RESUMO
Significance: Near-infrared autofluorescence (NIRAF) utilizes the natural autofluorescence of parathyroid glands (PGs) to improve their identification during thyroid surgeries, reducing the risk of inadvertent removal and subsequent complications such as hypoparathyroidism. This study evaluates NIRAF's effectiveness in real-world surgical settings, highlighting its potential to enhance surgical outcomes and patient safety. Aim: We evaluate the effectiveness of NIRAF in detecting PGs during thyroidectomy and central neck dissection and investigate autofluorescence characteristics in both fresh and paraffin-embedded tissues. Approach: We included 101 patients diagnosed with papillary thyroid cancer who underwent surgeries in 2022 and 2023. We assessed NIRAF's ability to locate PGs, confirmed via parathyroid hormone assays, and involved both junior and senior surgeons. We measured the accuracy, speed, and agreement levels of each method and analyzed autofluorescence persistence and variation over 10 years, alongside the expression of calcium-sensing receptor (CaSR) and vitamin D. Results: NIRAF demonstrated a sensitivity of 89.5% and a negative predictive value of 89.1%. However, its specificity and positive predictive value (PPV) were 61.2% and 62.3%, respectively, which are considered lower. The kappa statistic indicated moderate to substantial agreement (kappa = 0.478; P < 0.001 ). Senior surgeons achieved high specificity (86.2%) and PPV (85.3%), with substantial agreement (kappa = 0.847; P < 0.001 ). In contrast, junior surgeons displayed the lowest kappa statistic among the groups, indicating minimal agreement (kappa = 0.381; P < 0.001 ). Common errors in NIRAF included interference from brown fat and eschar. In addition, paraffin-embedded samples retained stable autofluorescence over 10 years, showing no significant correlation with CaSR and vitamin D levels. Conclusions: NIRAF is useful for PG identification in thyroid and neck surgeries, enhancing efficiency and reducing inadvertent PG removals. The stability of autofluorescence in paraffin samples suggests its long-term viability, with false positives providing insights for further improvements in NIRAF technology.
Assuntos
Imagem Óptica , Glândulas Paratireoides , Espectroscopia de Luz Próxima ao Infravermelho , Tireoidectomia , Humanos , Glândulas Paratireoides/cirurgia , Glândulas Paratireoides/metabolismo , Masculino , Feminino , Pessoa de Meia-Idade , Imagem Óptica/métodos , Adulto , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Inclusão em Parafina/métodos , Idoso , Câncer Papilífero da Tireoide/cirurgia , Câncer Papilífero da Tireoide/patologia , Câncer Papilífero da Tireoide/metabolismo , Receptores de Detecção de Cálcio/metabolismo , Receptores de Detecção de Cálcio/análiseRESUMO
Objective. CoolSeal is a new vessel sealing system for dissection and hemostasis during surgery. No clinical studies have investigated safety, advantages or disadvantages regarding the use of this device. The aim of the present study was to investigate the safety of CoolSeal and compare it with conventional ligation technique or LigaSure during the total thyroidectomy. We hypothesized that the use of CoolSeal would reduce the operating time and bleeding without complications increase. Study design represents a retrospective cohort study with a tertiary reference center setting. Methods. We analyzed total thyroidectomy data from January 2021 to June 2023. We recorded patients' characteristics, surgical information, and postoperative outcome. Results. We performed 221 total thyroidectomies in the study period. Analysis was restricted to 171 patients operated by only two surgeons. Hemostasis was secured by conventional ligation in 117 patients (68%), LigaSure in 34 patients (20%) and CoolSeal in 20 patients (12%). Median thyroid weight and bleeding were 67 g and 50 ml, respectively. Procedures using LigaSure or Cool-Seal were on larger glands (median 205 g) without increased bleeding (50 ml). Operating time was shortest with CoolSeal (96 min, p=0.003) compared with LigaSure (117 min) or conventional ligation (115 min). Bleeding was reduced with CoolSeal compared with LigaSure (45 vs. 100 ml, p=0.003). With CoolSeal, median hospitalization was one postoperative day, no patients required re-operation. There was no palsy of recurrent laryngeal nerves and no permanent hypoparathyroidism. Conclusion. In our first clinical experience, CoolSeal was safe and efficient for total thyroidectomy. With a small sample size, we saw a clinical benefit with reduced operating time without post-operative complications increase.
Assuntos
Perda Sanguínea Cirúrgica , Hemostasia Cirúrgica , Duração da Cirurgia , Tireoidectomia , Humanos , Tireoidectomia/métodos , Tireoidectomia/instrumentação , Tireoidectomia/efeitos adversos , Feminino , Masculino , Estudos Retrospectivos , Pessoa de Meia-Idade , Adulto , Hemostasia Cirúrgica/instrumentação , Hemostasia Cirúrgica/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Idoso , Ligadura/instrumentação , Ligadura/métodos , Resultado do TratamentoRESUMO
OBJECTIVE: To analyze the complications following endoscopic hemithyroidectomy and to develop the principles of tissue dissection for safe surgical intervention. MATERIAL AND METHODS: The results of surgical treatment of 136 patients were studied. The main group consisted of 44 patients who underwent endoscopic hemithyroidectomy through a «gasless¼ axillary approach (EH group). The first control group consisted of 45 patients who underwent minimally invasive video-assisted hemithyroidectomy (MIVAH group). The second control group consisted of 47 patients who underwent open hemithyroidectomy (OH group). RESULTS. O: Verall complication rate was significantly higher in the EH group (20.5% vs. 6.4% in the OH group and 4.4% in the MIVAH group; p<0.05). In the EH group, Clavien-Dindo grade I complications occurred in 11.4% of cases. There were no similar complications in the control groups (p<0.05). Clavien-Dindo grade II complications occurred in 9.1% of patients in the EH group, 4.3% in the OH group and no similar events were identified in the MIVAH group (p>0.05). Clavien-Dindo grade III complications occurred in 1 (2.1%) case in the OH group and 2 (4.4%) cases in the MIVAH group. There were no Clavien-Dindo grade III complications in the EH group. Thus, minor complications prevailed in the EH group. Their incidence decreased along with accumulation of experience. Moreover, endoscopic procedure is safer regarding the risk of severe complications. CONCLUSION: Endoscopic hemithyroidectomy is safe, and the proposed principles of tissue dissection can further increase surgical safety.
Assuntos
Complicações Pós-Operatórias , Tireoidectomia , Humanos , Tireoidectomia/métodos , Tireoidectomia/efeitos adversos , Feminino , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Pessoa de Meia-Idade , Adulto , Endoscopia/métodos , Endoscopia/efeitos adversos , Cirurgia Vídeoassistida/métodos , Cirurgia Vídeoassistida/efeitos adversos , Dissecação/métodos , Dissecação/efeitos adversos , Avaliação de Processos e Resultados em Cuidados de Saúde , Neoplasias da Glândula Tireoide/cirurgia , Federação Russa/epidemiologia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversosRESUMO
OBJECTIVE: To create a formalized method for predicting papillary thyroid cancer recurrence after hemithyroidectomy based on preoperative data. MATERIAL AND METHODS: At this stage of the study, we selected 101 patients with papillary thyroid cancer who underwent surgical treatment in 2017-2023. Recurrence was observed in in 47 patients. Fifty-four patients had no recurrence within 5 years after surgical treatment, i.e. these patients underwent surgery in 2017-2018. To find prediction rules, we used original classification method based on searching for subsets of variables and piecewise linear rules separating classes in pairs with subsequent voting of such rules to make a decision. RESULTS: The exam was carried out using a training sample (101 cases) and sliding control method (10 tests on 10 random cases). On the training sample, sensitivity of predictive algorithm was 91%, specificity 78% and error rate 13%. The aggregated result of 10 trials using sliding control method revealed sensitivity of predictive algorithm 86%, specificity 75% and error rate 15%. This result is close to overall sample and confirms the effectiveness of this method for predicting recurrence. CONCLUSION: The pilot experiments revealed the patterns in data for potential prediction of recurrence based on preoperative indicators. Further study of this problem may be valuable for decision-making and adjustments in the management of patients with papillary thyroid cancer.
Assuntos
Recidiva Local de Neoplasia , Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide , Tireoidectomia , Humanos , Câncer Papilífero da Tireoide/cirurgia , Câncer Papilífero da Tireoide/diagnóstico , Recidiva Local de Neoplasia/epidemiologia , Masculino , Feminino , Tireoidectomia/métodos , Pessoa de Meia-Idade , Neoplasias da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/patologia , Adulto , Algoritmos , Período Pré-OperatórioRESUMO
BACKGROUND: Thyroid disease is a global health problem and the most common type of endocrine disorder next to diabetic mellitus, accounting for around 30-40% burden of the endocrine disorders. OBJECTIVE: The objective of the study was to assess patterns, treatment outcome and associated factors of surgically treated thyroid disease at Public Hospitals in Eastern Ethiopia. METHODS: The study was conducted among surgically treated patients for thyroid disorders using a retrospective cross-sectional study design by reviewing all patients' charts. A data abstraction sheet was used to collect relevant data, and the collected data was analyzed using SPSS version 26 software. Bi-variable and multivariable binary logistic regression was employed to assess the association between dependent and independent variables. RESULTS: The study was conducted on 200 patients' medical records who had complete information. Out of this, 84.5% were female and 66.5% of patients' age was between 20 and 40 years. Toxic goiter was the most common thyroid disease which accounted for 49.5%. Hemorrhage and Hypocalcemia were the most common complications after surgery. Anterior neck swelling of greater than 15 years [(AOR: 52.892 CI = 95% (6.087-459.5.68) (P-0.000)], Total/ near total thyroidectomy [(AOR: 20.139 CI = 95% (4.059-99.931) P-00.000] were significantly associated with complicated post-operative course, while female sex [(AOR: 0.124 CI = 95% (0.34-0.494) P- 0.003)] was associated with lower risk of developing post-operative complications. CONCLUSION: This study showed that 9.5% of operated patients with thyroid disease had complicated post-operative course. Long standing goiter and total/ near total thyroidectomy were significantly associated with complicated post-operative course.
Assuntos
Hospitais Públicos , Doenças da Glândula Tireoide , Tireoidectomia , Humanos , Estudos Transversais , Feminino , Etiópia/epidemiologia , Estudos Retrospectivos , Masculino , Adulto , Hospitais Públicos/estatística & dados numéricos , Doenças da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Tireoidectomia/efeitos adversos , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem , Adolescente , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , IdosoRESUMO
PURPOSE: The survival rate of patients with medullary thyroid carcinoma (MTC) who fail to achieve a biochemical cure after surgery is reduced. This study aimed to investigate the prognostic factors affecting the survival of MTC patients who do not achieve a biochemical cure after surgery. METHODS: Cox univariate and multivariate proportional hazard models were used to determine the influence of different variables on overall survival (OS). Pearson's chi-square test was used for categorical variables, and paired t-test was used for continuous variables. RESULTS: In our study of 277 MTC patients treated between 2012 and 2022, there were 96 with raised postoperative 1-month calcitonin (Ct) levels (0-9.52 pg/ml). The overall survival (OS) rates of patients with high postoperative 1-month Ct values at 1, 3, and 5 years were 97.9%, 94.6%, and 86.8%, respectively. The univariate analysis revealed that patients with a postoperative 1-month Ct > 441.9 pg/ml had a greater risk of mortality than patients with postoperative 1-month Ct values ranging from 9.52 to 73.4 pg/ml (p = 0.043). Subsequent analyses revealed that receiving targeted therapy did not improve the OS of patients with distant metastasis among those with high postoperative 1-month Ct values (p = 0.527). CONCLUSION: This study confirmed that MTC patients who did not achieve biochemical remission after surgery had an increased risk of death when the Ct level was > 441.9 pg/ml 1 month after surgery. Additionally, for MTC patients who have not achieved biochemical remission and have experienced disease progression or distant metastasis after surgery, the use of targeted therapy does not prolong survival.
Assuntos
Calcitonina , Carcinoma Neuroendócrino , Neoplasias da Glândula Tireoide , Tireoidectomia , Humanos , Neoplasias da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/mortalidade , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/sangue , Neoplasias da Glândula Tireoide/terapia , Masculino , Feminino , Calcitonina/sangue , Pessoa de Meia-Idade , Carcinoma Neuroendócrino/patologia , Carcinoma Neuroendócrino/mortalidade , Carcinoma Neuroendócrino/cirurgia , Carcinoma Neuroendócrino/terapia , Taxa de Sobrevida , Prognóstico , Seguimentos , Adulto , Estudos Retrospectivos , Idoso , Biomarcadores Tumorais/sangue , Biomarcadores Tumorais/metabolismo , Terapia de Alvo Molecular/métodos , Adulto Jovem , Período Pós-Operatório , AdolescenteRESUMO
We demonstrate the technical nuances and operative strategy of uniportal video-assisted thoracoscopic surgical excision of a giant mediastinal goitre in a patient with a complex medical history, including a prior total thyroidectomy for multinodular goitre and partial gastrectomy for gastrointestinal stromal tumour. The video tutorial presents the surgical removal of a substantial mediastinal goitre, persisting post-total thyroidectomy performed 2 years prior via a collar incision. We opted for a thoracoscopic technique for the removal of the residual mediastinal mass. A 3-cm uniportal incision was made at the fifth intercostal space along the mid-axillary line. Pleural exploration confirmed the absence of adhesions. Subsequent dissection revealed a large retrocaval goitre adjacent to the trachea. Utilizing a combination of LigaSure technology for sharp dissection, and blunt dissection techniques using the peanuts, we severed the goitre's attachments to surrounding critical structures, including the trachea, superior vena cava and oesophagus. The dissection continued, extending into the cervical region from the thoracic approach. The mass was safely enclosed within an endobag and extracted through the uniportal incision. This case demonstrates the feasibility and effectiveness of the uniportal thoracoscopic approach for complex mediastinal pathology. This approach was successfully executed with an uneventful perioperative course and no complications, indicating positive outcomes in complex thoracic cases despite a minimally invasive approach for the resection of mediastinal masses.
Assuntos
Cirurgia Torácica Vídeoassistida , Tireoidectomia , Humanos , Cirurgia Torácica Vídeoassistida/métodos , Tireoidectomia/métodos , Feminino , Pessoa de Meia-Idade , Bócio Subesternal/cirurgia , Bócio Subesternal/diagnósticoRESUMO
BACKGROUND: The prevalence of genetic mutations in thyroid cancer varies significantly among different ethnic backgrounds. The present study aimed to investigate the clinical potential of BRAF V600E in a large group of homogenous Han Chinese patients. METHODS: From 2018 to 2021, 6232 thyroid disease patients who underwent thyroidectomy at our hospital were enrolled. We measured the diagnostic value of BRAF and plotted ROC curves. Patients with full clinical-pathological data were selected and divided into the BRAF mutation and wild type groups. We conducted univariate and multivariate analyses to quantify the differences in potential predictive factors of papillary thyroid carcinoma (PTC) patients between the groups. Kaplan-Meier survival analysis was used to estimate overall recurrence and recurrence rate. RESULTS: The prevalence of BRAF V600E mutation was 86.0% in PTCs. The sensitivity and specificity of BRAF mutation for diagnosing PTC from suspicious lesions were 85.5% and 100%, respectively. The sensitivity and specificity of BRAF analysis in the indeterminate cytology group were 72.5% and 100%, respectively. BRAF mutation showed an independent association with older age, negative HT, larger tumor size, extrathyroidal extension, and multifocality in PTCs. In micro-PTCs (tumor size ≤ 1), the mutation was also positively correlated with progressive phenotypes of extrathyroidal extension and multifocality. BRAF mutation was associated with poorer recurrence-free probability in Kaplan-Meier survival analysis. CONCLUSIONS: This large single-center study reveals that BRAF V600E is highly prevalent in the Han Chinese population and demonstrates BRAF V600E mutation testing has high diagnostic accuracy and its strong association with the progress of aggressiveness in PTCs and a higher probability of recurrence. BRAF mutation can serve as an accurate marker for diagnosis and decision-making with great value.
Assuntos
Mutação , Recidiva Local de Neoplasia , Proteínas Proto-Oncogênicas B-raf , Neoplasias da Glândula Tireoide , Tireoidectomia , Humanos , Proteínas Proto-Oncogênicas B-raf/genética , Masculino , Feminino , Neoplasias da Glândula Tireoide/genética , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Pessoa de Meia-Idade , Prognóstico , Recidiva Local de Neoplasia/genética , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/epidemiologia , Adulto , Seguimentos , China/epidemiologia , Biomarcadores Tumorais/genética , Câncer Papilífero da Tireoide/genética , Câncer Papilífero da Tireoide/patologia , Câncer Papilífero da Tireoide/cirurgia , Taxa de Sobrevida , Povo Asiático/genética , Idoso , Estudos Retrospectivos , População do Leste AsiáticoRESUMO
Objectives: This study aimed to evaluate the effectiveness of thyroid fine needle aspiration cytology (FNAC) using a novel-cell preserving matrix called Cytomatrix in improving diagnostic accuracy for thyroid nodules. Materials and methods: Fifty patients undergoing thyroidectomy were enrolled and FNAC was performed on the excised thyroid glands, with the collected sample being placed on the Cytomatrix. The results were compared with histopathological analysis, and diagnostic performance was assessed statistically. Results: Cytomatrix demonstrated an accuracy of 96%, sensitivity of 84.61%, and specificity of 100%. Concordance between cytological and histopathological findings highlighted Cytomatrix's potential to enhance thyroid FNAC accuracy. Conclusion: FNAC using Cytomatrix shows promise in improving diagnostic accuracy for thyroid nodules. Its application, marked by faster processing and efficient resource utilization, coupled with the preservation of cellular architecture, holds considerable potential in enhancing cytological diagnosis, thus optimizing patient management strategies.
Assuntos
Nódulo da Glândula Tireoide , Humanos , Nódulo da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/cirurgia , Biópsia por Agulha Fina/métodos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Tireoidectomia/métodos , Citodiagnóstico/métodos , Idoso , Glândula Tireoide/patologia , Glândula Tireoide/cirurgia , Sensibilidade e Especificidade , Adulto Jovem , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/cirurgia , CitologiaRESUMO
Our research seeks to evaluate the utility of intraoperative frozen analysis of sentinel lymph nodes (SLNs) in the lateral cervical compartment (LCC) as a tool to inform decision-making regarding therapeutic neck dissection in patients with medullary thyroid carcinoma (MTC). This is particularly relevant due to the variability observed in guidelines regarding the indication for lateral neck dissection in this patient population. The study comprised 64 patients (25 males, 39 females) aged between 29 and 81 years, with a median age of 59, who underwent surgery for MTC at stage T1-3N0-1M0 between January 1, 2012, and December 31, 2020. A standardized surgical approach involving total thyroidectomy with central neck dissection was adopted. LCC dissection was reserved for patients with clinically apparent nodal metastases. In patients lacking clinical evidence of nodal involvement, SLNs were identified using patent blue dye, excised, and subjected to intraoperative frozen analysis. If metastasis was confirmed, LCC dissection was subsequently performed. Among the study participants, 14 individuals (21.9%) underwent therapeutic LCC dissection due to clinical lymph node (LN) metastases. This intervention resulted in clinical remission for 9 patients, while disease progression was observed in 5 cases, leading to 2 fatalities. In the remaining cohort of 50 patients clinically negative for nodal involvement, SLNs were successfully identified and examined in 38 cases, revealing metastases in 6 patients (15.8%). Among both subsets of patients with analyzed SLNs, irrespective of metastatic status, one patient each required repeat surgery due to disease recurrence; however, all patients eventually achieved clinical remission. Lymphatic mapping in the LCC plays a pivotal role in detecting early metastases, thereby aiding in the avoidance of unnecessary repeat neck surgeries, and ultimately improving the prognosis in patients with MTC.
Assuntos
Carcinoma Neuroendócrino , Esvaziamento Cervical , Linfonodo Sentinela , Neoplasias da Glândula Tireoide , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Esvaziamento Cervical/métodos , Neoplasias da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/patologia , Adulto , Linfonodo Sentinela/patologia , Linfonodo Sentinela/cirurgia , Idoso de 80 Anos ou mais , Carcinoma Neuroendócrino/cirurgia , Carcinoma Neuroendócrino/patologia , Metástase Linfática , Tireoidectomia/métodos , Biópsia de Linfonodo Sentinela/métodosRESUMO
A világossejtes vesecarcinoma pajzsmirigyáttétei nagyon ritkák, évtizedekkel a primer tumor sebészi eltávolítása után is megjelenhetnek. Felismerésük még ismert vesesejtes carcinoma esetén is nehézséget okozhat, a nephrectomián átesett betegek hosszú távú követése javasolt. Újabb pajzsmirigygöb megjelenésekor mindig gondolni kell rá, és benignus ultrahangkép mellett is szükséges az aspirációs citológia elvégzése.Közleményünkben egy olyan esetet mutatunk be, ahol 11 év után adott a vesesejtes carcinoma a pajzsmirigybe áttétet.
Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Nefrectomia , Neoplasias da Glândula Tireoide , Humanos , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Carcinoma de Células Renais/cirurgia , Carcinoma de Células Renais/secundário , Carcinoma de Células Renais/patologia , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Nefrectomia/métodos , Masculino , Tireoidectomia , Pessoa de Meia-Idade , UltrassonografiaRESUMO
Reported postoperative complications of mediastinal goitre include recurrent laryngeal nerve palsy, hypoparathyroidism and tracheomalacia. Voice and swallowing symptoms after thyroid surgery have been associated with laryngopharyngeal reflux, but it is unclear whether the retrograde flow of gastric contents into the oesophagus, larynx and pharynx worsens after thyroid surgery. We present the case of a man in his 40s with gastro-oesophageal reflux disease (GERD) who developed heartburn and laryngeal granuloma after total thyroidectomy for mediastinal goitre. Vonoprazan therapy effectively controlled these symptoms. Although the exact cause remains unclear, we suggest that changes in pressure dynamics after thyroidectomy may worsen the retrograde flow of gastric contents into the oesophagus, larynx and pharynx, contributing to GERD symptoms and laryngeal granuloma. This case highlights the need to consider the management of retrograde flow of gastric contents into the oesophagus, larynx and pharynx in the postoperative care of mediastinal goitre resections.
Assuntos
Refluxo Gastroesofágico , Granuloma Laríngeo , Complicações Pós-Operatórias , Tireoidectomia , Humanos , Masculino , Refluxo Gastroesofágico/complicações , Complicações Pós-Operatórias/etiologia , Adulto , Granuloma Laríngeo/etiologia , Granuloma Laríngeo/cirurgia , Bócio Subesternal/cirurgia , Bócio Subesternal/complicaçõesRESUMO
BACKGROUND: Spontaneous hepatic hemorrhage is a rare condition, most commonly diagnosed in patients with hepatocellular carcinoma or hepatic adenomas, and is seldom caused by metastatic disease. In this case report, we present a patient with spontaneous hepatic hemorrhage due to hepatic metastasis of papillary thyroid carcinoma, an exceptionally rare occurrence. CASE PRESENTATION: The patient was a 77-year-old white male with a history of atrial fibrillation treated with apixaban. He presented at a local hospital with abdominal pain and nausea. A CT scan revealed a hepatic lesion in segment 3 with an adjacent hematoma. He was referred to our tertiary center and treated conservatively. Further evaluation revealed an intrathoracic goiter containing a tumorous process diagnosed as a papillary thyroid carcinoma (PTC), and the patient subsequently underwent thyroidectomy. A biopsy of the hepatic lesion confirmed it as a PTC metastasis. Due to worsening abdominal pain and anorexia, the patient underwent subacute hepatic segmental resection. Postoperatively, he developed iodine-refractory disease with disseminated metastasis and passed away 22 months after the initial admission. CONCLUSIONS: To our knowledge, this is the first recorded case of metastasized papillary thyroid carcinoma presenting with spontaneous hepatic hemorrhage-adding to the list of rare causes for this condition.
Assuntos
Hemorragia , Neoplasias Hepáticas , Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide , Humanos , Masculino , Idoso , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/secundário , Câncer Papilífero da Tireoide/secundário , Câncer Papilífero da Tireoide/complicações , Câncer Papilífero da Tireoide/patologia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/complicações , Hemorragia/etiologia , Tomografia Computadorizada por Raios X , Evolução Fatal , Tireoidectomia , Carcinoma Papilar/secundário , Carcinoma Papilar/patologia , Carcinoma Papilar/complicaçõesRESUMO
Background and Objectives: As the global aging population grows, the incidence of thyroidectomy in elderly patients is increasing. This study aimed to evaluate the surgical outcomes of thyroidectomy in patients aged 80 years and older. Materials and Methods: All patients aged 80 years and older who underwent thyroidectomies at our hospital between January 2015 and December 2022 were reviewed in this retrospective cohort study. Collected data consisted of patients' clinical characteristics, functional status, compression symptoms, preoperative assessments, perioperative outcomes, postoperative complications (such as bleeding events, recurrent laryngeal nerve injury, hypocalcemia), pathological findings, readmission, and follow-up outcomes. Results: Seventeen patients were included in this study, with female predominance (82.4%). The mean age was 85.6 ± 4.8 years. Fourteen patients (82.4%) exhibited compression-related symptoms as surgical indications. Based on pathological reports, patients were categorized into benign (12/17, 70.6%) and malignancy (5/17, 29.4%) groups. The benign group had a shorter operation time compared with the malignancy group (164.3 ± 32.0 min vs. 231.0 ± 79.1 min, p = 0.048). No major postoperative complications developed. The median postoperative follow-up duration was 28 months (range: 2-91 months). Thirteen patients (76.5%) were alive at the end of the study period. Conclusions: Despite potential age-related risks, thyroidectomy is feasible for carefully selected patients aged 80 years and older. It provides benefits not only in terms of oncological curative treatment but also in improving the quality of life, such as compressive symptoms and wound condition.
Assuntos
Complicações Pós-Operatórias , Tireoidectomia , Humanos , Feminino , Masculino , Tireoidectomia/métodos , Tireoidectomia/efeitos adversos , Tireoidectomia/estatística & dados numéricos , Estudos Retrospectivos , Idoso de 80 Anos ou mais , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Estudos de Coortes , Duração da CirurgiaRESUMO
Introduction: To investigate the ultrasound characteristics of recurrent laryngeal nerves (RLNs) during radical surgery for thyroid cancer and to enhance the understanding of RLN ultrasound features. Methods: From October 2021 to December 2022, a prospective study was conducted involving 24 patients scheduled for bilateral thyroid surgery. Near the conclusion of the surgery, intraoperative ultrasonography of the RLN within the tracheoesophageal groove was performed using a 15-7 MHz transducer. The thickness and width of the RLN were measured during the procedure. Results: The internal architecture of the RLN was observed to consist of multiple hypoechoic, parallel, but discontinuous linear hyperechoic areas separated by bands. In the normal RLN group, the diameter of the RLN was relatively consistent, with thickness ranging from 2.20 to 2.71 mm (mean: 2.48 ± 0.14 mm) and width from 1.25 to 1.70 mm (mean: 1.45 ± 0.11 mm). Both weight and the body mass index (BMI) showed a statistically significant correlation with RLN thickness (Weight: r=0.544, P=0.001; BMI: r=0.605, P=0.001). The BMI also showed a statistically significant correlation with the RLN width (r=0.377, P=0.033). In the RLN invasion group, the width of invaded RLNs ranged from 1.9 to 2.3 mm (mean: 2.10 ± 0.11 mm), while the width of non-invaded RLNs ranged from 2.6 to 3.2 mm (mean: 2.93 ± 0.20 mm). Conclusions: Ultrasound effectively reveals the structural features of the RLN and enhances sonographers' understanding of RLN characteristics.
Assuntos
Nervo Laríngeo Recorrente , Neoplasias da Glândula Tireoide , Tireoidectomia , Ultrassonografia , Humanos , Tireoidectomia/métodos , Feminino , Masculino , Nervo Laríngeo Recorrente/diagnóstico por imagem , Pessoa de Meia-Idade , Ultrassonografia/métodos , Estudos Prospectivos , Adulto , Neoplasias da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Idoso , Traumatismos do Nervo Laríngeo Recorrente/etiologiaRESUMO
BACKGROUND/AIM: This study compared the initial outcomes of gas-insufflation one-step single-port transaxillary (GOSTA) robotic thyroidectomy with traditional open thyroidectomy for thyroid cancer at a single institution. PATIENTS AND METHODS: A retrospective analysis was conducted on 77 patients who underwent thyroidectomy for differentiated thyroid cancer from January to June 2024. Exclusion criteria included benign nodules, Graves' disease, and previous thyroid surgeries. Two surgeons performed the procedures, with one having no prior robotic surgery experience. RESULTS: Of the 77 patients, 48 underwent open thyroidectomy and 29 underwent GOSTA thyroidectomy. The GOSTA group had a significantly lower mean age (40.1 vs. 47.6 years, p=0.002) and a higher proportion of female patients (p=0.040). The open group patients had more harvested lymph nodes than the GOSTA group patients (7.9 vs. 2.4, p<0.001). The GOSTA group patients had longer operation time (156.4 vs. 80.6 min, p<0.001), and had extended hospital stay than the open group patients (5.9 vs. 3.4 days, p<0.001). Complication rates were similar between the groups. CONCLUSION: GOSTA robotic thyroidectomy provides comparable safety and effectiveness to open thyroidectomy, with improved cosmetic outcomes despite longer operation times and hospital stays. This technique is feasible for surgeons without prior robotic experience, offering a viable alternative for patients prioritizing cosmetic results.
Assuntos
Procedimentos Cirúrgicos Robóticos , Neoplasias da Glândula Tireoide , Tireoidectomia , Humanos , Tireoidectomia/métodos , Tireoidectomia/efeitos adversos , Feminino , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Neoplasias da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/patologia , Masculino , Pessoa de Meia-Idade , Adulto , Estudos Retrospectivos , Resultado do Tratamento , Duração da Cirurgia , Axila , Tempo de InternaçãoRESUMO
BACKGROUND: Differentiated thyroid carcinoma (DTC), mainly papillary (PTC), at low risk of recurrence is currently managed with active surveillance strategies or less aggressive surgeries. However, total thyroidectomy with 131I treatment is still performed both if these tumors are diagnosed before or occasionally after surgery. This real-life study aimed to evaluate the rate of biochemical, structural, and functional events in a large series of consecutive DTCs at low risk of recurrence treated by total thyroidectomy, but not with 131I, in a medium-long-term follow-up. PATIENTS AND METHODS: We evaluated clinical-pathologic data of 383 consecutive patients (2006-2012) with unifocal DTC [T1a/b(s)] at low risk of recurrence, treated with total thyroidectomy but without lymph node dissection and 131I treatment after surgery. We evaluated if structural, biochemical, and functional events were detected during the follow-up. RESULTS: Females accounted for 75.7% of our study group, and the median age was 50 years. The median tumor dimension was 0.4 cm (range 0.1-1.2). Most of the patients had a unifocal T1a tumor (98.9%), and 73.6% had a classic variant of PTC. We divided the patients according to the absence (group A-n = 276) or presence (group B-n = 107) of interfering TgAb at first control after surgery. After a median follow-up of 10 years, no structural events were detected. Sixteen out of three hundred and eighty-three (4.2%) patients developed biochemical events: 12/276 (4.3%) in group A and 4/107 (3.7%) in group B. The median time elapsed from surgery to detecting a biochemical event was 14.5 and 77.5 months in groups A and B, respectively. No patients performed additional treatments and were followed up with an active surveillance strategy. CONCLUSIONS: This study confirmed that patients with DTC at low risk of recurrence showed an excellent outcome in a medium long-term follow-up since no structural events were diagnosed. Significant variations in Tg/TgAb were detected in a few cases, all managed with an active surveillance strategy without the need for other treatments. Therefore, a relaxed follow-up with neck ultrasound and Tg/TgAb measurement is enough to early identify those very unusual cases of recurrence.
Assuntos
Neoplasias da Glândula Tireoide , Tireoidectomia , Humanos , Neoplasias da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia/métodos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Idoso , Resultado do Tratamento , Adulto Jovem , Radioisótopos do Iodo/uso terapêutico , Adolescente , Recidiva Local de Neoplasia , Idoso de 80 Anos ou maisRESUMO
BACKGROUND: Surgical treatment of benign thyroid disease varies from lobectomy, subtotal thyroidectomy, and total thyroidectomy (TT). OBJECTIVE: The current study aimed to compare complications of both total and subtotal thyroidectomy (STT) for patients with bilateral benign thyroid disorders. METHODS: Sixty patients with benign goiter, 32 for TT and 28 for STT, where indications for surgery, operating time, hospital stay, and complications were studied. RESULTS: The incidence of transient recurrent laryngeal nerve (RLN) palsy was (6.25%) for TT vs (3.57%) for STT, and temporary hypoparathyroidism was (9.38%) in TT patients compared to (7.14%) in STT patients. Permanent RLN palsy and hypoparathyroidism occurred only in one case (3.12%) from the TT group. No permanent complications occurred in STT patients. Recurrence of goiter occurred in two patients (7.14%) undergoing STT. Incidental papillary carcinoma was (7.14%) in STT patients and (3.13%) for follicular carcinoma in TT patients. There was no postoperative mortality. CONCLUSION: TT is a suitable surgical procedure in patients with bilateral benign thyroid disease as complication rate, operative time, and hospital stay are less comparable to STT. It will give a permanent cure without recurrences, and incidental thyroid malignancies can be avoided.
CONTEXTE: Le traitement chirurgical des maladies bénignes de la thyroïde varie de la lobectomie, thyroïdectomie subtotale à la thyroïdectomie totale (TT). OBJECTIF: La présente étude visait à comparer les complications de la thyroïdectomie totale et subtotale (STT) chez les patients atteints de troubles thyroïdiens bénins bilatéraux. MÉTHODES: Soixante patients atteints de goitre bénin, 32 pour TT et 28 pour STT, où les indications pour la chirurgie, le temps opératoire, la durée d'hospitalisation et les complications ont été étudiés. RÉSULTATS: L'incidence de la paralysie transitoire du nerf laryngé récurrent (RLN) était de (6,25%) pour TT contre (3,57%) pour STT, et l'hypoparathyroïdie temporaire était de (9,38%) chez les patients TT contre (7,14%) chez les patients STT. La paralysie permanente du RLN et l'hypoparathyroïdie sont survenues chez un seul cas (3,12%) du groupe TT. Aucune complication permanente n'a été observée chez les patients STT. La récidive du goitre est survenue chez deux patients (7,14%) ayant subi une STT. Un carcinome papillaire incidentel a été observé chez (7,14%) des patients STT et un carcinome folliculaire chez (3,13%) des patients TT. Il n'y a pas eu de mortalité postopératoire. CONCLUSION: La TT est une procédure chirurgicale appropriée chez les patients atteints de maladie thyroïdienne bénigne bilatérale, car le taux de complications, le temps opératoire et la durée d'hospitalisation sont moindres par rapport à la STT. Elle offre une guérison permanente sans récidives, et les malignités thyroïdiennes incidentelles peuvent être évitées. MOTS-CLÉS: Troubles thyroïdiens bénins, Thyroïdectomie subtotale, Thyroïdectomie totale.
Assuntos
Tempo de Internação , Complicações Pós-Operatórias , Doenças da Glândula Tireoide , Tireoidectomia , Humanos , Tireoidectomia/métodos , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Doenças da Glândula Tireoide/cirurgia , Hipoparatireoidismo/etiologia , Hipoparatireoidismo/epidemiologia , Paralisia das Pregas Vocais/etiologia , Paralisia das Pregas Vocais/epidemiologia , Duração da Cirurgia , Resultado do Tratamento , Bócio/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Adulto JovemRESUMO
BACKGROUND: The indication and extent of selective lateral neck dissection (LND) for cN1a papillary thyroid carcinoma (PTC) remain uncertain. The present study aimed to identify potential predictors and distribution pattern of lateral lymph node recurrence (LLNR) after central neck dissection in cN1a PTC patients. METHODS: The cN1a PTC patients who underwent initial central neck dissection at our centre were retrospectively reviewed, and the median follow-up period was 6.8 years. Reoperation with LND was performed when LLNR was confirmed. Risk factors for LLNR were identified, and the metastatic status of each lateral level was recorded. RESULTS: Of the 310 patients enrolled in the present study, fifty-eight patients (18.7%) presented with LLNR. Six independent factors, including tumour diameter, pathological T4 stage, number of involved central lymph nodes, pTNM stage, extrathyroidal extension, and I131 treatment (P values < 0.05) were identified via multivariate analysis. LLNR was found at level II in 26 patients (44.8%), level III in 38 patients (65.5%), level IV in 30 patients (51.7%), and level V in 8 patients (13.8%). The number of positive lateral lymph nodes at levels II, III, IV and V was 44 (22.9%), 76 (39.6%), 63 (32.8%), and 9 (4.9%), respectively. CONCLUSIONS: For cN1a PTC patients who underwent central neck dissection, tumour diameter ≥ 2 cm, pathological T4 stage, number of involved central lymph nodes ≥ 3, pTNM stage III-IV, extrathyroidal extension, and failure to receive I131 treatment were independent predictors of LLNR, which was more likely to occur at levels III and IV.