterminate result on fine needle aspiration. This procedure is most useful in excluding malignancy in patients with a negative 99mTc sestamibi scan.

The American Thyroid Association appointed a panel of experts to revise the original guidelines: "Medullary Thyroid Carcinoma: Management Guidelines of the American Thyroid Association", based on a review of the relevant literature. Relevant articles were identified using a systematic PubMed search and supplemented with additional published materials. Evidence-based recommendations were created and then categorized using criteria adapted from the United States Preventive Services Task Force, Agency for Healthcare Research and Quality. The original "Medullary Thyroid Cancer: Management Guidelines of the American Thyroid Association" provided abundant source material and an excellent organizational structure that served as the basis for the current revisions. The primary focus of this revision is on the diagnosis and treatment of patients with sporadic and hereditary MTC. The panel developed 68 evidence-based recommendations to assist clinicians in the care of pati...

Background: The management of thyroid papillary microcarcinoma (PMC) is controversial. Total thyroidectomy, thyroid lobectomy=isthmectomy, and even no treatment have been proposed. We investigated the clinical course and prognostic factors for disease recurrence and distant metastasis in 445 patients with PMC. Methods: Data from 445 patients diagnosed with PMC in the period from 1978 to 2003 were reviewed and analyzed. Total thyroidectomy was performed in 404 patients and loboisthmusectomy in 41. Neck dissection took place in 226 patients (49.7%), with 166 of only the central compartment and 60 of both the central and lateral compartments. Radioiodine ( 131 I) ablation treatment was given to 389 patients. Results: Median tumor size was 7 mm (range 1-10 mm). PMC was multifocal in 156 cases (35%) and bilateral in 60 cases (13.5%). Extrathyroidal tumor extension (pT3) and neck lymph node metastasis (pN1) were present in 133 (30%) and 182 (40.9%) patients, respectively. Capsular invasion without extrathyroidal tumor extension was observed in 39 (8.7%) patients. Mean follow-up was 5.3 (range 1-26) years. Seventeen (3.8%) patients had recurrence or persistence of disease: neck recurrence (NR) in 12 (2.7%), distant metastasis (DM) in four (0.9%), NR þ DM in one (0.2%). One patient (0.2%) died of the disease. Capsular invasion, extrathyroidal tumor extension (pT3), and neck lymph node metastasis at presentation (pN1) were the only independent risk factors for NR and=or DM occurrence ( p < 0.05). Patients not showing these features, who were treated with loboisthmusectomy only, never experienced disease recurrence. Conclusion: Total thyroidectomy seems advisable in PMC with extrathyroidal extension and neck lymph node metastasis at presentation. Capsular invasion without extrathyroidal extension may suggest aggressive tumor behavior and require radical treatment.

Plain radiology is the standard means of assessing upper airway obstruction in patients with goiters. Flow volume loop curves will provide additional information, because they allow a quantitative assessment of airflow dynamics in the respiratory cycle. Fifty-one patients had flow volume loops performed before and after thyroidectomy. There was a significant increase in the maximum inspiratory flow rate (3.9 ± 0.2 versus 4.9 ± 0.2 L/ second, p < 0.01) after thyroidectomy. Eight of twelve patients with normal tracheal radiology had improved airflow dynamics in the postoperative period. The flow volume loop curve is a simple noninvasive means of assessing airflow dynamics in patients with goiters and may be superior to conventional radiology. U T PPER RESPIRATORY TRACT obstruction is a wellrecognized complication ofthyroid disease and up to 45% of patients with goiters have symptoms suggestive of upper airway obstruction.' Plain radiology of the thoracic inlet is the standard way of identifying this complication. This investigation, however, provides a static measurement only of the upper respiratory tract and gives no information on airflow dynamics in the upper respiratory tree.

Hypothyroidism impairs early long-term potentiation (LTP) in the CA1 but not in the dentate gyrus (DG) of hippocampus of anesthetized adult rats. Protein levels and activities of signaling molecules in both the CA1 and DG of surgically thyroidectomized and shamoperated euthyroid rats were measured. Basal levels of total calmodulin kinase II (CaMKII) protein in both the CA1 and DG were decreased in hypothyroidism. Marked reduction of basal P-CaMKII levels and CaMKII activity was seen in CA1, but not in the DG of the same hypothyroid animals. Basal levels of calmodulin and protein kinase Cg (PKCg) were decreased in CA1 but remained unchanged in the DG of hypothyroid rats. Basal calcineurin levels and activity, although enhanced in CA1, were reduced in the DG of hypothyroid rats. These findings suggest that the DG may possess a compensatory mechanism whereby calcineurin levels are reduced, to allow sufficient CaMKII activity to produce an apparently normal LTP in hypothyroid rats. ' 2005 Wiley-Liss, Inc.

Hyperthyroid Graves' disease (GD) is a B-cellmediated disease caused by antibodies stimulating the thyroid stimulating hormone (TSH) receptor (TRAb). A proportion of patients (40-60%) present with an associated ophthalmopathy (TAO), a progressive inflammatory autoimmune disease of the retroorbital tissue. We thought that the anti-CD20 monoclonal antibody rituximab (RTX), by inducing transient B-cell depletion, may potentially modify the active inflam-matory phase of TAO. One patient with GD and TAO in its active phase and unresponsive to steroid, was treated with RTX. Whereas the ophthalmopathy responded to RTX therapy and a decrease in the clinical activity score from 5 to 2 was observed during the B-cell depletion, serum antithyroid antibodies, and in particular serum TRAb, were not affected by therapy. When the patient underwent total thyroidectomy, we found B-cells in the thyroid tissue specimens. The eye disease remained stable (clinical activity score=2) and the patient subsequently underwent orbital decompression to correct proptosis of the eye. At that time we did not find lymphocytes in any of the orbital tissue specimens. We believe that RTX therapy in GD may cause amelioration of ophthalmopathy by depleting total lymphocyte population in the orbit, but not lymphocyte depletion in thyroid tissue with consequent unchanged serum TRAb levels.

Background: Many studies have investigated the association between chronic lymphocytic thyroiditis (CLT) and papillary thyroid carcinoma (PTC), but clinical management of this condition has never been addressed specifically, even in recent guidelines. Surprisingly the likelihood of a nodule as being cancerous in a CLT has never been explicitly expressed in terms of relative risk. Methods: This study was based on a retrospective analysis of 404 patients undergoing total thyroidectomy. Results: Sixty-nine patients (17.1%) had histological findings of true CLT, and 36.2% had concurrent PTC versus 22.6% of patients in the non-CLT group (p ! 0.05), with a tumour risk in the CLT group of ! 1.6 (95% CI = 1.21-1.94, likelihood ratio = +1.63). Conclusions: Patients with CLT and a nodular condition have a ! 1.6 increased risk of harbouring a PTC. Moreover, these patients develop multicentric PTC more frequently, and, as a result, total thyroidectomy should always be considered.

A retrospective study of 1534 consecutive biopsies Aim of study > To assess the value of intraoperative frozen-section diagnosis in thyroid surgery and determine its limitations. Methods > This retrospective study examined the results of 1534 frozen sections of thyroid specimens analyzed over the 11-year period from 1995 through 2005 and their correlations with the final histological examination. Deferred responses were not taken into account for statistical calculations. Results > In our series, frozen-section diagnosis was concordant with subsequent histopathological examination in 92% of cases, discordant in 3%, and deferred in 5%. The global specificity of frozen section analysis for all histological subtypes was 99.8% and its sensitivity 67%. Its sensitivity for thyroid cancer was lower in follicular (42%) and papillary carcinoma (64%) than medullary (100%), anaplastic (100%), secondary (100%), mixed (100%), and insular carcinomas (86%). Conclusion > In our series, as in the literature, most of the discordances between frozen-section and definitive diagnosis were associated with microfollicular lesions, which explain the low tome 37 > n86 > juin 2008 > cahier 1

Background Benign thyroid tumors account for most nodular thyroid disease. Determination of whether a thyroid nodule is benign or malignant is a major clinical dilemma and underlies the decision to proceed to surgery in many patients. Although the accuracy of thyroid nodule fine-needle aspiration (FNA) has reduced the need for surgery over the years, questions regarding how to follow FNA-designated benign nodules remain unresolved. This is true at least in part because of uncertainty over whether some benign nodules harbor malignant potential. Methods An evidence-based review of recent clinical, pathologic, and molecular data is presented. A summary of data and observations from our own experience is also provided.

BACKGROUND: The influence of minimally invasive options has led to the application of new evolving techniques in thyroid surgery to eliminate visible neck scars. Here, we describe one author's experience with transaxillary robotic thyroidectomy and examine the effect of experience on determining the learning curve and improvements over time in operative performance. STUDY DESIGN: With IRB approval, a prospective analysis of our surgical experience was performed. All patients underwent robotic transaxillary thyroidectomy by a single surgeon between September 2009 and June 2011. Principal outcomes measures included length of hospital stay, incidence of complications, and effect of obesity on outcomes.