Therapeutic options in locally advanced thyroid carcinoma. Our experience.

PubMed

Avenia, Nicola; Monacelli, Massimo; Sanguinetti, Alessandro; Santoprete, Stefano; Pecoriello, Roberta; Ragusa, Mark; Puma, Francesco

2012-01-01

Thyroid cancer is the most common endocrine malignancy with an incidence equal to 1% of all malignant tumors. Prognostic factors affecting survival are manifold, including in several classifications (AMES, AGES, CORN and TNM). In this sense, the invasion of adjacent structures is one of the most important variables. The authors describe the experience of a single center in surgical treatment of advanced thyroid cancer. Between 1986 and 2010 , 1565 patients were undergoing surgery with thyroid cancer. In particular, 1403 interventions were made for differentiated cancer, 97 for medullary carcinoma, 25 for insular carcinoma, 29 for anaplastic carcinoma, 2 for plasmacytoma, and 7 for lymphoma and 2 for angiosarcoma. Among these 896 showed invasion of adjacent structures and / or distant metastases. There were no perioperative deaths or major complications. Surgical procedures consisted of: 13 loboistmectomy, 519 total thyroidectomy (TT), 325 TT with lymphadenectomy of the central compartment, 7 TT with radical lymphectomy, 621 TT with functional lymphectomy, 6 TT with breast lumpectomy, 5 TT with with video-assisted lung metastasectomy, 16-TT with resection and tracheal anastomosis, 6 TT with laryngotracheal resection, 3 TT with laryngectomy, 4 TT with trachetomy, 28 TT with respiratory stent placement, 12 tracheotomy. At present, 1328 patients were free of disease, while 104 showed recurrence. Total of 133 deaths were recorded, all linked to disease relapse. The role of surgery in the treatment of advanced thyroid cancer is still undeniable. In the presence of extracapsular trespassing, in fact, the adoption of interventions demolition permits long-term survival, given the lack of aggressiveness of the tumor differentiated representing the majority of cases. The aim of surgical radicalization addition, even in the presence of distant metastases, it is justified by the possibilities offered by the therapeutic radioiodine treatment, which is not feasible in the presence of significant amounts of thyroid tissue which picks. In the presence of undifferentiated tumors, finally, endoscopic or surgical treatment may be indicated by simple purpose of palliation of respiratory symptoms.

Risk factors for postoperative hypocalcemia.

PubMed

Docimo, Giovanni; Ruggiero, Roberto; Casalino, Giuseppina; Del Genio, Gianmattia; Docimo, Ludovico; Tolone, Salvatore

2017-06-01

Hypocalcaemia is one of the most common complications after thyroidectomy; however, it is still unclear what preoperative factors could predict this event. The aim of this study was to evaluate the role of risk factors for hypocalcaemia after total thyroidectomy (TT). Consecutive patients who underwent total thyroidectomyat our institution between January 2014 and January 2016 were enrolled. The clinical and pathologic characteristics and surgical details of normocalcemic and hypocalcemic patients were compared. Univariate and multivariate analyses to estimate risk ratio were assessed. A total of 328 patients underwent TT; histology revealed benign and malignant disease in 83 and 17% of cases, respectively. Central-compartment neck dissection (CCND) was performed in 36 subjects (10.9%). Parathyroid glands were observed in 23% (76) of specimens. Laboratory asymptomatic hypocalcaemia was observed in 92 (28%) patients; symptomatic hypocalcaemia occurred in 26 (7.9%). Transient hypocalcaemia has been observed in 48 (14.6%) patients; permanent hypocalcaemia occurred in two subjects (0.6%). On univariate analysis, malignant pathology (p < 0.001), CCND (p < 0.05), female gender (p < 0.001), presence of at least two parathyroid glands in specimens (p < 0.002), and operative time longer than 120 min (p < 0.05) were factors that significantly increased the risk of developing asymptomatic and transient hypocalcaemia. After logistic regression analysis, malignant pathology (p < 0.000; p < 0.001) and CCND (p < 0.005; p = 0.013) were the significant factors that affected the development of symptomatic and transient hypocalcaemia. The presence of malignant pathology and CCND was found to be significant risks factors for postoperative hypocalcaemia. In patients in whom this pathological features are present, attention should be paid to rapidly start an adequate therapy.

A cost-utility analysis for prophylactic central neck dissection in clinically nodal-negative papillary thyroid carcinoma.

PubMed

Wong, Carlos K H; Lang, Brian Hung-Hin

2014-03-01

Although prophylactic central neck dissection (pCND) may reduce future locoregional recurrence after total thyroidectomy (TT) for low-risk papillary thyroid carcinoma (PTC), it is associated with a higher initial morbidity. We aimed to compare the long-term cost-effectiveness between TT with pCND (TT+pCND) and TT alone in the institution's perspective. Our case definition was a hypothetical cohort of 100,000 nonpregnant female patients aged 50 years with a 1.5-cm cN0 PTC within one lobe. A Markov decision tree model was constructed to compare the estimated cost-effectiveness between TT+pCND and TT alone after a 20-year period. Outcome probabilities, utilities, and costs were estimated from the literature. The threshold for cost-effectiveness was set at US$50,000 per quality-adjusted life year (QALY). Sensitivity and threshold analyses were used to examine model uncertainty. Each patient who underwent TT+pCND instead of TT alone cost an extra US$34.52 but gained an additional 0.323 QALY. In fact, in the sensitivity analysis, TT+pCND became cost-effective 9 years after the initial operation. In the threshold analysis, none of the scenarios that could change this conclusion appeared clinically possible or likely. However, TT+pCND became cost-saving (i.e., less costly and more cost-effective) at 20 years if associated permanent vocal cord palsy was kept ≤ 1.37 %, permanent hypoparathyroidism was ≤ 1.20 %, and/or postoperative radioiodine ablation use was ≤ 73.64 %. In the institution's perspective, routine pCND for low-risk PTC began to become cost-effective 9 years after initial surgery and became cost-saving at 20 years if postoperative radioiodine use and/or permanent surgical complications were kept to a minimum.

Preventing post-operative hypocalcemia in Graves’ patients: A prospective study

PubMed Central

Oltmann, Sarah C.; Brekke, Andrew V.; Schneider, David F.; Schaefer, Sarah C.; Chen, Herbert; Sippel, Rebecca S.

2014-01-01

Background Hypocalcemia occurs after total thyroidectomy (TT) for Graves’ disease via parathyroid injury and/or from increased bone turnover. Current management is to supplement calcium after surgery. This study evaluates the impact of preoperative calcium supplementation on hypocalcemia after Graves’ TT. Methods A prospective study of Graves’ patients undergoing TT was performed. Graves’ patients managed over a 9 month period took 1gm of calcium carbonate (CC) three times a day for two weeks before TT. Those managed the previous year, without supplementation served as historic controls. Age-, gender-, and thyroid weight-matched, non-Graves’ TT patients were procedure controls. Patient demographics, postoperative laboratory values, complaints and medications were reviewed. PTH based postoperative protocols dictated postoperative CC and calcitriol use. Results 45 Graves’ patients were treated with CC before TT, while 38 Graves’ patients were not. 40 non-Graves’ controls were identified. Age, gender and thyroid weight were comparable. Pre-operative calcium and PTH levels were equivalent. PTH values immediately after surgery, POD 1 and at 2 week follow-up were equivalent. Post-operative use of scheduled CC(p=0.10) and calcitriol(p=0.60) was similar. Post-operatively, untreated Graves’ had lower serum calcium levels than pre-treated Graves’ or non-Graves’ controls(8.3mg/dL vs. 8.6 vs. 8.6, p=0.05). Complaints of numbness and tingling were more common in non-treated Graves’(26%) than pretreated Graves’(9%) or non-Graves’ controls(10%, p<0.05). Conclusions Calcium supplementation before TT for Graves’ significantly reduced biochemical and symptomatic postoperative hypocalcemia. Preoperative calcium supplementation is a simple treatment that can reduce symptoms of hypocalcemia after Graves’ TT. PMID:25212835

Recurrent Laryngeal Nerve Injury In Total Versus Subtotal Thyroidectomy.

PubMed

Sajid, Tahira; Qamar Naqvi, Syeda Rifaat; Qamar Naqvi, Syeda Saima; Shukr, Irfan; Ghani, Rehman

2016-01-01

Both Total and Subtotal Thyroidectomy are correct treatment options for symptomatic Euthyroid Multinodular Goitre. The choice depends upon surgeon's preference due to consideration of disadvantages like permanent hypothyroidism in Total Thyroidectomy and high chances of recurrence in Subtotal Thyroidectomy. Many surgeons believe that there is a higher incidence of Recurrent Laryngeal nerve injury in Total Thyroidectomy which affects their choice of surgery. This study aimed to compare the incidence of recurrent laryngeal nerve injury in total versus subtotal thyroidectomy. This non randomized controlled trial was carried out at Department of Surgery and ENT of Ayub Teaching Hospital Abbottabad, and Combined Military Hospital Rawalpindi from 1st September 2013 to 30th August 2014. During the period of study, patients presenting in surgical outpatient department with euthyroid multinodular goitre having pressure symptoms requiring thyroidectomy were divided into two groups by convenience sampling with 87 patients in group 1 and 90 patients in group 2. Group-1 was subjected to total thyroidectomy and Group -2 underwent subtotal thyroidectomy. All the patients had preoperative Indirect Laryngoscopy examination and it was repeated postoperatively to check for injury to the recurrent laryngeal nerve. A total of 177 patients were included in the study. Out of these, 87 patients underwent total thyroidectomy (Group-1). Two of these patients developed recurrent laryngeal nerve injury (2.3%). In group-2 subjected to subtotal thyroidectomy, three of the patients developed recurrent laryngeal nerve injury (3.3%). The p-value was 0.678. The overall risk of injury to this nerve in both surgeries combined was 2.8%. There is no significant difference in the risk of recurrent laryngeal nerve damage in patients undergoing total versus subtotal thyroidectomy.

Occult thyroid carcinoma in our experience -- should we reconsider total thyroidectomy for benign thyroid pathology?

PubMed

Alecu, L; Bărbulescu, M; Ursuţ, B; Enciu, O; Slavu, I; Braga, V

2014-01-01

The reported incidence rate of occult thyroid carcinoma in patients operated for benign thyroid pathology has been much higher than expected in the last years,especially for multinodular goitre, which raises the question about which should the proper surgical management for these cases be. To assess the incidence rate of OTC in a single medium volume surgical center and to establish the correct indication for initial surgical management, as well as to identify the benign thyroid pathology most frequently associated with OTC. We also reviewed the relevant scientific literature on this topic. We conducted a retrospective study in the General Surgery Clinic of "Prof. dr. Agrippa Ionescu" Clinical Emergency Hospital, Bucharest, on a series of 145 patients who underwent surgical interventions for preoperatively diagnosed benign thyroid pathology over a ten year period, between 1st January 2002 - 31st December 2012. All cases of known thyroid cancer were excluded. Incidence rate of occult thyroid carcinoma in our series was 6.9 % (10 out of 145 patients), 80 % of them being diagnosed with multinodular goitre and two cases (20 %) with Hashimoto's lymphocytic thyroiditis. 6.8 % of all patients with multinodular goitre were found to present occult carcinoma,but this association was without statistical significance(p 0.05). Incidence rate of occult cancer among patients with Hashimoto thyroiditis was proved to be as high as 28.6%,statistically significant (p=0.020). The mean size of postoperatively diagnosed occult microcarcinoma was 7 mm, ranging between 3 mm and 14 mm, 90% of them being smaller than 1cm. Histologically, papillary microcarcinoma was found in all cases. The mean age of the patients diagnosed with occult microcarcinoma was 47.8 years with majority of the female gender. The most frequent operation performed was total thyroidectomy (70.8%). Overall morbidity in our series was 6.9% with a 0.7 % mortality rate (1 case). In our opinion, primary total thyroidectomy should be performed as the procedure of choice for the most part of preoperatively diagnosed benign thyroid pathology and particularly for multinodular goitre and Hashimoto thyroiditis,in order to radically resect all possible foci of aggressive thyroid microcarcinomas.Abbreviations and Acronyms: OTC (Occult Thyroid Carcinoma), PTMC (Papillary Thyroid Microcarcinoma); TT(Total Thyroidectomy), MNG (Multinodular Goitre), GD(Graves' disease), TNG (Toxic Nodular Goitre), FNAB(fine-needle aspiration biopsy). Celsius.

Total thyroidectomy versus hemithyroidectomy for patients with follicular neoplasm. A cost-utility analysis.

PubMed

Corso, C; Gomez, X; Sanabria, A; Vega, V; Dominguez, L C; Osorio, C

2014-01-01

Thyroid nodules are a common condition. Overall, 20% of the nodules assessed with FNAB correspond to the follicular pattern. A partial thyroidectomy is the minimal procedure that should be performed to determine the nature of these nodules. Some authors have suggested performing a total thyroidectomy based on the elimination of reoperation and ultrasound follow-up. The aim of this study was to evaluate the most cost-useful surgical strategy in a patient with an undetermined nodule, assessing complications, reoperation, recurrence and costs. A cost-utility study was designed to compare hemithyroidectomy and total thyroidectomy. The outcomes were complications (definitive RLN palsy, permanent hypoparathyroidism, reoperation for cancer, and recurrence of the disease), direct costs and utility. We used the payer perspective at 5 years. A deterministic and probabilistic sensitivity analysis was completed. In a deterministic analysis, the cost, utility and cost-utility ratio was COP $12.981.801, 44.5 and COP $291.310 for total thyroidectomy and COP $14.309.889, 42.0 and $340.044 for partial thyroidectomy, respectively. The incremental cost-utility ratio was -$535.302 favoring total thyroidectomy. Partial thyroidectomy was more cost-effective when the risks of RLN injury and definitive hypoparathyroidism were greater than 8% and 9% in total thyroidectomy, respectively. In total, 46.8% of the simulations for partial thyroidectomy were located in the quadrant of more costly and less effective. Under a common range of complications, and considering the patient's preference and costs, total thyroidectomy should be selected as the most cost-effective treatment for patients with thyroid nodules and follicular patterns. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Necessity of therapy for post-thyroidectomy hypocalcaemia: a multi-centre experience.

PubMed

De Pasquale, L; Sartori, P V; Vicentini, L; Beretta, E; Boniardi, M; Leopaldi, E; Gini, P; La Manna, L; Cozzaglio, L; Steffano, G B; Andreani, S; Badiali, S; Cantoni, G M; Galimberti, A; Ghilardi, G; Gusmeroli, M; Maggiore, R; Morenghi, E; Pauna, J; Poggi, L; Testa, V

2015-04-01

Hypoparathyroidism is one of the most common and most feared complications of total thyroidectomy (TT). The aim of this study is to detect possible markers that may facilitate early tracing of hypocalcaemia-prone patients in order to reduce clinical cost by optimizing patient discharge and to avoid unnecessary treatment. Over an 18-month period, 995 patients, 23 % male and 77 % female, aged 52.9 ± 13.4 years, underwent TT in ten Lombardy hospitals. The following parameters were analyzed: calcaemia before and 12-24 and 48 h after surgery, pre- and post-operative parathyroid hormone (PTH) at 24 h and pre-operative 25OH vitamin D. Mortality was nil and morbidity was 22.4 %. Mean 24-h calcaemia and PTH were 2.17 ± 0.15 mmol/l and 31.81 ± 20.35 pg/ml, respectively; mean 24-h PTH decay was 36.7 ± 34.12 %. Four hundred seventy-three (47.5 %) patients were hypocalcaemic at discharge; 142 of whom had transient hypoparathyroidism that became permanent in 27. Patients developing hypocalcaemia had significantly higher values of PTH and calcium decay. At multiple logistic regression, only 24-h calcium decay, PTH drop and the presence of symptoms and parathyroid auto-grafting were significantly related to hypoparathyroidism. The association of these factors had a 99.2 % negative predictive value (NPV) for the development of hypoparathyroidism. A 70 % PTH drop had a 93.75 NPV for transient hypoparathyroidism. A 12 % calcaemia decay had a 95.7 NPV for hypoparathyroidism. Hypocalcaemic asymptomatic patients with less than 70 % PTH and 12 % calcaemia decay may be safely discharged without treatment. Symptomatic patients and those with parathyroid grafting should receive calcium and vitamin D.

Intraoperative serum parathyroid hormone level is an indicator of hypocalcaemia in total thyroidectomy patients.

PubMed

Islam, M S; Sultana, T; Paul, D; Huq, A H M Z; Chowdhury, A A; Ferdous, C; Ahmed, A N N

2012-12-01

Postoperative hypocalcaemia is the most frequent and common complication after total thyroidectomy. It is necessary to diagnose or to predict hypocalcaemia immediately after total thyroidectomy for minimizing complications. A prospective observational study was carried out in the Department of Clinical Pathology in collaboration with Department of Microbiology & Immunology, Department of Surgery, Department of Otolaryngology, Bangabandhu Sheikh Mujib Medical University (BSMMU) and Department of Otolaryngology, Dhaka Medical College & Hospital (DMC&H), Dhaka, during the period of September 2010 to August 2011 to evaluate intraoperative (20 minutes after total thyroidectomy) parathyroid hormone (PTH) measurement as a predictor of post thyroidectomy hypocalcaemia. Total 65 patients were enrolled in this study those came for total thyroidectomy. Postoperative hypocalcaemia developed in 25 cases. Intraoperative PTH was assessed and significant correlation was found between intraoperative PTH level and development of hypocalcaemia. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value of intraoperative serum PTH for prediction of post total thyroidectomy hypocalcaemia were 84.0%, 85.0%, 84.6%, 77.8%, and 89.5% respectively. Because of the high sensitivity, specificity and accuracy of intraoperative serum PTH of this study, the early prediction of hypocalcaemia could be made by single assay of intraoperative serum PTH level at 20 minutes after total thyroidectomy.

Review analysis of medullary carcinoma of the thyroid: a 15-year Indian experience.

PubMed

Dorairajan, N; Siddharth, D; Kanna, Srinivasulu

2006-01-01

The aim of this study was to emphasize the importance of adequate primary surgery in cases of medullary carcinoma of the thyroid. We retrospectively reviewed 44 cases of medullary carcinoma of the thyroid treated in Government General Hospital, Chennai between 1987 and 2002. Patients who underwent total thyroidectomy with only central compartment dissection were compared with those who had undergone total thyroidectomy with meticulous triple compartment (bilateral lateral and central groups) nodal dissection. The group of total thyroidectomy with only central compartment dissection had a high rate of lymph nodal recurrence and persistent hypercalcitoninemia compared with the group with total thyroidectomy with meticulous triple compartment nodal dissection. (chi square, 4.503; P > 0.05). Primary surgery with total thyroidectomy with meticulous triple compartment dissection is superior to total thyroidectomy with central compartment dissection alone in terms of preventing nodal and local recurrences and achieving normal (basal and stimulated) serum calcitonin levels postoperatively.

Robotic thyroidectomy learning curve for beginning surgeons with little or no experience of endoscopic surgery.

PubMed

Park, Jae Hyun; Lee, Jandee; Hakim, Nor Azham; Kim, Ha Yan; Kang, Sang-Wook; Jeong, Jong Ju; Nam, Kee-Hyun; Bae, Keum-Seok; Kang, Seong Joon; Chung, Woong Youn

2015-12-01

This study assessed the results of robotic thyroidectomy by fellowship-trained surgeons in their initial independent practice, and whether standard fellowship training for robotic surgery shortens the learning curve. This prospective cohort study evaluated outcomes in 125 patients who underwent robotic thyroidectomy using gasless transaxillary single-incision technique by 2 recently graduated fellowship-trained surgeons. Learning curves were analyzed by operation time, with proficiency defined as the point at which the slope of the time curve became less steep. Of the 125 patients, 113 underwent robotic less-than-total thyroidectomy, 9 underwent robotic total thyroidectomy and 3 underwent robotic total thyroidectomy with modified radical neck dissection. Mean total times for these 3 operations were 100.8 ± 20.6 minutes, 134.2 ± 38.7 minutes, and 284.7 ± 60.4 minutes, respectively. For both surgeons, the operation times gradually decreased, reaching a plateau after 20 robotic less-than-total thyroidectomies. The surgical learning curve for robotic thyroidectomy performed by recently graduated fellowship-trained surgeons with little or no experience in endoscopic surgery showed excellent results compared with those in a large series of more experienced surgeons. © 2014 Wiley Periodicals, Inc.

Prospective evaluation of intra-operative quick parathyroid hormone assay as an early predictor of post thyroidectomy hypocalcaemia.

PubMed

Reddy, Ashwini C; Chand, Gyan; Sabaretnam, M; Mishra, Anjali; Agarwal, Gaurav; Agarwal, Amit; Verma, A K; Mishra, S K

2016-10-01

Hypocalcaemia following total thyroidectomy is a major contributing factor in delayed hospital discharge and dissuading surgeons from day care thyroidectomy. We prospectively evaluated the utility of Intra-operative serum quick parathyroid hormone level measurement twenty minutes after total thyroidectomy in predicting post-operative hypocalcemia. Prospective longitudinal study which included patients undergoing total thyroidectomy for benign or malignant thyroid disorders at SGPGIMS, Lucknow, India from November 2013 to February 2015. Patients who received calcium prophylaxis were excluded from the study. Intraoperative serum quick PTH level measurements were done twenty minutes after resection of thyroid. Serum calcium levels were estimated preoperatively and on three consecutive post operative days. Calcium supplementation was started in patients with symptomatic hypocalcemia. The study included 100 patients with a mean age of 41 years, range 17-72 years. 48 patients had Euthyroid multinodular goitre, 10 patients grave's disease and 42 patients had differentiated thyroid cancer. Total thyroidectomy was performed in 88 patients, total thyroidectomy with lymph node dissection in 12 patients. Post-operatively 23% patients experienced symptomatic hypocalcemia. The IOPTH level of 9 pmol/L, twenty minutes after total thyroidectomy, had the highest sensitivity and specificity of 92% and 83% respectively in predicting post-operative hypocalcemia. Parathyroid hormone assay twenty minutes after thyroidectomy is an accurate and reliable means of predicting clinically relevant hypocalcemia. Patients with PTH values greater than 9 pmol/L twenty minutes after thyroidectomy, can be safely discharged on the same postoperative day as the probability of life threatening hypocalcemia is unlikely. Copyright © 2016. Published by Elsevier Ltd.

Persistent hyperthyroidism and de novo Graves' ophthalmopathy after total thyroidectomy.

PubMed

Tay, Wei Lin; Loh, Wann Jia; Lee, Lianne Ai Ling; Chng, Chiaw Ling

2017-01-01

We report a patient with Graves' disease who remained persistently hyperthyroid after a total thyroidectomy and also developed de novo Graves' ophthalmopathy 5 months after surgery. She was subsequently found to have a mature cystic teratoma containing struma ovarii after undergoing a total hysterectomy and salpingo-oophorectomy for an incidental ovarian lesion. It is important to investigate for other causes of primary hyperthyroidism when thyrotoxicosis persists after total thyroidectomy.TSH receptor antibody may persist after total thyroidectomy and may potentially contribute to the development of de novo Graves' ophthalmopathy.

The impact of body habitus on the surgical outcomes of transaxillary single-incision robotic thyroidectomy in papillary thyroid carcinoma patients.

PubMed

Lee, Sohee; Park, Seulkee; Lee, Cho Rok; Son, Haiyoung; Kim, Jungwoo; Kang, Sang-Wook; Jeong, Jong Ju; Nam, Kee-Hyun; Chung, Woong Youn; Park, Cheong Soo

2013-07-01

Robotic applications have achieved safe and precise thyroidectomy with notable cosmetic and functional benefits. This study was designed to document the influence of body habitus on robotic thyroidectomy in papillary thyroid carcinoma (PTC) patients. From July 2009 to February 2010, 352 patients underwent robotic thyroidectomy using a gasless, transaxillary single-incision approach at Yonsei University Health System. Body habitus was described using body mass index category (normal weight, overweight, obese), neck length, shoulder width, and shoulder width to neck length ratios. The impact of body habitus on surgical outcomes was analyzed with respect to operation time, number of retrieved central nodes, bleeding amount, and postoperative complications. Of the 352 patients, 217 underwent less than total thyroidectomy and 135 underwent total thyroidectomy. Operative variables (i.e. operation times, bleeding amounts, and numbers of retrieved central nodes) showed no significant differences between three BMI groups for less than total thyroidectomy. However, total operation and working space times were longer for obese patients during total thyroidectomy. In particular, shoulder width was positively correlated with total operation time, working space time, console time, and number of retrieved central nodes. On the other hand, postoperative complications were not significantly different in the three BMI groups and showed no significant correlation with the other indices of body habitus. Standardized robotic thyroidectomy can be performed safely and feasibly in patients with a large body habitus despite longer operation times.

Hypomagnesemia associated with hypocalcemia after total thyroidectomy: an observational study.

PubMed

Mahmoud, Renata Regina da Graça Lorencetti; Neto, Vergilius José Furtado de Araujo; Alves, Wellington; Lin, Chin Shien; Leite, Ana Kober Nogueira; Matos, Leandro Luongo; Filho, Vergilius José Furtado de Araujo; Cernea, Claudio Roberto

2016-06-01

Serum magnesium is frequently low in patients with hypocalcemia after total thyroidectomy. The aim of the present study was to analyze the variations in serum magnesium and calcium concentrations after total thyroidectomy, and the relationship between both ions. We conducted an observational study of 142 patients who had undergone total thyroidectomy, measuring serum calcium and magnesium levels preoperatively and on the day following surgery. The incidence of postoperative hypocalcemia was compared with that of postoperative hypomagnesemia. A total of 142, total thyroidectomies were performed: 54 patients (38%) presented with hypocalcemia on the first postoperative day. A marked decrease in blood magnesium in the group of patients with hypocalcemia was observed when compared to those with normal calcemia on the first postoperative day (mean variation respectively, 0.125 ± 0.065 mmol/L versus 0.035 ± 0.020 mmol/L; P = 0.0002). Hypomagnesemia is significantly associated with early hypocalcemia following thyroidectomy.

Validity of early parathyroid hormone assay as a diagnostic tool for sub-total thyroidectomy related hypocalcaemia.

PubMed

Riaz, Umbreen; Shah, Syed Aslam; Zahoor, Imran; Riaz, Arsalan; Zubair, Muhammad

2014-07-01

To determine the validity of early (one hour postoperatively) parathyroid hormone (PTH) assay (² 10 pg/ml), keeping gold standard as the serum ionic calcium level, for predicting sub-total thyroidectomy-related hypocalcaemia and to calculate the sensitivity and specificity of latent signs of tetany. Cross-sectional validation study. Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad from August 2008 to August 2010. Patients undergoing sub-total thyroidectomy were included by convenience sampling. PTH assay was performed 1 hour post sub-total thyroidectomy. Serum calcium levels were performed at 24 and 48 hours, 5th day and 2 weeks after surgery. Cases that developed hypocalcaemia were followed-up for a period of 6 months with monthly calcium level estimation to identify cases of permanent hypocalcaemia. Symptoms and signs of hypocalcaemia manifesting in our patients were recorded. Data was analyzed through SPSS version 10. 2 x 2 tables were used to calculate sensitivity and specificity of PTH in detecting post-thyroidectomy hypocalcaemia. Out of a total of 110 patients included in the study, 16.36% (n=18) developed hypocalcaemia including 1.81% (n=2) cases of permanent hypoparathyroidism. The sensitivity of one hour postoperative PTH assay as a predictive tool for post-thyroidectomy related hypocalcaemia was 94.4% while its specificity was 83.6% with 53% positive predictive value and 98.7% negative predictive value. One hour post sub-total thyroidectomy PTH assay can be helpful in predicting post sub-total thyroidectomy hypocalcaemia. Moreover, it can be useful in safe discharge of day-care thyroidectomy patients.

Total Thyroidectomy for Benign Thyroid Diseases: What is the Price to be Paid?

PubMed Central

Gangappa, Rajashekara Babu; Chowdary, Prashanth Basappa; Patanki, Adithya Malolan; Ishwar, Mahalakshmi

2016-01-01

Introduction Total thyroidectomy has been used to treat patients with malignant thyroid disease. But for patients with benign thyroid disease, the safety and efficacy of total thyroidectomy is a matter of debate. Subtotal thyroidectomy that was previously the treatment of choice for benign thyroid disease has been associated with high recurrence rates. The risk of permanent complications is greatly increased in patients who undergo surgery for recurrence of benign thyroid disease. Total thyroidectomy is an operation that can be safely performed, with low incidence of permanent complications, which allows one to broaden its indications in various benign thyroid diseases, thus avoiding future recurrences and reoperations. Aim To assess the benefits of total thyroidectomy for benign thyroid diseases. Materials and Methods This randomized prospective study was conducted between Feb 2013 and Nov 2014 in the Department of General Surgery at Bangalore Medical College and Research Institute. It included 116 patients undergoing total thyroidectomy procedure for benign thyroid disease. All cases were followed-up for a period of 6 months for incidence of RLN palsy, hypoparathyroidism, disease recurrence and number of incidental malignancies detected on postoperative histological analyses of the thyroid specimens. Results Most of the patients were in the third decade of their lives. The female to male ratio was 6.7:1. Total thyroidectomy was done for 116 benign thyroid diseases with multinodular goiter as the most common diagnosis. The incidence of postoperative hypocalcaemia was 16.37% (however, only 1 patient developed permanent hypocalcaemia) and that of wound infection was 2.58% and seroma formation was 2.58%. None of the patients included in this study had haematoma formation or RLN paralysis. An incidental malignancy was identified in 11.20% patients. Conclusion Total thyroidectomy shows benefits in eradicating multinodular goiter, alleviating Grave’s opthalmopathy, treating Hashimoto’s thyroiditis and preventing recurrence. It decreases the likelihood of future operations for recurrent disease or completion thyroidectomy for incidental thyroid cancer thus decreasing the associated risks of increased morbidity associated with second operation. Therefore, for benign thyroid diseases requiring surgical management total thyroidectomy can be considered the treatment of choice. PMID:27504342

An iPTH based protocol for the prevention and treatment of symptomatic hypocalcemia after thyroidectomy

PubMed Central

Carter, Yvette; Chen, Herbert; Sippel, Rebecca S.

2013-01-01

Background Symptomatic hypocalcemia after thyroidectomy is a barrier to same day surgery, and the cause of ER visits. A standard protocol of calcium and vitamin D supplementation, dependent on intact parathyroid hormone (iPTH) levels, can address this issue. How effective is it? When does it fail? Methods We performed a retrospective review of the prospective Thyroid Database from January 2006 to December 2010. 620 patients underwent completion (CT) or total thyroidectomy (TT), and followed our post-operative protocol of calcium carbonate administration for iPTH levels ≥10pg/ml and calcium carbonate and 0.25μg calcitriol BID for iPTH <10pg/ml. Calcium and iPTH values, pathology and medication, were compared to evaluate protocol efficacy. A p value <0.05 was considered statistically significant. Results Using the protocol, sixty-one (10.2%) patients were chemically hypocalcemic but never developed symptoms and twenty-four (3.9%) patients developed breakthrough symptomatic hypocalcemia. The symptomatic (SX) and asymptomatic (ASX) groups were similar with regard to gender, cancer diagnosis, and pre-operative calcium and iPTH. The symptomatic group was significantly younger (39.6 ± 2.8 vs. 49 ± 0.6 years, p=0.01), with lower post-operative iPTH levels. 33% (n=8) of SX patients had an iPTH ≤5 pg/ml vs. only 6% (n=37) of ASX patients. While the majority of patients with a PTH <5 pg/ml were asymptomatic, 62.5% (n=5) of SX patients with iPTH levels ≤5 pg/ml, required an increased in calcitriol dose to achieve both biochemical correction and symptom relief. Conclusion Prophylactic calcium and vitamin D supplementation based on post-operative iPTH levels can minimize symptomatic hypocalcemia after thyroidectomy. An iPTH ≤ 5pg/ml may warrant higher initial doses of calcitriol in order to prevent symptoms. PMID:24144426

Thyroid gland removal - discharge

MedlinePlus

... tingling in your face or lips Alternative Names Total thyroidectomy - discharge; Partial thyroidectomy - discharge; Thyroidectomy - discharge; Subtotal thyroidectomy - discharge References Lai SY, Mandel SJ, Weber RS. Management of thyroid neoplasms. In: Flint PW, Haughey BH, ...

Total thyroidectomy: is morbidity higher for Graves' disease than nontoxic goiter?

PubMed

Welch, Kellen C; McHenry, Christopher R

2011-09-01

Total thyroidectomy for treatment of Graves' disease is controversial and much of the debate centers on the concern for complications. The purpose of this study was to evaluate the morbidity of total thyroidectomy for Graves' disease and determine if it is different than for patients with nontoxic nodular goiter. The rates of life threatening neck hematoma, recurrent laryngeal nerve (RLN) injury, transient hypocalcemia, and hypoparathyroidism were determined for consecutive patients with Graves' disease treated with total thyroidectomy from 1996 to 2010. Results were compared with patients who underwent total thyroidectomy for nontoxic nodular goiter during the same period, matched for the weight of the excised thyroid gland. Total thyroidectomy was performed in 111 patients with Graves' disease (group I) and 283 patients with nontoxic nodular goiter (group II). Parathyroid autotransplantation was performed in 31(28%) patients in group I and 98 (35%) patients in group II (P = NS). Comparative analysis of morbidity revealed no significant difference in neck hematoma, 0(0%) (I) versus 3(1%) (II); permanent RLN injury, 0(0%) (I) versus 2(1%) (II); and permanent hypoparathyroidism in 1(1%) (I) versus 1 (0.4%) (II) (P = NS). Transient hypocalcemia was more common in patients with Graves' disease, 80(72%) (I) versus 170 (60%) (II) (P < 0.05), but not when matched for thyroid weight. Total thyroidectomy can be performed with low morbidity in patients with Graves' disease; only transient hypocalcemia occurred more often than in patients with nodular goiter. Total thyroidectomy should be presented as a therapeutic option for all patients with Graves' disease. Copyright © 2011 Elsevier Inc. All rights reserved.

Practice patterns in the management of patients with differentiated thyroid cancer in Ontario Canada 2000-2008

PubMed Central

2014-01-01

Background The extent of treatment for differentiated thyroid cancer remains controversial. The objective of this study was to describe the variations in practice prior to diagnosis and for the first year after diagnosis, including the investigations, the extent of surgery and the use of RAI 131, for all patients with thyroid cancer (TC) treated Jan 1 2000 to Dec 2008 across Ontario Canada. Method Population-based study of all patients who had a therapeutic surgical procedure for TC based on the data holdings of the Institute of Clinical Investigative Sciences (ICES) linking the Ontario Cancer Registry to the Ontario Health Insurance Plan and to the Canadian Institutes of Health Information. The analysis includes comparisons between health care utilization/geographic regions and between treating specialties. The study population was 12957 patients. Results There was a 112% increase in case detection over 9 years. Overall the initial (index) surgery was less-than-total thyroidectomy (LTT) in 37.6% and 63.4% of the patients who had total thyroidectomy (TT) as an index surgery went on to adjuvant RAI, however there was wide variation in all aspects of patient care across the province, between Local Health Networks and between surgical specialties. Conclusion In Ontario, there was wide variation for most aspects of the management of TC and, as the incidence of TC is increasing at least 7% per year in females, these data provide a foundation for future discussions, the provision of health care services and research. PMID:25055715

Pre-operative serum alkaline phosphatase as a predictive indicator of post-operative hypocalcaemia in patients undergoing total thyroidectomy.

PubMed

Miah, M S; Mahendran, S; Mak, C; Leese, G; Smith, D

2015-11-01

This study aimed to evaluate whether a pre-operative elevated serum alkaline phosphatase level is a potential predictor of post-operative hypocalcaemia after total thyroidectomy. Data was retrospectively collected from the case notes of patients who had undergone total thyroidectomy. Patients were divided into Graves' disease and non-Graves' groups. Pre-operative and post-operative biochemical markers, including serum calcium, alkaline phosphatase and parathyroid hormone levels, were reviewed. A total of 225 patients met the inclusion criteria. Graves' disease was the most common indication (n = 134; 59.5 per cent) for thyroidectomy. Post-operative hypocalcaemia developed in 48 patients (21.3 per cent) and raised pre-operative serum alkaline phosphatase was noted in 94 patients (41.8 per cent). Raised pre-operative serum alkaline phosphatase was significantly associated with post-operative hypocalcaemia, particularly in Graves' disease patients (p < 0.05). Pre-operative serum alkaline phosphatase measurements help to predict post-thyroidectomy hypocalcaemia, especially in patients who do not develop hypoparathyroidism. Ascertaining the pre-operative serum alkaline phosphatase level in patients undergoing total thyroidectomy may help surgeons to identify at-risk patients.

Thyroid surgery for Graves' disease and Graves' ophthalmopathy.

PubMed

Liu, Zi Wei; Masterson, Liam; Fish, Brian; Jani, Piyush; Chatterjee, Krishna

2015-11-25

Graves' disease is an autoimmune disease caused by the production of auto-antibodies against the thyroid-stimulating hormone receptor, which stimulates follicular cell production of thyroid hormone. It is the commonest cause of hyperthyroidism and may cause considerable morbidity with increased risk of cardiovascular and respiratory adverse events. Five per cent of people with Graves' disease develop moderate to severe Graves' ophthalmopathy. Thyroid surgery for Graves' disease commonly falls into one of three categories: 1) total thyroidectomy, which aims to achieve complete macroscopic removal of thyroid tissue; 2) bilateral subtotal thyroidectomy, in which bilateral thyroid remnants are left; and 3) unilateral total and contralateral subtotal thyroidectomy, or the Dunhill procedure. Recent American Thyroid Association guidelines on treatment of Graves' hyperthyroidism emphasised the role of surgery as one of the first-line treatments. Total thyroidectomy removes target tissue for the thyroid-stimulating hormone receptor antibody. It controls hyperthyroidism at the cost of lifelong thyroxine replacement. Subtotal thyroidectomy leaves a thyroid remnant and may be less likely to lead to complications, however a higher rate of recurrent hyperthyroidism is expected and revision surgery would be challenging. The choice of the thyroidectomy technique is currently largely a matter of surgeon preference, and a systematic review of the evidence base is required to determine which option offers the best outcomes for patients. To assess the optimal surgical technique for Graves' disease and Graves' ophthalmopathy. We searched the Cochrane Library, MEDLINE and PubMed, EMBASE, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). The date of the last search was June 2015 for all databases. We did not apply any language restrictions. Only randomised controlled trials (RCTs) involving participants with a diagnosis of Graves' disease based on clinical features and biochemical findings of hyperthyroidism were eligible for inclusion. Trials had to directly compare at least two surgical techniques of thyroidectomy. There was no age limit to study inclusion. Two review authors independently extracted and cross-checked the data for analysis, evaluation of risk of bias and establishment of 'Summary of findings' tables using the GRADE instrument. The senior review authors reviewed the data and reconciled disagreements. We included five RCTs with a total of 886 participants; 172 were randomised to total thyroidectomy, 383 were randomised to bilateral subtotal thyroidectomy, 309 were randomised to the Dunhill procedure and 22 were randomised to either bilateral subtotal thyroidectomy or the Dunhill procedure. Follow-up ranged between six months and six years. One trial had three comparison arms. All five trials were conducted in university hospitals or tertiary referral centres for thyroid disease. All thyroidectomies were performed by experienced surgeons. The overall quality of the evidence ranged from low to moderate. In all trials, blinding procedures were insufficiently described. Outcome assessment for objective outcomes was blinded in one trial. Surgeons were not blinded in any of the trials. One trial blinded participants. Attrition bias was a substantial problem in one trial, with 35% losses to follow-up. In one trial the analysis was not carried out on an intention-to-treat basis.Total thyroidectomy was more effective than subtotal thyroidectomy techniques (both bilateral subtotal thyroidectomy and the Dunhill procedure) at preventing recurrent hyperthyroidism in 0/150 versus 11/200 participants (OR 0.14 (95% CI 0.04 to 0.46); P = 0.001; 2 trials; moderate quality evidence). Total thyroidectomy was also more effective than bilateral subtotal thyroidectomy at preventing recurrent hyperthyroidism in 0/150 versus 10/150 participants (odds ratio (OR) 0.13 (95% confidence interval (CI) 0.04 to 0.44); P = 0.001; 2 trials; moderate quality evidence). Compared to bilateral subtotal thyroidectomy, the Dunhill procedure was more likely to prevent recurrent hyperthyroidism in 20/283 versus 8/309 participants (OR 2.73 (95% CI 1.28 to 5.85); P = 0.01; 3 trials; low quality evidence). Total thyroidectomy compared with subtotal thyroidectomy conferred a greater risk of permanent hypocalcaemia/hypoparathyroidism in 8/172 versus 3/221 participants (OR 4.79 (95% CI 1.36 to 16.83); P = 0.01; 3 trials; low quality evidence). Effects of the various surgical techniques on permanent recurrent laryngeal nerve palsy and regression of Graves' ophthalmopathy were neutral. One death was reported in one study in year three of follow-up. No study investigated health-related quality of life or socioeconomic effects. Total thyroidectomy is more effective than subtotal thyroidectomy (both bilateral subtotal thyroidectomy and the Dunhill procedure) at preventing recurrent hyperthyroidism in Graves' disease. The type of surgery performed does not affect regression of Graves' ophthalmopathy. There was some evidence that total thyroidectomy compared with subtotal thyroidectomy conferred a greater risk of permanent hypocalcaemia/hypoparathyroidism, which however, was not seen in comparison with bilateral subtotal thyroidectomy. Permanent recurrent laryngeal nerve palsy did not seem to be affected by type of thyroidectomy. Health-related quality of life as a patient-important outcome measure should form a core determinant of any future trial on the effects of thyroid surgery for Graves' disease.

Review analysis of medullary carcinoma thyroid--15-year Indian experience.

PubMed

Dorairajan, N; Saravanakumar, P; Karthikeyan, S; Siddharth, D; Kanna, Srinivasulu

2005-08-01

To emphasize the importance of adequate primary surgery in cases of medullary carcinoma of the thyroid, 44 cases of treated medullary carcinoma of thyroid were retrospectively reviewed in Government General Hospital, Chennai between 1987 and 2002. Patients who underwent total thyroidectomy with only central compartment dissection were compared with those who had undergone total thyroidectomy with meticulous triple compartment (bilateral lateral and central groups) nodal dissection. The group of total thyroidectomy with only central compartment dissection had high rate of lymph nodal recurrence and persistent hypercalcitoninaemia when compared with the group of total thyroidectomy with meticulous triple compartment nodal dissection. (Chi square value 4.503 with p<0.05).

Hypocalcaemia after total thyroidectomy: incidence, control and treatment.

PubMed

Herranz González-Botas, Jesús; Lourido Piedrahita, Diana

2013-01-01

Hypocalcaemia, although usually transitory, is the most frequent complication after total thyroidectomy. To identify factors associated with a higher risk of hypoparathyroidism and related to aetiology and surgical procedure. A total of 254 total thyroidectomies were analysed for the incidence of transitory or permanent hypocalcaemia based on the relationship with etiological and surgical factors. Transient hypocalcaemia was present in 29.1% of the cases and permanent hypocalcemia was present in 4.7%. Postoperative hypocalcaemia was lower in patients with completion thyroidectomy than in patients that underwent total thyroidectomy in a single operation, 12% vs. 31%. Patients with Graves-Basedow disease developed postoperative hypocalcaemia in 50% of the cases. Mean recovery time of parathyroid function was 5.2 months, with 72.2% of the patients recovering before 6 months. Postoperative hypocalcaemia is a frequent complication of total thyroidectomy, but it is seldom permanent. Patients with Graves-Basedow disease have a higher incidence of postoperative hypocalcaemia and need closer follow-up. Postoperative calcium level analysis at 24 and 48 h after surgery is not useful for rapid identification of patients at high risk of hypocalcaemia. Copyright © 2012 Elsevier España, S.L. All rights reserved.

A Prospective Study on Cardiovascular Dysfunction in Patients with Hyperthyroidism and Its Reversal After Surgical Cure.

PubMed

Muthukumar, Sankaran; Sadacharan, Dhalapathy; Ravikumar, Krishnan; Mohanapriya, Gajarajan; Hussain, Zahir; Suresh, R V

2016-03-01

Cardiovascular dysfunction (CVD) is a major cause of mortality and morbidity in hyperthyroidism. CVD and its reversibility after total thyroidectomy (TT) are not adequately addressed. This prospective case-control study evaluates the effect of hyperthyroidism on myocardium and its reversibility after TT. Surgical candidates of new onset hyperthyroidism, Group A (n = 41, age < 60 years) was evaluated with 2D Echocardiography, serum n-terminal probrain natriuretic peptide (NT-proBNP) at the time of diagnosis (Point A), after achieving euthyroidism (Point B) with antithyroid drugs, and 3 months after TT (Point C). 20 patients with nontoxic benign thyroid nodules undergoing TT served as controls (Group B). Both groups were age and sex matched. Group A (n = 41) comprises Graves disease (n = 22) and Toxic Multinodular goiter (n = 19). At point A, CVD was evident in 26/41(63.4%), pulmonary hypertension (PHT) in 24/41(58.5%)--mild in 17/41(41.4%) and moderate in 7/41(17%)--dilated cardiomyopathy (DCM) in 8/41(19.5%), heart failure in 4/41(9.7%), and NT-proBNP elevated in 28/41(68.3%). At point B, recovery was observed in PHT 19/26(73.1%), DCM 4/8(50%), heart failure 4/4(100%), NT-proBNP in 3/28(10.7%). At Point C, further improvement occurred in PHT 23/24(95.8%), DCM 7/8(87.5%), heart failure 4/4(100%), and NT-proBNP in 24/28(85.7%). Pulmonary hypertension is completely reversible at 3 months after TT and is the most common cardiac event in Hyperthyroidism. Various parameters of CVD improved consistently after surgical cure. NT-proBNP levels correlated well with the severity and duration of CVD and hence can be an objective tool in monitoring of hyperthyroid cardiac dysfunction.

Effect of central compartment neck dissection on hypocalcaemia incidence after total thyroidectomy for carcinoma.

PubMed

Mitra, I; Nichani, J R; Yap, B; Homer, J J

2011-05-01

Central compartment neck dissection is increasingly performed as part of surgical management of differentiated thyroid carcinoma. However, elective central neck dissection remains controversial due to complications and lack of evidence of survival benefit. To investigate and compare rates of transient and permanent hypocalcaemia following total thyroidectomy alone, compared with total thyroidectomy with central neck dissection, for differentiated thyroid carcinoma. Retrospective study of 127 consecutive patients referred with differentiated thyroid carcinoma, 2004-2006; 78 patients had undergone total thyroidectomy (group one) and 49 total thyroidectomy with central compartment node dissection (group two). Surgery was performed in various hospitals by both otolaryngologists and endocrine surgeons. In groups one and two, the incidence of transient hypocalcaemia was 18 per cent (14/78) and 51 per cent (25/49) (p < 0.001), and the incidence of permanent hypocalcaemia 1 per cent (one of 77) and 12 per cent (six of 49) (p < 0.01), respectively. Most patients undergoing central neck dissection had evidence of pathological level six lymphadenopathy (29/49). Total thyroidectomy combined with central neck dissection for the treatment of differentiated thyroid carcinoma is more likely to result in transient (51 per cent) and permanent (12 per cent) hypocalcaemia. Elective neck dissection should be performed selectively, with a high expectation of post-operative hypocalcaemia.

[Surgery for benign goiter in Germany: fewer operations, changed resectional strategy, fewer complications].

PubMed

Dralle, H; Stang, A; Sekulla, C; Rusner, C; Lorenz, K; Machens, A

2014-03-01

The increase of certain operations in the wake of the introduction of the German Diagnosis-Related Groups (G-DRG) system rekindled debate on the risk-benefit profile of what is widely being perceived as a too high number of thyroidectomies for benign goiter in Germany. The numbers of thyroidectomy for benign goiter from 2005-2011 were obtained from the Federal Bureau of Statistics ("Statistisches Bundesamt"). For the purpose of the study, the following operation and procedure key (OPS) codes were selected: hemithyroidectomy (OPS code 5-061); partial thyroid resection (OPS code 5-062); total thyroidectomy (OPS code 5-063); and thyroid surgeries via sternotomy (OPS code 5-064). The rates of permanent hypoparathyroidism and vocal cord palsy were calculated based on two prospective multicenter evaluation studies conducted in 1998-2001 (PETS 1) and 2010-2013 (PETS 2) in Germany. Between 2005 and 2011, the number of thyroidectomies for benign thyroid goiter decreased by 8 %, and the age-standardized surgery rate decreased by 6 % in men (2005: 599 per 1 million; 2011: 565 per 1 million) and 11 % in women (2005: 1641 per 1 million; 2011: 1463 per 1 million). At the same time, the rates of partial and subtotal thyroidectomy decreased by 59 % in men and 64 % in women, whereas the rates of hemithyroidectomy and total thyroidectomy increased by 65 % (113 %) in men and 42 % (97 %) in women. Despite a greater proportion of thyroidectomies over time, the approximated rates for postoperative hypoparathyroidism were reduced from 2.98 to 0.83 % and for postoperative vocal cord palsy from 1.06 to 0.86 %. Irrespective of that decline, either complication was more frequent after total than after subtotal thyroidectomy. The total number of thyroid surgeries due to benign goiter has decreased substantially in Germany from 2005 through 2011. Despite changes in the resectional strategy with an increase in the total number thyroidectomies and a decrease of subtotal resections, the rates for postoperative hypoparathyroidism and vocal cord palsy have decreased. The complication rates for total thyroidectomy, however, are still higher compared to subtotal resection. An individualized risk-oriented surgical approach is warranted.

Transient and permanent hypocalcemia after total thyroidectomy: Early predictive factors and long-term follow-up results.

PubMed

Seo, Sung Tae; Chang, Jae Won; Jin, Jun; Lim, Young Chang; Rha, Ki-Sang; Koo, Bon Seok

2015-12-01

Post-thyroidectomy hypocalcemia is among the most common complications of total thyroidectomy. The purpose of this study was to evaluate early predictive factors and long-term changes in intact parathyroid hormone (iPTH) levels in patients with transient and permanent hypocalcemia after total thyroidectomy. A total of 349 consecutive patients who underwent total thyroidectomy with or without neck dissection between 2009 and 2011 were reviewed. PTH, total calcium (Ca), and ionized Ca (iCa) levels were evaluated at 1 hour, and 1, 3, 5, and 7 days, and 1, 3, 6, and 12 months postoperatively. Biochemical profiles at 1 hour after total thyroidectomy in patients with transient and permanent hypocalcemia were compared. Patients with postoperative hypocalcemia were followed for 12 months. Lesser preoperative serum levels of Ca and more extensive surgery were significantly associated with postoperative hypocalcemia (P < .05). The absolute level and relative decline (%) in iPTH at 1 hour were the most reliable predictors of postoperative hypocalcemia according to the receiver operating characteristics curve, with a threshold of 10.42 pg/mL and 70%. Sensitivity and specificity of the predictors were 83.4% (95% CI, 76.4-89.1), 100% (95% CI, 84.6-100.0), 84.1 (95% CI, 77.2-89.7), and 95.5% (95% CI, 77.2-99.9), respectively. Parathyroid function recovered in the first month after total thyroidectomy in 78 of 99 patients (79%) with transient hypocalcemia. However, 46 of 61 patients (74%) with a subnormal iPTH level at 3 months after surgery had permanent hypocalcemia. Mean postoperative PTH level and the mean relative decline in PTH measured 1 hour postoperatively were the most reliable predictors of postoperative or permanent hypocalcemia. Copyright © 2015 Elsevier Inc. All rights reserved.

Is ionized calcium a reliable predictor of hypocalcemia after total thyroidectomy? A before and after study

PubMed Central

TARTAGLIA, F.; GIULIANI, A.; SGUEGLIA, M.; PATRIZI, G.; DI ROCCO, G.; BLASI, S.; RUSSO, G.; TORTORELLI, G.; GIANNOTTI, D.; REDLER, A.

2014-01-01

Summary Wanting to find a way of identifying patients suitable for early discharge after thyroidectomy, we set out to establish whether ionized calcium concentration is a better predictor of post-surgical hypocalcemia than total serum calcium. Data were analyzed to establish whether serum ionized calcium concentrations are correlated with total serum calcium levels and symptomatic hypocalcemia after thyroidectomy. Sixty-two patients undergoing total thyroidectomy at the Department of Surgical Sciences of the “Sapienza” University of Rome, Italy, in 2010. Ionized calcium was measured before (day 0) and after surgery (days 1, 2 and 60) in all the patients. These measurements were compared with preoperative (day 0) and postoperative total serum calcium levels (days 1, 2 and 60). The preoperative ionized calcium levels differed from the ionized calcium levels recorded on days 1 and 2; this pattern was not observed for the total calcium concentrations. Conversely, total calcium on days I and II correlated significantly with the various ionized calcium measurements. The presence of parathyroid glands in the surgical specimen did not seem to affect suitability for discharge. The statistical analysis showed that ionized calcium measurements are more reliable than total calcium measurements in the immediate and long-term follow-up of total thyroidectomy patients. Applying a 95% confidence interval we established reference values for both total serum calcium and ionized calcium, below which all patients develop postoperative symptomatic hypocalcemia. In conclusion, measurement of ionized calcium, as opposed to total calcium, should be strongly recommended in the immediate and long-term follow-up of total thyroidectomy patients. PMID:24690338

[Total thyroidectomy in patients with amiodarone-induced hyperthyroidism: when does the risk of conservative treatment exceed the risk of surgery?].

PubMed

Meerwein, C; Vital, D; Greutmann, M; Schmid, C; Huber, G F

2014-02-01

Amiodarone plays a pivotal role in the treatment of ventricular and supraventricular arrhythmias. However, amiodarone-induced hyperthyroidism (AIH) is one of the most feared complications, which necessitates interdisciplinary treatment and careful balancing of the risks of conservative treatment against those of total thyroidectomy. In this article we discuss the pharmacological aspects of amiodarone and its diverse effects on the thyroid. Furthermore, we present diagnostic and therapeutic strategies and report our positive experiences with total thyroidectomy in patients with AIH. Particularly in patients for whom continuation of amiodarone treatment is compulsory, a well-timed total thyroidectomy is a reliable therapeutic option, with minimal complication rates and immediate amelioration of symptoms.

[Pay attention to the prevention of intraoperative complications of total thyroidectomy].

PubMed

Tian, Wen

2015-03-01

The incidence of thyroid cancer has increased sharply year by year. Thyroid cancer ranked from the 14th in 2003 to the 4th in 2012 most common cancers in female in Beijing. Surgery is still main solution for thyroid cancer, there are two operative procedure for thyroid cancer: total thyroidectomy, lateral lobectomy and isthmus resection. The surgeon must pay attention to intraoperative recurrent laryngeal nerve and parathyroid injury, with particular emphasis on the prevention of total thyroidectomy complications. Precise dissection of thyroid capsule, intraoperative recurrent laryngeal nerve monitoring and application of lymphatic mapping to recognize and protect negative stained parathyroid by using carbon nanoparticles tracer is prone to reduce the incidence of recurrent laryngeal nerve and parathyroid injury in the total thyroidectomy.

Factors Associated With Neck Hematoma After Thyroidectomy

PubMed Central

Suzuki, Sayaka; Yasunaga, Hideo; Matsui, Hiroki; Fushimi, Kiyohide; Saito, Yuki; Yamasoba, Tatsuya

2016-01-01

Abstract To identify risk factors for post-thyroidectomy hematoma requiring airway intervention or surgery (“wound hematoma”) and determine post-thyroidectomy time to intervention. Post-thyroidectomy hematoma is rare but potentially lethal. Information on wound hematoma in a nationwide clinical setting is scarce. Using the Japanese Diagnosis Procedure Combination database, we extracted data from records of patients undergoing thyroidectomy from July 2010 to March 2014. Patients with clinical stage IV cancer or those with bilateral neck dissection were excluded because they could have undergone planned tracheotomy on the day of thyroidectomy. We assessed the association between background characteristics and wound hematoma ≤2 days post-thyroidectomy, using multivariable logistic regression analysis. Among 51,968 patients from 880 hospitals, wound hematoma occurred in 920 (1.8%) ≤2 days post-thyroidectomy and in 203 (0.4%) ≥3 days post-thyroidectomy (in-hospital mortality = 0.05%). Factors significantly associated with wound hematoma ≤2 days post-thyroidectomy were male sex (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.30–1.77); higher age (OR 1.01, 95% CI 1.00–1.02); overweight or obese (OR 1.22, 95% CI 1.04–1.44); type of surgery (partial thyroidectomy for benign tumor compared with: total thyroidectomy, benign tumor [OR 1.95, 95% CI 1.45–2.63]; partial thyroidectomy, malignant tumor [OR 1.21, 95% CI 1.00–1.46]; total thyroidectomy, malignant tumor [OR 2.49, 95% CI 1.82–3.49]; and thyroidectomy for Graves disease [OR 3.88, 95% CI 2.59–5.82]); neck dissection (OR, 1.53, 95% CI 1.05–2.23); antithrombotic agents (OR 1.58, 95% CI 1.15–2.17); and blood transfusion (OR 5.33, 95% CI 2.39–11.91). Closer monitoring of airway and neck is recommended for patients with risk factors, and further cautious monitoring beyond 3 days post-thyroidectomy. PMID:26886632

Thyroidectomy Practice After Implementation of the 2015 American Thyroid Association Guidelines on Surgical Options for Patients With Well-Differentiated Thyroid Carcinoma.

PubMed

Hirshoren, Nir; Kaganov, Kira; Weinberger, Jeffrey M; Glaser, Benjamin; Uziely, Beatrice; Mizrahi, Ido; Eliashar, Ron; Mazeh, Haggi

2018-03-29

The recommended extent of surgery for well-differentiated thyroid carcinoma has been modified considerably in the updated 2015 American Thyroid Association guidelines published in January 2016. To date, the changes in clinical practice after publication of these new guidelines have not been demonstrated. The aim of this study was to evaluate clinical practice changes associated with implementation of the updated guidelines on the surgical procedure rates of total thyroidectomy, thyroid lobectomy, and completion thyroidectomy at a single tertiary medical center. This is a retrospective cohort study of 169 patients at the Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Patients with pathologically proved, well-differentiated thyroid carcinoma who underwent surgery between January 1, 2013, and December 31, 2014, were compared with patients who underwent surgery from January 1 to December 31, 2016. A total of 434 thyroidectomy procedures were performed during the study period, and 251 had pathologically proved, well-differentiated thyroid carcinoma. Patients with tumors larger than 4 cm, involved lymph nodes, or bilateral nodules were excluded. Primary outcomes were the rate of up-front total thyroidectomy vs lobectomy and the rates of completion thyroidectomy before and after the implementation of the new guidelines. Of the 169 patients in the final analysis, 118 (69.8%) were included from 2013 to 2014 and 51 (30.2%) in 2016. The mean (SD) age for the entire cohort was 44 (13.8) years, and 129 (76.3%) were women. Up-front total thyroidectomy was performed in 72 of 118 patients (61.0%) prior to the 2015 American Thyroid Association guidelines and 16 of 51 (31.4%) following their implementation (odds ratio, 0.29; 95% CI, 0.14-0.59). The rate of completion thyroidectomy also significantly decreased between these periods (73.9% vs 20.0%; odds ratio, 0.09; 95% CI, 0.04-0.19). The updated 2015 American Thyroid Association guidelines implementation was associated with a significant decrease in the rates of both up-front total thyroidectomy and completion thyroidectomy. According to these findings, only 1 of 5 patients who undergoes thyroid lobectomy will require a completion procedure.

Neonatal hyperthyroidism: neonatal clinical course of two brothers born to a mother with Graves-Basedow disease, before and after total thyroidectomy.

PubMed

Zuppa, A A; Sindico, P; Savarese, I; D'Andrea, V; Fracchiolla, A; Cota, F; Romagnoli, C

2007-04-01

About 1-2% of infants born to mothers with Graves' disease or Hashimoto's thyroiditis develop neonatal hyperthyroidism because of transplacental passage of IgG stimulating TSH receptors (TRAb). To evaluate the effect of maternal total thyroidectomy on neonatal clinical course. We describe two brothers born to a mother with Graves' disease, before and after total thyroidectomy. The first child showed persistent tachycardia, the presence of TRAb and a laboratory pattern of hyperthyroidism. Lugol's solution was started and then propylthiouracil was added. Digitalis, furosemide and diazepam were necessary for treatment of heart failure, hypertension and irritability. On the 70th day of life, hormone serum levels normalized and treatment was interrupted. TRAb normalized by the third month of life. The second infant was born 2 years after the mother underwent total thyroidectomy. In spite of a laboratory pattern of hyperthyroidism and positivity to TRAb, he showed only considerable weight loss, and no therapy was required. TRAb may persist after total thyroidectomy: clinical and instrumental follow-up of the newborn is recommended.

Impact of Extent of Surgery on Survival for Papillary Thyroid Cancer Patients Younger Than 45 Years

PubMed Central

Abdelgadir Adam, Mohamed; Pura, John; Goffredo, Paolo; Dinan, Michaela A.; Hyslop, Terry; Reed, Shelby D.; Scheri, Randall P.; Sosa, Julie A.

2015-01-01

Context: Papillary thyroid cancer (PTC) patients <45 years old are considered to have an excellent prognosis; however, current guidelines recommend total thyroidectomy for PTC tumors >1.0 cm, regardless of age. Objective: Our objective was to examine the impact of extent of surgery on overall survival (OS) in patients <45 years old with stage I PTC of 1.1 to 4.0 cm. Design, Setting, and Patients: Adult patients <45 years of age undergoing surgery for stage I PTC were identified from the National Cancer Data Base (NCDB, 1998–2006) and the Surveillance, Epidemiology, and End Results dataset (SEER, 1988–2006). Main Outcome Measure: Multivariable modeling was used to compare OS for patients undergoing total thyroidectomy vs lobectomy. Results: In total, 29 522 patients in NCDB (3151 lobectomy, 26 371 total thyroidectomy) and 13 510 in SEER (1379 lobectomy, 12 131 total thyroidectomy) were included. Compared with patients undergoing lobectomy, patients having total thyroidectomy more often had extrathyroidal and lymph node disease. At 14 years, unadjusted OS was equivalent between total thyroidectomy and lobectomy in both databases. After adjustment, OS was similar for total thyroidectomy compared with lobectomy across all patients with tumors of 1.1 to 4.0 cm (NCDB: hazard ratio = 1.45 [confidence interval = 0.88–2.51], P = 0.19; SEER: 0.95 (0.70–1.29), P = 0.75) and when stratified by tumor size: 1.1 to 2.0 cm (NCDB: 1.12 [0.50–2.51], P = 0.78; SEER: 0.95 [0.56–1.62], P = 0.86) and 2.1 to 4.0 cm (NCDB: 1.93 [0.88–4.23], P = 0.10; SEER: 0.94 [0.60–1.49], P = 0.80). Conclusions: After adjusting for patient and clinical characteristics, total thyroidectomy compared with thyroid lobectomy was not associated with improved survival for patients <45 years of age with stage I PTC of 1.1 to 4.0 cm. Additional clinical and pathologic factors should be considered when choosing extent of resection. PMID:25337927

Can Total Thyroidectomy Be Safely Performed by Residents?

PubMed Central

Gurrado, Angela; Bellantone, Rocco; Cavallaro, Giuseppe; Citton, Marilisa; Constantinides, Vasilis; Conzo, Giovanni; Di Meo, Giovanna; Docimo, Giovanni; Franco, Ilaria Fabiola; Iacobone, Maurizio; Lombardi, Celestino Pio; Materazzi, Gabriele; Minuto, Michele; Palazzo, Fausto; Pasculli, Alessandro; Raffaelli, Marco; Sebag, Frederic; Tolone, Salvatore; Miccoli, Paolo; Testini, Mario

2016-01-01

Abstract This retrospective comparative multicenter study aims to analyze the impact on patient outcomes of total thyroidectomy (TT) performed by resident surgeons (RS) with close supervision and assistance of attending surgeons (AS). All patients who underwent TT between 2009 and 2013 in 10 Units of endocrine surgery (8 in Italy, 1 in France, and 1 in UK) were evaluated. Demographic data, preoperative diagnosis, extension of goiter, type of surgical access, surgical approach, operative time, use and duration of drain, length of hospitalization, histology, and postoperative complications were recorded. Patients were divided into 3 groups: A, when treated by an AS assisted by an RS; B and C, when treated by a junior and a senior RS, respectively, assisted by an AS. The 8908 patients (mean age 51.1 ± 13.6 years), with 6602 (74.1%) females were enrolled. Group A counted 7092 (79.6%) patients, Group B 261 (2.9%) and Group C 1555 (17.5%). Operative time was significantly greater (P < 0.001) in B (101.3 ± 43.0 min) vs A (71.8 ± 27.6 min) and C (81.2 ± 29.9 min). Duration of drain was significantly lower (P < 0.001) in A (47.4 ± 13.2 h) vs C (56.4 ± 16.5 h), and in B (42.8 ± 14.9 h) vs A and C. Length of hospitalization was significantly longer (P < 0.001) in C (3.8 ± 1.8 days) vs B (2.4 ± 1.0 days) and A (2.6 ± 1.5 days). No mortality occurred. Overall postoperative morbidity was 22.3%: it was significantly higher in B vs A (29.5% vs 22.3%; odds ratio [OR] 1.46, 95% confidence interval [CI] 1.11–1.92, P = 0.006) and C (21.3%; OR 1.55, 95% CI 1.15–2.07, P = 0.003). No differences were found for recurrent laryngeal nerve palsy, hypoparathyroidism, hemorrhage, and wound infection. The adjusted ORs in multivariate analysis showed that overall morbidity remained significantly associated with Group B vs A (OR 1.48, 95% CI 1.12–1.96, P = 0.005) and vs C (OR 1.60, 95% CI 1.19–2.17, P = 0.002), while no difference was observed in Group A vs B + C. TT can be safely performed by residents correctly supervised. Innovative gradual training in dedicated high-volume hospitals should be proposed in order to allow adequate autonomy for the RS and safeguard patient outcome. PMID:27057861

The advantages of subtotal thyroidectomy and suppression of TSH in the primary treatment of papillary carcinoma of the thyroid

DOE Office of Scientific and Technical Information (OSTI.GOV)

Crile, G. Jr.; Antunez, A.R.; Esselstyn, C.B. Jr.

1985-06-01

Patients between the ages of 6 and 45 years with distant metastases from papillary carcinoma of the thyroid can be treated as effectively by subtotal thyroidectomy and suppressive doses of thyroid hormone as by total thyroidectomy followed by treatment with iodine 131 (/sup 131/I). Moreover, distant metastases can be treated by either /sup 131/I or suppression as effectively after they are apparent on x-ray as they can be when treated in a subclinical stage. Therefore, in patients younger than 45 years old it is rarely necessary to perform a total thyroidectomy or to do frequent postoperative scans. In patients oldermore » than 44 or younger than 7 who have distant metastases or extensive involvement of both lobes, total or almost total thyroidectomy is justified if it can be done with minimal morbidity. In patients of this age group whose tumors fail to respond to suppressive doses of thyroid, /sup 131/I should be used. In view of the importance of diagnostic related groups (DRG) to the economy of hospitals, we note that the cost of total thyroidectomy, ablation by /sup 131/I, and intermittent body scans is at least three times that of less radical procedures which, in conjunction with suppression by thyroid feeding, give the same survival with less morbidity.« less

Parathyroid hormone and serum calcium levels measurements as predictors of postoperative hypocalcemia in total thyroidectomy

PubMed Central

Algarni, Mohammed; Dionigi, Gianlorenzo; Hadi, Al-Hakami; AlSubayea, Haia

2017-01-01

Background The rules of quantitative measures such as parathyroid hormone (PTH) levels in the first hours following total thyroidectomy have since been validated repeatedly. Such measures play an integral rule in identifying patients at significant risk for hypocalcaemia and have allowed for earlier supplementation of these patients with calcium with or without vitamin D. Methods A retrospective analysis was conducted of 40 consecutive patients with well differentiated thyroid cancer (WDTC) who underwent total thyroidectomy without central neck dissection (CND) as an initial surgery and no comorbidity at King Abdulaziz Medical City (National Guard hospital), between July 2011 and July 2012. A blood testing protocol was applied for all patients that measured serum calcium PTH at 6 hours postoperatively. Results Following total thyroidectomy, women were found to experience transient hypocalcaemia in 12.5% of cases (4/32), whereas no men cases encountered this postoperative complication (0/8). However, most probably due to small sample size, this difference was not statistically significant. PTH level was significantly associated with post thyroidectomy hypocalcaemia (43.7±39.3 versus 13.40±24.9 ng/L), P=0.014. Only negligible differences in the length of hospital stay were observed with and without post-thyroidectomy hypocalcaemia. Conclusions Using post-thyroidectomy PTH levels to predict hypocalcaemia has been confirmed in the current study. So, the use of PTH levels allows for early risk stratification of our patients and we feel this has resulted in better patient satisfaction. PMID:29142830

Outcomes analysis of radioactive iodine and total thyroidectomy for pediatric Graves' disease.

PubMed

Cohen, Reuven Zev; Felner, Eric I; Heiss, Kurt F; Wyly, J Bradley; Muir, Andrew B

2016-03-01

The majority of pediatric patients with Graves' disease will ultimately require definitive therapy in the form of radioactive iodine (RAI) ablation or thyroidectomy. There are few studies that directly compare the efficacy and complication rates between RAI and thyroidectomy. We compared the relapse rate as well as the acute and long-term complications of RAI and total thyroidectomy among children and adolescents with Graves' disease treated at our center. Medical records from 81 children and adolescents with a diagnosis of Graves' disease who received definitive therapy over a 12-year period were reviewed. Fifty one patients received RAI and 30 patients underwent thyroidectomy. The relapse rate was not significantly different between RAI and thyroidectomy (12.1% vs. 0.0%, p=0.28). There were no acute or long-term complications in the RAI group, but there were eight cases of hypoparathyroidism (two transient and six permanent) in the thyroidectomy group. None of the patients developed a recurrent laryngeal nerve injury. RAI is a safe and effective option for treatment of children and adolescents with Graves' disease. In light of the rate of permanent hypoparathyroidism seen at our center with thyroidectomy and previously published long-term safety of RAI, we recommend RAI as the first line treatment for children and adolescents with Graves' disease. For those centers performing thyroidectomies, we recommend that each center select 1-2 high-volume pediatric surgeons to perform all thyroid procedures, allowing individuals to increases case volume and potentially decrease long-term complications of thyroidectomy.

Predictors factors for post-thyroidectomy hypocalcaemia.

PubMed

Sousa, Alexandre de Andrade; Salles, José Maria Porcaro; Soares, João Marcos Arantes; Moraes, Gustavo Meyer de; Carvalho, Jomar Rezende; Savassi-Rocha, Paulo Roberto

2012-12-01

To evaluate the incidence and predictors of post-thyroidectomy definitive hypocalcemia and hypoparathyroidism. We assessed ionic calcium preoperatively and postoperatively (first, second and 30th day) in 333 patients undergoing thyroidectomy. In those presenting hypocalcemia, measurements were also made 90 and 180 days after surgery, when parathormone was also dosed. Patients were grouped according to the presence or absence of hypocalcemia and evaluated according to age, gender, thyroid function, thyroid volume, number of parathyroid glands identified and need to parathyroid reimplantation, type of operation, operative time, and histopathological diagnosis. The incidence of temporary hypocalcemia was 40.8% (136 patients), and of definitive hypoparathyroidism 4.2% (14 patients). Reoperation or total thyroidectomy, neck dissection, hyperthyroidism, operative time and age above 50 years were factors related to higher incidence of hypocalcemia and definitive hypoparathyroidism (p <0.05). predictors of postoperative hypocalcemia included age (> 50 years), total thyroidectomy, reoperation, neck dissection and operative time. The predictors of post-thyroidectomy definitive hypoparathyroidism included type of operation, histological diagnosis and hyperthyroidism.

Post-thyroidectomy complications. The role of the device: bipolar vs ultrasonic device: Collection of data from 1,846 consecutive patients undergoing thyroidectomy.

PubMed

De Palma, Maurizio; Rosato, Ludovico; Zingone, Fabiana; Orlando, Giulio; Antonino, Antonio; Vitale, Mario; Puzziello, Alessandro

2016-07-01

Specific complications after thyroid surgery, such as recurrent laryngeal nerve injury (RLN) or hypoparathyroidism, are feared because they may give rise to a lifelong disability for the patient. The aim of this study was to evaluate the possible association between the types of device used (bipolar vs ultrasound-based harmonic scalpel defined Harmonic Focus) and major postoperative complications. During a 1-year period, between October 2010 and October 2011, Italian Endocrine Surgery Units affiliated with the Italian Endocrine Surgery Units Association collected data on all consecutive patients older than 18 years who had undergone primary total thyroidectomy, near total thyroidectomy, and completion thyroidectomy. The data were included in a dataset, listing demographic variables, details on the surgical procedure, and 2 major complications of the thyroid surgery: postoperative RLN palsy/hypomobility and hypocalcemia. Our population comprised 1,846 subjects (78.6% women, median age 52 years). Six hundred four (32.7%) subjects underwent thyroidectomy by bipolar forceps and 1,242 (67.3%) by ultrasonic device. The risk of hypocalcemia in subjects undergoing thyroidectomy by ultrasonic device was similar to those undergoing thyroidectomy by bipolar after adjusting for sex, type of thyroidectomy, and central lymphadenectomy (odds ratio .94, 95% confidence interval .76 to 1.17). Subjects who underwent thyroidectomy by ultrasonic device had a lower risk of RLN paralysis compared with those undergoing thyroidectomy by bipolar forceps also after adjusting for central lymphadenectomy (odds ratio .39, 95% confidence interval .2 to .7). This multicenter study acknowledges the value of the ultrasonic device as a protective factor only for RLN palsy, confirming nodal dissection as a risk factor for postoperative hypocalcemia and vocal folds disorders. Copyright © 2015 Elsevier Inc. All rights reserved.

Association between Decreased Serum Parathyroid Hormone after Total Thyroidectomy and Persistent Hypoparathyroidism

PubMed Central

Wang, Jian-Biao; Sun, Hai-Li; Song, Chun-Yi; Gao, Li

2015-01-01

Background Postoperative hypocalcemia caused by hypoparathyroidism is one of the most common morbidities of total thyroidectomy. The aim of this study was to analyze the kinetics and factors affecting PTH levels after total thyroidectomy and central neck dissection (CND). Material/Methods We performed a retrospective study in 438 consecutive patients who underwent total thyroidectomy between January 2007 and December 2010. No patient had a history of thyroid or neck surgery. PTH and calcium levels were recorded 1 day before the operation, during the first 5 days, and during follow-up (2 weeks and 2, 6, and 12 months). Results PTH levels declined to 41.90% of its initial value on the first day after the operation. After surgery, PTH was correlated positively with calcium and inversely with phosphate levels from postoperative day 1 to 14. Based on clinical observation, using a PTH threshold of <7 ng/L on postoperative day 1 was predictive of persistent hypoparathyroidism, with sensitivity and negative predictive value 100%, but poor specificity (70.19%). CND increased the risk of transient hypoparathyroidism compared with total thyroidectomy alone. Patients with thyroiditis had an increased risk of permanent hypoparathyroidism compared with those without thyroiditis. Iatrogenic removal of the parathyroid glands increased the risk of permanent hypoparathyroidism compared with those without iatrogenic parathyroidectomy. Conclusions PTH declined on the first day after thyroidectomy. PTH levels <7 ng/L on the first day after surgery might be associated with persistent hypoparathyroidism. CND, thyroiditis, and iatrogenic parathyroidectomy increased the risk of hypoparathyroidism. PMID:25923249

A review of treatment options for Graves' disease: why total thyroidectomy is a viable option in selected patients.

PubMed

Mohan, Vinuta; Lind, Robert

2016-01-01

Graves' disease is the most common cause of hyperthyroidism. If left untreated, patients may have multiple systemic complications such as cardiac, reproductive, and skeletal disease. Thionamides, such as methimazole and propylthiouracil, and I(131) iodine ablation are the most commonly prescribed treatment for Graves' disease. Total thyroidectomy is often overlooked for treatment and is usually only offered if the other options have failed. In our case, we discuss a patient who was admitted to our medical center with symptomatic hyperthyroidism secondary to long-standing Graves' disease. She had a history of non-compliance with medications and medical clinic follow-up. The risks and benefits of total thyroidectomy were explained and she consented to surgery. A few months after the procedure, she was biochemically and clinically euthyroid on levothyroxine. She had no further emergency room visits or admissions for uncontrolled thyroid disease. Here we review the advantages and disadvantages of the more typically prescribed treatments, thionamides and I(131)iodine ablation. We also review the importance of shared decision making and the benefits of total thyroidectomy for the management of Graves' disease. Given the improvement in surgical techniques over the past decade and a significant reduction of complications, we suggest total thyroidectomy be recommended more often for patients with Graves' disease.

Mechanisms behind Post-Thyroidectomy Hypocalcemia: Interplay of Calcitonin, Parathormone, and Albumin-A Prospective Study.

PubMed

Chisthi, Meer M; Nair, Rakhi S; Kuttanchettiyar, Krishnakumar G; Yadev, Induprabha

2017-08-01

Hypocalcemia after thyroidectomy is attributed to injury or ischemia to parathyroid glands. Transient hypocalcemia in thyroidectomy when parathyroids are preserved is not adequately explained. Release of calcitonin and hypoalbuminemia are two proposed reasons. Primary objective of this study was to find the change in calcitonin in the postoperative period after total thyroidectomy. Secondarily, hypocalcemia and its correlation with calcitonin, albumin, and parathormone were also studied. This Cohort study was carried out at the general surgical department of a tertiary level teaching institution from April 2015 to December 2015. One hundred adult patients undergoing total thyroidectomy, with at least three parathyroids being preserved were included. Changes in calcium, calcitonin, albumin, and parathormone were studied based on preoperative levels and the values at 1, 6, 24, and 48 hr after surgery. Calcitonin increased at one hour after thyroidectomy and fell below preoperative levels subsequently. Parathormone showed a mild rise at one hour and normalized subsequently. Total calcium, corrected calcium, and albumin showed decline at one hour and recovered gradually over the next two days. At preoperative level, calcium had significant correlation with parathormone alone. Calcium levels at one hour had significant correlation with calcitonin. All post-operative calcium levels had significant correlation with parathormone and the number of parathyroids preserved in situ without auto-transplantation. There is significant hypocalcemia within the first 24 hr after thyroidectomy, caused by calcitonin release and hypoalbuminemia. Preservation of maximum number of parathyroids in-situ can counter and normalize this hypocalcemia.

Postoperative hypocalcemia after thyroidectomy for Graves' disease.

PubMed

Pesce, Catherine E; Shiue, Zita; Tsai, Hua-Ling; Umbricht, Christopher B; Tufano, Ralph P; Dackiw, Alan P B; Kowalski, Jeanne; Zeiger, Martha A

2010-11-01

It is believed that patients who undergo thyroidectomy for Graves' disease are more likely to experience postoperative hypocalcemia than patients undergoing total thyroidectomy for other indications. However, no study has directly compared these two groups of patients. The aim of this study was to determine whether there was an increased incidence or severity of postoperative hypocalcemia in patients who underwent thyroidectomy for Graves' disease. An institutional review board-approved database was created of all patients who underwent thyroidectomy from 1998 to 2009 at the Johns Hopkins Hospital. There were a total of 68 patients with Graves' disease who underwent surgery. Fifty-five patients who underwent total thyroidectomy were randomly selected and served as control subjects. An analysis was conducted that examined potential covariates for postoperative hypocalcemia, including age, gender, ethnicity, preoperative alkaline phosphatase level, size of goiter, whether parathyroid tissue or glands were present in the specimen, and the reason the patient underwent surgery. Specific outcomes examined were calcium levels on postoperative day 1, whether or not patients experienced symptoms of hypocalcemia, whether or not Rocaltrol was required, the number of calcium tablets prescribed upon discharge, whether or not postoperative tetany occurred, and calcium levels 1 month after discharge. Each outcome was analyzed using a logistic regression. Graves' disease patients had a significantly (p-value < 0.001) higher odds of greater number of calcium tablets prescribed upon discharge. Further, 6 of 68 patients with Graves' disease and no patient in the control group were readmitted with tetany (p = 0.033). There was a trend, though not significant, toward patients with Graves' disease having a higher prevalence of hypocalcemia the day after thyroidectomy and 1 month later. Patients with Graves' disease are more likely to require increased dosages of calcium as well as experience tetany postoperatively than patients undergoing total thyroidectomy for other indications. This suggests that patients operated upon for Graves' disease warrant close followup as both inpatients and outpatients for signs and symptoms of hypocalcemia.

[Thyroid cancer in patients with Grave's Disease].

PubMed

Mssrouri, R; Benamr, S; Essadel, A; Mdaghri, J; Mohammadine, El H; Lahlou, M-K; Taghy, A; Belmahi, A; Chad, B

2008-01-01

To evaluate the incidence of thyroid carcinoma in patients operated on for Graves' disease, to identify criteria which may predict malignancy, and to develop a practical approach to determine the extensiveness of thyroidectomy. Retrospective study of all patients who underwent thyroidectomy for Graves' disease between 1995 and 2005. 547 patients underwent subtotal thyroidectomy for Graves' disease during this period. Post-operative pathology examination revealed six cases of thyroid cancer (1.1%). All six cases had differentiated thyroid carcinoma (papillary carcinoma in 3 cases, follicular carcinoma in 2 cases and papillo-follicular carcinoma in 1 case). The indication for initial thyroidectomy was a palpable thyroid nodule in 3 cases (50%), failure of medical treatment for Grave's disease in 2 cases (33%), and signs of goiter compression in 1 case (17%). Five patients underwent re-operative total thyroidectomy. This study shows that while malignancy in Grave's disease is uncommon, the presence of thyroid nodule(s) in patients with Grave's disease may be considered as an indication for radical surgery. The most adequate radical surgery in this situation is to perform a total thyroidectomy.

Epidemiology of Vocal Fold Paralyses After Total Thyroidectomy for Well-Differentiated Thyroid Cancer in Medicare Population

PubMed Central

Francis, David O.; Pearce, Elizabeth C.; Ni, Shenghua; Garrett, C. Gaelyn; Penson, David F.

2014-01-01

Objectives Population-level incidence of vocal fold paralysis after thyroidectomy for well-differentiated thyroid carcinoma (WDTC) is not known. This study aimed to measure longitudinal incidence of post-operative vocal fold paralyses and need for directed interventions in the Medicare population undergoing total thyroidectomy for WDTC. Study Design Retrospective Cohort Study Setting United States Population Subjects Medicare Beneficiaries Methods SEER-Medicare data (1991 – 2009) were used to identify beneficiaries who underwent total thyroidectomy for WDTC. Incident vocal fold paralyses and directed interventions were identified. Multivariate analyses were used to determine factors associated with odds of developing these surgical complications. Results Of 5,670 total thyroidectomies for WDTC, 9.5% were complicated by vocal fold paralysis [8.2% unilateral vocal fold paralysis (UVFP); 1.3% bilateral vocal fold paralysis (BVFP)]. Rate of paralyses decreased 5% annually from 1991 to 2009 (OR 0.95, 95% CI 0.93 – 0.97; p<0.001). Overall, 22% of patients with vocal fold paralysis required surgical intervention (UVFP 21%, BVFP 28%). Multivariate logistic regression revealed odds of post-thyroidectomy paralysis increased with each additional year of age, with non-Caucasian race, particular histologic types, advanced stage, and in particular registry regions. Conclusions Annual rates of post-thyroidectomy vocal fold paralyses are decreasing among Medicare beneficiaries with WDTC. High incidence in this aged population is likely due to a preponderance of temporary paralyses, which is supported by the need for directed intervention in less than a quarter of affected patients. Further population-based studies are needed to refine the population incidence and risk factors for paralyses in the aging population. PMID:24482349

Total thyroidectomy: safe and adequate treatment for papillary microcarcinoma of the thyroid gland.

PubMed

Uhliarova, B; Hajtman, A

2016-08-01

Total thyroidectomy: safe and adequate treatment for papillary microcarcinoma of the thyroid gland. The purpose of this study was to evaluate the incidence of and surgical approach in patients with papillary thyroid microcarcinoma (PTMC; thyroid cancer s10 mm) when these patients underwent surgery for presumed benign thyroid conditions. Between January 2006 and December 2013, 1460 adult patients underwent partial or total thyroidectomy for presumed benign thyroid conditions in the Department of Otorhinolaryngology, Head and Neck Surgery, Comenius University, Jessenius Faculty of Medicine, University Hospital in Martin, Slovakia. Of this population, 78 patients with incidental PTMC were further studied. Incidental papillary microcarcinoma was more frequently detected in patients with multinodular goitre (P = 0.034) or Hashimoto's thyroiditis (P=0.00 13) than in patients with other thyroid diseases. Multifocal and bilateral occurance of PTMC was identified in 26% and 18% of patients, respectively. The initial surgical procedure was -hemithyroidectomy in 23% of patients. All patients initially treated with hemithyroidectomy underwent completion thyroidectomy 10-32 days (median 19 ±7 days) after initial surgery. There were no significant differences in postoperative complications (recurrent laryngeal nerve injury, hypoparathyroidism) between patients with hemithyroidectomy and patients with total thyroidectomy at the first operation (P = 0.647). Completion surgery in patients with hemithyroidectomy was not followed by a significant increase in the incidence of complications (P=0.228). Incidental PTMC is more often detected in patients that undergo surgery for multinodular goitre and Hashimoto's thyroiditis. Total thyroidectomy constitutes a safe and adequate surgical approach in patients with PTMC.

Laryngeal and vocal alterations after thyroidectomy.

PubMed

Iyomasa, Renata Mizusaki; Tagliarini, José Vicente; Rodrigues, Sérgio Augusto; Tavares, Elaine Lara Mendes; Martins, Regina Helena Garcia

2017-09-21

Dysphonia is a common symptom after thyroidectomy. To analyze the vocal symptoms, auditory-perceptual and acoustic vocal, videolaryngoscopy, the surgical procedures and histopathological findings in patients undergoing thyroidectomy. Prospective study. Patients submitted to thyroidectomy were evaluated as follows: anamnesis, laryngoscopy, and acoustic vocal assessments. Moments: pre-operative, 1st post (15 days), 2nd post (1 month), 3rd post (3 months), and 4th post (6 months). Among the 151 patients (130 women; 21 men). Type of surgery: lobectomy+isthmectomy n=40, total thyroidectomy n=88, thyroidectomy+lymph node dissection n=23. Vocal symptoms were reported by 42 patients in the 1st post (27.8%) decreasing to 7.2% after 6 months. In the acoustic analysis, f0 and APQ were decreased in women. Videolaryngoscopies showed that 144 patients (95.3%) had normal exams in the preoperative moment. Vocal fold palsies were diagnosed in 34 paralyzes at the 1st post, 32 recurrent laryngeal nerve (lobectomy+isthmectomy n=6; total thyroidectomy n=17; thyroidectomy+lymph node dissection n=9) and 2 superior laryngeal nerve (lobectomy+isthmectomy n=1; Total thyroidectomy+lymph node dissection n=1). After 6 months, 10 patients persisted with paralysis of the recurrent laryngeal nerve (6.6%). Histopathology and correlation with vocal fold palsy: colloid nodular goiter (n=76; palsy n=13), thyroiditis (n=8; palsy n=0), and carcinoma (n=67; palsy n=21). Vocal symptoms, reported by 27.8% of the patients on the 1st post decreased to 7% in 6 months. In the acoustic analysis, f0 and APQ were decreased. Transient paralysis of the vocal folds secondary to recurrent and superior laryngeal nerve injury occurred in, respectively, 21% and 1.3% of the patients, decreasing to 6.6% and 0% after 6 months. Copyright © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Bilateral benign multinodular goiter: What is the adequate surgical therapy? A review of literature.

PubMed

Mauriello, Claudio; Marte, Gianpaolo; Canfora, Alfonso; Napolitano, Salvatore; Pezzolla, Angela; Gambardella, Claudio; Tartaglia, Ernesto; Lanza, Michele; Candela, Giancarlo

2016-04-01

Benign multinodular goiter (BMNG) is the most common endocrine disease requiring surgery. During the last few years a more aggressive approach has become the trend for bilateral BMNG treatment. Randomized clinical trials of any size that compared bilateral subtotal resection, Dunhill procedure and total thyroidectomy for benign multinodular goiter, published between January 2000 and the end of March 2015, were reviewed. Total thyroidectomy can be considered the most reliable approach in preventing recurrence. The Dunhill procedure is related to a higher rate of recurrence, but rarely recurrences after Dunhill procedure lead to reoperation. Total thyroidectomy avoid completion thyroidectomy for incidental carcinoma and its related risks. Recurrent laryngeal nerve (RLN) palsy becomes less common as surgical experience increases. Transient and permanent hypoparathyroidism is strictly related to the extent of neck dissection. In the risk-cost analysis we must consider the type of patient candidated to surgery and the impact of the surgical protocol we apply. When thyroid surgery is taken in consideration, specific complication rates of different procedures in each hospital must be analyzed accordingly to patient-specific risk factors and local expertise. The Dunhill procedure seems to be a good compromise between radicality and prevention of complications, avoiding reoperation for recurrence or completion thyroidectomy for incidental thyroid carcinoma. More follow-up studies and prospective studies are necessary to better evaluate, definitively, whether to prefer total thyroidectomy or Dunhill procedure in case of benign goiter surgery. Copyright © 2015. Published by Elsevier Ltd.

Nerve sparing sutureless total thyroidectomy. Preliminary study.

PubMed

Parmeggiani, Domenico; De Falco, Massimo; Avenia, Nicola; Sanguinetti, Alessandro; Fiore, Andrea; Docimo, Giovanni; Ambrosino, Pasquale; Madonna, Imma; Peltrini, Roberto; Parmeggiani, Umberto

2012-01-01

In the present study the authors assess the advantages of new technologies in thyroid surgery: to prevent nerve injury by using an intra-operative continuous nerve-monitoring techniques and to compare the real advantages of advanced coagulation devices. Among a series of 440 thyroidectomies (jan 2004-feb 2006) the Authors reviewed charts from two groups: (1) 240 total thyroidectomies performed using the traditional monopolar electrocautery, non-absorbable stitches for the principal vascular pedicles. (2) 140 total thyroidectomies performed using dedicated small bipolar electro thermal coagulator (ligasure-precise). (3) Since 2006 in a double blind group selection of 70, we've performed sutureless thyroidectomy with continuous intraoperative nerve monitoring using dedicated endotracheal tube. Mean operative time, post-operative bleeding, post-operative stay, incidence of transient or definitive laryngeal nerve lesions, incidence of permanent or transient hypocalcaemia, costs of the procedures were analyzed. Major complications in the first two groups compared with the data of the literature are absolutely over-imposable, except a reduction of incidence of transient hypocalcaemia in the Precise group, but if we compare data of the 3rd group (NIM), we find a significative reduction of transient and permanent laryngeal nerve palsy incidence. This new technology offers several advantages: (1) atraumatic; (2) easy to use; (3) continuous monitoring and audio feedback to the surgeon (4) works outside the operation field (5) high sensitiveness. Cost-analysis confirm that NIM + ligasure have same or less cost and time and probably less complications than traditional Total Thyroidectomy.

Postoperative day 1 levels of parathyroid as predictor of occurrence and severity of hypocalcaemia after total thyroidectomy.

PubMed

Karatzanis, Alexander D; Ierodiakonou, Despo P; Fountakis, Emmanuel S; Velegrakis, Stylianos G; Doulaptsi, Maria V; Prokopakis, Emmanuel P; Daraki, Vasiliki N; Velegrakis, George A

2018-05-01

Hypocalcaemia is a common and serious complication after thyroidectomy. The purpose of this study is to assess the effectiveness of first postoperative day parathyroid hormone (PTH) measurement in order to predict the presence and severity of postthyroidectomy hypocalcaemia. One hundred consecutive cases undergoing total thyroidectomy in a tertiary referral center were prospectively assessed. Preoperative measurements of PTH were compared with postoperative levels in the first morning after surgery. All cases of hypocalcaemia were recorded and evaluated with regard to preoperative and postoperative levels of PTH. A decrease of 56% of PTH levels on the first postoperative day could accurately predict postoperative hypocalcaemia with a sensitivity and specificity of 80%. Serum PTH levels on the first postoperative day may be used as a reliable predictive marker for calcium supplementation need and even prolonged hospitalization in cases undergoing total thyroidectomy. © 2018 Wiley Periodicals, Inc.

A Case of Type 2 Amiodarone-Induced Thyrotoxicosis That Underwent Total Thyroidectomy under High-Dose Steroid Administration

PubMed Central

Hashimoto, Koshi; Ota, Masaki; Irie, Tadanobu; Takata, Daisuke; Nakajima, Tadashi; Kaneko, Yoshiaki; Tanaka, Yuko; Matsumoto, Shunichi; Nakajima, Yasuyo; Kurabayashi, Masahiko; Oyama, Tetsunari; Takeyoshi, Izumi; Mori, Masatomo; Yamada, Masanobu

2015-01-01

Amiodarone is used commonly and effectively in the treatment of arrhythmia; however, it may cause thyrotoxicosis categorized into two types: iodine-induced hyperthyroidism (type 1 amiodarone-induced thyrotoxicosis (AIT)) and destructive thyroiditis (type 2 AIT). We experienced a case of type 2 AIT, in which high-dose steroid was administered intravenously, and we finally decided to perform total thyroidectomy, resulting in a complete cure of the AIT. Even though steroid had been administered to the patient (maximum 80 mg of prednisolone), the operation was performed safely and no acute adrenal crisis as steroid withdrawal syndrome was found after the operation. Few cases of type 2 AIT that underwent total thyroidectomy with high-dose steroid administration have been reported. The current case suggests that total thyroidectomy should be taken into consideration for patients with AIT who cannot be controlled by medical treatment and even in those under high-dose steroid administration. PMID:25664188

Is There a Minimum Number of Thyroidectomies a Surgeon Should Perform to Optimize Patient Outcomes?

PubMed

Adam, Mohamed Abdelgadir; Thomas, Samantha; Youngwirth, Linda; Hyslop, Terry; Reed, Shelby D; Scheri, Randall P; Roman, Sanziana A; Sosa, Julie A

2017-02-01

To determine the number of total thyroidectomies per surgeon per year associated with the lowest risk of complications. The surgeon volume-outcome association has been established for thyroidectomy; however, a threshold number of cases defining a "high-volume" surgeon remains unclear. Adults undergoing total thyroidectomy were identified from the Health Care Utilization Project-National Inpatient Sample (1998-2009). Multivariate logistic regression with restricted cubic splines was utilized to examine the association between the number of annual total thyroidectomies per surgeon and risk of complications. Among 16,954 patients undergoing total thyroidectomy, 47% had thyroid cancer and 53% benign disease. Median annual surgeon volume was 7 cases; 51% of surgeons performed 1 case/y. Overall, 6% of the patients experienced complications. After adjustment, the likelihood of experiencing a complication decreased with increasing surgeon volume up to 26 cases/y (P < 0.01). Among all patients, 81% had surgery by low-volume surgeons (≤25 cases/y). With adjustment, patients undergoing surgery by low-volume surgeons were more likely to experience complications (odds ratio 1.51, P = 0.002) and longer hospital stays (+12%, P = 0.006). Patients had an 87% increase in the odds of having a complication if the surgeon performed 1 case/y, 68% for 2 to 5 cases/y, 42% for 6 to 10 cases/y, 22% for 11 to 15 cases/y, 10% for 16 to 20 cases/y, and 3% for 21 to 25 cases/y. This is the first study to identify a surgeon volume threshold (>25 total thyroidectomies/y) that is associated with improved patient outcomes. Identifying a threshold number of cases defining a high-volume thyroid surgeon is important, as it has implications for quality improvement, criteria for referral and reimbursement, and surgical education.

Hypocalcaemia following thyroidectomy for treatment of Graves' disease: implications for patient management and cost-effectiveness.

PubMed

Hughes, O R; Scott-Coombes, D M

2011-08-01

No consensus exists on optimal treatment for Graves' disease once anti-thyroid medication fails to induce remission. Total thyroidectomy is a more cost-effective treatment than radioactive iodine or life-long anti-thyroid medication, but hypocalcaemia is an important complication, leading to longer hospital admissions and increased prescription costs. This study aimed to compare the relative risk of hypocalcaemia requiring medical treatment for patients with Graves' disease. Prospective cohort study of patients undergoing total thyroidectomy for Graves' disease and for multinodular goitre, calculating serum calcium levels 24-hours post-operatively and prescription rates. Mean corrected calcium concentrations 24 hours post-operatively were 2.05 mmol/l for Graves' disease patients and 2.14 mmol/l for multinodular goitre patients (p = 0.003). Biochemical hypocalcaemia developed in 92 per cent (n = 34) of Graves' disease patients and 71 per cent (n = 43) of multinodular goitre patients (p = 0.012). Graves' disease patients were more likely to be prescribed calcium supplementation pre-discharge (p = 0.037). Total thyroidectomy for Graves' disease carries an increased risk of hypocalcaemia at 24 hours, and of calcium supplementation pre-discharge. Graves' disease patients should be informed of the increased risk of hypocalcaemia associated with total thyroidectomy, and this risk must be factored into future cost-effectiveness analysis.

Effectiveness of an i-PTH Measurement in Predicting Post Thyroidectomy Hypocalcemia: Prospective Controlled Study

PubMed Central

Kim, Jin Pyeong; Park, Jung Je; Son, Hee Young; Kim, Rock Bum; Kim, Ho Youp

2013-01-01

Purpose Hypocalcemia is the most common complication after total thyroidectomy. The purpose of this study was to determine whether measurement of intact parathyroid hormone (i-PTH) level in thyroidectomy patients could predict hypocalcemia. Materials and Methods We performed a prospective study of patients undergoing total thyroidectomy. Serum concentration of i-PTH, total calcium (Ca), ionized calcium (Ca2+), phosphate (P), magnesium (Mg), and albumin were measured preoperatively and at 0 hour, 6 hours, 12 hours, 24 hours, 48 hours, and 72 hours postoperatively. Results 108 patients were recruited to the study. A total of 50 patients (46%) experienced hypocalcemia. The serum i-PTH concentration was linearly related to the time of measurement, while concentrations of P, Mg, albumin, Ca, and Ca2+ were not. We compared odds ratios, and found that the concentration of i-PTH at 6 hours post operation was the most closely related to the occurrence of hypocalcemic symptom. On ROC analysis using i-PTH level at 6 hours, an i-PTH level of 10.6 mg/dL was found to maximize both sensitivity and specificity at the same time point. Conclusion We found that i-PTH was a predictor of hypocalcemia, and that the earliest predictor of hypocalcemic symptoms was an i-PTH concentration lower than 10.6 mg/dL obtained 6 hours after total thyroidectomy. PMID:23549808

Impact of postoperative magnesium levels on early hypocalcemia and permanent hypoparathyroidism after thyroidectomy.

PubMed

Garrahy, Aoife; Murphy, Matthew S; Sheahan, Patrick

2016-04-01

Postoperative hypocalcemia is a common complication of thyroidectomy. Magnesium is known to modulate serum calcium levels and hypomagnesemia may impede correction of hypocalcemia. The purpose of this study was to investigate whether hypomagnesemia after thyroidectomy has any impact on early hypocalcemia and/or permanent hypoparathyroidism. We conducted a retrospective review of prospectively maintained databases. Inclusion criteria were total or completion total thyroidectomy with postoperative magnesium levels available. The incidence of postoperative hypocalcemia was correlated with postoperative hypomagnesemia and other risk factors. Two hundred one cases were included. Twenty-six patients (13%) developed postoperative hypomagnesemia. Hypomagnesemia (p = .002), cancer diagnosis (p = .01), central neck dissection (p = .02), and inadvertent parathyroid resection (p = .02) were significantly associated with hypocalcemia. On multivariate analysis, only hypomagnesemia (p = .005) remained significant. Hypomagnesemia was also a significant predictor of permanent hypoparathyroidism (p = .0004). Hypomagnesemia is significantly associated with early hypocalcemia and permanent hypoparathyroidism after thyroidectomy. Magnesium levels should be closely monitored in patients with postthyroidectomy hypocalcemia. © 2015 Wiley Periodicals, Inc.

Economic analysis of routine neuromonitoring of recurrent laryngeal nerve in total thyroidectomy.

PubMed

Sanabria, Álvaro; Ramírez, Adonis

2015-01-01

Thyroidectomy is a common surgery. Routine searching of the recurrent laryngeal nerve is the most important strategy to avoid palsy. Neuromonitoring has been recommended to decrease recurrent laryngeal nerve palsy. To assess if neuromonitoring of recurrent laryngeal nerve during thyroidectomy is cost-effective in a developing country. We designed a decision analysis to assess the cost-effectiveness of recurrent laryngeal nerve neuromonitoring. For probabilities, we used data from a meta-analysis. Utility was measured using preference values. We considered direct costs. We conducted a deterministic and a probabilistic analysis. We did not find differences in utility between arms. The frequency of recurrent laryngeal nerve injury was 1% in the neuromonitor group and 1.6% for the standard group. Thyroidectomy without monitoring was the less expensive alternative. The incremental cost-effectiveness ratio was COP$ 9,112,065. Routine neuromonitoring in total thyroidectomy with low risk of recurrent laryngeal nerve injury is neither cost-useful nor cost-effective in the Colombian health system.

[Variation of extralaryngeal furcation of the recurrent laryngeal nerve in total thyroidectomy].

PubMed

Fan, Zhe; Zhang, Lin; Zhang, Yingyi

2015-12-01

To explore the extralaryngeal furcation variation of the recurrent laryngeal nerve (RLN) in total thyroidectomy. The clinical data of 216 RLNs from 108 patients undergone total thyroidectomy were retrospectively analyzed. RLN was found during every operation and exposed in whole course until access into larynx. Twenty (9.26%) pieces of RLNs showed bifurcated or trifurcated RLNs before access into larynx. Ratio of furcation is lower than that reported before internationally. Bifurcations of RLNs on the left were more than that on the right. The protection of RLN is important for thyroid operation, especially in total thyroidetomy. Variation of extralaryngeal furcation of RLN usually leads to injury of RLN. Understanding of variation of RLN could decrease nerve function related complication.

Hypocalcaemia following total thyroidectomy: An analysis of 806 patients.

PubMed

Nair, C Gopalakrishnan; Babu, Misha J C; Menon, Riju; Jacob, Pradeep

2013-03-01

Permanent hypocalcaemia following thyroidectomy causes considerable morbidity. This prospective observational study aims to define the factors likely to predict hypocalcaemia following total thyroidectomy. Patients who were subjected to total thyroidectomy during January 2005 to December 2009 were followed up for a minimum period of 1 year. Efficacy of an intraoperative parathyroid hormone assay to predict hypocalcaemia was validated. Overall incidence of hypocalcaemia was 23.6% (n = 190) and that of permanent hypocalcaemia was 1.61% (n = 13). Onset was delayed up to 3(rd) postoperative day in 13 patients. Hypocalcaemia was significantly associated with thyroidectomy for Grave's Disease (P = 0.001), Hashimoto's thyroiditis (P = 0.003), and with incidental parathyroidectomy (P = 0.006). The intraoperative assay of parathyroid hormone showed low sensitivity (0.5) and satisfactory specificity (0.9) in predicting hypocalcemia. Hypocalcemia could manifest late in the immediate postoperative period and this may explain latent hypocalcemia. High incidence of hypocalcaemia noted in Grave's Disease could be due to the autoimmunity since same feature was noted associated with Hashimoto's thyroiditis and the incidence of hypocalcaemia was not high in the subgroup with toxic nodular goiter. The incidence of hypocalcemia was not affected by age or sex.

Hypocalcaemia following total thyroidectomy: An analysis of 806 patients

PubMed Central

Nair, C. Gopalakrishnan; Babu, Misha J. C.; Menon, Riju; Jacob, Pradeep

2013-01-01

Background: Permanent hypocalcaemia following thyroidectomy causes considerable morbidity. This prospective observational study aims to define the factors likely to predict hypocalcaemia following total thyroidectomy. Materials and Methods: Patients who were subjected to total thyroidectomy during January 2005 to December 2009 were followed up for a minimum period of 1 year. Efficacy of an intraoperative parathyroid hormone assay to predict hypocalcaemia was validated. Results: Overall incidence of hypocalcaemia was 23.6% (n = 190) and that of permanent hypocalcaemia was 1.61% (n = 13). Onset was delayed up to 3rd postoperative day in 13 patients. Hypocalcaemia was significantly associated with thyroidectomy for Grave's Disease (P = 0.001), Hashimoto's thyroiditis (P = 0.003), and with incidental parathyroidectomy (P = 0.006). The intraoperative assay of parathyroid hormone showed low sensitivity (0.5) and satisfactory specificity (0.9) in predicting hypocalcemia. Conclusion: Hypocalcemia could manifest late in the immediate postoperative period and this may explain latent hypocalcemia. High incidence of hypocalcaemia noted in Grave's Disease could be due to the autoimmunity since same feature was noted associated with Hashimoto's thyroiditis and the incidence of hypocalcaemia was not high in the subgroup with toxic nodular goiter. The incidence of hypocalcemia was not affected by age or sex. PMID:23776907

Quality of life and cosmetic result of single-port access endoscopic thyroidectomy via axillary approach in patients with papillary thyroid carcinoma.

PubMed

Huang, Jian-Kang; Ma, Ling; Song, Wen-Hua; Lu, Bang-Yu; Huang, Yu-Bin; Dong, Hui-Ming

2016-01-01

Endoscopic thyroidectomy for minimally invasive thyroid surgery has been widely applied in the past decade. The present study aimed to evaluate the effects of single-port access transaxillary totally endoscopic thyroidectomy on the postoperative outcomes and functional parameters, including quality of life and cosmetic result in patients with papillary thyroid carcinoma (PTC). Seventy-five patients with PTC who underwent endoscopic thyroidectomy via a single-port access transaxillary approach were included (experimental group). A total of 123 patients with PTC who were subjected to conventional open total thyroidectomy served as the control group. The health-related quality of life and cosmetic and satisfaction outcomes were assessed postoperatively. The mean operation time was significantly increased in the experimental group. The physiological functions and social functions in the two groups were remarkably augmented after 6 months of surgery. However, there was no significant difference in the scores of speech and taste between the two groups at the indicated time of 1 month and 6 months. In addition, the scores for appearance, satisfaction with appearance, role-physical, bodily pain, and general health in the experimental group were better than those in the control group at 1 month and 6 months after surgery. The single-port access transaxillary totally endoscopic thyroidectomy is safe and feasible for the treatment of patients with PTC. The subjects who underwent this technique have a good perception of their general state of health and are likely to participate in social activities. It is worthy of being clinically used for patients with PTC.

Parathyroid hormone levels 1 hour after thyroidectomy: an early predictor of postoperative hypocalcemia

PubMed Central

AlQahtani, Awad; Parsyan, Armen; Payne, Richard; Tabah, Roger

2014-01-01

Background Parathyroid dysfunction leading to symptomatic hypocalcemia is not uncommon following a total or completion thyroidectomy and is often associated with significant patient morbidity and a prolonged hospital stay. A simple, reliable indicator to identify patients at risk would permit earlier pharmacologic prophylaxis to avoid these adverse outcomes. We examined the role of intact parathormone (PTH) levels 1 hour after surgery as a predictor of post-thyroidectomy hypocalcemia. Methods We prospectively reviewed the cases of consecutive patients undergoing total or completion thyroidectomy. Ionized calcium (Ca2+) and intact PTH levels were measured preoperatively and at 1-, 6- and 24-hour intervals postoperatively. The specificity, sensitivity, negative and positive predictive values of the 1-hour PTH serum levels (PTH-1) in predicting 24-hour post-thyroidectomy hypocalcemia and eucalcemia were determined. Results We reviewed the cases of 149 patients. Biochemical hypocalcaemia (Ca2+ < 1.1 mmol/L) developed in 38 of 149 (25.7%) patients 24 hours after thyroidectomy. The sensitivity, specificity, positive and negative predictive values of a low PTH-1 were 89%, 100%, 97% and 100%, respectively. Conclusion We found that PTH-1 levels were predictive of symptomatic hypocalcemia 24 hours after thyroidectomy. Routine use of this assay should be considered, as it could prompt the early administration of calcitriol in patients at risk of hypocalcemia and allow for the safe and timely discharge of patients expected to remain eucalcemic. PMID:25078927

Parathyroid hormone levels 1 hour after thyroidectomy: an early predictor of postoperative hypocalcemia.

PubMed

AlQahtani, Awad; Parsyan, Armen; Payne, Richard; Tabah, Roger

2014-08-01

Parathyroid dysfunction leading to symptomatic hypocalcemia is not uncommon following a total or completion thyroidectomy and is often associated with significant patient morbidity and a prolonged hospital stay. A simple, reliable indicator to identify patients at risk would permit earlier pharmacologic prophylaxis to avoid these adverse outcomes. We examined the role of intact parathormone (PTH) levels 1 hour after surgery as a predictor of post-thyroidectomy hypocalcemia. We prospectively reviewed the cases of consecutive patients undergoing total or completion thyroidectomy. Ionized calcium (Ca(2+)) and intact PTH levels were measured preoperatively and at 1-, 6- and 24-hour intervals postoperatively. The specificity, sensitivity, negative and positive predictive values of the 1-hour PTH serum levels (PTH-1) in predicting 24-hour post-thyroidectomy hypocalcemia and eucalcemia were determined. We reviewed the cases of 149 patients. Biochemical hypocalcaemia (Ca(2+) < 1.1 mmol/L) developed in 38 of 149 (25.7%) patients 24 hours after thyroidectomy. The sensitivity, specificity, positive and negative predictive values of a low PTH-1 were 89%, 100%, 97% and 100%, respectively. We found that PTH-1 levels were predictive of symptomatic hypocalcemia 24 hours after thyroidectomy. Routine use of this assay should be considered, as it could prompt the early administration of calcitriol in patients at risk of hypocalcemia and allow for the safe and timely discharge of patients expected to remain eucalcemic.

Hypocalcaemia after total thyroidectomy: could intact parathyroid hormone be a predictive factor for transient postoperative hypocalcemia?

PubMed

Puzziello, Alessandro; Gervasi, Rita; Orlando, Giulio; Innaro, Nadia; Vitale, Mario; Sacco, Rosario

2015-02-01

Hypocalcemia, the most common complication of thyroidectomy, is a transient condition in up to 27% of patients and a permanent condition approximately 1% of patients. The aim of this prospective study was to evaluate reliability of postoperative intact parathyroid hormone (iPTH) assessment for predicting clinically relevant postthyroidectomy hypocalcemia for a safe early discharge of patients with no overtreatment. Seventy-five consecutive patients (age 51 ± 13 years [mean ± SD]) undergoing total or completion thyroidectomy with no concomitant parathyroid diseases or renal failure were included in the present study. Serum iPTH level was determined before and 2 hours after thyroidectomy. Serum calcium concentration was determined 1 day before and 2 days postoperatively. The occurrence of postoperative hypocalcemia was correlated both with the absolute and relative iPTH decrease, determined as a ratio of the preoperative value (P < .0001). There was a greater difference in relative decrease in iPTH between patients remaining normocalcemic and those with hypocalcemia present on the second postoperative day. Hypocalcemic patients on the second postoperative day had a 62% relative decrease in iPTH 2 hours after thyroidectomy. The relative decrease in serum iPTH was greater in patients with hypocalcemia arising on the second postoperative day rather than in patients who remained normocalcemic. The relative decrease in iPTH determined 2 hours after total thyroidectomy together with the serum calcium concentration 24 hours after thyroidectomy proved to be useful predictors of sustained hypocalcemia and might change the clinical management of patients after thyroid surgery to support a longer hospitalization in these selected patients. Copyright © 2015 Elsevier Inc. All rights reserved.

Robotic thyroidectomy for benign thyroid diseases: a stepwise strategy to the adoption of robotic thyroidectomy (gasless, transaxillary approach).

PubMed

Giannopoulos, George; Kang, Sang-Wook; Jeong, Jong J; Nam, Kee-Hyun; Chung, Woong Y

2013-06-01

Thyroid surgery for benign diseases mainly involves young women, and thus, cosmetic considerations have motivated the development of "no scar to the neck" procedures. Endoscopic techniques are often strenuous, and therefore, discouraging to adopt. However, the recent incorporation of robotic technology proposes a feasible, safe, extracervical approach that alleviates most of the technical difficulties associated with endoscopy. Here, the authors present a series of robotic thyroidectomies performed to treat benign thyroid diseases and detail the key issues of initial patient selection. From November 2007 to December 2010, 44 patients with benign thyroid disease were operated upon using a robotic procedure. Indications were follicular/Hürthle cell lesions smaller than 5 cm, nodules with an indefinite/suspicious cytology, or Graves disease. All patients underwent robotic gasless, transaxillary thyroidectomy using the da Vinci S system. Thirty-nine of the 44 patients were women, and the overall mean age was 38.2 years (range, 16 to 60 y). The most common pathology was adenomatous hyperplasia (20 lesions) followed by follicular adenoma (10 lesions). Seven patients had Graves disease. The mean tumor size was 1.68 cm (range, 0.3 to 5 cm). Thirty-nine patients underwent less than total thyroidectomy and 5 underwent total or near total thyroidectomy. The mean total operative time was 129.8 minutes (range, 75 to 242 min) and the mean duration of postoperative hospital stay was 3.1 days (range, 2 to 5 d). Postoperative complications were 1 transient hoarseness, 1 transient hypocalcemia, and 1 permanent recurrent laryngeal nerve injury. Robotic thyroidectomy, although novel and sophisticated, has already been used to treat over 4000 thyroid cancer patients in Korea. Female patients with a small to average build, with a follicular lesion and concerned about neck scarring, seem to be the best candidates. Patients with small suspicious nodules without severe thyroiditis are also a rational choice. In contrast, patients with Graves disease should be reserved, unless significant experience has been gained.

Early Predictors of Hypocalcemia After Total Thyroidectomy

PubMed Central

Noureldine, Salem I.; Genther, Dane J.; Lopez, Michael; Agrawal, Nishant; Tufano, Ralph P.

2015-01-01

IMPORTANCE Postoperative hypocalcemia is common after total thyroidectomy, and perioperative monitoring of serum calcium levels is arguably the primary reason for overnight hospitalization. Confidently predicting which patients will not develop significant hypocalcemia may allow for a safe earlier discharge. OBJECTIVE To examine associations of patient characteristics with hypocalcemia, duration of hospitalization, and postoperative intact parathyroid hormone (IPTH) level after total thyroidectomy. DESIGN, SETTING, AND PARTICIPANTS Retrospective study of consecutive patients who underwent total thyroidectomy by a single high-volume surgeon between February 1, 2010, and November 30, 2012. Postoperative serum 25-hydroxyvitamin D (vitamin D), calcium, and IPTH levels were tested within 6 to 8 hours after surgery. Mild hypocalcemia was defined as any postoperative serum calcium level of less than 8.4 to 8.0 mg/dL. Significant hypocalcemia was defined as any postoperative serum calcium level of less than 8.0 mg/dL or the development of hypocalcemia-related symptoms. INTERVENTIONS Total thyroidectomy. MAIN OUTCOMES AND MEASURES Associations of patient demographic and clinical characteristics and laboratory values with postoperative mild and significant hypocalcemia were examined using univariate analysis, and independent predictors of hypocalcemia, duration of hospitalization, and IPTH level were determined using multivariate analysis. RESULTS Overall, 304 total thyroidectomies were performed. Mild and significant hypocalcemia occurred in 68 (22.4%) and 91 (29.9%) patients, respectively, of which the majority were female (P = .003). The development of significant hypocalcemia was associated with postoperative IPTH level (P < .001). On multivariate analysis, males had a decreased risk of developing mild (odds ratio, 0.37 [95% CI, 0.16–0.85]) and significant (odds ratio, 0.57 [95% CI, 0.09–0.78]) hypocalcemia. Every 10-pg/mL increase in postoperative IPTH level predicted a 43% decreased risk of significant hypocalcemia (P < .001) and an 18% decreased risk of hospitalization beyond 24 hours (P = .03). Presence of malignant neoplasm carried a 27% risk of mild hypocalcemia (P = .02). There was a progressively increasing risk of lower IPTH levels for each parathyroid gland inadvertently resected or autotransplanted. Male sex and African American race were independently predictive of higher IPTH levels. CONCLUSIONS AND RELEVANCE Low postoperative IPTH level, female sex, and presence of malignant neoplasm are all significant, independent predictors of hypocalcemia after total thyroidectomy. Clinicians should consider these variables when deciding how to best manage or prevent postoperative hypocalcemia. PMID:25321339

Minimally invasive thyroidectomy (MIT): indications and results.

PubMed

Docimo, Giovanni; Salvatore Tolone, Salvatore; Gili, Simona; d'Alessandro, A; Casalino, G; Brusciano, L; Ruggiero, Roberto; Docimo, Ludovico

2013-01-01

To establish if the indication for different approaches for thyroidectomy and the incision length provided by means of pre-operative assessment of gland volume and size of nodules resulted in safe and effective outcomes and in any notable aesthetic or quality-of-life impact on patients. Ninehundred eightytwo consecutive patients, undergoing total thyroidectomy, were enrolled. The thyroid volume and maximal nodule diameter were measured by means of ultrasounds. Based on ultrasounds findings, patients were divided into three groups: minimally invasive video assisted thyroidectomy (MIVAT), minimally invasive thyroidectomy (MIT) and conventional thyroidectomy (CT) groups. The data concerning the following parameters were collected: operative time, postoperative complications, postoperative pain and cosmetic results. The MIVAT group included 179 patients, MIT group included 592 patients and CT group included 211 patients. Incidence of complications did not differ significantly in each group. In MIVAT and MIT group, the perception of postoperative pain was less intense than CT group. The patients in the MIVAT (7±1.5) and MIT (8±2) groups were more satisfied with the cosmetic results than those in CT group (5±1.3) (p= <0.05). The MIT is a technique totally reproducible, and easily convertible to perform surgical procedures in respect of the patient, without additional complications, increased costs, and with better aesthetic results.

Predictors of thyroid gland involvement in hypopharyngeal squamous cell carcinoma.

PubMed

Chang, Jae Won; Koh, Yoon Woo; Chung, Woong Youn; Hong, Soon Won; Choi, Eun Chang

2015-05-01

Decision to perform concurrent ipsilateral thyroidectomy on patients with hypopharyngeal cancer is important, and unnecessary thyroidectomy should be avoided if oncologically feasible. We hypothesized that concurrent ipsilateral thyroidectomy is not routinely required to prevent occult metastasis. This study aimed to determine the prevalence of histological thyroid invasion in patients with hypopharyngeal cancer, and to refine the indications for prophylactic ipsilateral thyroidectomy in patients with hypopharyngeal cancer. A retrospective review of the medical records from the Department of Otolaryngology at Yonsei University College of Medicine was conducted from January 1994 to December 2009. A total of 49 patients underwent laryngopharyngectomy with thyroidectomy as a primary treatment of hypopharyngeal cancer. The incidence of thyroid gland involvement was 10.2%. The most common route of invasion was direct extension through the thyroid cartilage. Thyroid cartilage invasion (p=0.034) was the most significant factor associated with thyroid invasion. Disease-specific survival at 5 years was lower in patients with than without thyroid gland invasion (26.7% vs. 55.2%, respectively; p=0.032). Disease-free survival at 5 years was also lower in patients with than without thyroid gland invasion (20.0% vs. 52.1%, respectively; p=0.024). Ipsilateral thyroidectomy in combination with total laryngopharyngectomy is indicated when invasion of the thyroid cartilage is suspected in patients with hypopharyngeal cancer.

A Prospective Study on Role of Supplemental Oral Calcium and Vitamin D in Prevention of Postthyroidectomy Hypocalcemia.

PubMed

Ravikumar, Krishnan; Sadacharan, Dhalapathy; Muthukumar, Sankaran; Sundarram, Thalavai; Periyasamy, Selladurai; Suresh, R V

2017-01-01

Postoperative transient hypocalcemia is sequelae of total thyroidectomy (TT), which is observed in up to 50% of patients. Routine oral calcium and Vitamin D supplementation have been proposed to prevent symptomatic hypocalcemia preventing morbidity and facilitating early discharge. A total of 208 patients with nontoxic benign thyroid disorders, undergoing TT, were serially randomized into four groups: Group A (no supplements were given), Group B (oral calcium - 2 g/day given), Group C (calcium and calcitriol - 1 mcg/day are given), and Group D (calcium, calcitriol, and cholecalciferol - 60,000 IU/day are given). Patients were monitored for clinical and biochemical hypocalcemia (serum calcium, [Sr. Ca] <8 mg/dl), along with serum intact parathormone (Sr. PTH) and magnesium 6 h after surgery and Sr. Ca every 24 h. Intravenous (IV) calcium infusion was started, if any of the above four groups exhibit frank hypocalcemia. Patients are followed up with Sr. Ca and Sr. PTH at 3 and 6 months. All groups were age and sex matched. Hypocalcemia was observed in 72/208 (34.61%) cases. Incidence of hypocalcemia was higher in Group A (57.69%) and Group B (50%) compared to Group C (15.38%) and Group D (15.38%). Hypocalcemia necessitating IV calcium occurred in 31/208 (14.90%) patients. IV calcium requirement exceeded in Group A (26.92%) and Group B (23.07%) compared to Group C (5.76%) and Group D (3.84%). There was no statistical difference in basal levels of serum Vitamin D, calcium, magnesium, intact PTH, and 6 h after surgery. Permanent hypoparathyroidism developed in five patients on follow-up. Routine postoperative supplementation of oral calcium and Vitamin D will help in the prevention of postthyroidectomy transient hypocalcemia significantly. Preoperative Vitamin D levels do not predict postoperative hypocalcemia.

Voice changes after thyroidectomy without recurrent laryngeal nerve injury.

PubMed

Sinagra, Diego L; Montesinos, Manuel R; Tacchi, Verónica A; Moreno, Julio C; Falco, Jorge E; Mezzadri, Norberto A; Debonis, Daniel L; Curutchet, H Pablo

2004-10-01

Injury of the inferior laryngeal nerve is not the only cause of voice alteration after thyroidectomy; many patients notice minimal changes immediately after operation, without evidence of inferior laryngeal nerve damage. We hypothesized that there may be other causes for voice modification, such as injuries of the superior laryngeal nerve, prethyroid strap muscles, and cricothyroid muscles. We describe voice changes after total thyroidectomy, without inferior laryngeal nerve injury, using a computer program to objectively compare different patterns of voice. Forty-six consecutive patients who underwent total thyroidectomy were studied between March 1997 and December 1999. Acoustic voice analysis was performed preoperatively and at the second, fourth, and sixth postoperative months using a microphone adapted to a personal computer. Parameters measured were intensity of the voice (Shimmer) and fundamental frequency (Fo). No complications occurred during operation or in the postoperative period. Voice fatigue during phonation was the most common symptom after thyroidectomy. Forty patients (87%) stated that their voices had changed since the operation, and common complaints were voice alteration while speaking loudly, changes in voice pitch, and voice disorder while singing. Changes in the Fo and Shimmer values in smokers versus nonsmokers were similar (Fo overall, p = 0.56; Shimmer overall, p = 0.66), as were the same parameters in benign and malignant pathologies (Fo overall, p = 0.66; Shimmer overall, p = 0.67). Voice changes after uncomplicated thyroidectomy occur and can be objectively measured. This is important in the preoperative counseling of patients before thyroidectomy, for ethical and legal purposes.

Management of the thyroid gland during total laryngectomy in patients with laryngeal squamous cell carcinoma.

PubMed

Mourad, Moustafa; Saman, Masoud; Sawhney, Raja; Ducic, Yadranko

2015-08-01

The goal of the study was to determine the role of routine total thyroidectomy and hemithyroidectomy in patients undergoing total laryngectomy for laryngeal squamous cell carcinoma. The study group consisted of 343 patients who underwent total laryngectomy (98 treated with surgery alone, 136 treated following radiation failure, and 109 following chemoradiation failure). Total thyroidectomy was performed in all obstructing and bilateral lesions or if there was suspicion of contralateral lobe involvement. Hemithyroidectomy was performed in all lateralized lesions. Retrospective histopathologic analysis of thyroid specimens was subsequently performed. In all, 262 patients underwent total thyroidectomy during total laryngectomy, six of which demonstrated squamous cell carcinoma evident within the thyroid gland (4 from transglottic lesions, 2 from subglottic lesions). Hemithyroidectomy was performed in 81 patients, with only one patient demonstrating evidence of squamous cell carcinoma within the thyroid gland. Hypothyroidism was observed in 88% (n = 61) of patients who underwent thyroid lobectomy alone, requiring hormone supplementation. Routine surgical management of the thyroid gland should not be performed, except in cases of subglottic primary lesions, lesions with significant subglottic extension, or transglottic lesions. Despite efforts to preserve the contralateral thyroid lobe in cases of selective lobectomy, these patients often have a high rate of hypothyroidism, and a total thyroidectomy should be considered when involvement of the thyroid gland is suspected. N/A. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Tissue-engineered thyroid cell sheet rescued hypothyroidism in rat models after receiving total thyroidectomy comparing with nontransplantation models.

PubMed

Arauchi, Ayumi; Shimizu, Tatsuya; Yamato, Masayuki; Obara, Takao; Okano, Teruo

2009-12-01

For hormonal deficiency caused by endocrine organ diseases, continuous oral hormone administration is indispensable to supplement the shortage of hormones. In this study, as a more effective therapy, we have tried to reconstruct the three-dimensional thyroid tissue by the cell sheet technology, a novel tissue engineering approach. The cell suspension obtained from rat thyroid gland was cultured on temperature-responsive culture dishes, from which confluent cells detach as a cell sheet simply by reducing temperature without any enzymatic treatment. The 8-week-old Lewis rats were exposed to total thyroidectomy as hypothyroidism models and received thyroid cell sheet transplantation 1 week after total thyroidectomy. Serum levels of free triiodothyronine (fT(3)) and free thyroxine (fT(4)) significantly decreased 1 week after total thyroidectomy. On the other hand, transplantation of the thyroid cell sheets was able to restore the thyroid function 1 week after the cell sheet transplantation, and improvement was maintained for 4 weeks. Moreover, morphological analyses showed typical thyroid follicle organization, and anti-thyroid-transcription-factor-1 antibody staining demonstrated the presence of follicle epithelial cells. The presence of functional microvessels was also detected within the engineered thyroid tissues. In conclusion, our results indicate that thyroid cell sheets transplanted in a model of total thyroidectomy can reorganize histologically to resemble a typical thyroid gland and restore thyroid function in vivo. In this study, we are the first to confirm that engineered thyroid tissue can repair hypothyroidism models in rats and, therefore, cell sheet transplantation of endocrine organs may be suitable for the therapy of hormonal deficiency.

Unintentional parathyroidectomy and postoperative hypocalcaemia. Conventional thyroidectomy versus miniinvasive thyroidectomy.

PubMed

Del Rio, Paolo; De Simone, Belinda; Viani, Lorenzo; Arcuri, Maria Francesca; Sianesi, Mario

2014-01-01

Hypocalcemia and unintentional parathyroidectomy would be associated as cause of post-thyroidectomy hypocalcemia. We analysed the cases treated with total thyroidectomy by two experienced endocrine surgeons from January 2010 to December 2011 at the Unit of General Surgery and Organ Transplantation of the University Hospital of Parma. These cases were divided in two groups: "Group A" included patients for whom a histological report was made that was negative for a parathyroid avulsion, and "Group B" included patients for whom an inadvertent avulsion of the intracapsular parathyroid glands had occurred. In total, 538 patients were treated with a total thyroidectomy from January 2010 to December 2011. In 26 cases, the histological report highlighted the presence of an intracapsular parathyroid gland. The values of pre-operative calcaemia in group A and group B were 9.204 ± 0.2703 mg/dl versus 9.283 ± 0.401 mg/dl, respectively (p=0.32). The values of post-operative calcaemia were 8.039 ± 0.596 mg/dl for group A versus 7.569 ± 0.618 mg/dl for group B (p=0.0002) In Group A, 91/512 patients were treated with the minimally invasive video-assisted thyroidectomy (MIVAT) technique (17,7%), while 1/26 patients in group B was treated with a MIVAT (3,8%). Unintentional parathyroidectomies can occur with experienced surgeons, but this complication is not related to a substantial difference in the incidence of hypocalcemia. MIVAT can helps the endocrine surgeon in the detection of the parathyroids glands, but when the parathyroid is intracapsular, is difficult to preserve it, during surgical dissection.

Evolution in the profile of thyroid cancer cases treated in an oncology reference service: what changed in the last 20 years.

PubMed

Lira, Renan Bezerra; Carvalho, Genival Barbosa de; Gonçalves Filho, João; Kowalski, Luiz Paulo

2014-01-01

To evaluate the characteristics of thyroid carcinoma cases treated at a reference hospital for cancer between 2008 and 2010. we studied 807 cases and analyzed the following clinicopathologic variables: symptoms, risk factors, diagnostic tests, staging, histological type, treatment performed and complications. Females were more affected, with 660 cases (82%). The average age at diagnosis was 44.5 years. Prior exposure to ionizing radiation was reported by 22 (3%) patients, a family history of thyroid cancer by 89 (11%), and 289 (36%) individuals reported other types of cancer in the family. The fine needle aspiration biopsy was the main parameter for surgical indication and was suggestive of carcinoma in 463 patients (57%). Papillary carcinoma was the most common histological type, with 780 cases (96.6%). There were 728 (90%) total thyroidectomies, 43 (5.3%) reoperations or partial thyroidectomies followed by totalization, 23 (2.8%) extended thyroidectomies and only 13 (1.6%) partial thyroidectomies (lobectomy with isthmectomy). Neck dissection associated with thyroidectomy was done in 158 patients (19.5%). We observed a predominance of tumors classified as T1 in 602 (74.6%) patients. Transient hypocalcemia was the most frequent complication. The results show that the worldwide increase in the incidence of thyroid cancer has changed the profile of patients seen at a referral service. In addition, there were changes in the type of surgical treatment used, with increased use of total thyroidectomy in relation to partial and subtotal ones, and decreased use of elective neck dissections.

[Role of parathyroid hormone measurement in prediction for symptomatic hypocalcaemia after total thyroidectomy].

PubMed

An, Chang-ming; Tang, Ping-zhang; Xu, Zhen-gang; Zhang, Bin; Zhang, Zong-min; Yan, Dan-gui; Li, Zheng-jiang

2010-03-01

To evaluate the role of parathyroid hormone (PTH) and serum calcium in prediction for hypocalcaemia after total thyroidectomy. One hundred and sixty-five patients undergoing total or complete total thyroidectomy were reviewed retrospectively. The indications included bilateral carcinoma, undifferential carcinoma, surroundings invasion, distant metastasis and huge benign lesions. Preoperative and postoperative PTH, calcium concentrations and their decline levels were compared between Jan. 2005 and May 2009. The role of PTH value and decline level predicting for symptomatic hypocalcaemia were analyzed by receiver operator characteristics (ROC) curve. After total thyroidectomy, 85 patients (51.5%) developed hypocalcemia. Symptoms were reported by 36 patients (21.8%). The mean concentration of PTH for normocalcaemia (80 cases), asymptomatic hypocalcaemia (49 cases) and symptomatic patients (36 cases) were 31.0 ng/L, 19.6 ng/L and 11.9 ng/L, respectively. The mean decline level for the three groups were 28.6%, 52.6% and 78.0%, respectively. PTH value and its decline level had a poor predicting value for symptomatic hypocalcaemia and high negative predicting value for asymptomatic patients. The serum calcium concentration more than 2.0 mmol/L, PTH level higher than 15 ng/L and PTH decline less than 50% had the good negative predicting value of 97.6%, 90.3% and 96.5%, respectively. Postoperative PTH and its decline level were significantly correlated with postoperative serum calcium concentration but had a low accuracy for predicting symptomatic hypocalcaemia. The serum calcium concentration more than 2.0 mmol/L, PTH level higher than 15 ng/L and PTH decline less than 50% had the good predicting value for asymptomatic patients. Calcium should be routinely supplemented in the first 24 h after total thyroidectomy to reduce the rate of hypocalcemia and the severity of hypocalcemia symptoms.

A safety-based comparison of pure LigaSure use and LigaSure-tie technique in total thyroidectomy.

PubMed

Pergel, A; Yucel, A Fikret; Aydin, I; Sahin, D A; Aras, S; Kulacoglu, H

2014-01-01

Sutureless total thyroidectomy by using vessel sealing devices has been shown to be safe in some recent clinical studies. However, some surgeons are still concerned about the use of these energy devices in the vicinity of there current laryngeal nerve and parathyroid glands. The objective of this study was to investigate the effects of the use of pure LigaSure on postoperative complications and to discuss the pertinent literature. A total of 456 patients having undergone a total thyroidectomy operation between June 2009 and March 2011 were included in the study. Data were prospectively collected and retrospectively evaluated. Patients were separated into 2 groups. Group L comprised of 182 patients where onlyLigaSure was used, and group LT consisted of 274 patients where ligation was used in the vicinity of the recurrent laryngeal nerve and parathyroid glands, and LigaSure was used in all other parts of the surgery. Patient's blood calcium values were checked preoperatively and at postoperative 24, 48, and 72 hours. Groups were assessed in terms of demographic properties, thyroid pathology, duration of operation, and postoperative complications. Groups were similar in respect of demographic properties, operation duration, thyroid gland pathology. No mortality rate was recorded. Laboratory hypocalcemia rate was higher in group L (P 0.003), but no significant difference was identified between groups in terms of symptomatic hypocalcemia.No permanent hypocalcemia or recurrent laryngeal nerve injury developed in any of the patients in the two groups. Pure LigaSure for total thyroidectomy may increase laboratory hypocalcemia rate, but not symptomatic hypocalcemia. Hemorrhage related complications were similar and low in the two groups. Ligations in the places close to delicate anatomic structures did not cause longer operative times and may be a safer option in total thyroidectomy. Celsius.

Value of intra-operative neuromonitoring of the recurrent laryngeal nerve in total thyroidectomy for benign goitre.

PubMed

Page, C; Cuvelier, P; Biet, A; Strunski, V

2015-06-01

This study aimed to evaluate the impact of intra-operative neuromonitoring of the recurrent laryngeal nerve during total thyroidectomy for benign goitre. A single-centre retrospective study using historical controls was conducted for a 10-year period, comprising a series of 767 patients treated by total thyroidectomy for benign goitre. Of these, 306 had intra-operative neuromonitoring of the recurrent laryngeal nerve and 461 did not. Post-operative laryngeal mobility was assessed in all patients by direct laryngoscopy before hospital discharge and at post-operative follow-up visits. In all, 6 out of 461 patients (1.30 per cent) in the control group and 6 out of 306 patients (1.96 per cent) in the intra-operative neuromonitoring group developed permanent recurrent laryngeal nerve palsy. No statistically significant difference was observed between the two patient groups. Intra-operative neuromonitoring does not appear to affect the post-operative recurrent laryngeal nerve palsy rate or to reliably predict post-operative recurrent laryngeal nerve palsy. However, it can accurately predict good nerve function after thyroidectomy.

Incidence and predictors of post-thyroidectomy hypocalcaemia in a tertiary endocrine surgical unit

PubMed Central

Prasad, P; Harrison, BJ; Balasubramanian, SP

2014-01-01

Background Post-thyroidectomy hypocalcaemia is a common complication with significant short and long term morbidity. The aim of this study was to determine the incidence and predictors of post-thyroidectomy hypocalcaemia (as defined by a corrected calcium <2.1 mmol/l) in a tertiary endocrine surgical unit. Methods A total of 238 consecutive patients who underwent completion or bilateral thyroid surgery between 2008 and 2011 were included in this retrospective study. Clinical and biochemical data were obtained from electronic and hard copy medical records. Results The incidence of post-thyroidectomy hypocalcaemia on first postoperative day (POD1) was 29.0%. There was variation in the incidence of hypocalcaemia depending on the timing of measurement on the first postoperative day. At six months following surgery, 5.5% of patients were on calcium and/or vitamin D supplementation. Factors associated with post-thyroidectomy hypocalcaemia were lower preoperative corrected calcium (p=0.005) and parathyroid gland (PTG) auto-transplant (p=0.001). Other clinical factors such as central lymph node dissection, inadvertent PTG excision, ethnicity, preoperative diagnosis and Lugol’s iodine were not associated with post-thyroidectomy hypocalcaemia. Conclusion The incidence of post-thyroidectomy hypocalcaemia was underestimated by 6% when only POD1 measurements were considered. The timing of measurement on POD1 has an impact on the incidence of post-thyroidectomy hypocalcaemia. Auto-transplantation and lower preoperative calcium were associated with post-thyroidectomy hypocalcaemia. PMID:24780788

Incidence and predictors of post-thyroidectomy hypocalcaemia in a tertiary endocrine surgical unit.

PubMed

Edafe, O; Prasad, P; Harrison, B J; Balasubramanian, S P

2014-04-01

Post-thyroidectomy hypocalcaemia is a common complication with significant short and long term morbidity. The aim of this study was to determine the incidence and predictors of post-thyroidectomy hypocalcaemia (as defined by a corrected calcium <2.1 mmol/l) in a tertiary endocrine surgical unit. A total of 238 consecutive patients who underwent completion or bilateral thyroid surgery between 2008 and 2011 were included in this retrospective study. Clinical and biochemical data were obtained from electronic and hard copy medical records. The incidence of post-thyroidectomy hypocalcaemia on first postoperative day (POD1) was 29.0%. There was variation in the incidence of hypocalcaemia depending on the timing of measurement on the first postoperative day. At six months following surgery, 5.5% of patients were on calcium and/or vitamin D supplementation. Factors associated with post-thyroidectomy hypocalcaemia were lower preoperative corrected calcium (p=0.005) and parathyroid gland (PTG) auto-transplant (p=0.001). Other clinical factors such as central lymph node dissection, inadvertent PTG excision, ethnicity, preoperative diagnosis and Lugol's iodine were not associated with post-thyroidectomy hypocalcaemia. The incidence of post-thyroidectomy hypocalcaemia was underestimated by 6% when only POD1 measurements were considered. The timing of measurement on POD1 has an impact on the incidence of post-thyroidectomy hypocalcaemia. Auto-transplantation and lower preoperative calcium were associated with post-thyroidectomy hypocalcaemia.

Serum phosphate predicts temporary hypocalcaemia following thyroidectomy.

PubMed

Sam, Amir H; Dhillo, W S; Donaldson, M; Moolla, A; Meeran, K; Tolley, N S; Palazzo, F F

2011-03-01

Temporary hypocalcaemia occurs in up to 40% of patients following a total thyroidectomy. Serum calcium and parathyroid hormone (PTH) measurements are currently used to predict post-thyroidectomy hypocalcaemia. However, immediate access to PTH measurement is expensive and not widely available. Serum phosphate responds rapidly to changes in circulating PTH levels, and its measurement is readily available in all hospitals. We evaluated the use of serum phosphate to predict temporary hypocalcaemia post-thyroidectomy. We retrospectively assessed 111 consecutive patients who had total or completion thyroidectomy. Patients had serum calcium and phosphate measured preoperatively, on the evening of surgery (day 0), on the morning of day 1 and over the following week as clinically indicated. Serum PTH was measured on the morning of day 1. Vitamin D levels were measured preoperatively. Seventy-six patients did not develop treatment-demanding hypocalcaemia. In these patients, the mean serum phosphate concentration was lower on the morning of day 1 compared to that on the evening of surgery. Seventeen patients with a vitamin D>25 nmol/l developed hypocalcaemia requiring treatment from day 1 onwards. All had an overnight rise in serum phosphate to >1.44 mmol/l (100% sensitivity and specificity for predicting hypocalcaemia). Twelve patients who had a vitamin D<25 nmol/l also developed hypocalcaemia but had an attenuated rise in serum phosphate. Serum phosphate is a reliable biochemical predictor of post-thyroidectomy hypocalcaemia in patients without vitamin D deficiency. The use of serum phosphate may facilitate safe day 1 discharge of patients undergoing thyroidectomy. © 2011 Blackwell Publishing Ltd.

Predictors of Thyroid Gland Involvement in Hypopharyngeal Squamous Cell Carcinoma

PubMed Central

Chang, Jae Won; Koh, Yoon Woo; Chung, Woong Youn; Hong, Soon Won

2015-01-01

Purpose Decision to perform concurrent ipsilateral thyroidectomy on patients with hypopharyngeal cancer is important, and unnecessary thyroidectomy should be avoided if oncologically feasible. We hypothesized that concurrent ipsilateral thyroidectomy is not routinely required to prevent occult metastasis. This study aimed to determine the prevalence of histological thyroid invasion in patients with hypopharyngeal cancer, and to refine the indications for prophylactic ipsilateral thyroidectomy in patients with hypopharyngeal cancer. Materials and Methods A retrospective review of the medical records from the Department of Otolaryngology at Yonsei University College of Medicine was conducted from January 1994 to December 2009. A total of 49 patients underwent laryngopharyngectomy with thyroidectomy as a primary treatment of hypopharyngeal cancer. Results The incidence of thyroid gland involvement was 10.2%. The most common route of invasion was direct extension through the thyroid cartilage. Thyroid cartilage invasion (p=0.034) was the most significant factor associated with thyroid invasion. Disease-specific survival at 5 years was lower in patients with than without thyroid gland invasion (26.7% vs. 55.2%, respectively; p=0.032). Disease-free survival at 5 years was also lower in patients with than without thyroid gland invasion (20.0% vs. 52.1%, respectively; p=0.024). Conclusion Ipsilateral thyroidectomy in combination with total laryngopharyngectomy is indicated when invasion of the thyroid cartilage is suspected in patients with hypopharyngeal cancer. PMID:25837190

Postoperative Outcomes in Graves' Disease Patients: Results from the Nationwide Inpatient Sample Database.

PubMed

Rubio, Gustavo A; Koru-Sengul, Tulay; Vaghaiwalla, Tanaz M; Parikh, Punam P; Farra, Josefina C; Lew, John I

2017-06-01

Current surgical indications for Graves' disease include intractability to medical and/or radioablative therapy, compressive symptoms, and worsening ophthalmopathy. Total thyroidectomy for Graves' disease may be technically challenging and lead to untoward perioperative outcomes. This study examines outcomes in patients with Graves' disease who underwent total thyroidectomy and assesses its safety for this patient population. A retrospective cross-sectional analysis was performed using the Nationwide Inpatient Sample database from 2006 to 2011. Total thyroidectomy performed in patients with Graves' disease, benign multinodular goiter (MNG), and thyroid cancer was identified. Demographic factors, comorbidities, and postoperative complications were evaluated. Chi-square, one-way analysis of variance, and risk-adjusted multivariable logistic regression were performed. Of 215,068 patients who underwent total thyroidectomy during the study period, 11,205 (5.2%) had Graves' disease, 110,124 (51.2%) MNG, and 93,739 (43.6%) thyroid malignancy. Patients with Graves' disease were younger than MNG and thyroid cancer patients (M age  = 42.8 years vs. 55.5 and 51.0 years; p < 0.01). The Graves' disease group included a higher proportion of women (p < 0.01) and nonwhites (p < 0.01). Postoperatively, Graves' patients had significantly higher rates of hypocalcemia (12.4% vs. 7.3% and 10.3%; p < 0.01), hematomas requiring reoperation (0.7% vs. 0.4% and 0.4%; p < 0.01), and longer mean hospital stay (2.7 days vs. 2.4 and 2.2 days; p < 0.01) compared to MNG and thyroid cancer patients, respectively. On risk-adjusted multivariate logistic regression, Graves' disease was independently associated with a higher risk of vocal-cord paralysis (odds ratio [OR] = 1.36 [confidence interval (CI) 1.08-1.69]), tracheostomy (OR = 1.35 [CI 1.1-1.67]), postoperative hypocalcemia (OR = 1.65 [CI 1.54-1.77]), and hematoma requiring reoperation (OR = 2.79 [CI 2.16-3.62]) compared to MNG patients. High-volume centers for total thyroidectomy were independently associated with lower risk of postoperative complications, including in patients with Graves' disease. Despite low overall morbidity following total thyroidectomy, Graves' disease patients are at increased risk of postoperative complications, including bleeding, vocal-cord paralysis, tracheostomy, and hypocalcemia. These risks appear to be lower when performed at high-volume centers, and thus referral to these centers should be considered. Total thyroidectomy may therefore be a safe treatment option for appropriately selected patients with Graves' disease when performed by experienced surgeons.

"Minimally invasive video-assisted thyroidectomy. Initial experience in a general surgery department".

PubMed

Dobrinja, Chiara; Trevisan, Giuliano; Liguori, Gennaro

2009-03-01

The aim of this study is to analyze our preliminary results from minimally invasive video-assisted thyroidectomy (MIVAT) and demonstrate the feasibility of MIVAT also in non-referral centers. We report our initial experience based on a series of 47 patients selected for MIVAT at General Surgery Department of University of Trieste during a period from May 2005 to February 2007. The eligibility criteria were rigorously observed. Age, goiter volume, major diameter of the dominant nodule, operative times, pathologic findings, postoperative pain, length of hospital stay, cosmetic results, and complications were retrospectively analyzed. Thyroid lobectomy was successfully accomplished in 33 cases, total thyroidectomy in 14. Conversion to standard cervicotomy was required in three patients (6%). Mean operative time of lobectomy was 82.6 min and 118.7 for total thyroidectomy. Postoperative complications included 11 (23.4%) transient hypocalcemias, 2 (4.2%) hematomas, and 2 (4.2%) temporary laryngeal nerve palsies. None-recurrent nerve palsies was observed. The cosmetic result was excellent in most cases. Our experience demonstrates that MIVAT, after adequate training, is feasible and safe, with results comparable to conventional thyroidectomy, also in a General Surgery Department, from a dedicated team, with a sufficient and specific activity volume.

Importance of in situ preservation of parathyroid glands during total thyroidectomy.

PubMed

Lorente-Poch, L; Sancho, J J; Ruiz, S; Sitges-Serra, A

2015-03-01

Parathyroid failure is the most common complication after total thyroidectomy but factors involved are not completely understood. Accidental parathyroidectomy and parathyroid autotransplantation resulting in fewer than four parathyroid glands remaining in situ, and intensity of medical treatment of postoperative hypocalcaemia may have relevant roles. The aim of this study was to determine the relationship between the number of parathyroid glands remaining in situ and parathyroid failure after total thyroidectomy. Consecutive patients undergoing first-time total thyroidectomy were studied prospectively, recording the number of Parathyroid Glands Remaining In Situ (PGRIS = 4 - (glands autografted + glands in the specimen)) and the occurrence of postoperative hypocalcaemia, and protracted and permanent hypoparathyroidism. Demographic, disease-related, laboratory and surgical variables were recorded. Patients were classified according to the PGRIS number into group 1-2 (one or two PGRIS), group 3 (three PGRIS) and group 4 (all four glands remaining in situ), and were followed for at least 1 year. A total of 657 patients were included, 43 in PGRIS group 1-2, 186 in group 3 and 428 in group 4. The prevalence of hypocalcaemia, and of protracted and permanent hypoparathyroidism was inversely related to the PGRIS score (group 1-2: 74, 44 and 16 per cent respectively; group 3: 51·1, 24·7 and 6·5 per cent; group 4: 35·3, 13·1 and 2·6 per cent; P < 0·001). Intact parathyroid hormone concentrations at 24 h and 1 month were inversely correlated with PGRIS score (P < 0·001). Logistic regression identified PGRIS score as the most powerful variable influencing acute and chronic parathyroid failure. In addition, a normal-high serum calcium concentration 1 month after thyroidectomy influenced positively the recovery rate from protracted hypoparathyroidism in all PGRIS categories. In situ parathyroid preservation is critical in preventing permanent hypoparathyroidism after total thyroidectomy. Active medical treatment of postoperative hypocalcaemia has a positive synergistic effect. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

Visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy: what about the costs?

PubMed

Dionigi, Gianlorenzo; Bacuzzi, Alessandro; Boni, Luigi; Rausei, Stefano; Rovera, Francesca; Dionigi, Renzo

2012-04-01

The objective of the present study was to evaluate costs for thyroidectomy performed with the aid of intraoperative neural monitoring (IONM), which has gained widespread acceptance during thyroid surgery as an adjunct to the gold standard of visual nerve identification. Through a micro-costing approach, the thyroidectomy patient-care process (with and without IONM) was analyzed by considering direct costs (staff time, consumables, equipment, drugs, operating room, and general expenses). Unit costs were collected from hospital accounting and standard tariff lists. To assess the impact of the IONM technology on hospital management, three macro-scenarios were considered: (1) traditional thyroidectomy; (2) thyroidectomy with IONM in a high-volume setting (5 procedures per week); and (3) thyroidectomy with IONM in a low-volume setting (1 procedure per week). Energy-based devices (EBD) for hemostasis and dissection in thyroidectomy were also evaluated, as well as the reimbursement made by the Italian Healthcare System on the basis of diagnosis related groups (DRGs), about €2,600. Comparison between costs and the DRG fee shows an underfunding of total hospitalization costs for all thyroidectomies, regardless of IONM use (scenario 1: €3,471). The main cost drivers are consumables and technologies (25%), operating room (16%), and staff (14%). Hospitalization costs for a thyroidectomy with IONM range from €3,713 to €3,770 (scenarios 2 and 3), 5–7% higher than those for traditional thyroidectomy. Major economic differences emerge when an EBD is used (€3,969). The regional DRG tariff for thyroid surgery is barely sufficient to cover conventional surgery costs. Intraoperative neural monitoring accounts for 5–7% of the hospitalization costs for a thyroidectomy.

Indocyanine green fluorescence angiography for quantitative evaluation of in situ parathyroid gland perfusion and function after total thyroidectomy.

PubMed

Lang, Brian Hung-Hin; Wong, Carlos K H; Hung, Hing Tsun; Wong, Kai Pun; Mak, Ka Lun; Au, Kin Bun

2017-01-01

Because the fluorescent light intensity on an indocyanine green fluorescence angiography reflects the blood perfusion within a focused area, the fluorescent light intensity in the remaining in situ parathyroid glands may predict postoperative hypocalcemia risk after total thyroidectomy. Seventy patients underwent intraoperative indocyanine green fluorescence angiography after total thyroidectomy. Any parathyroid glands with a vascular pedicle was left in situ while any parathyroid glands without pedicle or inadvertently removed was autotransplanted. After total thyroidectomy, an intravenous 2.5 mg indocyanine green fluorescence angiography was given and real-time fluorescent images of the thyroid bed were recorded using the SPY imaging system (Novadaq, Ontario, Canada). The fluorescent light intensity of each indocyanine green fluorescence angiography as well as the average and greatest fluorescent light intensity in each patient were calculated. Postoperative hypocalcemia was defined as adjusted calcium <2.00 mmol/L within 24 hours. The fluorescent light intensity between discolored and normal-looking indocyanine green fluorescence angiographies was similar (P = .479). No patients with a greatest fluorescent light intensity >150% developed postoperative hypocalcemia while 9 (81.8%) patients with a greatest fluorescent light intensity ≤150% did. Similarly, no patients with an average fluorescent light intensity >109% developed PH while 9 (30%) with an average fluorescent light intensity ≤109% did. The greatest fluorescent light intensity was more predictive than day-0 postoperative hypocalcemia (P = .027) and % PTH drop day-0 to 1 (P < .001). Indocyanine green fluorescence angiography is a promising operative adjunct in determining residual parathyroid glands function and predicting postoperative hypocalcemia risk after total thyroidectomy. Copyright © 2016 Elsevier Inc. All rights reserved.

The Effectiveness of Neck Stretching Exercises Following Total Thyroidectomy on Reducing Neck Pain and Disability: A Randomized Controlled Trial.

PubMed

Ayhan, Hatice; Tastan, Sevinc; Iyigün, Emine; Oztürk, Erkan; Yildiz, Ramazan; Görgülü, Semih

2016-06-01

Although there are a limited number of studies showing effects of neck stretching exercises following a thyroidectomy in reducing neck discomfort symptoms, no study has specifically dealt with and examined the effect of neck stretching exercises on neck pain and disability. To analyze the effect of neck stretching exercises, following a total thyroidectomy, on reducing neck pain and disability. A randomized controlled trial was conducted. The participants were randomly assigned either to the stretching exercise group (n = 40) or to the control group (n = 40). The stretching exercise group learned the neck stretching exercises immediately after total thyroidectomy. The effects of the stretching exercises on the participants' neck pain and disability, neck sensitivity, pain with neck movements as well as on wound healing, were evaluated at the end of the first week and at 1 month following surgery. When comparing neck pain and disability scale (NPDS) scores, neck sensitivity and pain with neck movement before thyroidectomy, after 1 week and after 1-month time-points, it was found that patients experienced significantly less pain and disability in the stretching exercise group than the control group (p < .001). At the end of the first week, the NPDS scores (mean [SD] = 8.82 [12.23] vs. 30.28 [12.09]), neck sensitivity scores (median [IR] = 0 [.75] vs. 2.00 [4.0]) and pain levels with neck movements (median [IR] = 0 [2.0] vs. 3.5 [5.75]) of the stretching exercise group were significantly lower than those of the control group. However, there was no significant difference between the groups with regard to the scores at the 1-month evaluation (p > .05). Neck stretching exercises done immediately after a total thyroidectomy reduce short-term neck pain and disability symptoms. © 2016 Sigma Theta Tau International.

Management of the thyroid gland during laryngectomy.

PubMed

Li, S X; Polacco, M A; Gosselin, B J; Harrington, L X; Titus, A J; Paydarfar, J A

2017-08-01

This study aimed to: describe the incidence of thyroid gland involvement in advanced laryngeal cancer, analyse patterns of spread to the thyroid and elucidate predictors of thyroid involvement. A retrospective review was performed on patients who underwent laryngectomy from 1991 to 2015 as a primary or salvage treatment for squamous cell carcinoma of the larynx, hypopharynx or base of tongue. The incidence of thyroidectomy during total laryngectomy, type of thyroidectomy, incidence of gland involvement, route of spread, and positive predictors of spread were analysed and reported. A total of 188 patients fit the inclusion criteria. Of these, 125 (66 per cent) underwent thyroidectomy. The thyroid was involved in 10 of the 125 patients (8 per cent), 9 by direct extension and 1 by metastasis. Cartilage invasion was a predictor of thyroid gland involvement, with a positive predictive value of 26 per cent. There is a low incidence of thyroid gland involvement in laryngeal carcinoma. Most cases of gland involvement occurred by direct extension. Thyroidectomy during laryngectomy should be considered for advanced stage tumours with cartilage invasion.

Better consenting for thyroidectomy: who has an increased risk of postoperative hypocalcaemia?

PubMed

Harris, Andrew S; Prades, Eduardo; Tkachuk, Olena; Zeitoun, Hisham

2016-12-01

Hypocalcaemia is the most common complication following thyroidectomy. This study aimed to establish the factors associated with increased risk of hypocalcaemia on day 1 following thyroidectomy. All patients who underwent thyroidectomy under a single consultant during a 5-year period were included. A multivariate analysis was undertaken to ascertain which variables had the most effect on the risk of hypocalcaemia. A prognosis table was constructed to allow risk to be predicted for individual patients based on these factors. Included in the analysis were 210 procedures and 194 patients. Eighty-two percent of patients had no calcium derangement postoperatively. Fourteen point nine percent were categorised as early hypocalcaemia, 1 % had protracted hypocalcaemia and 2.1 % had permanent hypocalcaemia. For hemi-thyroidectomies 2.8 % had postoperative hypocalcaemia and 0.9 % had permanent hypocalcaemia. The multivariate analysis revealed total thyroidectomy (risk ratio 26.5, p < 0.0001), diabetes (risk ratio 4.8, p = 0.07) and thyrotoxicosis (risk ratio 3.1, p = 0.04) as statistically significant variables for early postoperative hypocalcaemia. Gender as an isolated factor did not reach significance but was included in the model. The p value for the model was p < 1 × 10 -12 . Total thyroidectomy increases risk of early hypocalcaemia when compared to hemithyroidectomy. Gender, diabetes and thyrotoxicosis were also been found to influence the risk. All of these factors are available pre-operatively and can therefore be used to predict a more specific risk for individual patients. It is hoped that this can lead to better informed consent, prevention and better resource allocation.

Bilateral recurrent laryngeal nerve injury in a specialized thyroid surgery unit: would routine intraoperative neuromonitoring alter outcomes?

PubMed

Sarkis, Leba M; Zaidi, Nisar; Norlén, Olov; Delbridge, Leigh W; Sywak, Mark S; Sidhu, Stan B

2017-05-01

Bilateral recurrent laryngeal nerve (RLN) palsy following total thyroidectomy is a rare complication, however, poses significant morbidity to the patient when it does occur. The purpose of this paper was to determine the incidence of bilateral RLN palsy in a specialized thyroid unit and determine whether the routine use of intraoperative nerve monitoring (IONM) would alter the outcome. This is a retrospective review of prospectively gathered data. A total of 7406 patients underwent total thyroidectomy at the University of Sydney Endocrine Surgical Unit between January 1990 and February 2014. IONM was utilized on a selective basis and we sought to assess whether IONM would have altered outcome in those patients who developed bilateral RLN palsy. Of the 7406 patients who underwent total thyroidectomy, seven patients (0.09%) developed bilateral RLN palsy during the study period. There was one permanent RLN palsy (0.01%) and routine IONM may have prevented one death and altered the outcome in two of the seven patients. Bilateral RLN palsy is a rare entity occurring in one out of 1000 cases in a specialized thyroid unit. IONM may facilitate the decision to pursue delayed surgery where the signal is lost on the first surgical side and has the potential to avoid bilateral RLN palsy following total thyroidectomy. © 2015 Royal Australasian College of Surgeons.

The Impact of Potassium Iodide on Thyroidectomy for Graves’ disease: Implications for Safety and Operative Difficulty

PubMed Central

Randle, Reese W; Bates, Maria F; Long, Kristin L; Pitt, Susan C; Schneider, David F; Sippel, Rebecca S

2017-01-01

Background Potassium iodide (KI) is often prescribed prior to thyroidectomy for Graves’ disease, but the effect of KI on the ease and safety of thyroidectomy for Graves’ is largely unknown. Methods We conducted a prospective cohort study of patients with Graves’ disease undergoing thyroidectomy. For the first 8-months no patients received KI; for the next 8-months, KI was added to the pre-operative protocol for all patients. Outcomes included operative difficulty (based on the Thyroidectomy Difficulty Scale) and complications. Results A total of 31 patients in the no-KI group and 28 in the KI group were included. According to the Thyroidectomy Difficulty Scale, gland vascularity decreased in the KI group (mean score 2.6 vs. 3.3, p=0.04), but there were no significant differences in thyroid friability, fibrosis, size, or overall difficulty (p=NS for all). Despite similar operative difficulty, patients prescribed KI were less likely to experience transient hypoparathyroidism (7.1% vs. 25.9%, p=0.018) and transient hoarseness (0% vs. 16.1%, p=0.009) compared with the no-KI group. Conclusion KI administration decreases gland vascularity but does not change the overall difficulty of thyroidectomy. However, KI was associated with less transient hypoparathyroidism and transient hoarseness, suggesting that KI improves the safety of thyroidectomy for Graves’ disease. PMID:29108701

Incidental parathyroidectomy during thyroidectomy increases the risk of postoperative hypocalcemia.

PubMed

Lin, Yann-Sheng; Hsueh, Chuen; Wu, Hsin-Yi; Yu, Ming-Chin; Chao, Tzu-Chieh

2017-09-01

The correlation between incidental parathyroidectomy (IP) during thyroidectomy and postoperative hypocalcemia remains controversial. Our aim was to investigate the incidence of IP, risk factors, and impact on patient outcomes. Retrospective cohort study. This was a retrospective observational study including 3,186 consecutive patients who underwent thyroidectomy between January 2007 and December 2014. The patients were divided into two groups: the IP group and the non-IP. Numerous clinical parameters were collected and analyzed. The overall incidence of incidentally excised parathyroid glands during thyroidectomy was 6.4%. Patients with IP had significantly higher incidences of postoperative hypocalcemia and hypoparathyroidism than those without IP (P < 0.001). Intrathyroidal parathyroid glands presented only 2.2% of all removed parathyroid glands. Total thyroidectomy, central compartment lymph node dissection, and reoperation were independent risk factors for IP. Incidental parathyroidectomy during thyroidectomy is associated with the increased likelihood of postoperative hypocalcemia. All independent risk factors examined in the study for IP are surgery-related. Surgeons should perform meticulous dissection with the intention of avoiding IP and resultant hypocalcemia. 4. Laryngoscope, 127:2194-2200, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Minimally invasive video-assisted thyroidectomy compared with conventional thyroidectomy in a general surgery department.

PubMed

Dobrinja, Chiara; Trevisan, Giuliano; Makovac, Petra; Liguori, Gennaro

2009-10-01

We retrospectively evaluated a series of patients who underwent minimally invasive video-assisted thyroidectomy (MIVAT) to define its advantages or disadvantages. Between May 2005 and March 2008, 68 patients underwent MIVAT. Sixty-nine patients who underwent conventional thyroidectomy (CT) during the period before the introduction of the MIVAT technique in our department-chosen with the same inclusion criteria used for MIVAT-served as matched controls. The eligibility criteria for both groups was thyroid nodules < or = 35 mm, thyroid volume < 25 ml, no thyroiditis, and no previous surgery. Forty-five MIVAT and 43 CT patients underwent hemithyroidectomy. Twenty-three MIVAT and 26 CT patients underwent total thyroidectomy. No differences were found in terms of complications, operative time, and radicality of the procedure. Patients who underwent MIVAT experienced significantly less pain, better cosmetic results, and shorter hospital stay than patients who underwent conventional surgery The MIVAT technique, in selected patients, seems to be a valid option for thyroidectomy and even preferable to conventional surgery because of its significant advantages, especially in terms of cosmetic results, postoperative pain, and postoperative recovery.

The current status of robotic transaxillary thyroidectomy in the United States: an experience from two centers.

PubMed

Zaidi, Nisar; Daskalaki, Despoina; Quadri, Pablo; Okoh, Alexis; Giulianotti, Pier Cristoforo; Berber, Eren

2017-08-01

Few studies exist regarding the state of robotic transaxillary thyroidectomy (RT) and its outcomes at high-volume institutions. Eighty-nine patients underwent RT between January 2009 and September 2015 at two tertiary centers. Data were collected from prospectively-maintained IRB-approved databases. Patient demographic and clinical data, and trends were evaluated. Indications for RT included biopsy-proven or suspicion for malignancy in 20.2%, atypical cells or follicular neoplasm in 27.7%, multinodular goiter in 26.6%, thyrotoxicosis in 8.5%, need for completion thyroidectomy in 5.3%, and non-diagnostic FNA in 3.2%. 56% underwent total thyroidectomy and 44% lobectomy. Operative time (OT) was 153.5 minutes for lobectomies and 192.6 minutes for total thyroidectomy. The complication rate was 11.7%: temporary RLN neuropraxia in 2 patients, permanent hypoparathyroidism in 1 patient, temporary hypoparathyroidism in 6 patients, flap seroma in 1 patient, and flap hematoma in 1 patient. Pathology showed malignancy in 43 patients. At a mean follow-up of 31.9 months, there were no recurrences. Since 2013, the number of RTs performed has risen. The number of out-of-state patients increased from 18% to 37% after 2011. RT was performed without compromising outcomes in selected patients. There remains interest among patients seeking this procedure in expert centers.

Thyroid gland involvement in advanced laryngeal cancer: association with clinical and pathologic characteristics.

PubMed

Hilly, Ohad; Raz, Raanan; Vaisbuch, Yona; Strenov, Yulia; Segal, Karl; Koren, Rumelia; Shvero, Jacob

2012-11-01

Indications for thyroidectomy during laryngectomy are controversial. We examined whether clinicopathologic features can predict thyroid gland involvement, and the prognostic effect of thyroid gland involvement in patients undergoing total laryngectomy. The study set out to review preoperative assessment, operation findings, pathologic findings, and follow-up data. Thyroid gland involvement was found in 11 of 53 patients (21%) undergoing total laryngectomy and thyroidectomy. Preoperative work-up failed to predict thyroid gland involvement. Thyroid gland involvement was associated with salvage procedures (p = .025), paratracheal metastases (p = .003), and poor overall survival (hazard ratio = 2.74, p = .008). Thyroid gland involvement in patients undergoing total laryngectomy is frequent and is associated with poor prognosis. Preoperative assessment failed to predict thyroid gland involvement. We believe that thyroidectomy should be considered in cases with paratracheal lymphatic spread irrespective of tumor location within the larynx. Copyright © 2011 Wiley Periodicals, Inc.

Clinical Efficacy of Intravenous Lidocaine for Thyroidectomy: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial.

PubMed

Choi, Geun Joo; Kang, Hyun; Ahn, Eun Jin; Oh, Jong In; Baek, Chong Wha; Jung, Yong Hun; Kim, Jin Yun

2016-12-01

Systemic lidocaine has analgesic and anti-inflammatory effects. The purpose of this prospective, randomized, double-blind study was to evaluate the effects of intravenous lidocaine on pain following thyroidectomy. Fifty-eight adult patients scheduled for total thyroidectomy were randomly allocated to receive a 1.5 mg/kg lidocaine bolus followed by a 2 mg/kg/h infusion during surgery, or the same volume of normal saline (control). After thyroidectomy, we evaluated postoperative pain, nausea, fentanyl consumption, frequency of pushing the button (FPB) for patient-controlled analgesia (PCA), High-sensitivity C-reactive protein (hs-CRP) in serum, and patient satisfaction scores regarding the recovery process. Postoperative pain and nausea scores were significantly lower in the lidocaine group for the first 4 h following thyroidectomy, compared to the control group. Fentanyl consumption and FPB for the PCA were also significantly reduced in the lidocaine group for 4 h following thyroidectomy, and hs-CRP was significantly less in the lidocaine group at postoperative days 1 and 3. Furthermore, satisfaction scores were significantly higher in the lidocaine group compared to the control group. Intravenous lidocaine effectively reduced postoperative pain and nausea following thyroidectomy as well as improved the quality of recovery. Clinicaltrials.gov NCT01608360.

Hypocalcemia after thyroidectomy in patients with a history of bariatric surgery.

PubMed

Chereau, Nathalie; Vuillermet, Cindy; Tilly, Camille; Buffet, Camille; Trésallet, Christophe; du Montcel, Sophie Tezenas; Menegaux, Fabrice

2017-03-01

Hypocalcemia is a common complication after total thyroidectomy. Previous bariatric surgery could be a higher factor risk for hypocalcemia due to alterations in calcium absorption and vitamin D deficiency. To evaluate incidence and factors involved in the risk of hypocalcemia (transient and permanent) and the postoperative outcomes of these patients after total thyroidectomy. University hospital in Paris, France. All patients who had previously undergone obesity surgery (i.e., Roux-en-Y gastric bypass, sleeve gastrectomy, or adjustable gastric band) who had a total thyroidectomy from 2006 to 2015 were included. No patient was lost to follow-up. Each patient was matched 1:1 with a patient who had no previous bariatric surgery for age, gender, body mass index, and year of surgery. Forty-eight patients were identified (43 female; mean age 48.9±9.2 yr). Nineteen patients (40%) had a postoperative hypocalcemia: transient in 14 patients (29.2%) and permanent in 5 patients (10.4%). No significant predictive clinical or biochemical factors were found for hypocalcemia risk, except for the type of bariatric procedure: Bypass surgery had a 2-fold increased risk of hypocalcemia compared to others procedures (60% versus 30%, P = .05). In the matched pair analysis, the risk of hypocalcemia was significantly higher in patients with previous bariatric surgery than in the matched cohort (40% versus 15%, P = .006). Patients with previous bariatric surgery have an increased risk for hypocalcemia after total thyroidectomy, especially after Roux-en-Y gastric bypass. Careful and prolonged follow-up of calcium, vitamin D, and parathyroid hormone levels should be suggested for these patients. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Methamphetamine Use With Subsequent Thyrotoxicosis/Thyroid Storm, Agranulocytosis, and Modified Total Thyroidectomy: A Case Report.

PubMed

Viswanath, Omar; Menapace, Deanna C; Headley, Don B

2017-01-01

Thyroid storm is a rare, potentially lethal condition involving collapse of the hypothalamic-pituitary-thyroid feedback loop. Thyroid storm carries a significant mortality rate, thus requiring prompt identification and treatment. A 47-year-old woman presented to the emergency department complaining of palpitations, shortness of breath, and emesis for 24 hours after using methamphetamine. Past medical history was significant for untreated hyperthyroidism. Physical examination revealed a prominent, palpable thyroid. The Burch-Wartofsky-Score was 35. Management for thyroid storm included propylthiouracil (PTU), super saturated potassium iodide, intravenous hydrocortisone, and propranolol. However, a rare drug reaction to PTU on day 3 resulted in agranulocytosis. Propylthiouracil was withheld and a modified total thyroidectomy performed on day 8 without complications and the patient discharged on day 10 with levothyroxine. Undertreated hyperthyroidism may predispose patients to catecholamine-induced thyrotoxicosis due to catecholamine hypersensitivity. With known methamphetamine use, methamphetamine toxicity and a methamphetamine-exacerbated thyroid storm need to be included in the differential diagnosis in a patient presenting with signs of thyrotoxicosis. In addition, treating patients with agranulocytosis from PTU with a modified total thyroidectomy using ligation of the vascular supply as the initial surgical step limits release of thyroid hormone into the blood stream during thyroidectomy and decreases the possibility of intra operative thyroid storm.

Measuring Decision-Making During Thyroidectomy: Validity Evidence for a Web-Based Assessment Tool.

PubMed

Madani, Amin; Gornitsky, Jordan; Watanabe, Yusuke; Benay, Cassandre; Altieri, Maria S; Pucher, Philip H; Tabah, Roger; Mitmaker, Elliot J

2018-02-01

Errors in judgment during thyroidectomy can lead to recurrent laryngeal nerve injury and other complications. Despite the strong link between patient outcomes and intraoperative decision-making, methods to evaluate these complex skills are lacking. The purpose of this study was to develop objective metrics to evaluate advanced cognitive skills during thyroidectomy and to obtain validity evidence for them. An interactive online learning platform was developed ( www.thinklikeasurgeon.com ). Trainees and surgeons from four institutions completed a 33-item assessment, developed based on a cognitive task analysis and expert Delphi consensus. Sixteen items required subjects to make annotations on still frames of thyroidectomy videos, and accuracy scores were calculated based on an algorithm derived from experts' responses ("visual concordance test," VCT). Seven items were short answer (SA), requiring users to type their answers, and scores were automatically calculated based on their similarity to a pre-populated repertoire of correct responses. Test-retest reliability, internal consistency, and correlation of scores with self-reported experience and training level (novice, intermediate, expert) were calculated. Twenty-eight subjects (10 endocrine surgeons and otolaryngologists, 18 trainees) participated. There was high test-retest reliability (intraclass correlation coefficient = 0.96; n = 10) and internal consistency (Cronbach's α = 0.93). The assessment demonstrated significant differences between novices, intermediates, and experts in total score (p < 0.01), VCT score (p < 0.01) and SA score (p < 0.01). There was high correlation between total case number and total score (ρ = 0.95, p < 0.01), between total case number and VCT score (ρ = 0.93, p < 0.01), and between total case number and SA score (ρ = 0.83, p < 0.01). This study describes the development of novel metrics and provides validity evidence for an interactive Web-based platform to objectively assess decision-making during thyroidectomy.

Hybrid-type endoscopic thyroidectomy (HET: Tori's method) for differentiated thyroid carcinoma including invasion to the trachea.

PubMed

Tori, Masayuki

2014-03-01

Endoscopic thyroidectomy (ET) or robotic thyroidectomy is yet to be applied to thyroid carcinoma invasive to the trachea and to wide lymph node node metastasis. On the other hand, small-incision thyroidectomy lacks sufficient working space and clear vision. The author has newly developed hybrid-type endoscopic thyroidectomy (HET) to overcome these problems. From March 2011 to February 2012, HET was performed for 85 patients. Clinicopathologic characteristics were analyzed. To evaluate the superiority of HET for malignancy representatively, conventional lobectomy with central compartment node dissection (CCND) performed 1 year previously was compared with HET. In lobectomy and node dissection, a single skin incision (1.5 cm) is made above the clavicle, with a port incision (5 mm) made 3 cm below the clavicle. Then CCND is performed directly through the incision by lifting up the isthmus. To obtain sufficient working space for the lobectomy, the strap muscles are taped and pulled toward the head, then hung by the cradle. The thyroid lobe is retracted to the midline with a retractor, followed by isolation of the inferior laryngeal nerve and transection of the inferior thyroid vessels with the monitor of the scope. Lateral lymph nodes dissection can be performed at the same time, if necessary. In total thyroidectomy, the same procedure is performed at the opposite side. The scalpel can be used to shave through each incision in case of tracheal invasion. Of the 85 cases, 62 were malignant, involving papillary thyroid carcinoma (PTC), and 23 were benign. Total thyroidectomy was performed for 22 of the PTC cases and CCND for 49 of the cases. Shaving for tracheal invasion was performed for eight patients. No mortality, complications, recurrence, or metastasis was found 1-2 years after the operation. Compared with conventional thyroidectomy, HET was superior in blood loss, visual analog scale, and postoperative hospital stay. The author's method (Tori's method) might be less invasive, cosmetically excellent, and moreover, safe and feasible for differentiated thyroid carcinoma including invasion to the trachea.

The current status of robotic transaxillary thyroidectomy in the United States: an experience from two centers

PubMed Central

Zaidi, Nisar; Daskalaki, Despoina; Quadri, Pablo; Okoh, Alexis; Giulianotti, Pier Cristoforo

2017-01-01

Background Few studies exist regarding the state of robotic transaxillary thyroidectomy (RT) and its outcomes at high-volume institutions. Methods Eighty-nine patients underwent RT between January 2009 and September 2015 at two tertiary centers. Data were collected from prospectively-maintained IRB-approved databases. Patient demographic and clinical data, and trends were evaluated. Results Indications for RT included biopsy-proven or suspicion for malignancy in 20.2%, atypical cells or follicular neoplasm in 27.7%, multinodular goiter in 26.6%, thyrotoxicosis in 8.5%, need for completion thyroidectomy in 5.3%, and non-diagnostic FNA in 3.2%. 56% underwent total thyroidectomy and 44% lobectomy. Operative time (OT) was 153.5 minutes for lobectomies and 192.6 minutes for total thyroidectomy. The complication rate was 11.7%: temporary RLN neuropraxia in 2 patients, permanent hypoparathyroidism in 1 patient, temporary hypoparathyroidism in 6 patients, flap seroma in 1 patient, and flap hematoma in 1 patient. Pathology showed malignancy in 43 patients. At a mean follow-up of 31.9 months, there were no recurrences. Since 2013, the number of RTs performed has risen. The number of out-of-state patients increased from 18% to 37% after 2011. Conclusions RT was performed without compromising outcomes in selected patients. There remains interest among patients seeking this procedure in expert centers. PMID:28861379

The experience of gasless endoscopic-assisted thyroidectomy via the anterior chest approach for Graves' disease.

PubMed

Hong, Yun; Yu, Shi-Tong; Cai, Qian; Liang, Fa-Ya; Han, Ping; Huang, Xiao-Ming

2016-10-01

The aim of this study was to evaluate the safety, feasibility, effectiveness, and cosmesis of a gasless endoscopic-assisted thyroidectomy via the anterior chest in patients with Graves' disease. We retrospectively reviewed 38 patients with Graves' disease treated with thyroidectomy from November 2007 to June 2015. We analyzed clinical characteristics of patients, type of operation, operative indications, operative duration, length of postoperative hospital stay, and postoperative complications. The thyroidectomies were classified as total thyroidectomy (n = 12) or near-total thyroidectomy with a remnant of <1 g (n = 26). Surgical indications were recurrence after antithyroid drugs (ATDs) and unwillingness to undergo radioiodine therapy (n = 27), local compressive symptoms (n = 2), adverse drug reactions to ATDs (n = 5), and patient's preference (n = 4). Mean resection weight was 71.7 ± 16.2 g (range 44-109 g), mean operative duration 87.7 ± 17.3 min (range 66-136 min), intraoperative blood loss 70.6 ± 11.3 mL (range 43-92 mL), and drainage was 42.0 ± 8.5 mL (range 20-62 mL). Temporary postoperative recurrent laryngeal nerve palsy and temporary hypoparathyroidism occurred in 3 cases (7.89 %) each. Mean hospital stay was 2.5 ± 0.3 days (range 2-4 days). There was no recurrence of hyperthyroidism over the follow-up period of for 68.1 ± 5.6 months (range 6-89 months). All patients were satisfied with their cosmetic results. Gasless endoscopic-assisted thyroidectomy via the anterior chest approach for Graves' disease is a safe, feasible, and effective and provides an excellent cosmetic outcome procedure. It is a valid option in appropriately selected patients.

A Prospective Study on Role of Supplemental Oral Calcium and Vitamin D in Prevention of Postthyroidectomy Hypocalcemia

PubMed Central

Ravikumar, Krishnan; Sadacharan, Dhalapathy; Muthukumar, Sankaran; Sundarram, Thalavai; Periyasamy, Selladurai; Suresh, R. V.

2017-01-01

Background: Postoperative transient hypocalcemia is sequelae of total thyroidectomy (TT), which is observed in up to 50% of patients. Routine oral calcium and Vitamin D supplementation have been proposed to prevent symptomatic hypocalcemia preventing morbidity and facilitating early discharge. Patients and Methods: A total of 208 patients with nontoxic benign thyroid disorders, undergoing TT, were serially randomized into four groups: Group A (no supplements were given), Group B (oral calcium – 2 g/day given), Group C (calcium and calcitriol – 1 mcg/day are given), and Group D (calcium, calcitriol, and cholecalciferol – 60,000 IU/day are given). Patients were monitored for clinical and biochemical hypocalcemia (serum calcium, [Sr. Ca] <8 mg/dl), along with serum intact parathormone (Sr. PTH) and magnesium 6 h after surgery and Sr. Ca every 24 h. Intravenous (IV) calcium infusion was started, if any of the above four groups exhibit frank hypocalcemia. Patients are followed up with Sr. Ca and Sr. PTH at 3 and 6 months. Results: All groups were age and sex matched. Hypocalcemia was observed in 72/208 (34.61%) cases. Incidence of hypocalcemia was higher in Group A (57.69%) and Group B (50%) compared to Group C (15.38%) and Group D (15.38%). Hypocalcemia necessitating IV calcium occurred in 31/208 (14.90%) patients. IV calcium requirement exceeded in Group A (26.92%) and Group B (23.07%) compared to Group C (5.76%) and Group D (3.84%). There was no statistical difference in basal levels of serum Vitamin D, calcium, magnesium, intact PTH, and 6 h after surgery. Permanent hypoparathyroidism developed in five patients on follow-up. Conclusion: Routine postoperative supplementation of oral calcium and Vitamin D will help in the prevention of postthyroidectomy transient hypocalcemia significantly. Preoperative Vitamin D levels do not predict postoperative hypocalcemia. PMID:28670529

[Thyrotoxic hypokalemic periodic paralysis. Report of three cases].

PubMed

Pili, S; Devèze, A; Iacobone, M; Guibout, M; Henry, J F

2002-04-01

Hypokaliemic thyrotoxic periodic paralysis (HTPP) is an uncommon complication of hypothyroidism. Mostly described among Asian patients, it is rare in the other ethnic groups, in particular in caucasians people. Among the possible mechanisms, modification of potassic flows in relation to anomalies of the sodium-potassium pump were evoked. We present the cases of three caucasians patients operated on for HTPP. These patients had all previous history of several paretic episodes. The flask paralytic attacks occurred in a brutal way or were preceded by diffuse myalgias. They reached the proximal muscles, especially in inferior limbs. No patient had any respiratory complications. These three patients underwent total thyroidectomy to treat the symptoms of HTPP. In the three cases, a total thyroidectomy allowed the recovery of the symptoms. After a four years average period of post-operative follow-up, no patient presented any repetition of HTPP. The hyperthyroidism is the cause of decompensation of the molecular anomaly. In our opinion, surgical treatment (total thyroidectomy) is needed in order to reduce the potential gravity of this pathology.

Drug-induced liver injury caused by iodine-131

PubMed Central

Kim, Chei Won; Park, Ji Sun; Oh, Se Hwan; Park, Jae-Hyung; Shim, Hyun-Ik; Yoon, Jae Woong; Park, Jin Seok; Hong, Seong Bin; Kim, Jun Mi; Le, Trong Binh; Lee, Jin Woo

2016-01-01

Iodine-131 is a radioisotope that is routinely used for the treatment of differentiated thyroid cancer after total or near-total thyroidectomy. However, there is some evidence that iodine-131 can induce liver injury . Here we report a rare case of drug-induced liver injury (DILI) caused by iodine-131 in a patient with regional lymph node metastasis after total thyroidectomy. A 47-year-old woman was admitted with elevated liver enzymes and symptoms of general weakness and nausea. Ten weeks earlier she had undergone a total thyroidectomy for papillary thyroid carcinoma and had subsequently been prescribed levothyroxine to reduce the level of thyroid-stimulating hormone. Eight weeks after surgery she underwent iodine-131 ablative therapy at a dose of 100 millicuries, and subsequently presented with acute hepatitis after 10 days. To rule out all possible causative factors, abdominal ultrasonography, endoscopic ultrasonography (on the biliary tree and gall bladder), and a liver biopsy were performed. DILI caused by iodine-131 was suspected. Oral prednisolone was started at 30 mg/day, to which the patient responded well. PMID:27209646

Drug-induced liver injury caused by iodine-131.

PubMed

Kim, Chei Won; Park, Ji Sun; Oh, Se Hwan; Park, Jae-Hyung; Shim, Hyun-Ik; Yoon, Jae Woong; Park, Jin Seok; Hong, Seong Bin; Kim, Jun Mi; Le, Trong Binh; Lee, Jin Woo

2016-06-01

Iodine-131 is a radioisotope that is routinely used for the treatment of differentiated thyroid cancer after total or near-total thyroidectomy. However, there is some evidence that iodine-131 can induce liver injury . Here we report a rare case of drug-induced liver injury (DILI) caused by iodine-131 in a patient with regional lymph node metastasis after total thyroidectomy. A 47-year-old woman was admitted with elevated liver enzymes and symptoms of general weakness and nausea. Ten weeks earlier she had undergone a total thyroidectomy for papillary thyroid carcinoma and had subsequently been prescribed levothyroxine to reduce the level of thyroid-stimulating hormone. Eight weeks after surgery she underwent iodine-131 ablative therapy at a dose of 100 millicuries, and subsequently presented with acute hepatitis after 10 days. To rule out all possible causative factors, abdominal ultrasonography, endoscopic ultrasonography (on the biliary tree and gall bladder), and a liver biopsy were performed. DILI caused by iodine-131 was suspected. Oral prednisolone was started at 30 mg/day, to which the patient responded well.

Prophylactic oral calcium supplementation therapy to prevent early post thyroidectomy hypocalcemia and evaluation of postoperative parathyroid hormone levels to detect hypocalcemia: A prospective randomized study.

PubMed

Arer, Ilker Murat; Kus, Murat; Akkapulu, Nezih; Aytac, Huseyin Ozgur; Yabanoglu, Hakan; Caliskan, Kenan; Tarim, Mehmet Akin

2017-02-01

Postoperative hypocalcemia is the most common complication after total thyroidectomy. Postoperative parathyroid hormone (PTH) measurement is one of the methods to detect or prevent postoperative hypocalcemia. Prophylactic oral calcium supplementation is another method to prevent early postoperative hypocalcemia. The aim of this study is to detect the accurate timing of PTH and evaluate efficacy of routine oral calcium supplementation for postoperative hypocalcemia. A total of 106 patients were performed total thyroidectomy. Rotuine oral calcium supplementation was given to group 1 and no treatment to group 2 according to randomization. Serum calcium and PTH level of patients in group 2 at postoperative 6, 12 and 24 h and patients in both groups at postoperative day 7 were evaluated. Patients were compared according to age, sex, operation findings, serum calcium and PTH levels and symptomatic hypocalcemia. Half of the patients (50%) were in group 1. Most of the patients were female (83%). The most common etiology of thyroid disease was multinodular goiter (64.1%). Oral calcium supplementation was given to 18 (33.9%) patients in group 2. Symptomatic hypocalcemia for group 1 and 2 was found to be 1.9 and 33.9% respectively (p < 0.05). No statistical difference can be observed regarding the timing of serum biomarkers. Serum PTH levels at postoperative 12 and 24 h can predict early post-thyroidectomy hypocalcemia. Prophylactic oral calcium supplementation therapy can prevent early post-thyroidectomy hypocalcemia with advantages of being cost effective and safe. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Predictors of Hypocalcemia after Thyroidectomy: Results from the Nationwide Inpatient Sample

PubMed Central

Baldassarre, Randall L.; Chang, David C.; Brumund, Kevin T.; Bouvet, Michael

2012-01-01

Hypocalcemia is a common complication following thyroidectomy. However, the incidence of postoperative hypocalcemia varies widely in the literature, and factors associated with hypocalcemia after thyroid surgery are not well established. We aimed to identify incidence trends and independent risk factors of postoperative hypocalcemia using the nationwide inpatient sample (NIS) database from 1998 to 2008. Overall, 6,605 (5.5%) of 119,567 patients who underwent thyroidectomy developed hypocalcemia. Total thyroidectomy resulted in a significantly higher increased incidence (9.0%) of hypocalcemia when compared with unilateral thyroid lobectomy (1.9%; P < .001). Thyroidectomy with bilateral neck dissection, the strongest independent risk factor of postoperative hypocalcemia (odds ratio, 9.42; P < .001), resulted in an incidence of 23.4%. Patients aged 45 years to 84 years were less likely to have postoperative hypocalcemia compared with their younger and older counterparts (P < .001). Hispanic (P = .003) and Asian (P = .027) patients were more likely, and black patients were less likely (P = .003) than white patients to develop hypocalcemia. Additional factors independently associated with postoperative hypocalcemia included female gender, nonteaching hospitals, and malignant neoplasms of thyroid gland. Hypocalcemia following thyroidectomy resulted in 1.47 days of extended hospital stay (3.33 versus 1.85 days P < .001). PMID:22844618

Hypocalcaemia following total thyroidectomy: early post-operative parathyroid hormone assay as a risk stratification and management tool.

PubMed

Islam, S; Al Maqbali, T; Howe, D; Campbell, J

2014-03-01

To develop a practical, efficient and predictive algorithm to manage potential or actual post-operative hypocalcaemia after complete thyroidectomy, using a single post-operative parathyroid hormone assay. This paper reports a prospective study of 59 patients who underwent total or completion thyroidectomy over a period of 24 months. Parathyroid hormone levels were checked post-operatively on the day of surgery, and all patients were evaluated for hypocalcaemia both clinically and biochemically with serial corrected calcium measurements. No patient with an early post-operative parathyroid hormone level of 23 ng/l or more (i.e. approximately twice the lower limit of the normal range) developed hypocalcaemia. All the patients who initially had post-operative hypocalcaemia but had an early parathyroid hormone level of 8 ng/l or more (i.e. approximately two-thirds of the lower limit of the normal range) had complete resolution of their hypocalcaemia within three months. Early post-operative parathyroid hormone measurement can reliably predict patients at risk of post-thyroidectomy hypocalcaemia, and predict those patients expected to recover from temporary hypocalcaemia. A suggested post-operative management algorithm is presented.

Robotic Thyroidectomy: Comparison of a Postauricular Facelift Approach with a Gasless Unilateral Axillary Approach.

PubMed

Sung, Eui Suk; Ji, Yong Bae; Song, Chang Myeon; Yun, Bo Ram; Chung, Won Sang; Tae, Kyung

2016-06-01

Robotic thyroidectomy using remote access approaches has gained popularity with patients seeking to avoid neck scarring and enhanced cosmetic satisfaction. The aim of this study was to compare the efficacy and advantages of a postauricular facelift approach vs a gasless unilateral axillary (GUA) approach in robotic thyroidectomy. Case series with chart review. University tertiary care hospital. We retrospectively analyzed the data of 65 patients who underwent robotic thyroidectomy with or without central neck dissection using a GUA approach (45 patients) or a postauricular facelift approach (20 patients) between September 2013 and December 2014. We excluded patients who underwent simultaneous lateral neck dissection or completion thyroidectomy. Robotic procedures were completed without being converted to an open procedure in all patients. There were no significant differences in terms of patient and tumor characteristics, extent of thyroidectomy and central neck dissection, operative time, complications, and postoperative pain between the 2 approaches, except the higher female ratio in the GUA approach group (female ratio, 95.6% vs 75%, P = .042). Cosmetic satisfaction evaluated by a questionnaire was not significantly different between the 2 groups, and most patients of both groups (85.7%) were satisfied with postoperative cosmesis. Both GUA and postauricular facelift approaches are feasible, with no significant adverse events in patients, and result in excellent cosmesis. However, a GUA approach seems to be superior when performing total thyroidectomy using a unilateral incision based on the preliminary result. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Preoperative vitamin D level as predictor of post-thyroidectomy hypocalcemia in patients sustaining transient parathyroid injury.

PubMed

Danan, Deepa; Shonka, David C

2017-07-01

Several studies have sought to identify predictors of postoperative hypocalcemia after total thyroidectomy; however, there have been conflicting results regarding the impact of preoperative vitamin D deficiency. The medical records of patients undergoing total thyroidectomy were retrospectively reviewed. The number of parathyroid glands identified or reimplanted at the time of surgery was used as a marker of transient parathyroid gland damage. Sixty-seven patients were included in the study. Vitamin D deficiency was a significant predictor of hypocalcemia in patients in whom ≥3 parathyroid glands were identified, but not in patients in whom 0-2 parathyroid glands were identified intraoperatively (odds ratio [OR] 5.8; P = .036). Vitamin D deficiency is a significant predictor of postoperative hypocalcemia in patients in whom ≥3 parathyroid glands are identified intraoperatively, but not in patients who sustain minimal transient damage to the parathyroid glands. © 2017 Wiley Periodicals, Inc.

Management of thyroid gland invasion in laryngeal and hypopharyngeal squamous cell carcinoma.

PubMed

Arslanoğlu, Seçil; Eren, Erdem; Özkul, Yılmaz; Ciğer, Ejder; Kopar, Aylin; Önal, Kazım; Etit, Demet; Tütüncü, G Yazgı

2016-02-01

The objective of this study was to determine the incidence of thyroid gland invasion in laryngeal and hypopharyngeal squamous cell carcinoma; and the association between clinicopathological parameters and thyroid gland invasion. Medical records of 75 patients with laryngeal and hypopharyngeal squamous cell carcinoma who underwent total laryngectomy with thyroidectomy were reviewed, retrospectively. Preoperative computed tomography scans, clinical and operative findings, and histopathological data of the specimens were evaluated. There were 73 male and two female patients with an age range of 41-88 years (mean 60.4 years). Hemithyroidectomy was performed in 62 (82.7 %) and total thyroidectomy was performed in 13 patients (17.3 %). Four patients had histopathologically proven thyroid gland invasion (5.3 %). In three patients, thyroid gland involvement was by means of direct invasion. Thyroid gland invasion was significantly correlated with thyroid cartilage invasion. Therefore, prophylactic thyroidectomy should not be a part of the treatment policy for these tumors.

Stressing the recurrent laryngeal nerve during thyroidectomy.

PubMed

Serpell, Jonathan W; Lee, James C; Chiu, Wing K; Edwards, Glenn

2015-12-01

In thyroidectomy, little has been reported on the differential recurrent laryngeal nerve (RLN) palsy rates between the left and right sides. Even less is known about the potential differences causing these differential rates. This study reports the left versus right RLN palsy rates of total thyroidectomy cases in a single institution, relating them to the comparative stiffness of the left and right porcine RLNs. Computed stress modelling was also used to estimate the differential levels of tension within each RLN. For the comparison of the left and right RLN palsy rates, 1926 cases of total thyroidectomy (between 2007 and 2013) from the Monash University Endocrine Surgery Unit were included. Stiffness of porcine RLNs was experimentally determined by measuring nerve extension against incremental increase in load. Additionally, the tension of intraoperatively stretched RLNs was estimated by computer modelling. The left RLN had a palsy rate of 0.9% (18/1926), which was significantly lower (P = 0.025) than the right RLN palsy rate of 1.8% (34/1926). The left porcine RLN was 22% stiffer than the right RLN (P = 0.004). The stress modelling estimated that at the apex of the artificial RLN genu during anteromedial rotation of the thyroid lobe, the right RLN experiences twice the tension experienced by the left RLN. The stiffer left RLN and the higher tension generated in the right RLN during thyroidectomy may jointly contribute to the higher right RLN palsy rate. © 2015 Royal Australasian College of Surgeons.

Post- thyroidectomy haematoma causing severe supraglottic oedema and pulmonary oedema - a case report.

PubMed

Parate, Leena Harshad; Pujari, Vinayak Seenappa; Anandaswamy, Tejesh C; Vig, Saurabh

2014-08-01

Large, long standing goiters present multiple challenges to anaesthesiologist. Post thyroidectomy haematoma is a rare but life threatening complication of thyroid surgery leading to airway obstruction. We report a case of huge goiter that underwent near total thyroidectomy and developed post thyroidectomy haematoma. Within no time it resulted in near fatal airway obstruction, pulmonary oedema and cardiac arrest. The haematoma was evacuated immediately and patient was resuscitated successfully. Pulmonary oedema was further worsened by subsequent aggressive fluid resuscitation. She was electively ventilated with PEEP and was extubated after five days. Except for right vocal cord palsy her postoperative stay was uneventful. This is unique case where a post thyoidectomy haematoma has resulted in fatal supraglottic oedema and pulmonary oedema. Early recognition, immediate intubation and evacuation of haematoma are the key to manage this complication. We highlight on the pathophysiology of haematoma and discuss the strategies to prevent similar events in future.

Streptococcal toxic shock syndrome following total thyroidectomy.

PubMed

Hung, J A Z; Rajeev, P

2013-10-01

Group A streptococcal toxic shock syndrome following clean surgery is a rare occurrence. Its incidence following thyroid surgery has not been described in the literature. We report on the presentation and management of severe streptococcal toxic shock syndrome following a total thyroidectomy for a multinodular goitre in a patient with Cowden syndrome. This report presents an overview of streptococcal toxic shock syndrome with a focus on the management issues to consider so as to improve patient outcome. All surgeons must maintain a high index of suspicion for this rare but dangerous entity.

Streptococcal toxic shock syndrome following total thyroidectomy

PubMed Central

Hung, J AZ

2013-01-01

Group A streptococcal toxic shock syndrome following clean surgery is a rare occurrence. Its incidence following thyroid surgery has not been described in the literature. We report on the presentation and management of severe streptococcal toxic shock syndrome following a total thyroidectomy for a multinodular goitre in a patient with Cowden syndrome. This report presents an overview of streptococcal toxic shock syndrome with a focus on the management issues to consider so as to improve patient outcome. All surgeons must maintain a high index of suspicion for this rare but dangerous entity. PMID:24112488

Investigative clinical study on prostate cancer part IV: exploring functional relationships of total testosterone predicting free testosterone and total prostate-specific antigen in operated prostate cancer patients.

PubMed

Porcaro, Antonio B; Petrozziello, Aldo; Migliorini, Filippo; Lacola, Vincenzo; Romano, Mario; Sava, Teodoro; Ghimenton, Claudio; Caruso, Beatrice; Zecchini Antoniolli, Stefano; Rubilotta, Emanuele; Monaco, Carmelo; Comunale, Luigi

2011-01-01

To explore, in operated prostate cancer patients, functional relationships of total testosterone (tt) predicting free testosterone (ft) and total PSA. 128 operated prostate cancer patients were simultaneously investigated for tt, ft and PSA before surgery. Patients were not receiving 5α-reductase inhibitors, LH-releasing hormone analogues and testosterone replacement treatment. Scatter plots including ft and PSA versus tt were computed in order to assess the functional relationship of the variables. Linear regression analysis of tt predicting ft and PSA was computed. tt was a significant predictor of the response variable (ft) and different subsets of the patient population were assessed according to the ft to tt ratio. PSA was related to tt according to a nonlinear law. tt was a significant predictor of PSA according to an inversely nonlinear law and different significant clusters of the patient population were assessed according to the different constant of proportionality computed from experimental data. In our prostate cancer population, ft was significantly predicted by tt according to a linear law, and the ft/tt ratio was a significant parameter for assessing the different clusters. Also, tt was a significant variable predicting PSA by a nonlinear law and different clusters of the patient population were assessed by the different constants of proportionality. As a theory, we explain the nonlinear relation of tt in predicting PSA as follows: (a) the number of androgen-independent prostate cancer cells increases as tumor volume and PSA serum levels rise, (b) the prevalence of androgen-independent cells producing a substance which inhibits serum LH, and (c) as a result lower levels of serum tt are detected. Copyright © 2011 S. Karger AG, Basel.

Expert consensus of general surgery residents' proficiency with common endocrine operations.

PubMed

Phitayakorn, Roy; Kelz, Rachel R; Petrusa, Emil; Sippel, Rebecca S; Sturgeon, Cord; Patel, Kepal N; Perrier, Nancy D

2017-01-01

Proficiency with common endocrine operations is expected of graduating, general surgery residents. However, no expert consensus guidelines exist about these expectations. Members of the American Association of Endocrine Surgeons were surveyed about their opinions on resident proficiency with common endocrine operations. Overall response rate was 38%. A total of 92% of the respondents operate with residents. On average, they believed that the steps of a total thyroidectomy for benign disease and a well-localized parathyroidectomy could be performed by a postgraduate year 4 surgery resident. Specific steps that they thought might require more training included decisions to divide the strap muscles or leaving a drain. Approximately 66% of respondents thought that a postgraduate year 5 surgery resident could independently perform a total thyroidectomy for benign disease, but only 45% felt similarly for malignant thyroid disease; 79% thought that a postgraduate year 5 surgery resident could independently perform a parathyroidectomy. Respondents' years of experience correlated with their opinions about resident autonomy for total thyroidectomy (benign r = 0.38, P < .001; malignant r = 0.29, P = .001) but not parathyroidectomy. On multivariate analysis, sex and years of experience of the respondents were independently associated with opinions on autonomy but only for total thyroidectomy for benign disease (P = .001). Annual endocrine volume of the respondents did not correlate with beliefs in autonomy. There was general agreement among responding members of the AAES about resident proficiency and autonomy with common endocrine operations. As postgraduate year 5 residents may not be proficient in advanced endocrine operations, opportunities exist to improve training prior to the transition to independent practice for graduates that anticipate performing endocrine operations routinely. Copyright © 2016 Elsevier Inc. All rights reserved.

Hypoparathyroidism after total thyroidectomy: prospective evaluation and relation with early hypocalcemia.

PubMed

D'Alessandro, Nicola; Tramutola, Giuseppe; Fasano, Giovanni Michele; Gilio, Francesco; Iside, Giovanni; Izzo, Maria Lucia; Loffredo, Andrea; Pici, Mariano; Pinto, Margherita; Tramontano, Salvatore; Citro, Giuseppe

2016-01-01

Definitive hypoparathyrodism (hypo-PTH) represents one of the most dangerous complication after total thyroidectomy. Partial or total lesion or accidental removal of parathyroid glands is an unpredictable adverse event, although real incidence is not well defined, such as management of this deficit. We started a prospective evaluation of patients treated with total thyroidectomy in our centre, to identify incidence of hypo-PTH, symptomatic or not, in relation to incidence of early postoperative hypocalcemia in our experience. We prospectively evaluated 177 patients treated for benign and malign pathology, measuring calcium before surgery and calcium and PTH at least three months after surgery. Postoperative hypocalcemia was observed in 37.3% of cases. Eight patients (4.5% of cohort) presented low level of PTH, at mean follow-up of 9.1 months. Positive predictive value for postoperative hypocalcemia was 12.1%, while negative predictive was 95.4%; confirming high sensitivity (100%) and low specificity (65.4%) for detecting hypo-PTH. All patients with late hypo-PTH presented hypocalcemia on early analysis, while no case with normal postoperative calcemia accounted with hypo-PTH: this may indicate calcemia as valid prognostic factor of good gland production, when is in the range. Moreover, isolated analysis is too limited to determine real predictability. Technical standardization represents the best method for prevention of hypo-PTH. Early hypocalcemia is a prognostic factor, even with a low specificity, of deficit of PTH-production. This observation must be related to other known prognostic factors. Postoperative normal calcemia should be a positive prognostic factor of an acceptable PTHfunction, supported by large cohorts. Hypocalcemia, Parathormone, Thyroidectomy.

Algorithm for early discharge after total thyroidectomy using PTH to predict hypocalcemia: prospective study.

PubMed

Schlottmann, F; Arbulú, A L Campos; Sadava, E E; Mendez, P; Pereyra, L; Fernández Vila, J M; Mezzadri, N A

2015-10-01

Hypocalcemia is the most common complication after total thyroidectomy. The aim of this study was to determine whether postoperative parathyroid hormone (PTH) levels predict hypocalcemia in order to design an algorithm for early discharge. We present a prospective study including patients who underwent total thyroidectomy. Hypocalcemia was defined as serum ionized calcium < 1.09 mmol/L or clinical evidence of hypocalcemia. PTH measurement was performed preoperatively and at 1, 3, and 6 h postoperatively. The percent decline of preoperative values was calculated for each time point. One hundred and six patients were included. Thirty-six (33.9%) patients presented hypocalcemia. A 50% decline in PTH levels at 3 h postoperatively showed the highest sensitivity and specificity to predict hypocalcemia (91 and 73%, respectively). No patients with a decrease <35% developed hypocalcemia (100% sensitivity), and all patients with a decrease >80% had hypocalcemia (100% specificity). PTH determination at 3 h postoperatively is a reliable predictor of hypocalcemia. According to the proposed algorithm, patients with less than 80% drop in PTH levels can be safely discharged the day of the surgery.

Minimally invasive video-assisted thyroidectomy: Ascending the learning curve

PubMed Central

Capponi, Michela Giulii; Bellotti, Carlo; Lotti, Marco; Ansaloni, Luca

2015-01-01

BACKGROUND: Minimally invasive video-assisted thyroidectomy (MIVAT) is a technically demanding procedure and requires a surgical team skilled in both endocrine and endoscopic surgery. The aim of this report is to point out some aspects of the learning curve of the video-assisted thyroid surgery, through the analysis of our preliminary series of procedures. PATIENTS AND METHODS: Over a period of 8 months, we selected 36 patients for minimally invasive video-assisted surgery of the thyroid. The patients were considered eligible if they presented with a nodule not exceeding 35 mm and total thyroid volume <20 ml; presence of biochemical and ultrasound signs of thyroiditis and pre-operative diagnosis of cancer were exclusion criteria. We analysed surgical results, conversion rate, operating time, post-operative complications, hospital stay and cosmetic outcomes of the series. RESULTS: We performed 36 total thyroidectomy and in one case we performed a consensual parathyroidectomy. The procedure was successfully carried out in 33 out of 36 cases (conversion rate 8.3%). The mean operating time was 109 min (range: 80-241 min) and reached a plateau after 29 MIVAT. Post-operative complications included three transient recurrent nerve palsies and two transient hypocalcemias; no definitive hypoparathyroidism was registered. The cosmetic result was considered excellent by most patients. CONCLUSIONS: Advances in skills and technology allow surgeons to easily reproduce the standard open total thyroidectomy with video-assistance. Although the learning curve represents a time-consuming step, training remains a crucial point in gaining a reasonable confidence with video-assisted surgical technique. PMID:25883451

Bupivacaine application reduces post thyroidectomy pain: Cerrahpasa experience

PubMed Central

Teksoz, Serkan; Soylu, Selen; Erbabacan, Safak Emre; Ozcan, Murat; Bukey, Yusuf

2016-01-01

Background We aimed to evaluate the impact of bupivacaine administration into the surgical field after total thyroidectomy on post-operative pain and analgesic requirement with a double-blind, prospective, clinical and randomized study. Methods The study was performed between 2010 and 2011. Pain assessment was performed with the visual analog score (VAS). Patients were pre-operatively, randomly divided into two groups to receive either bupivacaine or saline. One group received a 10-mL of bupivacaine solution while the other group was treated with the same volume of 0.9% NaCl through the drain after completion of total thyroidectomy procedure. All patients were anesthetized and operated with the same anesthesia and surgical team. Results Ninety-one patients (20 males) were included in the study. No patient dropped out of the study during the procedures. No mortality was seen. The VAS scores were significantly lower in the bupivacaine administered group at post-operative minute 30 (3.7±3.2 vs. 5±2.9; P=0.03), hour one (3.04±2.4 vs. 4.2±2.8; P=0.04), and hour eight (1.8±2.04 vs. 3.2±2.1; P=0.005). Thirteen patients required analgesia during their hospital stay in the bupivacaine group while this number was twenty-two in the saline group (P=0.005). Conclusions Local bupivacaine administration into the surgical field after total thyroidectomy reduces pain and analgesic requirement during the hospital stay. PMID:28149801

Parathyroid hormone measurement in prediction of hypocalcaemia following thyroidectomy.

PubMed

Mehrvarz, Shaban; Mohebbi, Hassan Ali; Kalantar Motamedi, Mohammad Hosein; Khatami, Seyed Masoud; Rezaie, Ramzanali; Rasouli, Hamid Reza

2014-02-01

To determine the risk of postthyroidectomy hypocalcaemia by measuring parathyroid hormone (PTH) level after thyroidectomy. Cross-sectional study. Baqiyatallah Hospital, Tehran, Iran, from March 2008 to July 2010. All included patients were referred for total or near bilateral thyroidectomy. Serum Calcium (Ca) and PTH levels were measured before and 24 hours after surgery. In low Ca cases or development of hypocalcaemia symptoms, daily monitoring of Ca levels were continued. Data were analyzed using SPSS 20 software (SPSS, Chicago, IL, USA). A p-value less than 0.05 were considered statistically significant. To assess the standard value of useful predictive factors, we used receiver operating characteristic (ROC) curves. Of total 99 patients who underwent bilateral thyroidectomy, 47 patients (47.5%) developed hypocalcaemia, out of them, 12 (25.5%) became symptomatic while 2 patients developed permanent hypoparathyroidism. After surgery, mean rank of PTH level within the normocalcaemic and hypocalcaemic patients was 55.34 and 44.1 respectively, p=0.052. Twenty four hours after surgery, 62% drop in PTH was associated with 83.3% of symptomatic hypocalcaemic. For diagnosis of symptomatic hypocalcaemia, 62% PTH drop had sensitivity and specificity were 83.3% and 90.80%. The area under the ROC curve for the PTH postoperative and PTH drop for diagnostic symptomatic hypocalcaemia were 0.835 and 0.873 respectively. Measuring PTH levels after 24 hours postthyroidectomy is not reliable factor for predicting hypocalcaemia itself. For predicting the risk of hypocalcaemia after thyroidectomy it is more reliable to measure the serum PTH level before and after operation and compare the reduction level of percentage of PTH drop for predicting the risk of hypocalcaemia.

A short-stay unit for thyroidectomy patients increases discharge efficiency.

PubMed

Vrabec, Sara; Oltmann, Sarah C; Clark, Nicholas; Chen, Herbert; Sippel, Rebecca S

2013-09-01

Patients traditionally recover overnight on a general surgery ward after a thyroidectomy; however, these units often lack the efficiency and focus for rapid discharge, which is the goal of a short-stay (SS) unit. Using an SS unit for thyroidectomy patients, who are often discharged in <24 h, may reduce the duration of hospital stay and subsequently decrease associated costs and increase hospital bed and resource availability. A retrospective review of 400 patients undergoing thyroidectomy at a single academic hospital. We analyzed postoperative discharge information and hospital cost data. Adult patients who stayed a single night in the hospital were included. We compared patients staying on a designated SS unit versus a general surgery (GS) ward. A total of 223 patients were admitted to SS, and 177 to GS. Trends of admission location were blocked based on time period, with most patients per time period going to the same location. Discharge times were significantly quicker for patients admitted to SS (P < 0.001). A total of 70% of SS patients were discharged before noon, versus 40% of GS patients (P < 0.001). Many variances were identified to account for these differences. Direct costs were significantly lower with SS, owing to savings in pharmacy, recovery room, and nursing expenses (all P < 0.01). A designated short-stay hospital unit is an effective model for increasing the efficiency of discharge for thyroidectomy patients compared with those admitted to a general surgery ward. It also serves to increase bed availability, which decreases hospital cost and may improve patient flow. Copyright © 2013 Elsevier Inc. All rights reserved.

Midcervical scar satisfaction in thyroidectomy patients.

PubMed

Best, Amy R; Shipchandler, Taha Z; Cordes, Susan R

2017-05-01

Assess long-term patient satisfaction with conventional thyroidectomy scars and the impact of thyroidectomy scars on patient quality of life. Validated survey administration and retrospective review of clinical and demographic data. Patients who underwent conventional thyroidectomy through years 2000 to 2010 were identified and administered the validated Patient Scar Assessment Questionnaire. Mean satisfaction, appearance and scar-consciousness scores were determined. Thirty-seven patients also measured the length of their current scar. Patient demographic and operative data were collected retrospectively from the medical record. Data were analyzed with one-way analysis of variance and independent samples t testing. Sixty of 69 patients perceived the appearance of their scar to be "good" or "excellent." Sixty-three patients (91.3%) were satisfied with all scar outcomes; 67 (97.1%) were satisfied with the overall appearance of their scar. Mean total satisfaction score was 17.3 (<26 indicates a high level of satisfaction). Fifty-six (81.2%) were "not at all" self-conscious of their scar; 65 (94.2%) reported no attempt to hide their scar. Seven patients (10.1%) indicated any likelihood of pursuing scar revision. Females had significantly higher total satisfaction scores, consciousness scores, and satisfaction with appearance scores. The effect of perceived scar length was significant for scar-consciousness, not patient satisfaction. The majority of patients were satisfied with their thyroidectomy scar appearance. Few patients reported a desire to hide the scar or pursue revision. Women were more likely to be dissatisfied than men. Length may play a role in scar consciousness. 4 Laryngoscope, 127:1247-1252, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Thyroid surgery as a 23-hour stay procedure

PubMed Central

Perera, AH; Patel, SD

2014-01-01

Introduction The main barriers to short stay thyroidectomy are haemorrhage, bilateral recurrent laryngeal nerve palsy causing respiratory compromise and hypocalcaemia. This study assessed the safety and effectiveness of thyroidectomy as a 23-hour stay procedure. Methods All patients undergoing total or completion thyroidectomy were prescribed calcium and vitamin D3 supplements following surgery. Retrospective analysis identified patients admitted for longer than 23 hours and any readmissions. Results A total of 164 patients were admitted for 23-hour stay thyroid surgery over a 25-month period between 2008 and 2010. Four patients (2%) required admission for longer than 23 hours. No patients required emergency intervention for postoperative haemorrhage or airway compromise. Biochemical hypocalcaemia (despite calcium supplements) was detected in one patient when measured at the outpatient clinic two weeks following surgery. Twelve patients (7.3%) attended the accident and emergency department following discharge; four required admission for intravenous antibiotics for wound infection and one for biochemical hypocalcaemia. Conclusions This single centre UK experience demonstrates that thyroidectomy can be carried out both safely and effectively as a 23-hour stay procedure. Prophylactic prescription of calcium and vitamin D3 reduces hypocalcaemia, and thereby also prolonged admission and readmission due to hypocalcaemia. Supplements are an acceptable, cost effective method of reducing hypocalcaemia and shortening postoperative length of stay. PMID:24780020

Role of prophylactic thyroidectomy in RET 790 familial medullary thyroid carcinoma.

PubMed

Bihan, Hélène; Baudin, Eric; Meas, Taly; Leboulleux, Sophie; Al Ghuzlan, Abir; Hannoteaux, Véronique; Travagli, Jean-Paul; Valleur, Patrice; Guillausseau, Pierre-Jean; Cohen, Régis

2012-04-01

We describe a family harboring RET 790 mutation and review the role of prophylactic thyroidectomy for medullary thyroid carcinoma. We evaluated in detail both clinical and biological follow-up and reviewed literature reports. Among 86 family members, 15 of 22 members screened harbored the 790 mutation. Abnormal calcitonin levels were found in 8/15. Total thyroidectomy with lymph node dissection cured the 5 operated patients (range, 45-76 years). Tumor staging was pT1N0M0. Among 10 carriers who did not undergo surgery, 3 patients had abnormal calcitonin levels. For the others, calcitonin levels remained <30 pg/mL. Two asymptomatic carriers were older than 70 years. Four subjects were lost to follow-up. In RET codon 790 mutations families, a case-by-case decision instead of systematic prophylactic thyroidectomy should be discussed. Difficulties of follow-up should be taken into account and represent the main challenge. Copyright © 2011 Wiley Periodicals, Inc.

Preoperative therapeutic apheresis for severe medically refractory amiodarone-induced thyrotoxicosis: a case report.

PubMed

Yamamoto, Jennifer; Dostmohamed, Hanifa; Schacter, Isanne; Ariano, Robert E; Houston, Donald S; Lewis, Brenda; Knoll, Colleen; Katz, Pamela; Zarychanski, Ryan

2014-06-01

Amiodarone is associated with thyroid dysfunction and life-threatening thyrotoxicosis. In medically refractory cases, or where medical therapy is contraindicated, thyroidectomy may be required. To decrease perioperative thyroid storm and to reduce overall surgical risk, apheresis may be considered preoperatively to restore euthyroidism. We report a 46-year-old female with a history of cardiac arrhythmia and tachycardia-induced cardiomyopathy for which she received amiodarone. Months after discontinuation of amiodarone, the patient presented with wide complex tachycardia and symptoms of thyrotoxicosis. Laboratory testing confirmed severe thyrotoxicosis which was subsequently refractory to medical therapy. Total thyroidectomy was required. Following a total of 10 apheresis treatments, thyroid hormone levels were reduced to near normal levels and the patient's symptoms improved. Thyroidectomy was performed without intraoperative or postoperative complication. In the setting of life-threatening, medically refractory amiodarone-induced thyrotoxicosis, therapeutic apheresis can effectively reduce thyroid hormone levels and restore a state of clinical and biochemical euthyroidism. © 2013 Wiley Periodicals, Inc.

[Effect of vitamin D deficiency on hypocalcaemia after total thyroidectomy due to benign goitre].

PubMed

Díez, Manuel; Vera, Cristina; Ratia, Tomás; Diego, Lucía; Mendoza, Fernando; Guillamot, Paloma; San Román, Rosario; Mugüerza, José M; Rodríguez, Angel; Medina, Carlos; Gómez, Beatriz; Granell, Javier

2013-04-01

The purpose of this study was to analyse the relationship between preoperative serum levels of vitamin D and postoperative hypocalcaemia after total thyroidectomy. A prospective observational study was conducted on 113 patients treated by total thyroidectomy due to benign disease. Preoperative vitamin D serum levels and postoperative albumin-corrected calcium and parathormone (PTH) levels were determined. Sensitivity, specificity, positive predictive value and negative predictive value of vitamin D and PTH levels, respectively, in the diagnosis of postoperative hypocalcaemia were calculated. Hypocalcaemia was diagnosed in 44 (38.9%) patients. Vitamin D levels were significantly higher in the group of patients with normal postoperative calcium (median: 25.4pg/mL; range: 4-60), compared to those who developed hypocalcaemia (median: 16.4pg/mL; range: 6.3-46.9) (P=.001). Postoperative hypocalcaemia was more frequent in patients with vitamin D < 30ng/mL (39/78) (50%), than among those with normal levels (5/35) (14.2%) (P=.001). Sensitivity, specificity, positive predictive value and negative predictive value were 88% and 68%, 43% and 82%, 50% and 71%, and 85% and 80% for vitamin D and PTH, respectively. Vitamin D and PTH showed independent prognostic values on the risk of hypocalcaemia. The OR associated with vitamin D < 30ng/mL was 4.25 (95% CI: 1.31-13.78) (P=.016), and the OR of PTH<13pg/mL was 15.4 (95% CI: 4.83-49.1) (P<.001). Vitamin D deficiency is a risk factor of hypocalcaemia after total thyroidectomy for benign goitre. The vitamin D level provides independent prognostic information, which is complementary to that given by PTH. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

[Application of fibrin sealant in patients operated on for differentiated thyroid cancer. What do we improve?].

PubMed

Vidal-Pérez, Óscar; Flores-Siguenza, Luis; Valentini, Mauro; Astudillo-Pombo, Emiliano; Fernández-Cruz, Laureano; García-Valdecasas, Juan Carlos

2016-01-01

In recent years, several publications have shown that new adhesives and sealants, like Tissucol(®), applied in thyroid space reduce local complications after thyroidectomies. To demonstrate the effectiveness of fibrin glue Tissucol(®) in reducing the post-operative hospital stay of patients operated on for differentiated thyroid carcinoma in which total thyroidectomy with central and unilateral node neck dissection was performed (due to the debit drains decrease), with consequent cost savings. A prospective randomised study was conducted during the period between May 2009 and October 2013 on patients with differentiated thyroid carcinoma with cervical nodal metastases, and subjected to elective surgery. Two groups were formed: one in which Tissucol(®) was used (case group) and another where it was not used (control group). Patients were operated on by surgeons specifically dedicated to endocrine surgical pathology, using the same surgical technique in all cases. A total of 60 total thyroidectomies with lymph node dissection were performed, with 30 patients in the case group, and 30 patients in control group. No statistically significant differences were observed in most of the studied variables. However, the case group had a shorter hospital stay than the control group with a statistically significant difference (p<0.05). Implementation of Tissucol(®) has statistically and significantly reduced the hospital stay of patients undergoing total thyroidectomy with neck dissection, which represents a significant reduction in hospital costs. This decrease in hospital stay has no influence on the occurrence of major complications related to the intervention. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

Association between thyroid profile and perfluoroalkyl acids: Data from NHNAES 2007–2008

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jain, Ram B., E-mail: Jain.ram.b@gmail.com

The effect of six perfluoroalkyl acids (PFAAs), namely, perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), perfluorodecanoic acid (PFDE), perfluorohexane sulfonic acid (PFHxS), 2-(N-methyl-perfluorooctane sulfonamide) acetic acid (MPAH), and perfluorononanoic acid (PFNA) on the levels of six thyroid function variables, namely, thyroid stimulating hormone (TSH), free and total thyroxine (FT4, TT4), free and total triiodothyronine (FT3, TT3), and thyroglobulin (TGN) was evaluated. Data from National Health and Nutrition Examination Survey for the years 2007–2008 were used for this evaluation. TSH levels increased with increase in levels of PFOA (p<0.01). There were no statistically significant associations between the levels of FT3, and FT4more » with the levels of any of the six PFAAs. Levels of TT3 were found to increase with the levels of PFOA (p=0.01) and TT4 levels were found to increase with increase in PFHxS levels (p<0.01). Males had statistically significantly higher levels of FT3 than females and females had statistically significantly higher levels of TT4 than males. As compared to non-Hispanics whites and Hispanics, non-Hispanic blacks had lower levels of TSH, FT3, TT3, and TT4 but Hispanics had the lowest levels of TGN. Age was negatively associated with FT3 and TT3 but positively associated with FT4 and TT4. Non-smokers had higher levels of TSH and TT4 than smokers and smokers had higher levels of FT3 and TGN than non-smokers. Iodine deficiency was associated with increased levels of TSH, TT3, TT4, and TGN. -- Highlights: • Levels of total triiodothyronine were found to increase with the levels of PFOA. • Total thyroxine increased with increase in levels of perfluorohexane sulfonic acid. • There was a positive association between the levels of PFOA and TSH. • Iodine deficiency was associated with elevated levels of TSH, total T3 and T4. • Iodine deficiency was associated with elevated levels of thyroglobulin.« less

Survival outcome of radioiodine therapy in post thyroidectomy thyroid carcinoma patients: Outcome of long term follow up

NASA Astrophysics Data System (ADS)

Haque, F.; Nahar, N.; Sultana, S.; Nasreen, F.; Jabin, Z.; Alam, A. S. M. M.

2016-03-01

The overall prognosis of patients with thyroid carcinoma is excellent whenever managed following best practice guidelines. Objective: To calculate sex and age group affected by thyroid cancer; to compare between single or multiple dose of radio ablation needed after thyroidectomy and to determine the percentage of patients become disease free during their follow up. Methods: This was a retrospective study done in NINMAS, Bangladesh on 687 patients from 1984 to 2004. In all cases total or near total thyroidectomy was done before commencing radioiodine therapy. Patients TG level, neck ultrasonography, thyroid scan, whole body I131 scans, neck examination were done every six monthly/yearly. Results: Among 687 patients, female were more sufferers (68.1%) and female to male ratio was 2:1. Age group 19-40 years was mostly affected (57.8%). Most common type seen was papillary carcinoma (81.8%). After ablation 100 patients did not follow-up. Total 237 patients discontinued within 4 years. Remaining 450 patients undergone regular follow-up for 5 years and more, 394 were disease free (87.6%). Total recurrence of metastasis was 23 and 12 patients expired at different times. Conclusions: Long-term regular follow-up is necessary after radioiodine ablation to become free of disease.

The importance of surgeon experience for clinical and economic outcomes from thyroidectomy.

PubMed Central

Sosa, J A; Bowman, H M; Tielsch, J M; Powe, N R; Gordon, T A; Udelsman, R

1998-01-01

OBJECTIVE: To determine whether individual surgeon experience is associated with improved short-term clinical and economic outcomes for patients with benign and malignant thyroid disease who underwent thyroid procedures in Maryland between 1991 and 1996. SUMMARY BACKGROUND DATA: There is a prevailing belief that surgeon experience affects patient outcomes in endocrine surgery, but there is a paucity of objective evidence outside of clinical series published by experienced surgeons that supports this view. METHODS: A cross-sectional analysis of all patients who underwent thyroidectomy in Maryland between 1991 and 1996 was conducted using a computerized statewide hospital discharge data base. Surgeons were categorized by volume of thyroidectomies over the 6-year study period: A (1 to 9 cases), B (10 to 29 cases), C (30 to 100 cases), and D (>100 cases). Multivariate regression was used to assess the relation between surgeon caseload and in-hospital complications, length of stay, and total hospital charges, adjusting for case mix and hospital volume. RESULTS: The highest-volume surgeons (group D) performed the greatest proportion of total thyroidectomies among the 5860 discharges, and they were more likely to operate on patients with cancer. After adjusting for case mix and hospital volume, highest-volume surgeons had the shortest length of stay (1.4 days vs. 1.7 days for groups B and C and 1.9 days for group A) and the lowest complication rate (5.1 % vs. 6.1% for groups B and C and 8.6% for group A). Length of stay and complications were more determined by surgeon experience than hospital volume, which had no consistent association with outcomes. CONCLUSIONS: Individual surgeon experience is significantly associated with complication rates and length of stay for thyroidectomy. PMID:9742915

A prospective comparison of patient body image after robotic thyroidectomy and conventional open thyroidectomy in patients with papillary thyroid carcinoma.

PubMed

Lee, Sohee; Kim, Ha Yan; Lee, Cho Rok; Park, Seulkee; Son, Haiyoung; Kang, Sang-Wook; Jeong, Jong Ju; Nam, Kee-Hyun; Chung, Woong Youn; Park, Cheong Soo

2014-07-01

Body image is associated with self-esteem and identity and has a close relationship with quality of life (QoL). We compared the impact of surgical scars on the patient's perception of body image between conventional open thyroidectomy (OT) and robotic thyroidectomy (RT) in female papillary thyroid carcinoma patients. From October 2009 to December 2010, we enrolled prospectively 116 papillary thyroid carcinoma patients who underwent total thyroidectomy at the Yonsei University Health System (Seoul, Korea). Of these 116 patients, 56 had OT and 60 RT. Their scars were assessed using the Vancouver Scar Scale (VSS), and psychometric properties were evaluated using the Body Image Scale (BIS) questionnaire postoperatively. Both groups were compared using cross-sectional and time-series methods. Mean age was significantly younger in the RT group. Regarding scar quality, the OT group showed superiority in scar pigmentation and the total VSS score during the early postoperative period, but the VSS score improved over time and was similar between both groups at 9 months. The RT group had better scores regarding most of the BIS items, a trend that remained relatively constant over time. In patients with noticeable scars (VSS ≥ 2) at 9 months, the RT group had better BIS scores regarding almost all items, including "self-conscious," "physical attractiveness," "feeling of less feminine," "sexual attractiveness," "dissatisfaction with body, scar and appearance when dressed," and "avoidance of people due to appearance." RT provides a better self-body image and improves QoL compared with conventional OT by avoiding a noticeable cervical scar. Copyright © 2014 Mosby, Inc. All rights reserved.

Clinical value of intraoperative neuromonitoring of the recurrent laryngeal nerves in improving outcomes of surgery for well-differentiated thyroid cancer.

PubMed

Barczyński, Marcin; Konturek, Aleksander; Stopa, Małgorzata; Hubalewska-Dydejczyk, Alicja; Richter, Piotr; Nowak, Wojciech

2011-04-01

The recurrent laryngeal nerve (RLN) is particularly prone to injury during thyroidectomy in case of extralaryngeal bifurcation being present in approximately one-third of patients near the inferior thyroid artery or ligament of Berry. Meticulous surgical dissection in this area may be additionally facilitated by the use of intraoperative neuromonitoring (IONM) to assure safe and complete removal of thyroid tissue. The aim of the study was to verify the hypothesis that meticulous surgical technique of tissue dissection in the area of the posterior surface of the thyroid capsule and adjacent RLN may be additionally facilitated by intraoperative neuromonitoring (IONM), and may contribute to increasing the safety and radicalness of total thyroidectomy in patients with well-differentiated thyroid cancer. The outcomes of total thyroidectomy with level VI lymph node clearance for well-differentiated thyroid cancer (WDTC; pT1-3, N0-1, Mx) were retrospectively compared between 151 patients undergoing surgery with IONM (01/2005-06/2009) and 151 patients undergoing surgery without IONM (2003-2004). RLN morbidity (calculated for nerves at risk) was assessed by videolaryngoscopy or indirect laryngoscopy (mandatory before and after surgery and at 12-month follow-up). The anatomical course of the extralaryngeal segment of RLNs were analyzed in detail in each operation. Thyroid iodine uptake (131I) was measured during endogenous TSH stimulation test a week before radioiodine therapy. Among patients operated with vs. without IONM, the early RLN injury rate was 3% vs. 6.7% (p=0.02), including 2% vs. 5% (p=0.04) of temporary nerve lesions, and 1% vs. 1.7% of permanent nerve events (p=0.31), respectively. Extralaryngeal RLN bifurcation was identified in 42 (27.8%) vs. 25 (16.6%) of patients operated with vs. without IONM, respectively (p=0.001). Mean I-131 uptake following total thyroidectomy with vs. without IONM was 0.67 ± 0.39% vs. 1.59 ± 0.69% (p<0.001). 131I uptake lower than 1% was found in 106 (70.2%) vs. 38 (25.2%) patients operated with vs. without IONM, respectively (p<0.001). Most patients with WDTC who undergo total thyroidectomy have a small amount of residual thyroid tissue. The use of IONM may improve the outcomes of surgery among these patients by both increasing the completeness of total thyroidectomy and significantly reducing the prevalence of temporary RLN injury. The possible mechanism of this improvement is the aid in dissection at the level of the Berry's ligament offered by IONM which enhances the surgeon's ability to identify a branched RLN, and allows for reduction of traction injury and neuropraxia of the anterior branch of bifid nerves.

Robotic total thyroidectomy with modified radical neck dissection via unilateral retroauricular approach.

PubMed

Byeon, Hyung Kwon; Holsinger, F Christopher; Tufano, Ralph P; Chung, Hyo Jin; Kim, Won Shik; Koh, Yoon Woo; Choi, Eun Chang

2014-11-01

Traditionally, total thyroidectomy was performed through an open transcervical incision; in cases where there was evident nodal metastasis, the conventional surgical approach was to extend the incision into a large single transverse incision to complete the required neck dissection. However, recent innovation in the surgical technique of thyroidectomy has offered the opportunity to reduce the patient's burden from these prominent surgical scars in the neck. Minimally invasive surgical techniques have been developed and applied by many institutions worldwide, and more recently, various techniques of remote access surgery have been suggested and actively applied.1-6 Since the advent of robotic surgical systems, some have adopted the concept of remote access surgery into developing various robotic thyroidectomy techniques. The more former and widely acknowledged robotic thyroidectomy technique uses a transaxillary (TA) approach, which has been developed by Chung et al. in Korea.7,8 This particular technique has some limitations in the sense that accessing the lymph nodes of the central compartment is troublesome. Terris et al. realized some shortcomings of robotic TA thyroidectomy, especially in their patients in the United States, and developed and reported the feasibility of robotic facelift thyroidectomy.9-13 In cases of thyroid carcinomas with lateral neck node metastases, most abandoned the concept of minimally invasive or remote access surgery and safely adopted conventional open surgical methods to remove the tumor burden. However, Chung et al. have attempted to perform concomitant modified radical neck dissection (MRND) after robotic thyroidectomy through the same TA port.14 This type of robot-assisted neck dissection (RAND) had some inherent limitations, due to fact that lymph nodes of the upper neck were difficult to remove. Over the past few years, we have developed a RAND via modified facelift (MFL) or retroauricular (RA) approach and reported the feasibility and safety of this technique.15, 16 Since then, we have actively applied such RAND techniques in various head and neck cancers. In our country, almost all cases of robotic total thyroidectomy utilize the TA approach. According to the reports made by Terris et al., robotic facelift thyroidectomy technique has been solely applied for ipsilateral hemithyroidectomy. For total thyroidectomy, Terris et al. performed the robotic surgery with bilateral RA incisions. Here, we intend to introduce our novel surgical method after successfully attempting simultaneous robotic total thyroidectomy and RAND via a single RA approach without an axillary incision. To our knowledge, this is the first to report in the medical literature. We present four cases of our surgical experience since the beginning of 2013. All patients received robotic total thyroidectomy with MRND via single RA port without axillary incision after approval from the institutional review board at Severance Hospital, Yonsei University College of Medicine. The inclusion criteria for this operation were as follows: (1) patients with malignant carcinomas of the thyroid gland with evident cervical lymph node metastasis on preoperative imaging studies which are indicated for surgery; (2) patients with no previous history of treatment for thyroid carcinoma. The exclusion criteria were as follows: (1) patients with recurred thyroid tumors; (2) patients with thyroid carcinomas that showed gross invasion to local structures or extensive extrathyroidal capsular spread; (3) patients with clinically evident neck nodal metastasis with extracapsular spread; (4) patients with past history of neck surgery of any kind. In order to assess the extent of disease, neck ultrasonography with fine needle aspiration, neck CT or MRI and PET-CT were performed as preoperative evaluation. All patients were given full information of the possible treatment options for their thyroid cancer comprising of open transcervical approach and robotic surgery via RA approach, including the advantages and disadvantages of each treatment choice and provided written, informed consents before the surgery. General clinical information of the patients is outlined in Table 1. The skin incision for the operation was designed just like the approach for robotic facelift thyroidectomy by Terris et al. and RAND, which has been first reported by our institution.11 (,) 16 The operation was performed by the following sequence. Initially, the skin-subplatysmal flap was elevated after making the skin incision to create sufficient working space. During this process, the elevated skin flap was retracted and maintained by retractors held by the assistant. After application of the self-retaining retractor (Sangdosa Inc., Seoul), neck dissection of the upper neck levels was performed under gross vision. Next, RAND through the RA incision was conducted followed by ipsilateral thyroidectomy with central compartment neck dissection (CCND) via the same approach. Finally, contralateral thyroidectomy with CCND was performed via the single RA port. During these steps, the operator is aided by the bedside assistant with long-suction tips to manipulate and direct the dissected specimen to maintain optimal surgical view or to suck out the fume created by the thermocoagulation from the Harmonic shears. The da Vinci robotic surgical system (Intuitive Surgical, Sunnyvale, CA) was introduced via the RA port with a facedown 30° dual-channel endoscopic arm placed in the center, and two instrument arms equipped at either side with 5-mm Maryland forceps and Harmonic curved shears. During the step of robotic contralateral thyroidectomy, a ProGrasp forceps was utilized at times, instead of 5-mm Maryland forceps. The rest of the surgery was completed with the robotic system (see Video for demonstration of operation for patient 2). Table 1 Clinical characteristics of the patients Patient Sex/age (yr) BMI Side(a) Approach Pathology(b) Tumor size(c) (cm) CCND(d) MRND(d) Drain removal day Drainage amount (ml) Hospital stay (days) 1 F/38 23.8 L RA PC 0.7 2/5 8/23 8 788 11 2 F/18 18.3 L RA PC 0.8 2/8 7/35 6 398 9 3 F/44 23.1 L RA PC 0.9 5/12 5/27 6 607 9 4 F/26 32.9 L RA PC 1.4 3/14 9/48 7 476 15 BMI body mass index, RA retroauricular approach, PC papillary carcinoma, CCND central compartment neck dissection, MRND modified radical neck dissection (a)Side refers to the site of main lesion (b)Pathology refers to the primary tumor within the thyroid gland (c)Tumor size refers to the diameter of the largest tumor in the thyroid gland (d)For each type of lymph node dissection, the number of positive nodes/total number of retrieved nodes is stated For all of the patients, robotic total thyroidectomy with MRND (levels II, III, IV, V) via unilateral RA approach was successfully completed without any significant intraoperative complications or conversion to open or other approach methods. The total operation time was defined as the time from initial skin incision to removal of the final specimen, which was an average 306.1 ± 11.1 min (Table 2). This included the time for skin flap elevation and neck dissection under gross vision (87 ± 2.8 min), setting up the robotic system for RAND (6.8 ± 2.4 min), console time using the robotic system for RAND (59.3 ± 2.2 min), flap elevation for thyroidectomy (11.3 ± 2.5 min), robotic arms docking for ipsilateral thyroidectomy (6.3 ± 2.5 min), console time for ipsilateral thyroidectomy (61.3 ± 2.1 min), robotic arms docking for contralateral thyroidectomy (6.3 ± 2.5 min), and console time for contralateral thyroidectomy (61.8 ± 2.1 min). The working space created from RA incision was sufficient, and manipulations of the robotic instruments through this approach were technically feasible and safe without any mutual collisions throughout the entire operation. It also allowed for an excellent magnified surgical view enabling visualization of important local anatomical structures. There was no postoperative vocal cord palsy due to recurrent laryngeal nerve injury. However, two patients developed transient hypoparathyroidism, which resolved in the end without the need for calcium or vitamin D supplementation after certain period of medical management (Table 3). Also, there was no incidence of postoperative hemorrhage or hematoma formation, although a single patient developed a postoperative seroma on postoperative day 9, which was managed conservatively without the need for further surgical intervention. On average, the wound catheter was removed 6.8 ± 1 days after surgery and the patient was discharged from the hospital at an average 11 ± 2.8 days from admission (Table 1). Final surgical pathology confirmed the diagnosis of papillary carcinoma for every patient. The total number of cervical nodes retrieved from CCND and MRND was 9.8 ± 4 and 33.1 ± 11 respectively, and the number of positive metastatic nodes was 3 ± 1.4 and 7.3 ± 1.7 respectively (Table 1). In three patients (patients 2, 3, and 4), the presence of one parathyroid gland was each verified in the pathology specimen. All four patients have received high-dose (150 mCi) radioiodine ablation (RAI) therapy after the operation and are being followed up (average 11.3 months, range 9-13 months) on a regular basis with no evidence of recurrence (post-RAI, most recent, nonsuppressed thyroglobulin range 0.1-0.4 ng/ml, antithyroglobulin antibody range 13.7-147.5 IU/ml). (ABSTRACT TRUNCATED)

A rabbit model of fatal hypothyroidism mimicking "myxedema coma" established by microscopic total thyroidectomy.

PubMed

Ono, Yosuke; Fujita, Masanori; Ono, Sachiko; Ogata, Sho; Tachibana, Shoichi; Tanaka, Yuji

2016-06-30

Myxedema coma (MC) is a life-threatening endocrine crisis caused by severe hypothyroidism. However, validated diagnostic criteria and treatment guidelines for MC have not been established owing to its rarity. Therefore, a valid animal model is required to investigate the pathologic and therapeutic aspects of MC. The aim of the present study was to establish an animal model of MC induced by total thyroidectomy. We utilized 14 male New Zealand White rabbits anesthetized via intramuscular ketamine and xylazine administration. A total of 7 rabbits were completely thyroidectomized under a surgical microscope (thyroidectomized group) and the remainder underwent sham operations (control group). The animals in both groups were monitored without thyroid hormone replacement for 15 weeks. Pulse rate, blood pressure, body temperature, and electrocardiograms (ECG) were recorded and blood samples were taken from the jugular vein immediately prior to the thyroidectomy and 2 and 4 weeks after surgery. The thyroidectomized rabbits showed a marked reduction of serum thyroxine levels at 4 weeks after the surgical procedure vs. controls (0.50±0.10 vs. 3.32±0.68 μg/dL, p<0.001). Additionally, thyroidectomized rabbits exhibited several signs of hypothyroidism such as hypothermia, systolic hypotension, bradycardia, and low voltage on ECGs, compared with controls. Of the 7 rabbits with severe hypothyroidism, 6 died from 4 to 14 weeks after the thyroidectomy possibly owing to heart failure, because histopathologic examinations revealed a myxedema heart. In summary, we have established a rabbit model of fatal hypothyroidism mimicking MC, which may facilitate pathophysiological and molecular investigations of MC and evaluations of new therapeutic interventions.

The timing of calcium measurements in helping to predict temporary and permanent hypocalcaemia in patients having completion and total thyroidectomies.

PubMed

Pfleiderer, A G; Ahmad, N; Draper, M R; Vrotsou, K; Smith, W K

2009-03-01

Postoperative hypocalaemia commonly occurs after extensive thyroid surgery and may require calcium and/or vitamin D supplements to alleviate or prevent the symptoms. In this study, we determined the risk factors for developing hypocalcaemia and whether early serum calcium levels can predict the development of or differentiate between temporary or permanent hypocalcaemia. A total of 162 patients who either had a completion or total thyroidectomy formed the basis of this prospective study. Serial serum calcium measurements were recorded as well as details of the operation, pathology, indications for surgery, number of parathyroids identified at operation and any complications. Eighty-four (52%) patients did not develop hypocalcaemia but 69 (43%) were found to have temporary hypocalcaemia and 9 (5%) had permanent hypocalcaemia. Hypocalcaemia was more common after total than completion thyroidectomies and the identification of parathyroids at operation appears to have a significant adverse effect on outcome. The calcium levels measured on day 1 postoperatively and the slope (serum calcium levels of day 1 postoperative minus day of operation) were statistically significant in predicting the development of hypocalcaemia and possibly to differentiate between temporary or permanent hypocalcaemia. Although almost half the patients having extensive thyroid surgery developed hypocalcaemia (as defined by any postoperative corrected serum calcium level of < 2.12 mmol/l) only 24% had a serum calcium of < 2.12 mmol/l associated with clinical symptoms of hypocalcaemia or a calcium level of < 2.0 mmol/l. Only 5% had persistent hypocalcaemia defined as requiring exogenous supplements at 6 months' postoperatively. Patients having a completion thyroidectomy appear to be less likely to develop hypocalcaemia perhaps as a result of any iatrogenic effects on the parathyroids at the first operation being reversed before the second operation. Identification and, therefore, exposure of parathyroids at operation may have an adverse effect on the blood supply to the glands affecting their function. Serum calcium levels measured 6 hours' post-surgery and on day 1 postoperatively can be useful in predicting if the patient will develop hypocalcaemia and the slope may indicate whether the hypocalcaemia will be temporary or permanent. Patients with toxic goitres and those having a one-stage total thyroidectomy are most at risk of developing hypocalcaemia.

The Timing of Calcium Measurements in Helping to Predict Temporary and Permanent Hypocalcaemia in Patients Having Completion and Total Thyroidectomies

PubMed Central

Pfleiderer, AG; Ahmad, N; Draper, MR; Vrotsou, K; Smith, WK

2009-01-01

INTRODUCTION Postoperative hypocalaemia commonly occurs after extensive thyroid surgery and may require calcium and/or vitamin D supplements to alleviate or prevent the symptoms. In this study, we determined the risk factors for developing hypocalcaemia and whether early serum calcium levels can predict the development of or differentiate between temporary or permanent hypocalcaemia. PATIENTS AND METHODS A total of 162 patients who either had a completion or total thyroidectomy formed the basis of this prospective study. Serial serum calcium measurements were recorded as well as details of the operation, pathology, indications for surgery, number of parathyroids identified at operation and any complications. RESULTS Eighty-four (52%) patients did not develop hypocalcaemia but 69 (43%) were found to have temporary hypocalcaemia and 9 (5%) had permanent hypocalcaemia. Hypocalcaemia was more common after total than completion thyroidectomies and the identification of parathyroids at operation appears to have a significant adverse effect on outcome. The calcium levels measured on day 1 postoperatively and the slope (serum calcium levels of day 1 postoperative minus day of operation) were statistically significant in predicting the development of hypocalcaemia and possibly to differentiate between temporary or permanent hypocalcaemia. DISCUSSION Although almost half the patients having extensive thyroid surgery developed hypocalcaemia (as defined by any postoperative corrected serum calcium level of < 2.12 mmol/l) only 24% had a serum calcium of < 2.12 mmol/l associated with clinical symptoms of hypocalcaemia or a calcium level of < 2.0 mmol/l. Only 5% had persistent hypocalcaemia defined as requiring exogenous supplements at 6 months' postoperatively. Patients having a completion thyroidectomy appear to be less likely to develop hypocalcaemia perhaps as a result of any iatrogenic effects on the parathyroids at the first operation being reversed before the second operation. Identification and, therefore, exposure of parathyroids at operation may have an adverse effect on the blood supply to the glands affecting their function. CONCLUSIONS Serum calcium levels measured 6 hours' post-surgery and on day 1 postoperatively can be useful in predicting if the patient will develop hypocalcaemia and the slope may indicate whether the hypocalcaemia will be temporary or permanent. Patients with toxic goitres and those having a one-stage total thyroidectomy are most at risk of developing hypocalcaemia. PMID:19317937

Postoperative PTH measurement as a predictor of hypocalcaemia after thyroidectomy.

PubMed

Proczko-Markuszewska, M; Kobiela, J; Stefaniak, T; Lachiński, A J; Sledziński, Z

2010-01-01

Hypocalcaemia after thyroidectomy is the most common postoperative complication, with a reported incidence from 0.5% to even 50% of the operated patients. Hypoparathyroidism could be a result of careless or inadequate preparation during the surgical procedure. There is a variety of proposed options for the prediction of the incidence of hypocalcaemia. The most effective of them are the peri-operative and intra-operative measurements of the parathyroid hormone (PTH) level. A prospective study was performed on 100 patients who underwent total thyroidectomy from January 2007 to June 2008. The total calcium level and intact human PTH (iPTH) levels were measured 24 hours before as well as 1 hour and 24 hours after the surgery. The goal of the study was to assess the potential correlation between the iPTH levels after the operation and the development of hypocalcaemia. The possible prediction value of postoperative iPTH levels was to be assessed. We have presented a significant correlation between early iPTH measurement and the risk of hypocalcaemia. Moreover, a significant correlation between the iPTH level one hour after operation with the calcium level 24 hours after the operation was demonstrated. Early postoperative assessment of iPTH levels can be used to identify the group of patients at risk of hypocalcaemia after thyroidectomy. Pre-emptive calcium supplementation can lead to the avoidance of complications causing prolonged hospital stay and most importantly to prevent severe hypocalcaemia.

Relationship Between Changes in Serum Thyrotropin and Total and Lipoprotein Cholesterol with Prolonged Antarctic Residence

DTIC Science & Technology

1993-09-01

density lipoprotein ( HDL -C) cholesterol and triglyceride changes in TSH (P < .05)1 TBG (P < .01), TT3 (P < .05), ( TG ), on the other hand, were analyzed from...total thyroxine (TT4), free T4 (FT4), total T3 (TT3), free T3 (FT3), thyroid-binding globulin (TBG), total cholesterol (T-CHOL), high - density lipoprotein ... cholesterol ( HDL -C), triglyceride ( TG ), dietary cholesterol (D-CHOL), dietary fat (D-FAT), and dietary

Bilateral transaxillary endoscopic total thyroidectomy.

PubMed

Miyano, Go; Lobe, Thom E; Wright, Simon K

2008-02-01

Minimal-access thyroid surgery using various techniques is well described. The present study reviews our initial experience with total thyroidectomy using a robotic-assisted bilateral transaxillary endoscopic approach (R-BAEA) and a non-robotic-assisted bilateral transaxillary endoscopic approach (BAEA) to assess it's safety and feasibility. The study group was 13 consecutive patients who were candidates for total thyroidectomy with benign thyroid disease. Two young adult patients who were older than 20 years and 2 teenage patients who underwent a transaxillary endoscopic thyroid lobectomy were excluded from this study that was composed of 9 children. A detailed description of the surgical technique is provided. Eight patients were female and one was male. The mean age was 13.5 +/- 3.0 years. Two R-BAEAs and 7 BAEAs were performed. The initial diagnosis was Graves disease in all 9 cases. The mean operating time was 385 minutes (range, 364-407 minutes) for R-BAEA and 259 minutes (range, 135-385 minutes) for BAEA. The mean diameter of the resected specimens was 5.9 cm (range, 4.5-8.3 cm); the mean intraoperative blood loss was 15.0 mL (range, 10-30 mL). The recurrent laryngeal nerve and parathyroid glands were identified and preserved intact in all cases. No patients required conversion. There was one instance of postoperative wound erythema, and 2 patients experienced hypocalcemia that resolved spontaneously. Two patients with large glands experienced a transient postoperative hoarseness. The mean total postoperative morphine dose administered in the first 24 hours was 1.5 mg (range, 0-4 mg). Postoperative pain was minimal, and cosmetic results were considered excellent by all patients. All except one were discharged the day after surgery and returned immediately to normal activities. Total thyroidectomy using BAEA with or without robotic assistance is feasible and safe. The advantages of this approach are no cervical scar, no significant morbidity, less postoperative pain, and early return to normal activity compared with other published techniques.

Transoral robotic thyroidectomy: a preclinical feasibility study using the da Vinci Xi platform.

PubMed

Russell, Jonathon O; Noureldine, Salem I; Al Khadem, Mai G; Chaudhary, Hamad A; Day, Andrew T; Kim, Hoon Yub; Tufano, Ralph P; Richmon, Jeremy D

2017-09-01

Transoral thyroid surgery allows the surgeon to conceal incisions within the oral cavity without significantly increasing the amount of required dissection. TORT provides an ideal scarless, midline access to the thyroid gland and bilateral central neck compartments. This approach, however, presents multiple technical challenges. Herein, we present our experience using the latest generation robotic surgical system to accomplish transoral robotic thyroidectomy (TORT). In two human cadavers, the da Vinci Xi surgical system (Intuitive Surgical, Sunnyvale, CA, USA) was used to complete TORT. Total thyroidectomy and bilateral central neck dissection was successfully completed in both cadavers. The da Vinci Xi platform offered several technologic advantages over previous robotic generations including overhead docking, narrower arms, and improved range of motion allowing for improved execution of previously described TORT techniques.

Prophylactic thyroidectomy for asymptomatic 3-year-old boy with positive multiple endocrine neoplasia type 2A mutation (codon 634).

PubMed

Jesić, Maja D; Tancić-Gajić, Milina; Jesić, Milos M; Zivaljević, Vladan; Sajić, Silvija; Vujović, Svetlana; Damjanović, Svetozar

2014-01-01

The multiple endocrine neoplasia type 2A (MEN 2A) syndrome, comprising medullary thyroid carcinoma (MTC), pheochromocytoma and primary hyperparathyroidism (PHPT) is most frequently caused by codon 634 activating mutations of the RET (rearranged during transfection) proto-oncogene on chromosome 10. For this codon-mutation carriers, earlier thyroidectomy (before the age of 5 years) would be advantageous in limiting the potential for the development of MTC as well as parathyroid adenomas. This is a case report of 3-year-old boy from the MEN 2A family (the boy's father and grandmother and paternal aunt) in which cysteine substitutes for phenylalanine at codon 634 in exon 11 of the RET proto-oncogene, who underwent thyroidectomy solely on the basis of genetic information. A boy had no thyromegaly, thyroidal irregularities or lymphadenopathy and no abnormality on the neck ultrasound examination. The pathology finding of thyroid gland was negative for MTC. Two years after total thyroidectomy, 5-year-old boy is healthy with permanent thyroxine replacement. His serum calcitonin level is < 2 pg/ml (normal < 13 pg/ml), has normal serum calcium and parathyroid hormone levels and negative urinary catecholamines. Long-term follow-up of this patient is required to determine whether very early thyroidectomy improves the long-term outcome of PHPT. Children with familial antecedents of MEN 2A should be genetically studied for the purpose of determining the risk of MTC and assessing the possibilities of making prophylactic thyroidectomy before the age of 5 years.

Pediatric Graves’ disease: management in the post-propylthiouracil Era

PubMed Central

2014-01-01

The most prevalent cause of thyrotoxicosis in children is Graves’ disease (GD), and remission occurs only in a modest proportion of patients. Thus most pediatric patients with GD will need treatment with radioactive iodine (RAI; 131I) or surgical thyroidectomy. When antithyroid drugs (ATDs) are prescribed, only methimazole (MMI) should be administered, as PTU is associated with an unacceptable risk of severe liver injury. If remission does not occur following ATD therapy, 131I or surgery should be contemplated. When 131I is administered, dosages should be greater than 150 uCi/gm of thyroid tissue, with higher dosages needed for large glands. Considering that there will be low-level whole body radiation exposure associated with 131I, this treatment should be avoided in young children. When surgery is performed near total or total-thyroidectomy is the recommended procedure. Complications for thyroidectomy in children are considerably higher than in adults, thus an experienced thyroid surgeon is needed when children are operated on. Most importantly, the care of children with GD can be complicated and requires physicians with expertise in the area. PMID:25089127

Differential effect of blood collection tubes on total free fatty acids (FFA) and total triiodothyronine (TT3) concentration: a model for studying interference from tube constituents.

PubMed

Bowen, Raffick A R; Vu, Chi; Remaley, Alan T; Hortin, Glen L; Csako, Gyorgy

2007-03-01

Besides total triiodothyronine (TT3), total free fatty acids (FFA) concentrations were higher with serum separator tube (SST) than Vacuette tubes. The effects of surfactant, rubber stopper, and separator gel from various tubes were investigated on FFA, beta-hydroxybutyrate (beta-HB), and TT3 with 8 different tube types in blood specimens of apparently healthy volunteers. Compared to Vacuette tubes, serum FFA and TT3 concentrations were significantly higher in SST than glass tubes. Reformulated SST eliminated the increase in TT3 but not FFA. No significant difference was observed for beta-HB concentration among tube types. Surfactant and rubber stoppers from the different tube types significantly increased TT3 but not FFA and beta-HB concentrations. Agitation of whole blood but not serum or plasma specimens with separator gel from SST, reformulated SST and plasma preparation tube (PPT) tubes compared to Vacuette tubes gave higher FFA but not beta-HB levels. Unidentified component(s) from the separator gel in SST, reformulated SST and PPT tubes cause falsely high FFA concentration. In contrast to TT3, falsely high FFA results require exposure of whole blood and not serum to tube constituent(s). The approach employed here may serve as a model for assessing interference(s) from tube constituent(s).

The use of LigaSure in patients with hyperthyroidism.

PubMed

Barbaros, Umut; Erbil, Yeşim; Bozbora, Alp; Deveci, Uğur; Aksakal, Nihat; Dinççağ, Ahmet; Ozarmağan, Selçuk

2006-11-01

Thyroidectomies of hyperthyroidic patients are known to be more blood-spattered than the operations performed for euthyroid nodular diseases and require careful hemostasis. Our purpose was to evaluate the efficacy of the use of LigaSure in patients with hyperthyroidism. Between January 2004 and October 2005, 100 patients underwent total or near-total thyroidectomy. Bipolar vessel ligation system (LigaSure) was the choice of modality for hemostasis in half of these patients, and the conventional suture ligation technique was used for the rest. The following data were evaluated non-randomized and prospectively in this study: patients demographics, thyroid pathology, operative duration, presence of complications, and the duration of the hospital stay. Comparisons of the data were evaluated by the Wilcoxon and chi-square tests. Among the patients of the LigaSure group, 14 patients were detected to have hyperthyroidism (seven patients with Graves' disease and another seven patients with multinodular toxic goiter), while 36 patients were found to be euthyroidic. The durations of the operation time and of the hospital stay of the patients in the LigaSure group were significantly lower than the conventional thyroidectomy group (p<0.05). The complication rates of the LigaSure and conventional thyroidectomy groups were 4 and 6%, respectively (p>0.05). The use of LigaSure as an operative technique in the treatment of Graves' disease and toxic goiter is a safe and effective modality that provides a shorter hospital stay and a shorter operation time as well.

A Prospective, Observational Study to Evaluate the Role of Gabapentin as Preventive Analgesic in Thyroidectomy under General Anesthesia.

PubMed

Hema, Vadakkoot Raghavan; Ramadas, Konnanath Thekkethil; Biji, Kannammadathy Poulose; Indu, Suseela; Arun, Aravind

2017-01-01

Effective management of postoperative pain is a part of well-organized perioperative care, which helps in reduced morbidity and improved patient satisfaction. Preventive analgesia can reduce acute and chronic pain by blocking the noxious inputs to pain pathways, preventing sensitization. Studies have reported efficacy of gabapentin as a preventive analgesic in perioperative pain. In this study, we aimed to determine whether preoperative gabapentin reduced postoperative pain and tramadol consumption after thyroidectomy under general anesthesia. Sixty patients scheduled for thyroidectomy were allocated to two groups of thirty each for this prospective, observational study. Patients in Group A and Group B received oral gabapentin 600 mg (6 × 10 -4 kg) and diazepam 10 mg (1 × 10 -5 kg), respectively, 2 h prior to surgery. Tramadol was given as rescue analgesic for postoperative pain with a verbal rating score of two. The analgesic efficacy of preoperative gabapentin was assessed in terms of postoperative pain scores at rest or swallowing, time to first rescue analgesic, and total tramadol consumption for 24 h. Ramsay sedation score and side effects of drug were also looked into. Postoperative pain scores and total tramadol consumption were significantly lower in Group A during 24 h ( P = 0.00). Time to first rescue analgesic was significantly prolonged in Group A ( P = 0.001). Side effects were comparable. Oral gabapentin is effective as a preventive analgesic in reducing postoperative pain and tramadol consumption after thyroidectomy under general anesthesia.

Postoperative Calcium Management in Same-Day Discharge Thyroid and Parathyroid Surgery.

PubMed

Nelson, Kurt L; Hinson, Andrew M; Lawson, Bradley R; Middleton, Derek; Bodenner, Donald L; Stack, Brendan C

2016-05-01

To describe a safe and effective postoperative prophylactic calcium regimen for same-day discharge thyroid and parathyroid surgery. Case series with chart review. Tertiary referral academic institution. In total, 162 adult patients who underwent total thyroidectomy, completion thyroidectomy, unilateral parathyroidectomy, parathyroidectomy with bilateral neck exploration, or revision parathyroidectomy were identified preoperatively to be candidates for same-day discharge. All patients in this study were successfully discharged the same day on our standard prophylactic calcium regimen. Less than 1% (1/162) of patients re-presented to the hospital within 30 days of surgery, and that patient was successfully discharged from the emergency department after negative workup for hypocalcemia. There was no significant difference between preoperative and postoperative calcium levels in the total/completion thyroidectomy groups (9.3 vs 9.2 mg/dL, respectively; P = .14). The average postoperative calcium level in the parathyroid group was well within normal limits (9.5 mg/dL), and the difference in postoperative calcium levels between revision and primary parathyroidectomy cases was not significantly different (P = .34). The reported calcium regimen demonstrates a safe, effective, and objective means of postoperative calcium management in outpatient thyroid and parathyroid surgery in appropriately selected patients. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Total thyroidectomy: a clue to understanding the metabolic changes induced by subclinical hyperthyroidism?

PubMed

Bel Lassen, Pierre; Kyrilli, Aglaia; Lytrivi, Maria; Ruiz Patino, Maria; Corvilain, Bernard

2017-02-01

The effects of endogenous subclinical hyperthyroidism (eSCH) on heart and bone have been well documented. There are only limited data available regarding the impact of eSCH on weight regulation and lipid metabolism. Our aim was to evaluate the changes in body weight and metabolic parameters after total thyroidectomy in patients with pre-operative eSCH compared with pre-operative patients with euthyroid (EUT). A retrospective study of 505 patients who underwent total thyroidectomy for benign multinodular goitre in an academic hospital in Brussels (Belgium) was performed. Two hundred and 25 patients were included (eSCH group: n = 74; EUT group: n = 151). The mean follow-up time was 26·1 ± 0·8 months and was similar in both groups. Absolute BMI gain was significantly greater in the eSCH group than in the EUT group (1·11 ± 0·17 vs 0·33 ± 0·13 kg/m 2 ; P = 0·003). A significant increase in LDL cholesterol was observed in the eSCH group (16·1 ± 3·8 mg/dl; P < 0·001) but not in the EUT group (0·0 ± 3·0 mg/dl; P = 0·88). In a multivariate model, pre-operative TSH levels were the main factor significantly associated with increases in BMI or LDL cholesterol. Post-operative median TSH levels and L-thyroxine substitution were similar in both groups. After total thyroidectomy, increases in weight and serum cholesterol were observed in the eSCH group. Given that post-operative TSH levels were similar in the two groups, these observations are probably due to the correction of eSCH, suggesting a direct effect of eSCH on body weight regulation and lipid metabolism. © 2016 John Wiley & Sons Ltd.

Vocal palsy increases the risk of lower respiratory tract infection in low-risk, low-morbidity patients undergoing thyroidectomy for benign disease: A big data analysis.

PubMed

Nouraei, S A R; Allen, J; Kaddour, H; Middleton, S E; Aylin, P; Darzi, A; Tolley, N S

2017-12-01

Thyroidectomy is the commonest operation that places normally functioning laryngeal nerves at risk of injury. Vocal palsy is a major risk factor for dysphonia, dysphagia, and less commonly, airway obstruction. We investigated the association between post-thyroidectomy vocal palsy and long-term risks of pneumonia and laryngeal failure. An N=near-all analysis of the English administrative dataset using a previously validated informatics algorithm to identify young and otherwise low-risk patients undergoing first-time elective thyroidectomy for benign disease. Information about age, sex, morbidities, social deprivation and post-operative and late complications were derived. Between 2004 and 2012, 43 515 patients between the ages of 20 and 69 who had no history of cancer, neurological, or respiratory disease underwent elective total or hemithyroidectomy without concomitant or late neck dissection, parathyroidectomy or laryngotracheal surgery for benign thyroid disease for the first and only time. Information about age, sex, morbidities and in-hospital and late complications was recorded. Mean age at surgery was 46±12. There was a strong female preponderance (85%), and most patients (89%) had no recorded Charlson comorbidities Most patients (65%) underwent hemithyroidectomy. Late vocal palsy was recorded in 449 (1.03%) patients, and its occurrence was an independent risk factor for emergency hospital readmission (n=7113; Hazard Ratio 1.52; 95% confidence interval 1.21-1.91), hospitalisation for lower respiratory tract infection (n=944; HR 2.04; 95% CI 1.07-3.75), dysphagia (n=564; HR 3.47; 95% CI 1.57-7.65) and gastrostomy/tracheostomy placement (n=80; HR 20.8; 95% CI 2.5-171.2). Independent risk factors for late vocal palsy were age, burden of morbidities, total thyroidectomy, post operative bleeding, male sex, and annual surgeon volume <30. There is a significant association between post-thyroidectomy vocal palsy and long-term risks of hospital readmission, dysphagia, hospitalisation for lower respiratory tract infection, and gastrostomy/tracheostomy tube placement. This adds weight to the need, from a thyroid surgical perspective, to undertake universal post-thyroidectomy laryngeal surveillance as a minimum standard of care, with a focus on post-operative dysphagia and aspiration, and from a medical/respiratory perspective, to initiate investigations to identify occult vocal palsy in patients who present with pneumonia, who have a history of thyroid surgery. © 2017 John Wiley & Sons Ltd.

Update on sutureless thyroidectomy

PubMed Central

DOCIMO, G.; BOSCO, A.; VOLPE, M. LANZA; TERRACCIANO, G.; GUBITOSI, A.; DOCIMO, L.

2018-01-01

Introduction The Harmonic scalpel (“Focus” and the new version “Focus+”) is one of the first devices for surgical simultaneous cutting and tissue coagulation which allows to obtain dissection and hemostasis by direct application of ultrasound and allows minimally invasive surgical procedures with minimal lateral thermal spread and, thus, minimal adjacent tissue destruction. The aim of the study is to complete the previous study that we made in 2014, based on the TT performed between January 2008 and December 2013, with new data about TT performed in our Surgical Division between January 2014 and December 2016 and compare the outcome using the Ultrasonic scalpel versus the device Ligasure in term of safety, operative time, overall drainage volume, complications, hospital stay. Patients and methods 250 patients were randomized into two groups: Group A where Ultracision were used and Group B where the Ligasure device was used. Results The results of the group A and of the Group B 2014–2016 have been compared with the results of the previous study and we found that they are similar, but asymptomatic hypocalcaemia increased in the patients of the new study. Conclusions We found that the use of Ultrasonic scalpel and Ligasure is effective both in the hemostasis of all vessels and in dissection of tissues and confirm the results of our first study without significant difference in the rate of post-operative morbidity with these two different energy based devices used. PMID:29549681

Comparison of indocyanine green fluorescence and parathyroid autofluorescence imaging in the identification of parathyroid glands during thyroidectomy.

PubMed

Kahramangil, Bora; Berber, Eren

2017-12-01

Indocyanine green fluorescence (ICGF) and parathyroid autofluorescence (AF) are two new techniques that aid in the identification of parathyroid glands (PG) intraoperatively during thyroidectomy. There is no study comparing the efficacy of these techniques. This was an IRB-approved clinical study comparing the utility of ICGF and AF for identification of PGs during thyroidectomy. Data were collected prospectively. Both techniques were compared to naked eye (NE) for PG detection. Standard statistical methods were used for data analysis. Twenty-two patients in each group underwent a total of 39 total thyroidectomies and 5 thyroid lobectomies. AF and ICGF had similar detection rates for PGs [98% (61 of 62) and 95% (60 of 63) of PGs, respectively; P=0.31]. The location of PGs was suggested before detection with NE more frequently by AF than ICGF [52% (32 of 62) vs. 6% (4 of 63) of PGs; P<0.001]. In 82% (18 of 22) of patients at least one PG was detected by AF before NE, as opposed to 14% (3 of 22) by ICGF (P<0.001). The median (range) number of PGs detected before NE per patient was greater with AF than ICGF [2 (0-3) vs. 0 (0-2)];. Upper PGs were more likely to be detected by AF before recognition with NE than the lower ones (P=0.03). There was no predictive factor for ICGF detection. Postoperative hypocalcemia rates were similar [9% (2 of 22) and 5% (1 of 22) for AF and ICGF, respectively; P>0.99]. To the best of our knowledge, this is the first comparative study between parathyroid AF and ICGF in detection of PGs during thyroidectomy. Our data suggest both techniques have similarly high detection rates and that the main difference lies in the timing of detection. AF more frequently detects PGs before recognition with NE compared to ICGF.

Comparison of indocyanine green fluorescence and parathyroid autofluorescence imaging in the identification of parathyroid glands during thyroidectomy

PubMed Central

Kahramangil, Bora

2017-01-01

Background Indocyanine green fluorescence (ICGF) and parathyroid autofluorescence (AF) are two new techniques that aid in the identification of parathyroid glands (PG) intraoperatively during thyroidectomy. There is no study comparing the efficacy of these techniques. Methods This was an IRB-approved clinical study comparing the utility of ICGF and AF for identification of PGs during thyroidectomy. Data were collected prospectively. Both techniques were compared to naked eye (NE) for PG detection. Standard statistical methods were used for data analysis. Results Twenty-two patients in each group underwent a total of 39 total thyroidectomies and 5 thyroid lobectomies. AF and ICGF had similar detection rates for PGs [98% (61 of 62) and 95% (60 of 63) of PGs, respectively; P=0.31]. The location of PGs was suggested before detection with NE more frequently by AF than ICGF [52% (32 of 62) vs. 6% (4 of 63) of PGs; P<0.001]. In 82% (18 of 22) of patients at least one PG was detected by AF before NE, as opposed to 14% (3 of 22) by ICGF (P<0.001). The median (range) number of PGs detected before NE per patient was greater with AF than ICGF [2 (0–3) vs. 0 (0–2)];. Upper PGs were more likely to be detected by AF before recognition with NE than the lower ones (P=0.03). There was no predictive factor for ICGF detection. Postoperative hypocalcemia rates were similar [9% (2 of 22) and 5% (1 of 22) for AF and ICGF, respectively; P>0.99]. Conclusions To the best of our knowledge, this is the first comparative study between parathyroid AF and ICGF in detection of PGs during thyroidectomy. Our data suggest both techniques have similarly high detection rates and that the main difference lies in the timing of detection. AF more frequently detects PGs before recognition with NE compared to ICGF. PMID:29302480

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) for Graves' disease: a comparison of surgical results with open thyroidectomy.

PubMed

Jitpratoom, Pornpeera; Ketwong, Khwannara; Sasanakietkul, Thanyawat; Anuwong, Angkoon

2016-12-01

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) provides excellent cosmetic results from its potential for scar-free operation. The procedure has been applied successfully for Graves' disease by the authors of this work and compared with the standard open cervical approach to evaluate its safety and outcomes. From January 2014 to November 2016, a total of 97 patients with Graves' disease were reviewed retrospectively. Open thyroidectomy (OT) and TOETVA were performed in 49 patients and 46 patients, respectively. For TOETVA, a three-port technique through the oral vestibule was utilized. The thyroidectomy was done endoscopically using conventional laparoscopic instruments and an ultrasonic device. Patient demographics and surgical variables, including operative time, blood loss, and complications, were investigated and compared. TOETVA was performed successfully in all 45 patients, although conversion to open surgery was deemed necessary in one patient. All patient characteristics for both groups were similar. Operative time was shorter for the OT group compared to the TOETVA group, which totaled 101.97±24.618 and 134.11±31.48 minutes, respectively (P<0.5). Blood loss was comparable for both groups. The visual analog scale (VAS) pain score for the TOETVA group was significantly lower than for the OT group on day 1 (2.08±1.53 vs . 4.57±1.35), day 2 (0.84±1.12 vs . 2.57±1.08) and day 3 (0.33±0.71 vs . 1.08±1.01) (P<0.05). Transient recurrent laryngeal nerve (RLN) palsy was found in four and two cases of TOETVA and OT group, respectively. Transient hypocalcemia was found in ten and seven cases of TOETVA and OT group, respectively. No other complications were observed. TOETVA is a feasible and safe treatment for Graves' disease in comparison to the standard open cervical approach. It is considered a viable alternative for patients who have been indicated for surgery with excellent cosmetic results.

The effect of intra-operative transcutaneous electrical nerve stimulation on posterior neck pain following thyroidectomy.

PubMed

Park, C; Choi, J B; Lee, Y-S; Chang, H-S; Shin, C S; Kim, S; Han, D W

2015-04-01

Posterior neck pain following thyroidectomy is common because full neck extension is required during the procedure. We evaluated the effect of intra-operative transcutaneous electrical nerve stimulation on postoperative neck pain in patients undergoing total thyroidectomy under general anaesthesia. One hundred patients were randomly assigned to one of two groups; 50 patients received transcutaneous electrical nerve stimulation applied to the trapezius muscle and 50 patients acted as controls. Postoperative posterior neck pain and anterior wound pain were evaluated using an 11-point numerical rating scale at 30 min, 6 h, 24 h and 48 h following surgery. The numerical rating scale for posterior neck pain was significantly lower in the transcutaneous electrical nerve stimulation group compared with the control group at all time points (p < 0.05). There were no significant differences in the numerical rating scale for anterior wound pain at any time point. No adverse effects related to transcutaneous electrical nerve stimulation were observed. We conclude that intra-operative transcutaneous electrical nerve stimulation applied to the trapezius muscle reduced posterior neck pain following thyroidectomy. © 2014 The Association of Anaesthetists of Great Britain and Ireland.

Robotic and endoscopic transaxillary thyroidectomies may be cost prohibitive when compared to standard cervical thyroidectomy: a cost analysis.

PubMed

Cabot, Jennifer C; Lee, Cho Rok; Brunaud, Laurent; Kleiman, David A; Chung, Woong Youn; Fahey, Thomas J; Zarnegar, Rasa

2012-12-01

This study presents a cost analysis of the standard cervical, gasless transaxillary endoscopic, and gasless transaxillary robotic thyroidectomy approaches based on medical costs in the United States. A retrospective review of 140 patients who underwent standard cervical, transaxillary endoscopic, or transaxillary robotic thyroidectomy at 2 tertiary centers was conducted. The cost model included operating room charges, anesthesia fee, consumables cost, equipment depreciation, and maintenance cost. Sensitivity analyses assessed individual cost variables. The mean operative times for the standard cervical, transaxillary endoscopic, and transaxillary robotic approaches were 121 ± 18.9, 185 ± 26.0, and 166 ± 29.4 minutes, respectively. The total cost for the standard cervical, transaxillary endoscopic, and transaxillary robotic approaches were $9,028 ± $891, $12,505 ± $1,222, and $13,670 ± $1,384, respectively. Transaxillary approaches were significantly more expensive than the standard cervical technique (standard cervical/transaxillary endoscopic, P < .0001; standard cervical/transaxillary robotic, P < .0001; and transaxillary endoscopic/transaxillary robotic, P = .001). The transaxillary and standard cervical techniques became equivalent in cost when transaxillary endoscopic operative time decreased to 111 minutes and transaxillary robotic operative time decreased to 68 minutes. Increasing the case load did not resolve the cost difference. Transaxillary endoscopic and transaxillary robotic thyroidectomies are significantly more expensive than the standard cervical approach. Decreasing operative times reduces this cost difference. The greater expense may be prohibitive in countries with a flat reimbursement schedule. Copyright © 2012 Mosby, Inc. All rights reserved.

RISK FACTORS FOR NONREMISSION AND PROGRESSION-FREE SURVIVAL AFTER I-131 THERAPY IN PATIENTS WITH LUNG METASTASIS FROM DIFFERENTIATED THYROID CANCER: A SINGLE-INSTITUTE, RETROSPECTIVE ANALYSIS IN SOUTHERN CHINA.

PubMed

Chen, Pan; Feng, Hui-Juan; Ouyang, Wei; Wu, Ju-Qing; Wang, Jing; Sun, Yun-Gang; Xian, Jia-Lang; Huang, Liu-Hua

2016-09-01

Prognostic factors related to progression-free survival (PFS) have not received much attention in the literature regarding iodine-131 ((131)I) therapy for patients with differentiated thyroid cancer and lung metastases. We sought to explore the factors associated with PFS and nonremission in a group of patients with differentiated thyroid cancer and pulmonary metastases at initial diagnosis and to investigate the impact of (131)I therapy on pulmonary function and peripheral blood counts in the same cohort of patients. The medical records of 1,050 patients with differentiated thyroid cancer treated at the Zhujiang Hospital of Southern Medical University from January 2006 to January 2015 were retrospectively reviewed. Among them, 107 patients fulfilled the inclusion criteria. Multivariate Cox regression analysis indicated that age ≥45 years and (131)I nonavidity were independent risk factors for disease progression. Multivariate logistic regression analysis revealed that pulmonary nodule size ≥1 cm and (131)I nonavidity were the strongest risk factors predicting nonremission. Varying cumulative (131)I dosage had no association with posttreatment pulmonary function or peripheral blood cell counts. Similar to earlier studies, our results confirm that (131)I nonavidity was associated with an increased risk of disease progression and greater odds of nonremission. In addition, patients with differentiated thyroid cancer and lung metastases with pulmonary nodules ≥1 cm had a reduced likelihood of achieving remission. Furthermore, special attention is needed when monitoring patients over 45 years at a higher risk of disease progression. CI = confidence interval DTC = differentiated thyroid cancer (18)F-FDG = fluoro-18 fluorodeoxyglucose FEF = forced expiratory flow FTC = follicular thyroid cancer FVC = forced vital capacity GR = granulocytes Hb = hemoglobin HR = hazard ratio (131)I = iodine-131 LN = lymph node OR = odds ratio OS = overall survival PET/CT = positive positron emission tomography/computed tomography PFS = progression-free survival PT = partial thyroidectomy PTC = papillary thyroid cancer RAI = radioactive iodine RBC = red blood cell Tg = thyroglobulin TgAb = thyroglobulin antibody TSH = thyroid-stimulating hormone TT = total thyroidectomy WBC = white blood cells WBS = whole body scan.

Perioperative indicators of hypocalcemia in total thyroidectomy: the role of vitamin D and parathyroid hormone.

PubMed

Salinger, Eric M; Moore, John T

2013-12-01

Hypocalcemia is a common complication of thyroidectomy. The aim of this study was to identify risk factors for this problem. This prospective analysis included 111 patients undergoing total or completion thyroidectomy. Preoperative vitamin D levels and postoperative day 1 parathyroid hormone levels were analyzed for their predictive effects on postoperative hypocalcemia. Patients with ionized calcium <4.4 mg/dL had significantly lower mean parathyroid hormone levels than normocalcemic patients (13.0 vs 28.4 pg/mL, P < .001). Parathyroid hormone levels were also significantly lower in symptomatic patients (11.0 vs 28.4 pg/mL, P < .001). Preoperative vitamin D level, body mass index, gender, and pathologic findings were not associated with low calcium levels or symptoms of hypocalcemia. Younger age and low postoperative parathyroid hormone levels are predictive of symptomatic hypocalcemia. A parathyroid hormone level outside of the reference range may indicate a need for more aggressive postoperative calcium supplementation and treatment with activated vitamin D. Older patients with normal postoperative parathyroid hormone levels may be safely discharged with appropriate calcium supplementation. Copyright © 2013 Elsevier Inc. All rights reserved.

40 CFR Appendix A to Subpart O of... - Regulated Contaminants

Code of Federal Regulations, 2010 CFR

2010-07-01

..., young children, some of the elderly, and people with severely compromised immune systems. Total organic carbon (ppm) TT TT N/A Naturally present in the environment Total organic carbon (TOC) has no health effects. However, total organic carbon provides a medium for the formation of disinfection by products...

A Prospective, Observational Study to Evaluate the Role of Gabapentin as Preventive Analgesic in Thyroidectomy under General Anesthesia

PubMed Central

Hema, Vadakkoot Raghavan; Ramadas, Konnanath Thekkethil; Biji, Kannammadathy Poulose; Indu, Suseela; Arun, Aravind

2017-01-01

Background: Effective management of postoperative pain is a part of well-organized perioperative care, which helps in reduced morbidity and improved patient satisfaction. Preventive analgesia can reduce acute and chronic pain by blocking the noxious inputs to pain pathways, preventing sensitization. Studies have reported efficacy of gabapentin as a preventive analgesic in perioperative pain. In this study, we aimed to determine whether preoperative gabapentin reduced postoperative pain and tramadol consumption after thyroidectomy under general anesthesia. Materials and Methods: Sixty patients scheduled for thyroidectomy were allocated to two groups of thirty each for this prospective, observational study. Patients in Group A and Group B received oral gabapentin 600 mg (6 × 10−4 kg) and diazepam 10 mg (1 × 10−5 kg), respectively, 2 h prior to surgery. Tramadol was given as rescue analgesic for postoperative pain with a verbal rating score of two. The analgesic efficacy of preoperative gabapentin was assessed in terms of postoperative pain scores at rest or swallowing, time to first rescue analgesic, and total tramadol consumption for 24 h. Ramsay sedation score and side effects of drug were also looked into. Results: Postoperative pain scores and total tramadol consumption were significantly lower in Group A during 24 h (P = 0.00). Time to first rescue analgesic was significantly prolonged in Group A (P = 0.001). Side effects were comparable. Conclusion: Oral gabapentin is effective as a preventive analgesic in reducing postoperative pain and tramadol consumption after thyroidectomy under general anesthesia. PMID:28928577

Silk suture reaction in thyroid surgery

PubMed Central

Soylu, Selen; Teksoz, Serkan; Ozcan, Murat; Bukey, Yusuf

2017-01-01

Silk suture reaction (i.e., a benign granulomatous inflammatory foreign body reaction) is a rare complication of thyroid surgery. Here, two cases of post-thyroidectomy suture reaction are presented. Both of the patients were female, one is 48 and the other is 34 years old. The patients were presented with neck swelling and leakage of serous fluid from the Kocher’s incision. Both patients had normal free T4, free T3, and TSH values. The 48-year-old female patient had a right subtotal and left near-total thyroidectomy 6 years ago and the other had bilateral total thyroidectomy 6 years ago. In the physical examination a mobile, painless, red, swelling was palpated in front of neck. In the ultrasound of both patients, a heterogeneous nodule with hypoechoic rim was seen, however, in scintigraphy no radiopharmaceutical involvement was observed in thyroid region. Due to suspicion of thyroid malignancy, a fine needle aspiration biopsy was performed and foreign body reaction was revealed cytologically. A suture reaction can vary from an erythematous swelling to chronic granulomatous reaction. The time interval between the operation and formation of suture reaction was 6 years in both of the cases thus these patients were considered as chronic patients. Foreign body reaction diagnosis was confirmed with fine needle aspiration biopsy. It is important to diagnose these chronic inflammation cases since these cases can mimic recurrence in thyroid malignancies. A post-thyroidectomy suture reaction is diagnosed cytologically with fine needle aspiration biopsy and by surgical removal of suture, this chronic inflammatory reaction can be cured. PMID:29142853

Applied anatomy of a new approach of endoscopic technique in thyroid gland surgery.

PubMed

Liu, Hong; Xie, Yong-jun; Xu, Yi-quan; Li, Chao; Liu, Xing-guo

2012-10-01

To explore the feasibility and safety of transtracheal assisted sublingual approach to totally endoscopic thyroidectomy by studying the anatomical approach and adjacent structures. A total of 5 embalmed adult cadavers from Chengdu Medical College were dissected layer by layer in the cervical region, pharyngeal region, and mandible region, according to transtracheal assisted sublingual approach that was verified from the anatomical approach and planes. A total of 15 embalmed adult cadavers were dissected by arterial vascular casting technique, imaging scanning technique, and thin layer cryotomy. Then the vessel and anatomical structures of thyroid surgical region were analyzed qualitatively and quantitatively. Three-dimensional visualization of larynx artery was reconstructed by Autodesk 3ds Max 2010(32). Transtracheal assisted sublingual approach for totally endoscopic thyroidectomy was simulated on 5 embalmed adult cadavers. The sublingual observed access was located in the middle of sublingual region. The geniohyoid muscle, mylohyoid seam, and submental triangle were divided in turn in the middle to reach the plane under the plastima muscles. Superficial cervical fascia, anterior body of hyoid bone, and infrahyoid muscles were passed in sequence to reach thyroid gland surgical region. The transtracheal operational access was placed from the cavitas oris propria, isthmus faucium, subepiglottic region, laryngeal pharynx, and intermediate laryngeal cavit, and then passed from the top down in order to reach pars cervicalis tracheae where a sagittal incision was made in the anterior wall of cartilagines tracheales to reach a ascertained surgical region. Transtracheal assisted sublingual approach to totally endoscopic thyroidectomy is anatomically feasible and safe and can be useful in thyroid gland surgery.

Surgical approach to TIR3 cytology class A prospective evaluation.

PubMed

D'Alessandro, Nicola; Fasano, Giovanni Michele; Gilio, Francesco; Iside, Giovanni; Izzo, Maria Lucia; Loffredo, Andrea; Pinto, Margherita; Tramontano, Salvatore; Tramutola, Giuseppe; Citro, Giuseppe

2014-01-01

Fine-needle aspiration (FNA) has proven to be a safe and reliable method of investigation of thyroid lesions. Referencing to European classification, the associated risk of malignancy for TIR3, category reserved for aspirates that contain architectural and/or nuclear atypia, is variable in such studies. Aims of study were evaluating safety of surgical approach, assessing perioperative parameters surgically related, and estimating neoplastic rate for TIR3 group. A prospective evaluation of all TIR3 submitted to thyroidectomy was conducted by assessing histopatohologic results between January 2005 and December 2012, considering two categories, positive (neoplastic) and negative (not neoplastic) group. Intraoperative and complication rate was analyzed on TIR3 population. A total of 1514 total thyroidectomy was performed from 2005 to 2012: a total of 148 cases was considered on TIR3 group. Positive cases amounted to 64 (43.2%), 29 of which were carcinoma (19.6% of total population) and 35 of which were adenoma, while negative cases amounted to 84 (56.8%). Sensitivity and specificity of TIR3 as neoplastic screening was 43.2% and 82.1%. A total of 32 linfectomies was performed (21.6% of group). Positive group presented a significant lower mean age than negative group (42.1 vs 56.2 years) TIR3 group represents a various category, with probably different malignancy risk. Our results and neoplasms rate confirmed that surgical option should be gold standard, in order to define atypical pattern and reduce delayed diagnoses. Choice of a second FNA or a imaging monitoring should be adopted for specific condition. Fine-needle aspiration, Thyroidectomy, TIR3, Thyroid cancer.

Two-stage thyroidectomy in the era of intraoperative neuromonitoring

PubMed Central

Papandrikos, Ioannis; Polyzois, Georgios; Roukounakis, Nikolaos; Dionigi, Gianlorenzo; Vamvakidis, Kyriakos

2017-01-01

Background The use of intraoperative neuromonitoring (IONM) provides surgeons with real time information about recurrent laryngeal nerves (RLN) functional integrity. Hence, allowing them to modify the initially scheduled bilateral procedure, to a two-stage thyroidectomy in cases of loss of signal (LOS) on the first side of resection resulting in minimization of bilateral RLN injury. The purpose of our study was to present our results since the implementation of the above mentioned process in both malignant and benign thyroid disease. Methods We conducted a retrospective, observational cohort study of prospectively collected data from all patients who underwent a scheduled total thyroidectomy with or without neck dissection in our Department over the last 4 years [2013–2016]. From the 1,138 patients who received surgical treatment during that period, 284 were excluded since they did not meet the criteria. Exclusion criteria involved previous neck operation, parathyroid surgery, pre-existing vocal cord palsy (VCP) and unilateral surgery. A total of 854 patients were eligible for our study. All patients were subjected to pre- and postoperative indirect laryngoscopy by the same experienced ENT specialist team and all the surgeries were performed by the same experienced team. The whole procedure followed the International Neural Monitoring Study Group’s (INMSG) Guideline Statement. Results We experienced 70 cases (70/854, 8.2%) with postoperative VCP. Two of them (0.23%) had permanent VCP and the rest of those patients (7.97%) experienced transient VCP. Twenty-three (2.7%) patients were candidates for staged thyroidectomy after LOS on the first side of resection, including ten patients with papillary or medullary thyroid carcinoma and one with toxic multinodular goiter (MNG). Of those patients, 22 incidents of VCP (95.7%) have recovered within two months and one of them persisted for more than six months (permanent VCP). We did not experience any permanent bilateral RLN palsy after the implementation of the staged procedure. Conclusions Staged thyroidectomy seems a very attractive and promising procedure for both patient and surgeon, since it nearly eliminates one of the most fearful complications in thyroid surgery. We suggest staged thyroidectomy in all cases with first side of resection signal loss, even in malignancies, since the benefits are much more than the disabilities in a patient’s morbidity and quality of life. PMID:29142834

Impact of autofluorescence-based identification of parathyroids during total thyroidectomy on postoperative hypocalcemia: a before and after controlled study.

PubMed

Benmiloud, Fares; Rebaudet, Stanislas; Varoquaux, Arthur; Penaranda, Guillaume; Bannier, Marie; Denizot, Anne

2018-01-01

The clinical impact of intraoperative autofluorescence-based identification of parathyroids using a near-infrared camera remains unknown. In a before and after controlled study, we compared all patients who underwent total thyroidectomy by the same surgeon during Period 1 (January 2015 to January 2016) without near-infrared (near-infrared- group) and those operated on during Period 2 (February 2016 to September 2016) using a near-infrared camera (near-infrared+ group). In parallel, we also compared all patients who underwent surgery without near-infrared during those same periods by another surgeon in the same unit (control groups). Main outcomes included postoperative hypocalcemia, parathyroid identification, autotransplantation, and inadvertent resection. The near-infrared+ group displayed significantly lower postoperative hypocalcemia rates (5.2%) than the near-infrared- group (20.9%; P < .001). Compared with the near-infrared- patients, the near-infrared+ group exhibited an increased mean number of identified parathyroids and reduced parathyroid autotransplantation rates, although no difference was observed in inadvertent resection rates. Parathyroids were identified via near-infrared before they were visualized by the surgeon in 68% patients. In the control groups, parathyroid identification improved significantly from Period 1 to Period 2, although autotransplantation, inadvertent resection and postoperative hypocalcemia rates did not differ. Near-infrared use during total thyroidectomy significantly reduced postoperative hypocalcemia, improved parathyroid identification and reduced their autotransplantation rate. Copyright © 2017 Elsevier Inc. All rights reserved.

Hypothyroidism and hyponatremia: data from a series of patients with iatrogenic acute hypothyroidism undergoing radioactive iodine therapy after total thyroidectomy for thyroid cancer.

PubMed

Vannucci, L; Parenti, G; Simontacchi, G; Rastrelli, G; Giuliani, C; Ognibene, A; Peri, A

2017-01-01

The aim of the present study was to evaluate the role of hypothyroidism as a cause of hyponatremia in a clinical model of iatrogenic acute hypothyroidism due to thyroid hormone withdrawal prior to ablative radioactive iodine (RAI) therapy after total thyroidectomy. The study group consisted of 101 differentiated thyroid cancer (DTC) patients (77 women and 24 men). Plasma concentration of thyroid-stimulating hormone ([TSH]) and sodium ([Na + ]) was evaluated before total thyroidectomy (pre[TSH] and pre[Na + ]) and on the day of RAI therapy (post[TSH] and post[Na + ]). The frequency of hypothyroidism-associated hyponatremia was 4 % (4/101). Pre[Na + ] was significantly higher than post[Na + ] (140.7 ± 1.6 vs 138.7 ± 2.3 mEq/L, p = 0.012). Moreover, a linear correlation was identified between pre[Na + ] and post[Na + ]. Iatrogenic acute hypothyroidism-related hyponatremia is uncommon. However, because of the significant reduction of [Na + ] in the transition from euthyroidism to iatrogenic hypothyroidism, the value of pre[Na + ] should be viewed as a parameter to be considered. Since it acts as an independent risk factor for the development of hyponatremia, patients with a pre[Na + ] close to the lower limit of normal range may deserve a closer monitoring of [Na + ].

The estimation of the thyroid volume before surgery--an important prerequisite for minimally invasive thyroidectomy.

PubMed

Ruggieri, M; Fumarola, A; Straniero, A; Maiuolo, A; Coletta, I; Veltri, A; Di Fiore, A; Trimboli, P; Gargiulo, P; Genderini, M; D'Armiento, M

2008-09-01

Actually, thyroid volume >25 ml, obtained by preoperative ultrasound evaluation, is a very important exclusion criteria for minimally invasive thyroidectomy. So far, among different imaging techniques, two-dimensional ultrasonography has become the more accepted method for the assessment of thyroid volume (US-TV). The aims of this study were: (1) to estimate the preoperative thyroid volume in patients undergoing minimally invasive total thyroidectomy using a mathematical formula and (2) to verify its validity by comparing it with the postsurgical TV (PS-TV). In 53 patients who underwent minimally invasive total thyroidectomy (from January 2003 to December 2007), US-TV, obtained by ellipsoid volume formula, was compared to PS-TV determined by the Archimedes' principle. A mathematical formula able to predict the TV from the US-TV was applied in 34 cases in the last 2 years. Mean US-TV (14.4 +/- 5.9 ml) was significantly lower than mean PS-TV (21.7 +/- 10.3 ml). This underestimation was related to gland multinodularity and/or nodular involvement of the isthmus. A mathematical formula to reduce US-TV underestimation and predict the real TV was developed using a linear model. Mean predicted TV (16.8 +/- 3.7 ml) perfectly matched mean PS-TV, underestimating PS-TV in 19% of cases. We verified the accuracy of this mathematical model in patients' eligibility for minimally invasive total thyroidectomy, and we demonstrated that a predicted TV <25 ml was confirmed post-surgery in 94% of cases. We demonstrated that using a linear model, it is possible to predict from US the PS-TV with high accuracy. In fact, the mean predicted TV perfectly matched the mean PS-TV in all cases. In particular, the percentage of cases in which the predicted TV perfectly matched the PS-TV increases from 23%, estimated by US, to 43%. Moreover, the percentage of TV underestimation was reduced from 77% to 19%, as well as the range of the disagreement from up to 200% to 80%. This study shows that two-dimensional US can provide the accurate estimation of thyroid volume but that it can be improved by a mathematical model. This may contribute to a more appropriate surgical management of thyroid diseases.

Comparison of Bilateral Axillo-Breast Approach Robotic Thyroidectomy with Open Thyroidectomy for Graves' Disease.

PubMed

Kwon, Hyungju; Yi, Jin Wook; Song, Ra-Yeong; Chai, Young Jun; Kim, Su-jin; Choi, June Young; Lee, Kyu Eun

2016-03-01

There is an ongoing debate about whether robotic thyroidectomy (RT) is appropriate for Graves' disease. The aim of this study was to compare the safety of bilateral axillo-breast approach (BABA) RT with that of open thyroidectomy (OT) in patients with Graves' disease. From January 2008 to June 2014, 189 (44 BABA RT and 145 OT) patients underwent total thyroidectomy for Graves' disease. Recurrence of Graves' disease, intraoperative blood loss, hospital stay, and complication rates including recurrent laryngeal nerve (RLN) palsy and hypoparathyroidism were analyzed between BABA RT and OT groups, after propensity score matching according to age, gender, body mass index, surgical indication, the extent of operation, excised thyroid weight, and follow-up period. No patient experienced recurrence of Graves' disease after median follow-up of 35.0 months. Intraoperative blood loss (151.8 ± 165.4 mL vs. 134.5 ± 75.4 mL; p = 0.534) and hospital stay (3.4 ± 0.7 day vs. 3.3 ± 0.7 day; p = 0.564) were not different between BABA RT and OT groups. Complication rates including transient RLN palsy (11.4 vs. 11.4%; p = 1.000), transient hypoparathyroidism (18.2 vs. 20.5%; p = 0.787), permanent RLN palsy (0 vs. 2.3%; p = 0.315), and permanent hypoparathyroidism (2.3 vs. 2.3%; p = 1.000) were also comparable between groups. BABA RT for Graves' disease showed comparable surgical completeness and complications to conventional OT. BABA RT can be recommended as an alternative surgical option for patients with Graves' disease who are concerned about cosmesis.

[Surgical assessment of complications after thyroid gland operations].

PubMed

Dralle, H

2015-01-01

The extent, magnitude and technical equipment used for thyroid surgery has changed considerably in Germany during the last decade. The number of thyroidectomies due to benign goiter have decreased while the extent of thyroidectomy, nowadays preferentially total thyroidectomy, has increased. Due to an increased awareness of surgical complications the number of malpractice claims is increasing. In contrast to surgical databases the frequency of complications in malpractice claims reflects the individual impact of complications on the quality of life. In contrast to surgical databases unilateral and bilateral vocal fold palsy are therefore at the forefront of malpractice claims. As guidelines are often not applicable for the individual surgical expert review, the question arises which are the relevant criteria for the professional expert witness assessing the severity of the individual complication. While in surgical databases major complications after thyroidectomy, such as vocal fold palsy, hypoparathyroidism, hemorrhage and infections are equally frequent (1-3 %), in malpractice claims vocal fold palsy is significantly more frequent (50 %) compared to hypoparathyroidism (15 %), hemorrhage and infections (about 5 % each). To avoid bilateral nerve palsy intraoperative nerve monitoring has become of utmost importance for surgical strategy and malpractice suits alike. For surgical expert review documentation of individual risk-oriented indications, the surgical approach and postoperative management are highly important. Guidelines only define the treatment corridors of good clinical practice. Surgical expert reviews in malpractice suits concerning quality of care and causality between surgical management, complications and sequelae of complications are therefore highly dependent on the grounds and documentation of risk-oriented indications for thyroidectomy, intraoperative and postoperative surgical management.

The Role of Magnesium in Post-thyroidectomy Hypocalcemia.

PubMed

Cherian, Anish Jacob; Gowri, Mahasampath; Ramakant, Pooja; Paul, Thomas V; Abraham, Deepak Thomas; Paul, Mazhuvanchary Jacob

2016-04-01

The purpose of this study was to determine the prevalence of hypomagnesemia in patients undergoing thyroidectomy and evaluate the relationship of hypomagnesemia with transient and severe hypocalcemia. This was a prospective observational study of 50 patients undergoing thyroidectomy. Blood samples were collected pre- and postoperatively for calcium, albumin, magnesium, phosphorous and parathormone (PTH). Signs, symptoms of hypocalcemia and volume of intravenous fluids used perioperatively were documented. The statistical analysis was performed using STATA I/C 10.1. Preoperatively, twelve patients (24 %) had hypomagnesemia and one (2 %) hypocalcemia. On the first postoperative day, hypomagnesemia was seen in 70 % and hypocalcemia in 30 %. A similar trend was observed in the fall and rise of postoperative calcium and magnesium values (p = 0.41). Severe hypocalcemia was present in three patients (6 %). All three patients had a very low postoperative PTH (<2 pg/ml). Among them, two patients (66 %) had hypomagnesemia and their hypocalcemia responded to intravenous magnesium correction. Significant risk factors for postoperative hypocalcemia include a higher volume of fluid used perioperatively and low postoperative PTH (<8 pg/ml) (p = 0.01 and 0.03, respectively). Preoperative hypomagnesemia (24 %) was prevalent in this cohort of patients. Postoperative hypomagnesemia is a common event (70 %) following total thyroidectomy, and magnesium levels tend to mimic the calcium levels postoperatively. The cause of hypocalcemia post-thyroidectomy in this study is mainly a factor of parathyroid function and fluid status. Severe hypocalcemia is a rare event, and hypomagnesemia is associated in the majority of these patients. The role of magnesium correction to alleviate severe hypocalcemia needs to be further studied.

Thyroid surgery at a volunteer program in Sub-Saharan Africa.

PubMed

Pereira Pérez, Fernando; Calvo Espino, Pablo; Sánchez Arteaga, Alejandro; Muñoz Rodriguez, Joaquín Manuel; Nges, Lionel W; Kemmoe, Mireille; Vidal Fernández, Mercedes; Blázquez, Francisco Javier; Vives Espejo-Saavedra, Teresa; Picón Maroñas, Marina; Varela de Ugarte, Andrés

2016-01-01

The aim of this study is to demonstrate our experience at a volunteer surgical program in Cameroon, which is of special interest given to the inability to adopt international treatment guidelines for thyroid surgery in areas of limited resources due to the lack of preoperative testing and to the difficulty to obtain sustitutive hormonal treatment. This is a prospective observational study that includes 16 cases of thyroid surgery in Dschang (Cameroon) during June 2015. The patients were previously selected by a local medical team. All patients were black, 15 women and one man, with a mean age of 41 years. The surgical technique used for the removal of unilateral disease was hemithyroidectomy with isthmectomy and bilateral subtotal thyroidectomy for bilateral disease. Five subtotal thyroidectomies, 9hemithyroidectomies and 2isthmectomies were performed. Prethyroid muscles were divided only in one case. We visualized 86% of the parathyroid glands and 84% of the recurrent laryngeal nerves. The main complications observed were one symptomatic cervical haematoma that required reoperation and 2surgical wound infections. There were no clinical episodes of hypocalemia or recurrent nerve lesion. The mean length of stay was 2.3 days. At follow-up, all bilateral thyroidectomies developed high TSH levels. Thyroid surgery is safe in developing countries adopting protocols and techniques we use in our environment (avoiding total thyroidectomy). Bilateral thyroidectomies should not be performed unless functional studies are available in the follow-up and a thyroid hormone supplement stock guaranteed whenever necessary. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Role of Postoperative Vitamin D and/or Calcium Routine Supplementation in Preventing Hypocalcemia After Thyroidectomy: A Systematic Review and Meta-Analysis

PubMed Central

Alhefdhi, Amal; Mazeh, Haggi

2013-01-01

Background. Transient hypocalcemia is a frequent complication after total thyroidectomy. Routine postoperative administration of vitamin D and calcium can reduce the incidence of symptomatic postoperative hypocalcemia. We performed a systematic review to assess the effectiveness of this intervention. The primary aim was to evaluate the efficacy of routine postoperative oral calcium and vitamin D supplementation in preventing symptomatic post-thyroidectomy hypocalcemia. The second aim was to draw clear guidelines regarding prophylactic calcium and/or vitamin D therapy for patients after thyroidectomy. Methods. We identified randomized controlled trials comparing the administration of vitamin D or its metabolites to calcium or no treatment in adult patients after thyroidectomy. The search was performed in PubMed, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Google Scholar, and Web of Knowledge databases. Patients with a history of previous neck surgery, calcium supplementation, or renal impairment were excluded. Results. Nine studies with 2,285 patients were included: 22 in the vitamin D group, 580 in the calcium group, 792 in the vitamin D and calcium group, and 891 in the no intervention group, with symptomatic hypocalcemia incidences of 4.6%, 14%, 14%, and 20.5%, respectively. Subcomparisons demonstrated that the incidences of postoperative hypocalcemia were 10.1% versus 18.8% for calcium versus no intervention and 6.8% versus 25.9% for vitamin D and calcium versus no intervention. The studies showed a significant range of variability in patients' characteristics. Conclusions. A significant decrease in postoperative hypocalcemia was identified in patients who received routine supplementation of oral calcium or vitamin D. The incidence decreased even more with the combined administration of both supplements. Based on this analysis, we recommend oral calcium for all patients following thyroidectomy, with the addition of vitamin D for high-risk individuals. PMID:23635556

Validation of 1-hour post-thyroidectomy parathyroid hormone level in predicting hypocalcemia

PubMed Central

2014-01-01

Background Prior work by our group suggested that a single one hour post-thyroidectomy parathyroid hormone (1 hr PTH) level could accurately stratify patients into high and low risk groups for the development of hypocalcemia. This study looks to validate the safety and efficacy of a protocol based on a 1 hr PTH threshold of 12 pg/ml. Study design Retrospective analysis of consecutive cohort treated with standardized protocol. Methods One hundred and twenty five consecutive patients underwent total or completion thyroidectomy and their PTH level was drawn 1-hour post operatively. Based on our previous work, patients were stratified into either a low risk group (PTH < 12 pg/ml) or a high risk group (PTH ≥ 12 pg/ml). Patients in the high risk group were immediately started on prophylactic calcium carbonate (5–10 g/d) and calcitriol (0.5-1.0 mcg/d). The outcomes were then reviewed focusing mainly on how many low risk patients developed hypocalcemia (false negative rate), and how many high risk patients failed prophylactic therapy. Results Thirty one patients (25%) were stratified as high risk, and 94 (75%) as low risk. Five (16%) of the high risk patients became hypocalcemic despite prophylactic therapy. Two of the low risk group became hypocalcemic, (negative predictive value = 98%). None of the hypocalcemic patients had anything more than mild symptoms. Conclusions A single 1-hour post-thyroidectomy PTH level is a very useful way to stratify thyroidectomy patients into high and low risk groups for development of hypocalcemia. Early implementation of oral prophylactic calcium and vitamin D in the high risk patients is a very effective way to prevent serious hypocalcemia. Complex protocols requiring multiple calcium and PTH measurements are not required to guide post-thyroidectomy management. PMID:24476535

The use of tibial tuberosity-trochlear groove indices based on joint size in lower limb evaluation.

PubMed

Ferlic, Peter Wilhelm; Runer, Armin; Dirisamer, Florian; Balcarek, Peter; Giesinger, Johannes; Biedermann, Rainer; Liebensteiner, Michael Christian

2018-05-01

The correlation between tibial tuberosity-trochlear groove distance (TT-TG) and joint size, taking into account several different parameters of knee joint size as well as lower limb dimensions, is evaluated in order to assess whether TT-TG indices should be used in instead of absolute TT-TG values. This study comprised a retrospective analysis of knee CT scans, including 36 cases with patellofemoral instability (PFI) and 30 controls. Besides TT-TG, five measures of knee joint size were evaluated in axial CT slices: medio-lateral femur width, antero-posterior lateral condylar height, medio-lateral width of the tibia, width of the patella and the proximal-distal joint size (TT-TE). Furthermore, the length of the femur, the tibia and the total leg length were measured in the CT scanogram. Correlation analysis of TT-TG and the other parameters was done by calculating the Spearman correlation coefficient. In the PFI group lateral condylar height (r = 0.370), tibia width (r = 0.406) and patella width (r = 0.366) showed significant moderate correlations (p < 0.03) with TT-TG. Furthermore, we found a significant correlation between TT-TG and tibia length (r = 0.371) and total leg length (r = 381). The control group showed no significant correlation between TT-TG and knee joint size or between TT-TG and measures of lower limb length. Tibial tuberosity-trochlear groove distance correlates with several parameters of knee joint size and leg length in patients with patellofemoral instability. Application of indices determining TT-TG as a ratio of joint size could be helpful in establishing the indication for medial transfer of the tibial tuberosity in patients with PFI. Level III.

Impact of preoperative Vitamin D3 administration on postoperative hypocalcaemia in patients undergoing total thyroidectomy (HypoCalViD): study protocol for a randomized controlled trial.

PubMed

Wolak, Stefanie; Scheunchen, Mandy; Holzer, Katharina; Busch, Mirjam; Trumpf, Esra; Zielke, Andreas

2016-02-20

Total thyroidectomy is increasingly used as a surgical approach for many thyroid conditions. Subsequently, postoperative hypocalcaemia is observed with increasing frequency, often resulting in prolonged hospital stay, increased use of resources, reduced quality of life and delayed return to work. The administration of vitamin D is essential in the therapy of postoperative hypocalcaemia; calcitriol is most commonly used. What has not been examined so far is whether and how routine preoperative vitamin D prophylaxis using calcitriol can help to prevent postoperative hypocalcaemia. This study evaluates routine preoperative calcitriol prophylaxis for all patients who are to undergo a total thyroidectomy, compared with the current standard of post-treatment, i.e., selective vitamin D treatment for patients with postoperative hypocalcaemia. This clinical observational (minimal interventional clinical trial) trial is a multicentre, prospective, randomized superiority trial with an adaptive design. Datasets will be pseudonymized for analysis. Patients will be randomly allocated (1:1) to the intervention and the control groups. The only intervention is 0.5 μg calcitriol orally twice a day for 3 days prior to surgery. For the primary endpoint measure (number of patients with hypocalcaemia), hypocalcaemia is defined as serum calcium of less than 2.1 mmol/l on any day during the postoperative course; this measure will be analyzed using a Chi-square test comparing the two groups. Secondary endpoint measures, such as number of days to discharge, quality of life, and economic parameters will also be analyzed. By virtue of the direct comparison of clinically and economically relevant endpoints, the efficacy as well as efficiency of preoperative calcitriol prophylaxis of hypocalcaemia will be clarified. These results should be available 24 months after the first patient has been enrolled. The results will be used to inform a revised practice parameter guideline of whether or not to recommend preoperative calcitriol for all patients in whom total thyroidectomy is planned. Deutsches Register Klinischer Studien, DRKS00005615 (Feb.12.2016).

Prognostic value of total testosterone for pregnancy during treatment in patients with clomiphene-citrate-resistant polycystic ovary syndrome: a pilot study.

PubMed

Li, Chunyang; Cheng, Jing; Wang, Jianguang; Xue, Yamei; Huang, Zhaoxia; Zhang, Shengkun; Lv, Jieqiang

2011-09-01

Reduction of serum total testosterone (TT) is associated with pregnancy rate in polycystic ovary syndrome (PCOS) women receiving metformin, but most of the studies focus on the changes of basal levels of TT. The aim of this study was to evaluate whether the TT level around the ovulation period is related to the outcome of pregnancy in women with PCOS. In total, 30 non-obese PCOS women with clomiphene citrate (CC) resistance from the Medical College's Reproductive Health Center were enrolled and randomly assigned to be treated with placebo (Group 1) or metformin (850 mg) (Group 2) twice daily for 3 months as the pre-treatment. Then, metformin alone was administered with CC, human menopausal gonadotropin (HMG) and human chorionic gonadotropin (HCG) to induce ovulation for 3 months in Group 1. In Group 2, CC/HMG/HCG was used to induce ovulation for 3 months without metformin. Follicle-stimulating hormone, luteinizing hormone, estradiol and TT levels before and after ovulation in pregnant cycles and non-pregnant cycles were evaluated over the course of treatment. A total of 26 subjects completed 65 cycles. The TT levels after ovulation in the pregnant cycles were significantly lower than in the non-pregnant cycles in both groups (P = 0.001 and P < 0.001, respectively). The level of TT after ovulation may be of prognostic value for pregnancy in non-obese women with PCOS and CC resistance during treatment.

Results of early thyroidectomy for medullary thyroid carcinoma in children with multiple endocrine neoplasia type 2.

PubMed

Telander, R L; Zimmerman, D; van Heerden, J A; Sizemore, G W

1986-12-01

Children with multiple endocrine neoplasia type 2 (MEN2) often develop medullary carcinoma of the thyroid (MCT) or its precursor, C-cell hyperplasia. Survival results are improved if malignancy is diagnosed early from the results of plasma immunoreactive calcitonin (iCT) measurement. The effect of early detection and thyroidectomy in children with MEN2 syndrome was determined by reviewing the experience between 1975 and 1985. Seventeen children with MEN2 who were 12 years old or younger underwent a total thyroidectomy for MCT or C-cell hyperplasia. iCT was measured in all patients preoperatively and postoperatively. Of the 17 children, 14 (82%) had MEN2a and 3 (18%) had MEN2b. There were 14 (82%) female and three (18%) male patients; their mean age was 6.97 years (range 1.5 to 12 years). In all patients, the diagnosis of MCT was made from initial elevated levels of iCT after stimulation with pentagastrin. Three patients had clinical evidence of disease preoperatively. All patients underwent a total thyroidectomy and lymph nodes were removed from the central zone; a neck dissection was performed in the three with clinically obvious disease. MCT with C-cell hyperplasia was found in 11 children and C-cell hyperplasia alone in six. Of the 11 with carcinoma, eight had bilateral disease and three unilateral. Six children had bilateral C-cell hyperplasia. All 17 children were alive and feeling well at the time of this report; however, three had evidence of metastatic disease according to iCT measurements. None of the children had recurrent nerve injuries; one had evidence of hypoparathyroidism.(ABSTRACT TRUNCATED AT 250 WORDS)

Post-thyroidectomy hypocalcemia: Impact on length of stay.

PubMed

Grainger, Joe; Ahmed, Mohammed; Gama, Rousseau; Liew, Leonard; Buch, Harit; Cullen, Ronald J

2015-07-01

Hypocalcemia is a recognized complication following thyroid surgery. Variability in the definition of hypocalcemia and different opinions on its management can lead to unnecessary patient morbidity and longer hospital stays as a result of inappropriate or untimely treatment. Therefore, we developed a management guideline for the recognition and treatment of post-thyroidectomy hypocalcemia, and we conducted a retrospective study to assess its impact on length of stay (LOS). Between April 1, 2007, and March 31, 2009, 29 adults had undergone a total or completion thyroidectomy at our large district general hospital. Of this group, postoperative hypocalcemia (defined as a serum calcium level of <2.00 mmol/L) developed in 13 patients (44.8%) during the first 3 postoperative days. Our guideline went into effect on July 1, 2009, and from that date through June 30, 2010, 18 more adults had undergone a total or completion thyroidectomy. Of that group, hypocalcemia developed in 7 patients (38.9%); the guideline was actually followed in 5 of these 7 cases (71.4%). In the preguideline group, the development of hypocalcemia increased the mean LOS from 2.0 days to 7.0 days (p < 0.001). The management of postoperative hypocalcemia in these cases was highly variable and was dictated by variations in practice rather than patient needs. In the postguideline group, postoperative hypocalcemia increased the mean LOS from 2.7 days to only 3.7 days (p = 0.07). While the difference between LOS in the two hypocalcemic groups did not reach statistical significance, we believe it merely reflects the relatively small number of patients rather than any lack of guideline efficacy. The implementation of a simple flowchart guideline for the management of postoperative hypocalcemia in our hospital has resulted in more uniform management and a reduced LOS.

Short-stay Sutureless Thyroidectomy is Safe and Effective: Cerrahpasa Experience.

PubMed

Arikan, Akif Enes; Teksoz, Serkan; Bukey, Yusuf; Ferahman, Sina; Ozcan, Murat; Ozgultekin, Recep; Ozyegin, Ates

2014-11-01

Hospitalizing patients up to 72 hours after thyroidectomy is a classical approach. However, the length of hospitalization has decreased following surgical procedures with new technological devices. Seven hundred one consecutive patients who underwent sutureless total thyroidectomy (STT) between October 2011 and 2013 were included in this study. Six hundred seventy-two (95.9%) were discharged before 24 hours following surgery (short-stay = SS), and 29 were discharged later (delayed-discharge = DD). This study aims to assess short-stay STT with early postoperative complications and readmission to hospital. One hundred forty-three SS patients were male and 529 were female. Mean age was 48 ± 13 years, BMI was 28.7 ± 8.3 kg/m2. Mean hospital stay for SS was 18.13 ± 1.97 (17-23) hours. Histopathology was benign in 443 (65.92%) and malignant in 229 (34.08%) in the SS group. In three (0.4%) of the SS group drainage was required because of hematoma, and in seven (1%) wound infection was observed. One hundred seven (7.9%) [permanent = 7 (0.52%)] of 1344 recurrent laryngeal nerves (RLNs) in SS were seen paralyzed in postoperative vocal cord examination. Hypocalcemia (all transient) was observed in 52 (7.74%) of the SS group. Eight of those 52 readmitted to hospital with symptomatic hypocalcemia and were treated as outpatients. There was no mortality. Of the DD group, two stayed in the intensive care unit, two had dysphonia, two had hematoma with anti-coagulant use, one had fever, four did not tolerate diet, five refused discharge, and 13 had symptomatic hypocalcemia. Sutureless total thyroidectomy can be performed safely and effectively as short-stay surgery.

[Serum PTH levels as a predictive factor of hypocalcaemia after total thyroidectomy].

PubMed

Díez Alonso, Manuel; Sánchez López, José Daniel; Sánchez-Seco Peña, María Isabel; Ratia Jiménez, Tomás; Arribas Gómez, Ignacio; Rodríguez Pascual, Angel; Martín-Duce, Antonio; Guadalix Hidalgo, Gregorio; Hernández Domínguez, Sara; Granell Vicent, Javier

2009-02-01

Postoperative parathyroid hormone (PTH) levels as a predictor of hypocalcaemia in patients subjected to total thyroidectomy is analyzed. Prospective study involving 67 patients who underwent total thyroidectomy due to a benign disease. Serum PTH and ionised calcium were measured 20 h after surgery. Sensitivity, specificity and predictive values of PTH and ionised calcium levels were calculated to predict clinical and analytical hypocalcaemia. A total of 42 (62.7%) patients developed hypocalcaemia (ionised calcium<0.95 mmol/l), but only 20 (29.9%) presented with symptoms. PTH concentration the day after surgery was significantly lower in the group that developed symptomatic hypocalcaemia (5.57+/-6.4 pg/ml) than in the asymptomatic (21.5+/-15.3 pg/ml) or normocalcaemic (26.8+/-24.9 pg/ml) groups (p=0.001). Taking the value of 13 pg/ml as a cut-off point of PTH levels, sensitivity, specificity, positive predictive value and negative predictive value were 54%, 72%, 76% and 48%, respectively. On the other hand, sensitivity for predicting symptomatic hypocalcaemia was 95% and specificity was 76%. The test showed a high incidence of false positives (11/30, 36%). Negative predictive value was 97% and positive predictive value was 65%. In multivariate analysis, PTH and ionised calcium were the only perioperative factors that showed an independent predictive value as risk indicators of symptomatic hypocalcaemia. Normal PTH levels 20 h after surgery practically rule out the subsequent appearance of hypocalcaemia symptoms. On the other hand, low PTH levels are not necessarily associated to symptomatic hypocalcaemia due to the high number of false positives.

A case of metastatic follicular thyroid carcinoma complicated with Graves' disease after total thyroidectomy.

PubMed

Aoyama, Mariko; Takizawa, Hiromitsu; Tsuboi, Mitsuhiro; Nakagawa, Yasushi; Tangoku, Akira

2017-12-28

Thyroid cancer and Graves' disease may present simultaneously in one patient. The incidence of the development of hyperthyroidism from metastatic differentiated thyroid carcinoma is rare. We herein report a case of metastatic follicular carcinoma complicated with Graves' disease after total thyroidectomy. A 57-year-old woman underwent right hemithyroidectomy for follicular carcinoma. Metastatic lesions appeared in the lungs and skull two years after the first surgery, and remnant thyroidectomy was performed for radioactive iodine-131 (RAI) therapy, during which the TSH receptor antibody (TRAb) was found to be negative. The patient was treated with RAI therapy four times for four years and was receiving levothyroxine suppressive therapy. Although radioiodine uptake was observed in the lesions after the fourth course of RAI therapy, metastatic lesions had progressed. Four years after the second surgery, she had heart palpitations and tremors. Laboratory data revealed hyperthyroidism and positive TRAb. She was diagnosed with Graves' disease and received a fifth course of RAI therapy. 131I scintigraphy after RAI therapy showed strong radioiodine uptake in the metastatic lesions. As a result, the sizes and numbers of metastatic lesions decreased, and thyroid function improved. Metastatic lesions produced thyroid hormone and caused hyperthyroidism. RAI therapy was effective for Graves' disease and thyroid carcinoma.

[Surgical Diagnosis and Treatment of Primary Hyperthyroidism Complicated with Occult Thyroid Carcinoma].

PubMed

Wu, Xin; Yu, Jian-chun; Kang, Wei-ming; Ma, Zhi-qiang; Ye, Xin

2015-08-01

To evaluate the surgical diagnosis and treatment of primary hyperthyroidism complicated with occult thyroid carcinoma. Data of 51 cases of primary hyperthyroidism complicated with occult thyroid carcinoma admitted during January 2004 to November 2014 were analyzed retrospectively. The incidence of occult thyroid carcinoma was 5.03% in hyperthyroidism,and 47 cases (92.16%) were female. The preoperative diagnosis of all these 51 cases was primary hyperthyroidism and 11 cases were diagnosed thyroid carcinoma at the same time;25 cases were diagnosed thyroid carcinoma by frozen section and the remaining 26 cases were diagnosed by postoperative pathology. Finally,26 cases underwent subtotal thyroidectomy,4 cases underwent total thyroidectomy, and 21 cases underwent total thyroidectomy with lymphadenectomy. The tumor size ranged from 0.1 to 1.0 cm [mean:(0.63 ± 0.35) cm]. The lesions were less than or equal to 0.5 cm in 28 cases (54.9%). The follow-up lasted from 1 to 121 months [mean:(28.6 ± 22.7)months] in 43 patients,and all of them survived. Primary hyperthyroidism complicated with occult thyroid carcinoma is commonly found in female patients. Preoperative diagnosis is difficult. Ultrasound is the major examining method. Frozen section can increase the detection rate. The postoperative prognosis of hyperthyroidism complicated with occult thyroid carcinoma is satisfactory.

Evaluation of Federal Aviation Administration Engine Exhaust Sampling Rake.

DTIC Science & Technology

1977-06-01

Engine exit total pressure - Pt7 " High turbine discharge temperature - Tt65,6 . Engine exit total temperature - Tt7 - Burner pressure - Ps4 0 Total...illustrated by Figure 22, a plot of Ps4 /Pt7 (expansion thru the turbine) vs. EPR (Pt7/Pt2). This plot indicates that the ECCP rake has no measurable effect on

Comparison of natural drainage group and negative drainage groups after total thyroidectomy: prospective randomized controlled study.

PubMed

Woo, Seung Hoon; Kim, Jin Pyeong; Park, Jung Je; Shim, Hyun Seok; Lee, Sang Ha; Lee, Ho Joong; Won, Seong Jun; Son, Hee Young; Kim, Rock Bum; Son, Young-Ik

2013-01-01

The aim of this study was to compare a negative pressure drain with a natural drain in order to determine whether a negative pressure drainage tube causes an increase in the drainage volume. Sixty-two patients who underwent total thyroidectomy for papillary thyroid carcinoma (PTC) were enrolled in the study between March 2010 and August 2010 at Gyeongsang National University Hospital. The patients were prospectively and randomly assigned to two groups, a negative pressure drainage group (n=32) and natural drainage group (n=30). Every 3 hours, the volume of drainage was checked in the two groups until the tube was removed. The amount of drainage during the first 24 hours postoperatively was 41.68 ± 3.93 mL in the negative drain group and 25.3 ± 2.68 mL in the natural drain group (p<0.001). After 24 additional hours, the negative drain group was 35.19 ± 4.26 mL and natural drain groups 21.53 ± 2.90 mL (p<0.001). However, the drainage at postoperative day 3 was not statistically different between the two groups. In addition, the vocal cord palsy and temporary and permanent hypocalcemia were not different between the two groups. These results indicate that a negative pressure drain may increase the amount of drainage during the first 24-48 hours postoperatively. Therefore, it is not necessary to place a closed suction drain when only a total thyroidectomy is done.

Limitation of intraoperative frozen section during thyroid surgery.

PubMed

Estebe, Sandrine; Montenat, Cecile; Tremoureux, Adrien; Rousseau, Chloé; Bouilloud, François; Jegoux, Franck

2017-03-01

Retrospective analysis on 312 patients, operated for thyroid nodules between 2014 and 2015, was conducted to evaluate the impact of frozen section analysis on the strategy of thyroid nodule surgery. One hundred and ninety-three patients were included. They all underwent preoperative US, fine needle aspiration cytology (FNAC), per operative frozen section (FS) and post operative definitive pathological analysis. Se, Sp, VPP and VPN of FNAC and FS were calculated and compared (McNemar's test). Multivariate analysis was performed to identify independent factor of good results. Se of FS and FNAC were, respectively, 86.1 and 81% with significant superiority of FS (p = .0352). Sp of FS and FNAC were, respectively, 100 and 72% with significant superiority of FS (p = .0156). A strategy based only on FNAC would have led to a 3.6% rate of unnecessary total thyroidectomy vs. 0% using FS. Overall rate of second procedure after lobectomy would have been significantly greater 28.9% without (28.9%) than with (10.3%) FS (p = .018). Overall rate of undone one-stage central neck dissection concurrent to total thyroidectomy for MNG would not have been significantly different without (9.4%) and with (2.1%) FS (.058). FNAC alone is unable to determine the extent of thyroid nodule surgery whatever the Bethesda subtype may be. FS significantly decreases the risk of two-stage procedure. For one-stage total thyroidectomy for MNG, the gain with FS is scarce.

The function of androgen/androgen receptor and insulin growth factor‑1/insulin growth factor‑1 receptor on the effects of Tribulus terrestris extracts in rats undergoing high intensity exercise.

PubMed

Wu, Yin; Yang, Hongfang; Wang, Xiaohui

2017-09-01

Our previous study demonstrated that treatment with Tribulus terrestris (TT) extracts (120 mg/kg) promoted the muscle weight gain and performance of rats undergoing high intensity exercise. The present study was designed to explore the mechanisms underlying the effect of treatment with TT extracts and the involvement of androgens, the androgen receptor (AR), insulin growth factor‑1 (IGF‑1) and the IGF‑1 receptor (IGF‑1R). A total of 32 Sprague‑Dawley rats were randomly divided into groups as follows: Control; TT, treated with TT extracts, E, high intensity exercise; E+TT, high intensity exercise plus TT treatment. The rats of the E and E+TT groups underwent high intensity exercise with a progressively increasing load for 5 weeks, and TT extracts were intragastrically administered in the TT and E+TT rats 30 min prior to training. TT extract composition was analyzed using ultra‑high performance liquid chromatography‑quadrupole‑time of flight mass spectrometry. Testosterone and IGF‑1 plasma levels and AR, IGF‑1R and myosin heavy chain (MHC) protein levels in muscles were determined by ELISA and western blotting, respectively. The saponins tigogenin and diosgenin comprised ~71.35% of the total peak area. Compared with the E group, TT extracts increased the testosterone and IGF‑1 plasma levels, and AR, IGF‑1R and MHC protein levels in the gastrocnemius of rats undergoing high intensity exercise, accompanied with increased body weight and gastrocnemius weight. In conclusion, the effect of TT extracts on the performance of high intensity exercise rats may be attributed to increased levels of circulating testosterone and IGF‑1 and increased AR and IGF‑1R protein expression levels in the gastrocnemius, resulting in increased muscle weight and increased MHC in the gastrocnemius. The present study provided preliminary evidence supporting the use of TT extracts as a dietary supplement for the promotion of skeletal muscle mass increase and the enhancement of athletic performance in humans performing high intensity exercise.

Total thyroidectomy with ultrasonic dissector for cancer: multicentric experience

PubMed Central

2012-01-01

Background We conducted an observational multicentric clinical study on a cohort of patients undergoing thyroidectomy for thyroid carcinoma. The aim of this study was to evaluate the benefits of the use of ultrasonic dissector (UAS) vs. the use of a conventional technique (vessel clamp and tie) in patients undergoing thyroid surgery for cancer. Methods From June 2009 to May 2010 we evaluated 321 consecutive patients electively admitted to undergo total thyroidectomy for thyroid carcinoma. The first 201 patients (89 males, 112 females) presenting to our Department underwent thyroidectomy with the use of UAS while the following 120 patients (54 males, 66 females) underwent thyroidectomy performed with a conventional technique (CT): vessel clamp and tie. Results The operative time (mean: 75 min in UAS vs. 113 min in CT, range: 54 to 120 min in UAS vs. 68 to 173 min in CT) was much shorter in the group of thyroidectomies performed with UAS. The incidence of transient laryngeal nerve palsy (UAS 3/201 patients (1.49%); CT 1/120 patients (0.83%)) was higher in the group of UAS; the incidence of permanent laryngeal nerve palsy was similar in the two groups (UAS 2/201 patients (0.99%) vs. CT 2/120 patients (1.66%)). The incidence of transient hypocalcaemia (UAS 17/201 patients (8.4%) vs. CT 9/120 patients (7.5%)) was higher in the UAS group; no relevant differences were reported in the incidence of permanent hypocalcaemia in the two groups (UAS 5/201 patients (2.48%) vs. 2/120 patients (1.66%)). Also the average postoperative length of stay was similar in two groups (2 days). Conclusion The only significant advantage proved by this study is represented by the cost-effectiveness (reduction of the usage of operating room) for patients treated with UAS, secondary to the significant reduction of the operative time. The analysis failed to show any advantages in terms of postoperative transient complications in the group of patients treated with ultrasonic dissector: transient laryngeal nerve palsy (1.49% in UAS vs. 0.83% in CT) and transient hypocalcaemia (8.4% in UAS vs. 7.5%in CT). No significant differences in the incidence of permanent laryngeal nerve palsy (0.8% in UAS vs. 1.04% in CT) and permanent hypocalcaemia (2.6% in UAS vs. 2.04% in CT) were demonstrated. The level of surgeons’ expertise is a central factor, which can influence the complications rate; the use of UAS can only help surgical action but cannot replace the experience of the operator. PMID:22540914

Speech therapy after thyroidectomy

PubMed Central

Wu, Che-Wei

2017-01-01

Common complaints of patients who have received thyroidectomy include dysphonia (voice dysfunction) and dysphagia (difficulty swallowing). One cause of these surgical outcomes is recurrent laryngeal nerve paralysis. Many studies have discussed the effectiveness of speech therapy (e.g., voice therapy and dysphagia therapy) for improving dysphonia and dysphagia, but not specifically in patients who have received thyroidectomy. Therefore, the aim of this paper was to discuss issues regarding speech therapy such as voice therapy and dysphagia for patients after thyroidectomy. Another aim was to review the literature on speech therapy for patients with recurrent laryngeal nerve paralysis after thyroidectomy. Databases used for the literature review in this study included, PubMed, MEDLINE, Academic Search Primer, ERIC, CINAHL Plus, and EBSCO. The articles retrieved by database searches were classified and screened for relevance by using EndNote. Of the 936 articles retrieved, 18 discussed “voice assessment and thyroidectomy”, 3 discussed “voice therapy and thyroidectomy”, and 11 discussed “surgical interventions for voice restoration after thyroidectomy”. Only 3 studies discussed topics related to “swallowing function assessment/treatment and thyroidectomy”. Although many studies have investigated voice changes and assessment methods in thyroidectomy patients, few recent studies have investigated speech therapy after thyroidectomy. Additionally, some studies have addressed dysphagia after thyroidectomy, but few have discussed assessment and treatment of dysphagia after thyroidectomy. PMID:29142841

Detection of erythrovirus B19 in thyroidectomy specimens from Graves' disease patients: a case-control study.

PubMed

Page, Cyril; Hoffmann, Thomas Walter; Benzerdjeb, Nassim; Duverlie, Gilles; Sevestre, Henri; Desailloud, Rachel

2013-08-01

Environmental factors, such as viruses, are thought to contribute to the development of thyroid autoimmunity. Erythrovirus B19 (EVB19) is suspected to be involved in Hashimoto's thyroiditis, but no direct evidence is available concerning the role of EVB19 infection in Graves' disease. The objective of this study was to investigate whether the presence of EVB19 is more frequent in thyroidectomy specimens of patients undergoing thyroidectomy for Graves' disease (cases) than for multinodular thyroid (controls). Serum and thyroidectomy specimens were prospectively collected from 64 patients referred for total thyroidectomy over a 5-year period (2007-2011) and were investigated retrospectively and blindly for circulating EVB19 DNA by q-PCR (Qiagen), and for EVB19 thyrocyte infection by immunochemistry (VP2-Antibody, Dako). EVB19 serology was also determined. General clinical and laboratory data were collected. Twenty patients were referred for Graves' disease and 44 patients were referred for non-autoimmune multinodular thyroid. Patients with thyroid cancer were excluded. Ten percent of Graves' disease patients and 27.7% of control patients had positive staining of thyrocytes for EVB19 antibodies (ns). EVB19-positive and EVB19-negative cases did not differ. EVB19-positive controls were older than EVB19-negative controls (mean age: 57.5 [35-74] vs. 45 [28-80] years, P=0.03) No case of acute EVB19 infection was identified. EVB19-positive serology was more frequent in controls than in Graves' disease patients (88% vs. 45%, P<0.0001). EVB19 was detected in thyrocytes, but not more frequently in Graves' disease patients than in controls. Further studies are needed to determine the role of EVB19 infection in thyroid diseases. Copyright © 2013 Wiley Periodicals, Inc.

Prospective, randomized, and controlled trial on ketamine infusion during bilateral axillo-breast approach (BABA) robotic or endoscopic thyroidectomy: Effects on postoperative pain and recovery profiles

PubMed Central

Kim, Dong-Ho; Choi, June Young; Kim, Byoung-Gook; Hwang, Jin-Young; Park, Seong-Joo; Oh, Ah-Young; Jeon, Young-Tae; Ryu, Jung-Hee

2016-01-01

Abstract Background: Robotic or endoscopic thyroidectomy using bilateral axillo-breast approach (BABA) is frequently performed for excellent cosmesis. However, postoperative pain is remained as concerns due to the extent tissue dissection and tension during the operation. Ketamine is a noncompetitive N-methyl-d-aspartate (NMDA) receptor antagonist that reduces acute postoperative pain. We evaluated the effects of intraoperative ketamine infusion on postoperative pain control and recovery profiles following BABA robotic or endoscopic thyroidectomy. Methods: Fifty-eight adult patients scheduled for BABA robotic or endoscopic thyroidectomy were randomized into a control group (n = 29) and ketamine group (n = 29). Following induction of anesthesia, patients in each group were infused with the same volume of saline or ketamine solution (1 mg/kg bolus, 60 μg/kg/h continuous infusion). Total intravenous anesthesia with propofol and remifentanil was used to induce and maintain anesthesia. Pain scores (101-point numerical rating scale, 0 = no pain, 100 = the worst imaginable pain), the consumption of rescue analgesics, and other postoperative adverse effects were assessed at 1, 6, 24, and 48 hours postoperatively. Results: Patients in the ketamine group reported lower pain scores than those in the control group at 6 hours (30 [30] vs 50 [30]; P = 0.017), 24 hours (20 [10] vs 30 [20]; P < 0.001), and 48 hours (10 [10] vs 20 [15]; P < 0.001) in neck area. No statistically significant differences were found between the 2 groups in terms of the requirements for rescue analgesics or the occurrence of adverse events. Conclusion: Intravenous ketamine infusion during anesthesia resulted in lower postoperative pain scores following BABA robotic or endoscopic thyroidectomy, with no increase in adverse events. PMID:27930531

Prospective, randomized, and controlled trial on ketamine infusion during bilateral axillo-breast approach (BABA) robotic or endoscopic thyroidectomy: Effects on postoperative pain and recovery profiles: A consort compliant article.

PubMed

Kim, Dong-Ho; Choi, June Young; Kim, Byoung-Gook; Hwang, Jin-Young; Park, Seong-Joo; Oh, Ah-Young; Jeon, Young-Tae; Ryu, Jung-Hee

2016-12-01

Robotic or endoscopic thyroidectomy using bilateral axillo-breast approach (BABA) is frequently performed for excellent cosmesis. However, postoperative pain is remained as concerns due to the extent tissue dissection and tension during the operation. Ketamine is a noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist that reduces acute postoperative pain. We evaluated the effects of intraoperative ketamine infusion on postoperative pain control and recovery profiles following BABA robotic or endoscopic thyroidectomy. Fifty-eight adult patients scheduled for BABA robotic or endoscopic thyroidectomy were randomized into a control group (n = 29) and ketamine group (n = 29). Following induction of anesthesia, patients in each group were infused with the same volume of saline or ketamine solution (1 mg/kg bolus, 60 μg/kg/h continuous infusion). Total intravenous anesthesia with propofol and remifentanil was used to induce and maintain anesthesia. Pain scores (101-point numerical rating scale, 0 = no pain, 100 = the worst imaginable pain), the consumption of rescue analgesics, and other postoperative adverse effects were assessed at 1, 6, 24, and 48 hours postoperatively. Patients in the ketamine group reported lower pain scores than those in the control group at 6 hours (30 [30] vs 50 [30]; P = 0.017), 24 hours (20 [10] vs 30 [20]; P < 0.001), and 48 hours (10 [10] vs 20 [15]; P < 0.001) in neck area. No statistically significant differences were found between the 2 groups in terms of the requirements for rescue analgesics or the occurrence of adverse events. Intravenous ketamine infusion during anesthesia resulted in lower postoperative pain scores following BABA robotic or endoscopic thyroidectomy, with no increase in adverse events.

NONINVASIVE FOLLICULAR TUMOR WITH PAPILLARY-LIKE NUCLEAR FEATURES: NOT A TEMPEST IN A TEAPOT.

PubMed

Agrawal, Nidhi; Abbott, Collette E; Liu, Cheng; Kang, Stella; Tipton, Laura; Patel, Kepal; Persky, Mark; King, Lizabeth; Deng, Fang-Ming; Bannan, Michael; Ogilvie, Jennifer B; Heller, Keith; Hodak, Steven P

2017-04-02

Encapsulated non-invasive follicular variant papillary thyroid cancer (ENIFVPTC) has recently been retermed noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). This designation specifically omits the word "cancer" to encourage conservative treatment since patients with NIFTP tumors have been shown to derive no benefit from completion thyroidectomy or adjuvant radio-active iodine (RAI) therapy. This was a retrospective study of consecutive cases of tumors from 2007 to 2015 that met pathologic criteria for NIFTP. The conservative management (CM) group included patients managed with lobectomy alone or appropriately indicated total thyroidectomy. Those included in the aggressive management (AM) group received either completion thyroidectomy or RAI or both. From 100 consecutive cases of ENIFVPTC reviewed, 40 NIFTP were included for the final analysis. Of these, 10 (27%) patients treated with initial lobectomy received completion thyroidectomy and 6 of 40 (16%) also received postsurgical adjuvant RAI. The mean per-patient cost of care in the AM group was $17,629 ± 2,865, nearly twice the $8,637 ± 309 costs in the CM group, and was largely driven by the cost of completion thyroidectomy and RAI. The term NIFTP has been recently promulgated to identify a type of thyroid neoplasm, formerly identified as a low-grade cancer, for which initial surgery represents adequate treatment. We believe that since the new NIFTP nomenclature intentionally omits the word "cancer," the clinical indolence of these tumors will be better appreciated, and cost savings will result from more conservative and appropriate clinical management. AM = aggressive management CM = conservative management ENIFVPTC = encapsulated noninvasive form of FVPTC FVPTC = follicular variant of papillary thyroid carcinoma NIFTP = noninvasive follicular thyroid neoplasm with papillary-like nuclear features PTC = papillary thyroid carcinoma PTMC = papillary thyroid microcarcinoma RAI = radio-active iodine US = ultrasound.

High pressure homogenization processing, thermal treatment and milk matrix affect in vitro bioaccessibility of phenolics in apple, grape and orange juice to different extents.

PubMed

He, Zhiyong; Tao, Yadan; Zeng, Maomao; Zhang, Shuang; Tao, Guanjun; Qin, Fang; Chen, Jie

2016-06-01

The effects of high pressure homogenization processing (HPHP), thermal treatment (TT) and milk matrix (soy, skimmed and whole milk) on the phenolic bioaccessibility and the ABTS scavenging activity of apple, grape and orange juice (AJ, GJ and OJ) were investigated. HPHP and soy milk diminished AJ's total phenolic bioaccessibility 29.3%, 26.3%, respectively, whereas TT and bovine milk hardly affected it. HPHP had little effect on GJ's and OJ's total phenolic bioaccessibility, while TT enhanced them 27.3-33.9%, 19.0-29.2%, respectively, and milk matrix increased them 26.6-31.1%, 13.3-43.4%, respectively. Furthermore, TT (80 °C/30 min) and TT (90 °C/30 s) presented the similar influences on GJ's and OJ's phenolic bioaccessibility. Skimmed milk showed a better enhancing effect on OJ's total phenolic bioaccessibility than soy and whole milk, but had a similar effect on GJ's as whole milk. These results contribute to promoting the health benefits of fruit juices by optimizing the processing and formulas in the food industry. Copyright © 2016 Elsevier Ltd. All rights reserved.

A rare case of non-surgical vocal cord paralysis: Vocal cord hematoma.

PubMed

Arıkan, Akif Enes; Teksöz, Serkan; Bilgin, İsmail Ahmet; Tarhan, Özge; Özyeğin, Ateş

2017-01-01

Although vocal cord paralysis (VCP) following thyroidectomy is primarily associated with surgical trauma, it is not the sole etiology. Vocal cord paralysis following thyroidectomy can be caused by a vocal cord hematoma with an incidence of 1.4% due to direct injury during orotracheal intubation. In this article, we present a case of VCP caused by vocal cord hematoma. A 32-year-old male patient who has been receiving propylthiouracil treatment for toxic multinodular goiter since 10 years was admitted to our hospital to be operated because of persisting complaints. The patient was hospitalized for sutureless thyroidectomy after he became euthyroid. Preoperative fiberoptic laryngoscopy performed by the ear, nose, and throat department revealed bilaterally motile vocal folds and a completely open airway. Patient underwent sutureless total thyroidectomy with a vessel sealing device (Ligasure TM LF1212, Covidien, CO), and a minivac drainage system was placed in the thyroid lodge. On the morning of the first postoperative day, 50 mL of serosanguinous fluid was drained. The patient's voice was normal, and there was no ecchymosis. Postoperative fiberoptic laryngoscopy revealed a hematoma near the right vocal fold and paralysis of the right vocal fold; however, the airway was open. It should be kept in mind that VCP is not solely due to surgery but can also result from intubation, as observed in this case.

A rare case of non-surgical vocal cord paralysis: Vocal cord hematoma

PubMed Central

Arıkan, Akif Enes; Teksöz, Serkan; Bilgin, İsmail Ahmet; Tarhan, Özge; Özyeğin, Ateş

2017-01-01

Although vocal cord paralysis (VCP) following thyroidectomy is primarily associated with surgical trauma, it is not the sole etiology. Vocal cord paralysis following thyroidectomy can be caused by a vocal cord hematoma with an incidence of 1.4% due to direct injury during orotracheal intubation. In this article, we present a case of VCP caused by vocal cord hematoma. A 32-year-old male patient who has been receiving propylthiouracil treatment for toxic multinodular goiter since 10 years was admitted to our hospital to be operated because of persisting complaints. The patient was hospitalized for sutureless thyroidectomy after he became euthyroid. Preoperative fiberoptic laryngoscopy performed by the ear, nose, and throat department revealed bilaterally motile vocal folds and a completely open airway. Patient underwent sutureless total thyroidectomy with a vessel sealing device (LigasureTM LF1212, Covidien, CO), and a minivac drainage system was placed in the thyroid lodge. On the morning of the first postoperative day, 50 mL of serosanguinous fluid was drained. The patient’s voice was normal, and there was no ecchymosis. Postoperative fiberoptic laryngoscopy revealed a hematoma near the right vocal fold and paralysis of the right vocal fold; however, the airway was open. It should be kept in mind that VCP is not solely due to surgery but can also result from intubation, as observed in this case. PMID:29260141

Thyroid gland invasion in advanced squamous cell carcinoma of the larynx and hypopharynx.

PubMed

Mangussi-Gomes, João; Danelon-Leonhardt, Fernando; Moussalem, Guilherme Figner; Ahumada, Nicolas Galat; Oliveira, Cleydson Lucena; Hojaij, Flávio Carneiro

Squamous cell carcinoma of the larynx and hypopharynx has the potential to invade the thyroid gland. Despite this risk, the proposition of either partial or total thyroidectomy as part of the surgical treatment of all such cases remains controversial. To evaluate the frequency of invasion of the thyroid gland in patients with advanced laryngeal or hypopharyngeal squamous cell carcinoma submitted to total laryngectomy or pharyngolaryngectomy and thyroidectomy; to determine whether clinic-pathological characteristics can predict glandular involvement. A retrospective case series with chart review, from January 1998 to July 2013, was undertaken in a tertiary care university medical center. An inception cohort of 83 patients with larynx/hypopharynx squamous cell carcinoma was considered. All patients had advanced stage disease (clinically T3-T4) and underwent total laryngectomy or total pharyngolaryngectomy in association with thyroidectomy. Adjuvant therapy was indicated when tumor or neck conditions required. Frequency of thyroid cartilage invasion was calculated; univariate and multivariate analysis of demographic, clinical and pathological characteristics associated with cartilage invasion were performed. The overall frequency of invasion of the thyroid gland was 18.1%. Glandular involvement was associated with invasion of the following structures: anterior commissure (odds ratio=5.13; 95% confidence interval 1.07-24.5), subglottis (odds ratio=12.44; 95% confidence interval 1.55-100.00) and cricoid cartilage (odds ratio=15.95; 95% confidence interval 4.23-60.11). Invasion of the thyroid gland is uncommon in the context of laryngopharyngeal squamous cell carcinoma. Clinical and pathological features such as invasion of the anterior commissure, subglottis and cricoid cartilage are more associated with glandular invasion. Copyright © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Clinical management and outcomes in patients with hyperfunctioning distant metastases from differentiated thyroid cancer after total thyroidectomy and radioactive iodine therapy.

PubMed

Qiu, Zhong-Ling; Shen, Chen-Tian; Luo, Quan-Yong

2015-02-01

Hyperfunctioning distant metastasis (HFDM) from differentiated thyroid cancer (DTC) is a rare entity. This study aimed to assess the outcomes of DTC patients presenting with HFDM after total thyroidectomy and radioactive iodine therapy. A total of 5367 DTC patients treated with (131)I after total thyroidectomy were analyzed retrospectively from January 1991 to June 2013. Therapeutic efficacy was evaluated based on changes in serum thyroglobulin (Tg) and anatomical imaging changes in metastatic lesions. The relationships between survival time and several variables were assessed by univariate and multivariate analyses using the Kaplan-Meier method and Cox's proportional hazards model respectively. Thirty-eight patients with HFDM from DTC were diagnosed, including four with hyperthyroidism, four with subclinical hyperthyroidism, and three with subclinical hypothyroidism. The remaining 27 were euthyroid. Of 25 patients with lung metastases, 84% (21/25) showed disappearance or shrinkage of lung nodules; of 24 patients with bone metastases, 66.67% (16/24) exhibited no obvious imaging changes in metastatic bone lesions after (131)I therapy. Serum Tg decreased significantly in 81.58% (31/38) and increased in 18.42% (7/38) after (131)I therapy. The 10-year survival rate of DTC patients with HFDM was 65.79% (25/38). Multivariate analyses identified age at occurrence of distant metastases (<45 years), only lung metastases, and papillary thyroid cancer (PTC; p=0.032, NA, and 0.043) as independent predictors of survival. The response of hyperfunctioning lung metastases to (131)I treatment was better than that of non-hyperfunctioning lung metastases in DTC, while hyperfunctioning bone metastases responded similarly compared to non-hyperfunctioning bone metastases. Patients younger than 45 years at occurrence of distant metastases, those with only lung metastases, and patients with PTC had better prognoses.

Risk Factors for Hypogonadism in Male Patients with Type 2 Diabetes

PubMed Central

Zheng, Rendong; Cao, Lin; Cao, Wen; Chu, Xiaoqiu; Hu, Yongxin; Zhang, Huifeng; Xu, Juan; Sun, Hongping; Bao, Weiping; Liu, Kemian; Liu, Chao

2016-01-01

Background. Male hypogonadism is an endocrine disease characterized by low levels of serum testosterone and is closely related to the development of diabetes. The purpose of the present study was to observe the risk factors for hypogonadism in male patients with type 2 diabetes. Methods. A total of 213 patients with type 2 diabetes were enrolled and divided into a low total testosterone (TT) group (=75) and a normal TT group (=138). The patients' blood glucose, blood lipids, serum insulin, and sex hormones were measured. The correlations between the patients' metabolic index and sex hormone levels were analyzed. Results. Compared with the normal TT group, body mass index (BMI), fasting insulin (FINS), and HOMA insulin resistance index (HOMA-IR) levels were significantly higher, but the luteinizing hormone (LH) levels were significantly lower in the low TT group (p < 0.05). Correlation analyses found that TT was negatively correlated with BMI, waist circumference (WC), FINS, and HOMA-IR. TT was positively correlated with LH and follicle-stimulating hormone (FSH). Conclusions. Several risk factors of diabetes associated closely with hypogonadism. BMI, metabolic syndrome (MS), HOMA-IR, and LH are independent risk factors for hypogonadism in male patients with type 2 diabetes. PMID:27006953

Quality of life after robotic thyroidectomy by a gasless unilateral axillary approach.

PubMed

Song, Chang Myeon; Ji, Yong Bae; Bang, Hyang Sook; Park, Chul Won; Kim, Dong Sun; Tae, Kyung

2014-12-01

Robotic thyroidectomies have been safely performed with early surgical outcomes comparable to conventional cervical thyroidectomies. However, health-related quality of life (HRQOL) after robotic thyroidectomy has not yet been evaluated. The aim of this study was to compare HRQOL of patients who underwent robotic thyroidectomy with that of those who received conventional thyroidectomy. We conducted a cross-sectional study in 111 patients who underwent either robotic thyroidectomy (44 patients) via a gasless unilateral axillary approach, or conventional cervical thyroidectomy (67 patients), for papillary thyroid carcinoma (PTC). HRQOL of patients was assessed using two questionnaires, the University of Washington Quality of Life (UW-QOL) questionnaire for patients with head and neck cancer, and the Quality of Life-Thyroid Version (QOL-TV), which was specifically designed for thyroid cancer patients. The survey using the questionnaires was performed 1 year after surgery at a routine outpatient clinic follow-up. There was no difference in UW-QOL scores between the two groups for any factor other than neck appearance and physical composite score, which were higher in the robotic group. Humor (mood) and anxiety, emotional measures of UW-QOL, were selected by patients in both groups as being their most significant issue during the preceding 7 days. There was no between-group difference in the four QOL-TV domains (physical, psychological, social, and spiritual well-being). Patients who underwent robotic thyroidectomy reported a higher score for satisfaction with neck appearance compared to patients receiving conventional cervical thyroidectomy. However, the overall HRQOL of patients in the robotic and conventional groups was similar.

Calcium maelstrom: recalcitrant hypocalcaemia following rapid correction of thyrotoxicosis, exacerbated by pregnancy.

PubMed

Shin, Terry; Guerrero, Arthur F

2015-05-12

A 29-year-old pregnant woman with Graves' disease presented with severe persistent hypocalcaemia after thyroidectomy. Six months prior to presentation she was diagnosed with Graves' disease and remained uncontrolled with methimazole. She was confirmed pregnant prior to radioactive iodine ablation (RAI), and underwent total thyroidectomy during her second trimester. After surgery, continuous intravenous calcium infusion was required until delivery of the fetus allowed discontinuation at postoperative day 18, despite oral calcium and calcitriol administration. A total of 38 g of oral and 7.5 g of intravenous elemental calcium was administered. We report an unusual case of recalcitrant hypocalcaemia thought to be due to a combination of postoperative hypoparathyroidism, combined with thyrotoxic osteodystrophy and pregnancy, after surgical correction of Graves' disease. Increased vigilance and early calcium supplementation should be a priority in the management of these patients. 2015 BMJ Publishing Group Ltd.

Pancrelipase treatment in a patient with the history of Roux-en-Y gastric bypass operation that developed resistant hypocalcemia secondary to total thyroidectomy.

PubMed

Baldane, S; Ipekci, S H; Kebapcilar, L

2016-01-01

Roux-en-Y gastric bypass (RYGB) is an independent risk factor for moderate hypocalcaemia and may lead to the development of resistant hypocalcaemia following thyroid surgery. Subject and Results. A 35-year old female patient was referred to our hospital by her family physician for treatment of resistant hypocalcaemia. The patient underwent RYGB three years ago and a total thyroidectomy for a benign thyroid nodule one year ago. Calcitriol, calcium carbonate, magnesium oxide, and ergocalciferol therapeutic dosages were incremented. Despite dosage increments, the desired calcium levels were not achieved. In the sixth month after admission to our hospital, pancrelipase was added to patient's treatment scheme. On the following visit, a good calcium increase had been achieved. This report presents a case history of RYGB and resistant hypocalcaemia, which developed after thyroid surgery and positively responded to pancrelipase treatment.

Calcium maelstrom: recalcitrant hypocalcaemia following rapid correction of thyrotoxicosis, exacerbated by pregnancy

PubMed Central

Shin, Terry; Guerrero, Arthur F

2015-01-01

A 29-year-old pregnant woman with Graves’ disease presented with severe persistent hypocalcaemia after thyroidectomy. Six months prior to presentation she was diagnosed with Graves’ disease and remained uncontrolled with methimazole. She was confirmed pregnant prior to radioactive iodine ablation (RAI), and underwent total thyroidectomy during her second trimester. After surgery, continuous intravenous calcium infusion was required until delivery of the fetus allowed discontinuation at postoperative day 18, despite oral calcium and calcitriol administration. A total of 38 g of oral and 7.5 g of intravenous elemental calcium was administered. We report an unusual case of recalcitrant hypocalcaemia thought to be due to a combination of postoperative hypoparathyroidism, combined with thyrotoxic osteodystrophy and pregnancy, after surgical correction of Graves’ disease. Increased vigilance and early calcium supplementation should be a priority in the management of these patients. PMID:25969482

Regression of Ophthalmopathic Exophthalmos in Graves' Disease After Total Thyroidectomy: a Prospective Study of a Surgical Series.

PubMed

Bhargav, P R K; Sabaretnam, M; Kumar, S Chandra; Zwalitha, S; Devi, N Vimala

2017-12-01

Autoimmune ophthalmopathy is one of the salient clinical features associated with Graves' disease. Exophthalmos is one of the commonest manifestations of Graves' associated ophthalmopathy. It is reported to regress after thyroidectomy favourably compared to radioiodine or antithyroid drug therapy. In this context, we present our experience based on a surgical series of Graves' disease. This is a prospective study of 15 patients of Graves' disease associated with ophthalmopathic exophthalmos. Preoperative and monthly postoperative evaluation of exophthalmos was done with Hertel's exophthalmometer, apart from documenting lid, extra-ocular muscle and orbital involvement. The minimum follow-up of the cohort was 12 months. The female to male ratio was 12:3 and the mean age of the subjects was 33.4 years (18-55). Exophthalmos was bilateral in 13 and unilateral in 2 patients. All the 15 patients underwent total thyroidectomy without any major morbidity. Exophthalmos regressed in 12 patients at a mean follow-up of 15.6 ± 6.4 months (14-38) and was static in 3. None of the cases had worsened ophthalmopathy at the final follow-up. Mean regression of exophthalmos was 2.1 mm (1-5). The regression was statistically significant at P value = 0.035. Surgery has a positive impact on the regression of ophthalmopathic exophthalmos associated with Graves' disease.

Iatrogenic Subclinical Hyperthyroidism Does Not Promote Weight Loss.

PubMed

Kedia, Rohit; Lowes, Alicia; Gillis, Sarah; Markert, Ronald; Koroscil, Thomas

2016-02-01

Among patients who have undergone total thyroidectomy, do those with thyroid cancer being kept iatrogenically subclinical hyperthyroid (SCH) differ from euthyroid patients in long-term weight change? In a retrospective study, medical records identified 291 patients who had undergone a thyroidectomy for differentiated thyroid cancer or benign thyroid disease. Weight, thyroid-stimulating hormone, and levothyroxine dose were measured presurgery and 1, 2, and 3 years postsurgery. Of 291 patients, 147 were in the SCH group and 144 were in the euthyroid group. At all 3 years both groups gained weight from baseline, but the two groups did not differ in weight change from baseline at any time period: year 1 (SCH mean 0.4% ± 6.2% weight gain vs euthyroid group mean 2.2% ± 6.6% weight gain; P = 0.12), year 2 (SCH mean 1.1% ± 9.1% weight gain vs euthyroid mean 2.9% ± 7.8% weight gain; P = 0.22), and year 3 (SCH mean 2.6% ± 9.2% weight gain vs euthyroid mean 3.1% ± 11.1% weight gain; P = 0.49). Among total thyroidectomy patients, weight change did not differ between SCH patients and euthyroid patients at years 1 through 3. As such, the use of levothyroxine to induce SCH did not lead to long-term weight change when compared with euthyroid patients.

Thyroid carcinoma at King Edward VIII Hospital, Durban, South Africa.

PubMed

Mulaudzi, T V; Ramdial, P K; Madiba, T E; Callaghan, R A

2001-05-01

Western literature depicts papillary carcinoma as the most common thyroid malignancy followed by follicular carcinoma. To assess the clinical pattern of thyroid carcinoma among African and Indian patients. King Edward VIII Hospital, Durban, South Africa. A retrospective study. One hundred patients with thyroid carcinoma treated at a tertiary teaching hospital between 1990 and 1997. Seventy seven patients were Africans and 23 were Indians. The male to female ratio was 1:6. Ninety eight patients presented with goitre with or without regional lymph node involvement or distant disease. The duration of symptoms ranged from one to 360 months. The mean age at presentation was 48.6 +/- 16.0 years. Follicular carcinoma was the most common malignancy among African patients (68%), followed by papillary carcinoma (16%), anaplastic carcinoma (13%) and medullary carcinoma (2.6%). Papillary carcinoma was the most common malignancy among Indian patients (57%) followed by follicular carcinoma and medullary carcinoma. There was no anaplastic carcinoma among Indian patients. Fifty five patients underwent lobectomy with 32 undergoing subsequent completion thyroidectomy. Nine patients had near total thyroidectomy, 27 were offered total thyroidectomy as primary surgery and eight had biopsy only. The in-hospital mortality was 8%. Recurrence rate was 8%. Most patients present long after the development of symptoms. Follicular carcinoma is the most common thyroid malignancy among Africans. Further studies are required to explain this phenomenon.

Severe vitamin D deficiency: a significant predictor of early hypocalcemia after total thyroidectomy.

PubMed

Al-Khatib, Talal; Althubaiti, Abdulrahman M; Althubaiti, Alaa; Mosli, Hala H; Alwasiah, Reem O; Badawood, Lojain M

2015-03-01

To assess the role of preoperative serum 25 hydroxyvitamin D as predictor of hypocalcemia after total thyroidectomy. Retrospective cohort study. University teaching hospital. All consecutively performed total and completion thyroidectomies from February 2007 to December 2013 were reviewed through a hospital database and patient charts. The relationship between postthyroidectomy laboratory hypocalcemia (serum calcium≤2 mmol/L), clinical hypocalcemia, and preoperative serum 25 hydroxyvitamin D level was evaluated. Two hundred thirteen patients were analyzed. The incidence of postoperative laboratory and clinical hypocalcemia was 19.7% and 17.8%, respectively. The incidence of laboratory and clinical hypocalcemia among severely deficient (<25 nmol/L), deficient (<50 nmol/L), insufficient (<75 nmol/L), and sufficient (≥75 nmol/L) serum 25 hydroxyvitamin D levels was 54% versus 33.9%, 10% versus 18%, 2.9% versus 11.6%, and 3.1% versus 0%, respectively. Multiple logistic regression analysis revealed preoperative severe vitamin D deficiency as a significant independent predictor of postoperative hypocalcemia (odds ratio [OR], 7.3; 95% confidence interval [CI], 2.3-22.9; P=.001). Parathyroid hormone level was also found to be an independent predictor of postoperative hypocalcemia (OR, 0.6; 95% CI, 0.5-0.8; P=.002). Postoperative clinical and laboratory hypocalcemia is significantly associated with low levels of serum 25 hydroxyvitamin D. Our findings identify severe vitamin D deficiency (<25 nmol/L) as an independent predictor of postoperative laboratory hypocalcemia. Early identification and management of patients at risk may reduce morbidity and costs. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

Comparison of Natural Drainage Group and Negative Drainage Groups after Total Thyroidectomy: Prospective Randomized Controlled Study

PubMed Central

Woo, Seung Hoon; Kim, Jin Pyeong; Park, Jung Je; Shim, Hyun Seok; Lee, Sang Ha; Lee, Ho Joong; Won, Seong Jun; Son, Hee Young; Kim, Rock Bum

2013-01-01

Purpose The aim of this study was to compare a negative pressure drain with a natural drain in order to determine whether a negative pressure drainage tube causes an increase in the drainage volume. Materials and Methods Sixty-two patients who underwent total thyroidectomy for papillary thyroid carcinoma (PTC) were enrolled in the study between March 2010 and August 2010 at Gyeongsang National University Hospital. The patients were prospectively and randomly assigned to two groups, a negative pressure drainage group (n=32) and natural drainage group (n=30). Every 3 hours, the volume of drainage was checked in the two groups until the tube was removed. Results The amount of drainage during the first 24 hours postoperatively was 41.68±3.93 mL in the negative drain group and 25.3±2.68 mL in the natural drain group (p<0.001). After 24 additional hours, the negative drain group was 35.19±4.26 mL and natural drain groups 21.53±2.90 mL (p<0.001). However, the drainage at postoperative day 3 was not statistically different between the two groups. In addition, the vocal cord palsy and temporary and permanent hypocalcemia were not different between the two groups. Conclusion These results indicate that a negative pressure drain may increase the amount of drainage during the first 24-48 hours postoperatively. Therefore, it is not necessary to place a closed suction drain when only a total thyroidectomy is done. PMID:23225820

Cribriform-Morular Variant of Papillary Thyroid Carcinoma: Clinical and Pathological Features of 30 Cases.

PubMed

Akaishi, Junko; Kondo, Tetsuo; Sugino, Kiminori; Ogimi, Yuna; Masaki, Chie; Hames, Kiyomi Y; Yabuta, Tomonori; Tomoda, Chisato; Suzuki, Akifumi; Matsuzu, Kenichi; Uruno, Takashi; Ohkuwa, Keiko; Kitagawa, Wataru; Nagahama, Mitsuji; Katoh, Ryohei; Ito, Koichi

2018-04-25

Cribriform-morular variant of papillary thyroid carcinoma (CMV-PTC) is rare; it may occur in cases of familial adenomatous polyposis (FAP) or be sporadic. To clarify the clinicopathological features of CMV-PTC, the medical records of these patients were investigated retrospectively. Between 1979 and 2016, a total of 17,062 cases with PTC underwent initial surgery at Ito Hospital. Of these, 30 (0.2%) cases histologically diagnosed with CMV-PTC were reviewed. The patients were all women, with a mean age at the time of surgery of 24 years. Seven (23%) cases were thought to have FAP because they had colonic polyposis or a family history of FAP or APC gene mutation. The remaining 23 (77%) were thought to be sporadic. Multiple tumors were detected in 6 cases, with a solitary tumor in 24. One patient had lung metastasis at diagnosis. Eleven patients underwent total thyroidectomy or subtotal thyroidectomy, and 19 underwent lobectomy. Twenty-six (87%) patients underwent neck lymph node dissection. Three patients had tumor metastasis in central lymph nodes, but these were incidentally detected metastatic classical PTC (cPTC) based on histological examination. In this series, there were no cases of LN metastases of CMV-PTC. During a mean follow-up of 15 years, one patient had new cPTC in the remnant thyroid after initial surgery, and the other patients showed no signs of recurrence. CMV-PTC occurred in young women, their long-term prognosis was excellent. Total thyroidectomy is recommended for FAP-associated CMV-PTC, but modified neck lymph node dissection is not necessary.

Parathyroid Hormone as a Predictor of Post-Thyroidectomy Hipocalcemia: A Prospective Evaluation of 100 Patients.

PubMed

Melo, Fernando; Bernardes, António; Velez, Ana; Campos de Melo, Catarina; de Oliveira, Fernando José

2015-01-01

Hypocalcemia is a frequent complication after total thyroidectomy and the main reason for prolonged hospitalization of these patients. We studied prospectively 112 patients who underwent total or completation thyroidectomy between June 2012 and November 2013. Twelve patients with preoperative changes in parathyroid function were excluded. Parathyroid hormone and calcium levels were determined pre-operatively, immediately after surgery, on 1st day and on 14th day after surgery. Of the 100 patients enrolled, 60 have developed hypocalcaemia (60%) but only 14 patients had symptomatic hypocalcaemia. It mostly occurs 24 hours after surgery (76.7%). It was permanent in 3 patients and temporary in the others. In the 60 patients with hypocalcaemia, it has been found hypoparathyroidism in 19 patients immediately after surgery, in 14 patients on 1st day but only 3 had hypoparathyroidism (patients with permanent hypocalcaemia). Comparing the group of patients with and without hypocalcaemia we found a decrease of parathyroid hormone in both (immediately after surgery and on 1st day) but was more important in the hypocalcaemia group (p = 0.004 and p < 0.001). The decrease of PTH levels was more pronounced in the hypocalcaemia group, with significance on the first day (22.29% vs 50.29%, p < 0.001). The best predictor of hypocalcaemia identified was the decrease of parathyroid hormone levels > 19.4% determined on the 1st day (sensitivity = 82%; specificity = 63%). In our study there was a high incidence of hypocalcemia (60%), expressed predominantly 24 hours after surgery and conditioned, in these patients, a longer hospital stay. However, only 3 patients (3%) had permanent hypocalcemia. We still found a match in the oscillation of serum calcium levels and parathyroid hormone which identified the decrease in parathyroid hormone on the first day after surgery as a reliable predictor of hypocalcemia. Decrease of parathyroid hormone levels > 19.4% determined on 1st day is a good predictor of hypocalcemia after total / completation thyroidectomy, allowing to identify patients at higher risk of hypocalcemia, medicate them prophylactically and get early and safe discharges.

Brain-Only Metastases Seen on FDG PET as First Relapse of Papillary Thyroid Carcinoma Two Years Post-Thyroidectomy.

PubMed

Naddaf, Sleiman Y; Syed, Ghulam Mustafa Shah; Hadb, Abdulrahman; Al-Thaqfi, Saif

2016-09-01

We report a case of a 60-year-old man diagnosed with papillary thyroid cancer who had a relapse seen only in the brain at FDG PET on standard images. Total thyroidectomy was performed in July 2013 after initial diagnosis. Patient received I ablation in December 2013, followed by external beam radiotherapy to the neck. In September 2015, the patient presented with neurological symptoms. Brain MRI showed multiple brain metastases later confirmed on histopathology. An FDG PET/CT scan was performed to evaluate the whole body in November 2015. Multiple hypermetabolic lesions were identified in the brain with no other lesion up to mid thighs.

The role of vitamin D in post-thyroidectomy hypocalcemia: Still an enigma.

PubMed

Cherian, Anish Jacob; Ponraj, Sam; Gowri S, Mahasampath; Ramakant, Pooja; Paul, Thomas V; Abraham, Deepak Thomas; Paul, M J

2016-02-01

There is conflicting evidence regarding the role of vitamin D deficiency in the development of post-thyroidectomy hypocalcemia. Recent reports show postoperative parathormone (PTH) is unreliable in predicting post-thyroidectomy hypocalcemia in vitamin D deficient patients. We conducted this study to analyze the role of vitamin D status in the development of post-thyroidectomy hypocalcemia and to evaluate its effect on the predictability of PTH as a marker for post-thyroidectomy hypocalcemia. A retrospective review of prospectively collected data of patients undergoing thyroidectomy between August 2007 to September 2013 (n = 150) was performed. Results of preoperative calcium, albumin, vitamin D, PTH and postoperative calcium, albumin, and PTH were collated. Patients were divided into 2 groups based on their vitamin D status: group A, vitamin D ≥ 20 ng/mL and group B, vitamin D < 20 ng/mL. Vitamin D deficiency was present in 80 (53.3%) patients and post-thyroidectomy hypocalcemia developed in 67 (44.7%). The incidence of postoperative hypocalcemia was similar in both the groups (48.6% and 41.3%, respectively). Vitamin D status was not associated with the development of post-thyroidectomy hypocalcemia (P = .23). Postoperative PTH of <8 pg/mL was strongly associated with the development of hypocalcemia in both the groups (P = .0002 and .0045, respectively). The area under the receiver operator characteristic curve in group B (0.68) was less than in group A (0.76; P = .41). The majority of patients were vitamin D deficient in this cohort, but this did not increase the risk of post-thyroidectomy hypocalcemia, nor did it interfere with the predictability of PTH as a marker of post-thyroidectomy hypocalcemia. Copyright © 2016 Elsevier Inc. All rights reserved.

Intraoperative gamma probe guidance with 99mTc-pertechnetate in the completion thyroidectomy.

PubMed

Aras, Gülseren; Gültekin, Salih Sinan; Küçük, Nuriye Ozlem; Demirer, Seher; Tuğ, Tuğbay

2009-07-01

Intraoperative gamma probe (GP) guidance with (99m)Tc-pertechnetate in the completion total thyroidectomy after a first thyroidectomy was investigated in this prospective study. The study group comprises of fourteen consecutive patients (14 females, age mean 50.2 +/- 12.0 years, age range 29-73 years). All patients underwent a second thyroidectomy due to inadequate (5/14 patients) and complementary (9/14 patients) interventions. Serum-free three iodothyronine, free thyroxin and thyroid stimulating hormone measurements, a neck ultrasonography (USG) and thyroid scintigraphy (TS) were performed in the preoperative and postoperative period. After a 185 MBq (5 mCi) injection of (99m)Tc-pertechnetate, background (BG), left thyroid lobe (LTL), right thyroid lobe (RTL) and pyramidal tyroid lobe (PTL) regions were counted in time before and after resection of thyroid remnants by intraoperative GP. All resection materials were evaluated by histopathologic examination. Preoperative TSH was less than 30 mIU/mL (mean 21 +/- 7) in all patients. Functioning thyroid remnants were shown in 13/14 patients on the preoperative TS and USG, which were diagnosed by USG in one but by TS in other one. We calculated that percentage median (minimum-maximum) values were 220.90% (56.00-411.11%) in LTL, 80.43% (11.54-471.05%) in RTL and 66.60% (-3.33 to 158.33%) in PTL for counts before resection, on the other hand, 15.96% (-20.55 to 47.62%) in LTL, 17.59% (-15.07 to 38.46%) in RTL and 17.59% (-1.96 to 57.14%) in PTL regions for counts after resection. There were statistically significant differences between these values belonging to before and after resection for LTL (p = 0.001), RTL (p = 0.001) and PTL (p = 0.008). Bilateral small foci in a patient and unilateral focus in other patient were observed in postoperative TS. Unilateral focus was detected on the RTL by GP, but not bilateral foci. Postoperative TSH levels increased to 30 mIU/mL (mean 69 +/- 26) at least. There was a statistically significant difference between preoperative and postoperative TSH values (p < 0.001). Histopathologic confirmation revealed that all removed materials were the thyroid tissues. Gamma probe guidance with (99m)Tc-pertechnetate seemed to be a good option and easy available method in patients undergoing the completion total thyroidectomy.

Alternative transmission routes in the malaria elimination era: an overview of transfusion-transmitted malaria in the Americas.

PubMed

Alho, Regina M; Machado, Kim Vinícius Amaral; Val, Fernando F A; Fraiji, Nelson A; Alexandre, Marcia A A; Melo, Gisely C; Recht, Judith; Siqueira, André M; Monteiro, Wuelton M; Lacerda, Marcus V G

2017-02-15

Transfusion-transmitted (TT) malaria is an alternative infection route that has gained little attention from authorities, despite representing a life-threatening condition. There has been no systematic review of this health problem in American countries. The aim of this study was to describe the clinical and epidemiological characteristics of TT malaria in the Americas and identify factors associated with lethality based on the studies published in the literature. Potentially relevant papers in all languages were retrieved from MEDLINE and LILACS. Additional articles were obtained from reviews and original papers. Publications on screening of candidate blood donors and on surveillance of TT malaria cases were included. Odds ratios with respective 95% confidence intervals (95% CI) were calculated. Epidemiological characteristics of blood donors of TT malaria cases, including a pooled positivity of different tests for malaria diagnosis, were retrieved. A total of 63 publications regarding TT malaria from seven countries were included, from 1971 to 2016. A total of 422 cases of TT malaria were recorded. Most TT malaria cases were in females (62.0%) and 39.5% were in the ≥61 years-old age group. About half of all cases were from Mexico (50.7%), 40.3% from the United States of America (USA) and 6.6% from Brazil. Gyneco-obstetrical conditions (67.3%), surgical procedures (20.6%) and complications from neoplasias (6.1%) were the most common indications of transfusion. Packed red blood cells (RBCs) (50.7%) and whole blood (43.3%) were the blood products mostly associated with TT malaria. Cases were mostly caused by Plasmodium malariae (58.4%), followed by Plasmodium vivax (20.7%) and Plasmodium falciparum (17.9%). A total of 66.6% of cases were diagnosed by microscopy. Incubation period of 2-3 weeks was the most commonly observed (28.6%). Lethality was seen in 5.3% of cases and was associated with living in non-endemic countries, P. falciparum infection and concomitant neoplastic diseases. There is an important research and knowledge gap regarding the TT malaria burden in Latin American countries where malaria remains endemic. No screening method that is practical, affordable and suitably sensitive is available at blood banks in Latin American countries, where infections with low parasitaemia contribute greatly to transmission. Lethality from TT malaria was not negligible. TT malaria needs to be acknowledged and addressed in areas moving toward elimination.

[Meta-analysis of the clinical significance of thyroidectomy combined with central neck dissection in differentiated thyroid carcinoma at the first treatment].

PubMed

Sun, Ronghao; Li, Chao; Fan, Jinchuan; Liu, Jifeng; Chen, Jianchao; Zhang, Bing

2014-02-01

To compare the differences in recurrence rates and surgical complications between thyroidectomy alone and thyroidectomy combined with central neck dissection as initial treatments to differentiated thyroid cancer and evaluate the clinic significance of central neck dissection for these patients. The literatures published in 1998-2013 were searched in Wanfang database, Chongqing VIP database, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Pubmed, Medline and Beijing Kangjian foreign medical journal full text service. According to the inclusion and deletion criteria, 30 articles were included. Of them 26 articles involved in complications, hypocalcemia and recurrent laryngeal nerve palsy as two major complications were involved in 26 articles and 24 articles respectively, and 26 articles involved in recurrence rate. RevMan5.0 software package was used to perform meta-analysis. Total complication rate in experimental group (plus central neck dissection) was 13.08% higher than that in control group (thyroidectomy only), the odds ratio (OR) [95% confidence interval (95%CI)] was 2.32[2.02, 2.67], Z value was 11.80, P < 0.01. Hypocalcemia in the experimental group was 11.80% higher than that in control group, OR value [95%CI] was 2.58[2.21, 3.02], Z was 11.98, P < 0.01. The rates of recurrent laryngeal nerve paralysis were low in both experimental group (5.26%) and control group(3.95%), and OR value [95%CI] was 1.22 [0.94, 1.58], Z was 1.48, P = 0.14. Recurrence rate in experimental group was 2.23% lower than that in control group, OR value [95%CI] was 0.78 [0.63,0.97], Z was 2.35, P = 0.03. Central compartment dissection as initial treatment to differentiated thyroid cancer may reduce the risk of recurrence, but increases the incidence of total complications and hypocalcemia, and has no significant effect on the rate of the recurrent laryngeal nerve paralysis.

The use of a biologic topical haemostatic agent (TachoSil(®)) for the prevention of postoperative bleeding in patients on antithrombotic therapy undergoing thyroid surgery: A randomised controlled pilot trial.

PubMed

Erdas, Enrico; Medas, Fabio; Podda, Francesco; Furcas, Silvia; Pisano, Giuseppe; Nicolosi, Angelo; Calò, Pietro Giorgio

2015-08-01

Anticoagulants and antiplatelet agents are well-known risk factors for post-operative bleeding. The aim of this prospective, randomized pilot study was to evaluate the effectiveness of a topical haemostatic agent, namely TachoSil, for the prevention of postoperative bleeding in patients on antithrombotic therapy undergoing thyroidectomy. Perioperative management and some distinctive aspects of cervical haematomas were also discussed. Between January 2012 and May 2014, all patients taking vitamin K antagonists (VKAs) or acetyl salicylic acid (ASA) scheduled for total thyroidectomy were enrolled and randomly allocated to group 1 (standard haemostasis) and group 2 (standard haemostasis + TachoSil). Antithrombotic drugs were always suspended prior to surgery and, when indicated, replaced by bridging anticoagulation with low-molecular-weight heparin. The primary endpoint was the incidence of postoperative cervical haematomas. A total of 70 patients were included in the study, representing 8.5% (70/820) of all patients who underwent thyroidectomies in the same period. The overall rate of post-operative cervical haematoma was 7.1% (5/70) and reached 14.8% (4/27) in patients on VKA therapy. All but one occurred more than 24 h after surgery (32nd hour, 8th, 10th, and 13th days). Group 1 (37 patients) and group 2 (33 patients) were well-matched according to clinical and demographic features. Postoperative haematoma was observed in 2/37 patients (5.4%) recruited in the Group 1 and 3/33 patients (9.1%) recruited in the Group 2 (P = 0.661). Patients taking antithrombotic drugs represent a major problem in thyroid surgery. The incidence of bleeding after thyroidectomy is significantly high and the use of TachoSil do not seem effective in preventing its occurrence. However, larger multicenter study is needed to confirm these results. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

Evaluating the cost-effectiveness of laryngeal examination after elective total thyroidectomy.

PubMed

Lang, Brian Hung-Hin; Wong, Carlos K H; Tsang, Raymond K Y; Wong, Kai Pun; Wong, Birgitta Y H

2014-10-01

Although routine laryngeal examination (RLE) after thyroidectomy may cost more than selective laryngeal examination (SLE), it permits earlier detection and treatment of vocal cord palsy (VCP) and so may be cost-saving in the longer term. We compared the 2-year cost-effectiveness between RLE and SLE with RLE performed at 2 weeks (SLE-2w), 1 month (SLE-1m), and 3 months (SLE-3m) after thyroidectomy in the institution's perspective. Our case definition was a hypothetical 50-year-old woman who underwent an elective total thyroidectomy for a benign multinodular goiter. A decision-analytic model was constructed to compare the estimated cost-effectiveness between RLE, SLE-2w, SLE-1m, and SLE-3m after a 2-year period. Outcome probabilities, utilities, and costs were estimated from the literature. The threshold for cost-effectiveness was set at US$50,000/quality-adjusted life-year. Sensitivity and threshold analyses were used to examine model uncertainty. RLE was not cost-effective because its incremental cost-effectiveness ratio to SLE-2w, SLE-1m, and SLE-3m were US$302,755, US$227,883 and US$247,105, respectively. RLE was only cost-effective when the temporary VCP rate increased >42.7 % or when the cost of RLE equaled zero. Similarly, SLE-2w was only cost-effective to SLE-3m when dysphonia for temporary VCP at 3 months increased >39.13 %, dysphonia for permanent VCP at 3 months increased >50.29 %, or dysphonia without VCP at 3 months increased >42.69 %. However, none of these scenarios appeared clinically likely. In the institution's perspective, RLE was not cost-effective against the other three SLE strategies. Regarding to the optimal timing of SLE, SLE-3m appears to be a reasonable and acceptable strategy because of its relative low overall cost.

Anticonvulsants and thyroid function.

PubMed Central

Yeo, P P; Bates, D; Howe, J G; Ratcliffe, W A; Schardt, C W; Heath, A; Evered, D C

1978-01-01

Serum total and free thyroid hormone concentrations were estimated in 42 patients with epilepsy taking anticonvulsants (phenytoin, phenobarbitone, and carbamazepine either singly or in combination). There was a significant reduction in total thyroxine (TT4), free thyroxine (FT4), and free triiodothyronine (FT3) in the treated group compared with controls. Free hormone concentrations were lower than total hormone concentrations, suggesting that increased clearance of thyroid hormones occurs in patients receiving anticonvulsants. Detailed analysis indicated that phenytoin had a significant depressant effect on TT4, FT4, FT3, and reverse T3 (rT3). Phenobarbitone and carbamazepine had no significant main effects, but there were significant interactions between phenytoin and carbamazepine for TT4 and FT4. phenobarbitone and carbamazepine for FT3, and phenytoin and phenobarbitone for rT3. PMID:656820

Rare complication after thyroidectomy-cervical esophageal stenosis: a case report and literature review.

PubMed

Peng, Hanwei; Wang, Steven J; Li, Weixiong

2014-10-11

The most common complications after thyroidectomy are injuries associated with the recurrent laryngeal nerve and parathyroid gland. Cervical esophagus perforation is an exceptionally rare complication after thyroidectomy; it can usually be resolved by conservative care. Cervical esophageal stenosis secondary to intraoperative esophageal injury during thyroidectomy is much rarer and has not been reported in the literature to date. We report a case of esophageal stenosis following thyroidectomy performed at a peripheral hospital. The patient initially underwent a thyroidectomy for papillary thyroid carcinoma involving the cervical esophagus; esophageal perforation was noted intraoperatively, and closed using three number 4 silk sutures. Cervical esophageal stenosis subsequently developed after conservative care. The patient was successfully treated with cervical esophagectomy and reconstruction using a tubed forearm free flap after a failed attempt at endoscopic recanalization. This case is discussed in conjunction with a review of the literature.

Testosterone and Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Propensity Score-Matched Analysis.

PubMed

Lee, Jun Ho; Lee, Sung Won

2016-07-01

A recent study investigated the role of testosterone (T) in chronic prostatitis or chronic pelvic pain syndrome (CP/CPPS). However, only a small amount of data is available to date, and the results are inconsistent. To evaluate the relation between total T (TT) and CP/CPPS. We conducted a propensity-matched study by identifying men with a TT level lower than 3.5 ng/mL among 8,336 men in their 40s and 50s. A control group of men with a TT level of at least 3.5 ng/mL matched for age, metabolic syndrome, and body mass index at a 5:1 ratio was selected for comparison. Using the same cohort and methods, another case group (TT < 3.0 ng/mL) and control group (TT ≥ 3.0 ng/mL) were selected. The National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) was administered. A χ(2) test, a t-test and logistic regression analyses were used to evaluate the relation between TT and prostatitis-like symptoms. Association of TT with NIH-CPSI score. After propensity score matching, 948 cases (TT < 3.5 ng/mL) and 4,740 controls (TT ≥ 3.5 ng/mL) were included. The ratio of mild and moderate to severe prostatitis-like symptoms was higher in the case group than in the control group (24.0% vs 27.4%, P = .001). The ratio of moderate to severe prostatitis-like symptoms also was higher in the case group than in the control group (6.2% vs 9.2%, P = .028). The pain domain of the NIH-CPSI, quality of life, and total NIH-CPSI scores also were higher in the case group. Ratios of severe lower urinary tract symptoms (12.6% vs 15.1%, P = .044) to maximal flow rate no higher than 10 mL/sec (3.8% vs 5.3%, P = .044) and postvoid residual urine volume of at least 100 mL (4.0% vs 5.6%, P = .035), which suggest high pressure in the prostate urethra, were higher in the case group. After adjusting for voided volume during uroflowmetry and total prostate volume, the relations of a TT level lower than 3.5 ng/mL to a maximal flow rate no higher than 10 mL/sec (odds ratio = 1.402, 95% CI = 1.017-1.934, P = .039) and to a postvoid residual urine volume of at least 100 mL (odds ratio = 1.410, 95% CI = 1.031-1.927, P = .031) were maintained. Using the cutoff TT value of 3.0 ng/mL, 437 cases (TT < 3.0 ng/mL) and 2,185 controls (TT ≥ 3.0 ng/mL) were included. The result of the 3.0-ng/mL cutoff value for TT showed a higher incidence of prostatitis-like symptoms in the group with a TT level lower than 3.0 ng/mL, but this was not statistically significant. Low TT level (<3.5 ng/mL) was significantly correlated with prostatitis-like symptoms in this study. Copyright © 2016. Published by Elsevier Inc.

Evidence for tty Production and Measurement of (σ tt)γ/(σ tt)

DOE PAGES

Aaltonen, T.

2011-08-31

Using data corresponding to 6.0 fb -1 of pp collisions at √s = 1.96 TeV collected by the CDF II detector, we present a cross section measurement of top-quark pair production with an additional radiated photon, ttγ. The events are selected by looking for a lepton (ell), a photon (γ), significant transverse momentum imbalance (E T), large total transverse energy, and three or more jets, with at least one identified as containing a b quark (b). The ttγ sample requires the photon to have 10 GeV or more of transverse energy, and to be in the central region. Using anmore » event selection optimized for the ttγ candidate sample we measure the production cross section of tt (σ tt), and the ratio of cross sections of the two samples. Control samples in the dilepton+photon and lepton+photon+E T, channels are constructed to aid in decay product identification and background measurements. We observe 30 ttγ candidate events compared to the standard model expectation of 26.9 ± 3.4 events. We measure the ttγ cross section (σ tt) to be 0.18 ± 0.08 pb, and the ratio of σ ttγ to σ tt to be 0.024 ± 0.009. Assuming no tty production, we observe a probability of 0.0015 of the background events alone producing 30 events or more, corresponding to 3.0 standard deviations.« less

Functional Voice Outcomes After Thyroidectomy: An Assessment of the Dsyphonia Severity Index (DSI) After Thyroidectomy

DTIC Science & Technology

2010-01-01

patients in the objective NVO group demonstrated persistent signs of recurrent laryngeal nerve paralysis. Sub- jective and objective NVO patients were...DL, Montesinos MR, Tacchi VA, Moreno JC, Falco JE, Mezzadri NA, et al. Voice changes after thyroidectomy with- out recurrent laryngeal nerve injury. J...in a cancer hospital. Otolaryngol Head Neck Surg 2005;132:490-4. 10. Roy AD, Gardiner RH, Niblock WM. Thyroidectomy and the recurrent laryngeal nerve

Thyroid gland involvement in carcinoma of the hypopharynx.

PubMed

Joshi, P; Nair, S; Chaturvedi, P; Nair, D; Shivakumar, T; D'Cruz, A K

2014-01-01

The thyroid gland is removed en bloc during laryngectomy. There are no objective criteria for deciding the extent of thyroid gland resection in primary hypopharyngeal cancer cases. The present study aimed to determine the incidence of thyroid gland involvement in hypopharyngeal cancer and identify the various predictors of this involvement. This paper reports a retrospective analysis of 358 patients with hypopharyngeal cancer, who underwent total laryngectomy with partial or total pharyngectomy at Tata Memorial Hospital, Mumbai between 2004 and 2010. The mean age of this population was 61 years. The pyriform sinus was the most common hypopharyngeal subsite involved (in 89 per cent of cases). Most patients underwent hemi-thyroidectomy as part of their surgery. The thyroid gland was involved in only 13 per cent of cases. Thyroid gland involvement is not common in hypopharyngeal cancer. Cases that involved the post-cricoid area, subglottic extension, extralaryngeal spread or prior tracheostomy were associated with a higher risk of thyroid gland involvement. Ipsilateral thyroidectomy is sufficient in most patients undergoing surgery (laryngectomy with partial or total pharyngectomy) for hypopharyngeal cancers.

[Protection and bidirectional effect of rhubarb anthraquinone and tannins for rats' liver].

PubMed

Qin, Lu-shan; Zhao, Hai-ping; Zhao, Yan-ling; Ma, Zhi-jiel; Zeng, Ling-na; Zhang, Ya-ming; Zhang, Ping; Yan, Dan; Bai, Zhao-fang; Li, Yue; Hao, Qing-xiu; Zhao, Kui-jun; Wang, Jia-bo; Xiao, Xiao-he

2014-06-01

To compare the bidirectional effect of rhubarb total anthraquinone (TA) and total tannins (TT) on rats' liver. One hundred rats were randomly divided into 10 groups, i.e., the blank group, the model group, the blank + high dose TA group, the blank +low dose TA group, the blank + high dose TT group, the blank + low dose TT group, the model + high dose TA group, the model + low dose TA group, the model +high dose TT group, and the model + low dose TT group, 10 in each group. The carbon tetrachloride (CCI4) was used to prepare the acute liver injury rat model. TA and TT of rhubarb (at 5.40 g crude drugs/kg and 14.69 g crude drugs/kg) were intragastrically administrated to rats in all groups except the blank group and the model group, once daily for 6 successive days.The general state of rats, biochemical indices such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), laminin (LN), hyaluronic acid (HA), transforming growth factor beta1 (TGF-beta1), as well pathological results of rat liver tissues. Finally the protection laws of TA and TT for rats' liver were analyzed using factor analysis. Compared with the blank control group, all biochemical indices increased in the blank group (P < 0.05, P < 0.01). HA also increased in the blank + high dose TA group; AST, ALT, and HA also increased in the blank +high dose TT group (P < 0.05). Compared with the model group, AST, ALT, ALP, HA, and TGF-beta1 significantly decreased in the model + low dose TA group, the model + high dose TA group, the model + low dose TT group (P < 0.05, P < 0.01). Serum AST, ALT, and ALP also decreased in the model + high dose TT group (P < 0.05, P < 0.01). Pathological results showed that mild swollen liver cells in the model + high dose TA group. Fatty degeneration and fragmental necrosis around the central veins occurred in the blank + high dose TA group. The pathological injury was inproved in the model +low dose TA group. Two common factors, liver fibrosis and liver cell injury, were extracted by using factor analysis. TA showed stronger improvement of the two common factors than TT. Rhubarb TA and TT showed protective and harmful effects on rats' liver. At an equivalent dosage, TA had better liver protection than TT. High dose TT played a role in liver injury to some extent.

[A Case of Hereditary Medullary Thyroid Cancer (MEN2A/FMTC) Diagnosed at the Time of Recurrence].

PubMed

Enomoto, Keisuke; Shimizu, Kotaro; Hirose, Masayuki; Miyabe, Haruka; Morizane, Natsue; Takenaka, Yukinori; Shimazu, Kohki; Fushimi, Hiroaki; Uno, Atsuhiko

2015-03-01

We report a 42-year-old man with hereditary medullary thyroid cancer (multiple endocrine neoplasia, MEN2A/familial medullary thyroid carcinoma, FMTC), which was diagnosed at the time of tumor recurrence. He had a past history of a left thyroidectomy with neck dissection 7 years previously. A RET gene analysis revealed a point mutation (codon 618), and we diagnosed him as having hereditary medullary thyroid cancer. We resected the recurrent tumor in the right thyroid lobe together with performing a right lateral and central neck dissection. A RET gene analysis should be performed for patients with medullary thyroid cancer. When a RET gene mutation is present, a total thyroidectomy must be performed for the medullary thyroid cancer.

Postoperative IPTH compared with IPTH gradient as predictors of post-thyroidectomy hypocalcemia.

PubMed

Al Khadem, Mai G; Rettig, Eleni M; Dhillon, Vaninder K; Russell, Jonathon O; Tufano, Ralph P

2018-03-01

Predicting patients' risk for hypocalcemia after thyroidectomy may allow for same-day discharge. This study was designed to compare postoperative intact parathyroid hormone (IPTH) alone with percentage change in IPTH (IPTH gradient) in predicting post-thyroidectomy hypocalcemia. Retrospective cohort study. Patients undergoing total thyroidectomy by the senior author from May 2015 to May 2016 were included. Serum IPTH was measured preoperatively and 1 hour postoperatively, and IPTH gradient was calculated. Postoperative hypocalcemia was mild (≥8.0, <8.4) or severe (<8.0 and/or hypocalcemic symptoms). Postoperative IPTH and IPTH gradient were compared with hypocalcemia using logistic regression. Receiver operating characteristic analysis of IPTH measures as predictors of hypocalcemia was performed, and the area under the curve (AUC) was calculated. Overall, 119 patients were included. Forty-seven percent of the patients developed postoperative hypocalcemia, including 26 (22%) with mild and 30 (25%) with severe hypocalcemia. Thirteen patients had hypocalcemic symptoms. Median IPTH gradient and postoperative IPTH each differed significantly by category of hypocalcemia (P < .001). Higher IPTH gradient was significantly associated with odds of severe and symptomatic hypocalcemia (adjusted odds ratio [aOR]: 1.21, 95% confidence interval [CI]: 1.06-1.39 and aOR: 1.34, 95% CI: 1.05-1.71 per 10% increase), whereas lower postoperative IPTH was not (aOR: 1.27, 95% CI: 0.95-1.68 and aOR: 1.44, 95% CI: 0.90-2.31 per 10 pg/mL decrease). The AUC for predicting severe hypocalcemia was nonsignificantly higher for IPTH gradient than postoperative IPTH (AUC = 0.77 vs. 0.69, P = .10). The AUC for predicting symptomatic hypocalcemia was significantly higher for IPTH gradient (AUC = 0.75 vs. 0.72, P = .03). Our results suggest that the IPTH gradient may be more useful than postoperative IPTH alone in predicting risk of post-thyroidectomy hypocalcemia. 4. Laryngoscope, 128:769-774, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Thyroid cancer in Graves' disease: is surgery the best treatment for Graves' disease?

PubMed

Tamatea, Jade A U; Tu'akoi, Kelson; Conaglen, John V; Elston, Marianne S; Meyer-Rochow, Goswin Y

2014-04-01

Graves' disease is a common cause of thyrotoxicosis. Treatment options include anti-thyroid medications or definitive therapy: thyroidectomy or radioactive iodine (I(131) ). Traditionally, I(131) has been the preferred definitive treatment for Graves' disease in New Zealand. Reports of concomitant thyroid cancer occurring in up to 17% of Graves' patients suggest surgery, if performed with low morbidity, may be the preferred option. The aim of this study was to determine the rate of thyroid cancer and surgical outcomes in a New Zealand cohort of patients undergoing thyroidectomy for Graves' disease. This study is a retrospective review of Waikato region patients undergoing thyroid surgery for Graves' disease during the 10-year period prior to 1 December 2011. A total of 833 patients underwent thyroid surgery. Of these, 117 were for Graves' disease. Total thyroidectomy was performed in 82, near-total in 33 and subtotal in 2 patients. Recurrent thyrotoxicosis developed in one subtotal patient requiring I(131) therapy. There were two cases of permanent hypoparathyroidism and one of permanent recurrent laryngeal nerve palsy. Eight patients (6.8%) had thyroid cancer detected, none of whom had overt nodal disease. Five were papillary microcarcinomas (one of which was multifocal), two were papillary carcinomas (11 mm and 15 mm) and one was a minimally invasive follicular carcinoma. Thyroid cancer was identified in approximately 7% of patients undergoing surgery for Graves' disease. A low complication rate (<2%) of permanent hypoparathyroidism and nerve injury (<1%) supports surgery being a safe alternative to I(131) especially for patients with young children, ophthalmopathy or compressive symptoms. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

Recurrent laryngeal nerve landmarks during thyroidectomy.

PubMed

Ngo Nyeki, A-R; Njock, L-R; Miloundja, J; Evehe Vokwely, J-E; Bengono, G

2015-11-01

This study was designed to describe the various anatomical relations of the recurrent laryngeal nerve (RLN) during thyroid surgery in a Central African population. A prospective study was conducted between January 2012 and December 2012 in 5 otorhinolaryngology and head and neck surgery departments in Cameroon and Gabon. All patients undergoing total or subtotal thyroidectomy or loboisthmectomy with recurrent laryngeal nerve dissection, with no history of previous thyroid surgery, RLN dissection or tumour infiltration of the RLN, were included. Fifty-six patients were included, corresponding to 36 loboisthmectomies and 20 total or subtotal thyroidectomies. A total of 62 recurrent laryngeal nerves were identified: 32 on the right and 30 on the left. The course of the recurrent laryngeal nerve in relation to branches of the inferior thyroid artery (ITA) was retrovascular in 53.1% of cases on the right and 76.6% of cases on the left; transvascular in 15.6% of cases on the right and 13.4% of cases on the left. The course of the recurrent laryngeal nerve was modified by thyroid disease in 12.9% of cases. Six cases (9.7%) of extralaryngeal division of the recurrent laryngeal nerve were observed. No case of non-recurrent nerve was observed in this series. The anatomical relations of the recurrent laryngeal nerve with the inferior thyroid artery were very inconstant in this series and were predominantly retrovascular or transvascular in relation to the branches of the artery. The presence of extralaryngeal branches and modification of the course of the nerve by thyroid disease also introduced additional difficulties during recurrent laryngeal nerve dissection. The anatomical relations of the right recurrent laryngeal nerve in this African population differ from the classically described prevascular course. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

EXEIS - Expert Screening and Optimal Extraction/Injection Pumping Systems for Short-Term Plume Immobilization

DTIC Science & Technology

1990-05-01

i at time t, (L). hL lower limit on head at pump i, (L). i xviii hU upper limit on head at -’ump i, (L).i (h j ,TT) d head at observation well j which...constraints: L U hL U h .. (9) h. ih. i ...I hi,t 1 S(hj Q........................(10) J ho ,TT - (h ,TT ) d . . . . .. . . . . . .O where: I = total number...at pump i at time period t, (L); = hi, 0 -s i,t hU = upper limit on head at pump i, (L); 1 (hTT ) d = head at each observation well j which is down

DOE Office of Scientific and Technical Information (OSTI.GOV)

Aaboud, M.; Aad, G.; Abbott, B.

A measurement of the tt¯Z and tt¯W production cross sections in final states with either two same-charge muons, or three or four leptons (electrons or muons) is presented. The analysis uses a data sample of proton–proton collisions at √s = 13 TeV recorded with the ATLAS detector at the Large Hadron Collider in 2015, corresponding to a total integrated luminosity of 3.2 fb –1. The inclusive cross sections are extracted using likelihood fits to signal and control regions, resulting in σ tt¯Z = 0.9±0.3 pb and σ tt¯W = 1.5±0.8 pb, in agreement with the Standard Model predictions.

Continuous intraoperative neuromonitoring (CIONM) of the recurrent laryngeal nerve is sufficient as the only neuromonitoring technique in thyroidectomy performed because of benign goitre.

PubMed

Adamczewski, Zbigniew; Chwałkiewicz, Michał; Lewiński, Andrzej; Brzeziński, Jan; Dedecjus, Marek

2015-01-01

Recently, intraoperative neurophysiological neuromonitoring (IONM) of recurrent laryngeal nerves (RLN) has been evolving quickly. This evolution touched many aspects of the technique, leading to continuous stimulation of the RLN with real time analysis of the electrical signal. The aim of the study was to estimate the value of continuous intraoperative neuromonitoring (CIONM) as the only technique for intraoperative neuromonitoring in thyroidectomy performed because of benign goitre. The study comprised 80 women qualified for thyroidectomy due to nodular goitre. The patients were divided into 4 groups depending on the technique used for RLN integrity verification: group 1 - thyroidectomy with CIONM; group 2 - thyroidectomy with direct, intermittent stimulation of RLN and vagus nerve (NX); group 3 - both CIONM and intermittent stimulation of RLN and NX; group 4 - thyroidectomy without any IONM. Mean operation time did not differ significantly among the groups with IONM, but was significantly longer in comparison to group 4, as well as the operation's cost. In the analysed groups there was no significant difference in complication ratio. CIONM with RLN visualization in thyroidectomy performed because of benign goitre is as safe as other methods of IONM and gives a continuous confirmation of the electrical integrity of the loop NX-RLN-vocal folds during almost the entire procedure. There is a clinical need for the development of external stimulation of NX (transdermal or trancranial), particularly for minimally invasive techniques in which access to NX is limited (i.e. transoral thyroidectomy).

Steady-State Serum T3 Concentrations for 48 Hours Following the Oral Administration of a Single Dose of 3,5,3'-Triiodothyronine Sulfate (T3S).

PubMed

Santini, Ferruccio; Giannetti, Monica; Ricco, Ilaria; Querci, Giorgia; Saponati, Giorgio; Bokor, Daniela; Rivolta, Giovanni; Bussi, Simona; Braverman, Lewis E; Vitti, Paolo; Pinchera, Aldo

2014-07-01

Sulfate conjugation of thyroid hormones is an alternate metabolic pathway that facilitates the biliary and urinary excretion of iodothyronines and enhances their deiodination rate, leading to the generation of inactive metabolites. A desulfating pathway reverses this process, and thyromimetic effects have been observed following the parenteral administration of 3,5,3'-triiodothyronine (T3) sulfate (T3S) in rats. The present study investigated whether T3S is absorbed after oral administration in humans and if it represents a source of T3. Twenty-eight hypothyroid patients (7 men and 21 women; mean age, 44 ± 11 years) who had a thyroidectomy for thyroid carcinoma were enrolled. Replacement thyroid hormone therapy was withdrawn (42 days for thyroxine, 14 days for T3) prior to 131I remnant ablation. A single oral dose of 20, 40, 80 (4 patients/group), or 160 μg (16 patients/group) of T3S was administered 3 days before the planned administration of 131I. Blood samples for serum T3S and total T3 (TT3) concentrations were obtained at various times up to 48 hours after T3S administration. At all T3S doses, serum T3S concentrations increased, reaching a peak at 2 to 4 hours and progressively returning to basal levels within 8 to 24 hours. The T3S maximum concentration (Cmax) and area under the 0- to 48-hour concentration-time curve (AUC0-48h) were directly and significantly related to the administered dose. An increase in serum TT3 concentration was observed (significant after 1 hour), and the concentration increased further at 2 and 4 hours and then remained steady up to 48 hours after T3S administration. There was a significant direct correlation between the TT3 AUC0-48h and the administered dose of T3S. No changes in serum free thyroxine (T4) concentrations during the entire study period were observed, whereas serum thyroid-stimulating hormone levels increased slightly at 48 hours, but this was not related to the dose of T3S. No adverse events were reported. (1) T3S is absorbed following oral administration in hypothyroid humans; (2) after a single oral dose, T3S is converted to T3 in a dose-dependent manner, resulting in steady-state serum T3 concentrations for 48 hours; (3) T3S may represent a new agent in combination with T4 in the therapy of hypothyroidism, if similar conversion of T3S to T3 can be demonstrated in euthyroid patients who are already taking T4.

Hypomagnesemia predicts postoperative biochemical hypocalcemia after thyroidectomy.

PubMed

Luo, Han; Yang, Hongliu; Zhao, Wanjun; Wei, Tao; Su, Anping; Wang, Bin; Zhu, Jingqiang

2017-05-25

To investigate the role of magnesium in biochemical and symptomatic hypocalcemia, a retrospective study was conducted. Less-than-total thyroidectomy patients were excluded from the final analysis. Identified the risk factors of biochemical and symptomatic hypocalcemia, and investigated the correlation by logistic regression and correlation test respectively. A total of 304 patients were included in the final analysis. General incidence of hypomagnesemia was 23.36%. Logistic regression showed that gender (female) (OR = 2.238, p = 0.015) and postoperative hypomagnesemia (OR = 2.010, p = 0.017) were independent risk factors for biochemical hypocalcemia. Both Pearson and partial correlation tests indicated there was indeed significant relation between calcium and magnesium. However, relative decreasing of iPTH (>70%) (6.691, p < 0.001) and hypocalcemia (2.222, p = 0.046) were identified as risk factors of symptomatic hypocalcemia. The difference remained significant even in normoparathyroidism patients. Postoperative hypomagnesemia was independent risk factor of biochemical hypocalcemia. Relative decline of iPTH was predominating in predicting symptomatic hypocalcemia.

Synchronous papillary carcinoma in thyroglossal duct cyst and thyroid gland: case report and review of literature.

PubMed

Cherian, Mathew Pynumootil; Nair, Balakrishnan; Thomas, Shaji; Somanathan, Thara; Sebastian, Paul

2009-10-01

We report a rare case of synchronous occurrence of thyroglossal duct cyst carcinoma and thyroid carcinoma and discuss its management in detail. A 59-year-old woman was clinically diagnosed to have a thyroglossal duct cyst and a solitary nodule. Fine-needle aspiration cytology revealed a papillary carcinoma in the thyroglossal duct cyst and a colloid in the thyroid nodule. Sistrunk's procedure along with a total thyroidectomy was performed followed by postoperative radioiodine ablation. Histopathologic examination revealed thyroglossal duct cyst carcinoma and bilateral foci of papillary carcinoma in the thyroid gland. She has remained free of disease on follow-up. Most cancers arising in thyroglossal duct cysts are of low risk, and Sistrunk's procedure is an adequate treatment for such cancers. However, for synchronously occurring cancers of the thyroglossal duct cyst and thyroid gland, or high-risk thyroglossal duct cyst cancers, more aggressive treatment comprising total thyroidectomy, Sistrunk's procedure, and radioiodine therapy is indicated. (c) 2009 Wiley Periodicals, Inc.

[Trends in thyroid surgery at the Instituto Nacional de la Nutrición Salvador Zubirán].

PubMed

Herrera, M F; López, C M; Saldaña, J; Pérez, B; Rivera, R; González, O; Angeles, A; Letayf, V

1995-01-01

The diagnosis and treatment of thyroid disease has significantly changed with time. With the aim of analysing changes in thyroid surgery in our institution, a representative sample of patients from the first three years in four decades (1960-1992) were comparatively analysed. In the sixties, the diagnosis of thyroid cancer was made during surgery; by contrast, this diagnosis was correctly done by fine needle aspiration (FNA) in most patients of the last decade. Thyroid lobectomy, infrequently used in the treatment of differentiated thyroid carcinoma in earlier times, has now been abandoned and currently most patients undergo total or near-total thyroidectomy. Complications such as hypoparathyroidism and recurrent laryngeal nerve paralysis have importantly decreased with time and were not seen in the last decade. A trend toward an earlier diagnosis of thyroid carcinoma was also observed. In summary, the number of thyroidectomies for benign diseases has been importantly reduced by the use of FNA with the proportional increment of surgery for malignant disease.

Neuromuscular Electrical Stimulation for Treatment-Refractory Chronic Dysphagia in Tube-Fed Patients: A Prospective Case Series.

PubMed

Scarponi, Letizia; Mozzanica, Francesco; De Cristofaro, Valeria; Ginocchio, Daniela; Pizzorni, Nicole; Bottero, Alessandro; Schindler, Antonio

2015-01-01

The aim of this study was to evaluate the role of neuromuscular electrical stimulation (NMES) in tube-fed patients with severe and chronic dysphagia refractory to traditional swallowing therapy (TT). A total of 11 consecutive dysphagic patients with tube-dependent nutrition and who had not responded to 6 months of TT were enrolled. Each patient received NMES for 30 min and TT for 30 min, twice a day, 5 days per week for 4 weeks. In order to evaluate the swallowing impairment, each patient underwent a fiberoptic endoscopic examination of swallowing immediately before the beginning of the treatment, after 2 weeks and after 4 weeks. All enrolled patients managed to complete the swallowing treatment protocol for at least 2 weeks. After the 4-week treatment, 6 of 11 enrolled patients passed to a total oral diet with single or multiple consistencies despite specific food limitations or special preparation or compensation. Five patients, all affected by the most severe form of dysphagia, maintained tube-dependent nutrition. NMES as adjunctive treatment to TT may offer a new possibility for the management of tube-fed patients who are refractory to TT. © 2016 S. Karger AG, Basel.

CIRCULATING CONCENTRATIONS OF THYROID HORMONE IN BELUGA WHALES (DELPHINAPTERUS LEUCAS): INFLUENCE OF AGE, SEX, AND SEASON.

PubMed

Flower, Jennifer E; Allender, Matthew C; Giovanelli, Richard P; Summers, Sandra D; Spoon, Tracey R; St Leger, Judy A; Goertz, Caroline E C; Dunn, J Lawrence; Romano, Tracy A; Hobbs, Roderick C; Tuttle, Allison D

2015-09-01

Thyroid hormones play a critical physiologic role in regulating protein synthesis, growth, and metabolism. To date, because no published compilation of baseline values for thyroid hormones in beluga whales (Delphinapterus leucas) exists, assessment of thyroid hormone concentrations in this species has been underused in clinical settings. The purpose of this study was to document the concentrations of total thyroxine (tT4) and total triiodothyronine (tT3) in healthy aquarium-maintained and free-ranging beluga whales and to determine the influence of age, sex, and season on the thyroid hormone concentrations. Archived serum samples were collected from healthy aquarium-maintained (n=43) and free-ranging (n=39) belugas, and serum tT4 and tT3 were measured using chemiluminescence immunoassay. The mean tT4 concentration in aquarium-maintained belugas was 5.67±1.43 μg/dl and the mean tT3 concentration was 70.72±2.37 ng/dl. Sex comparisons showed that aquarium-maintained males had significantly greater tT4 and tT3 (9.70±4.48 μg/dl and 92.65±30.55 ng/dl, respectively) than females (7.18±2.82 μg/dl and 77.95±20.37 ng/dl) (P=0.004 and P=0.013). Age comparisons showed that aquarium-maintained whales aged 1-5 yr had the highest concentrations of tT4 and tT3 (8.17±0.17 μg/dl and 105.46±1.98 ng/dl, respectively) (P=0.002 and P<0.001). tT4 concentrations differed significantly between seasons, with concentrations in winter (4.59±1.09 μg/dl) being significantly decreased compared with spring (P=0.009), summer (P<0.0001), and fall (P<0.0001) concentrations. There was a significant difference in tT4 and tT3 concentrations between aquarium-maintained whales (5.67±1.43 μg/dl and 70.72±15.57 ng/dl, respectively) and free-ranging whales (11.71±3.36 μg/dl and 103.38±26.45 ng/dl) (P<0.0001 and P<0.001). Clinicians should consider biologic and environmental influences (age, sex, and season) for a more accurate interpretation of thyroid hormone concentrations in belugas. The findings of this study provide a baseline for thyroid health monitoring and comprehensive health assessments in both aquarium-maintained and free-ranging beluga whales.

Influence of thyroid gland status on the thyroglobulin cutoff level in washout fluid from cervical lymph nodes of patients with recurrent/metastatic papillary thyroid cancer.

PubMed

Lee, Jun Ho; Lee, Hyun Chul; Yi, Ha Woo; Kim, Bong Kyun; Bae, Soo Youn; Lee, Se Kyung; Choe, Jun-Ho; Kim, Jung-Han; Kim, Jee Soo

2016-04-01

The influence of serum thyroglobulin (Tg) and thyroidectomy status on Tg in fine-needle aspiration cytology (FNAC) washout fluid is unclear. A total of 282 lymph nodes were prospectively subjected to FNAC, fine-needle aspiration (FNA)-Tg measurement, and frozen and permanent biopsies. We evaluated the diagnostic performance of several predetermined FNA-Tg cutoff values for recurrence/metastasis in lymph nodes according to thyroidectomy status. The diagnostic performance of FNA-Tg varied according to thyroidectomy status. The optimized cutoff value of FNA-Tg was 2.2 ng/mL. However, among FNAC-negative lymph nodes, the FNA-Tg cutoff value of 0.9 ng/mL showed better diagnostic performance in patients with a thyroid gland. An FNA-Tg/serum-Tg cutoff ratio of 1 showed the best diagnostic performance in patients without a thyroid gland. Applying the optimal cutoff values of FNA-Tg according to thyroid gland status and serum Tg level facilitates the diagnostic evaluation of neck lymph node recurrences/metastases in patients with papillary thyroid carcinoma (PTC). © 2015 Wiley Periodicals, Inc. Head Neck 38: E1705-E1712, 2016. © 2015 Wiley Periodicals, Inc.

Minimally invasive video-assisted thyroidectomy: four-year experience of a single team in a General Surgery Unit.

PubMed

Scerrino, G; Paladino, N C; Di Paola, V; Morfino, G; Inviati, A; Amodio, E; Gulotta, G; Bonventre, S

2013-06-01

Minimally invasive video-assisted thyroidectomy (MIVAT) is a surgical technique that has showed increasingly good results, particularly in endocrine surgery centers. The aim of this prospective, non-randomized study was to evaluate feasibility, advantages and critical aspects of MIVAT in a general surgery unit. Two hundred twenty-four patients underwent total thyroidectomy for benign thyroid disease from May, 2008 to April, 2011. They were divided into two groups: one underwent conventional thyroidectomy (CT), and the other underwent MIVAT. The inclusion criteria were thyroid volume ≤35 mL and main nodule size ≤35 mm. For each patient, socio-demographic variables, hospitalization data and outcome measures (complication rate, operating time, post-operative pain, observer and patient scar assessment scale [OSAS and PSAS, respectively]) were collected. Multivariate regression analyses were done to assess the principal covariates affecting these outcome measures. There were 125 MIVATs and 99 CTs performed. The two groups were characterized by difference in age (38.4 vs. 50.9 years) and thyroid volume (18.6 vs. 23.3 mL). OSAS/PSAS scores were statistically significant in the MIVAT group (P<0.001 and P<0.001, respectively) even after adjusting for age and thyroid volume. Complication rate was similar in the two groups. MIVAT significantly decreased postoperative pain and improved cosmetic results. It can be performed in younger patients and in all cases in which there is a clear indication for the procedure. Its advantages were confirmed in a general surgery unit where correct indications were followed.

Does Calculated Free Testosterone Overcome Total Testosterone in Protecting From Sexual Symptom Impairment? Findings of a Cross-Sectional Study.

PubMed

Boeri, Luca; Capogrosso, Paolo; Ventimiglia, Eugenio; Cazzaniga, Walter; Pederzoli, Filippo; Moretti, Donatella; Dehò, Federico; Montanari, Emanuele; Montorsi, Francesco; Salonia, Andrea

2017-12-01

Although erectile dysfunction (ED) has been associated with low circulating total testosterone (TT) levels, the utility of free testosterone (FT) over TT is debatable. To assess the relative impact of low TT and low calculated FT (cFT) on androgen-related sexual symptoms in men with ED. Data from 485 men were analyzed. Comorbidities were scored with the Charlson Comorbidity Index (CCI). Patients completed the International Index of Erectile Function (IIEF) and the Beck Inventory for Depression (BDI). Descriptive statistics tested differences between patients with normal TT levels (>3 ng/mL) and normal cFT levels (>65 pg/mL; group 1) and men with normal TT and low cFT (group 2), low TT and normal cFT (group 3), and low TT and low cFT (group 4). Linear regression models tested the association between clinical predictors and sexual function impairment. We assessed the impact of different hormonal categories on androgen-related symptoms and the clinical utility of measuring cFT in men with ED. Groups 1, 2, 3, and 4 were composed of 338 (69.6%), 44 (9.1%), 34 (7.0%), and 69 (14.3%) patients, respectively. Compared with group 1, patients in group 2 were older (P < .001), had a higher body mass index (P < .01), and had a larger proportion with CCI scores of at least 1 (P = .006). Likewise, group 2 presented lower scores for the IIEF erectile function (P = .07), sexual desire (P = .04), and orgasmic function (P = .007) domains and lower BDI scores (P = .02) than group 1. Similar findings were found for group 4 vs 1. Conversely, patients in group 3 had similar scores on the questionnaires to those in group 1. Low cFT and normal or low TT achieved independent predictor status for pathologic IIEF domains and BDI scores after accounting for age, CCI, and body mass index. Conversely, low TT and normal cFT status was not associated with pathologic scores on the questionnaires. The inclusion of cFT in the first-line assessment of hypogonadal symptoms in men with ED has major clinical utility. This is the first study evaluating the concomitant impact of TT and cFT on men with ED using well-validated instruments to assess patients' sexuality and depressive symptoms. Limitations are the retrospective nature of the study and lack of physical function data and bone ultrasound measurements. Although normal cFT was not associated with signs and symptoms suggestive of testosterone deficiency, even when concomitant with low TT or low cFT irrespective of TT values, it was indicative of poorer clinical profiles and impaired sexual and depressive parameters compared with normal TT and normal cFT in a cohort of patients with ED. Boeri L, Capogrosso P, Ventimiglia E, et al. Does Calculated Free Testosterone Overcome Total Testosterone in Protecting From Sexual Symptom Impairment? Findings of a Cross-Sectional Study. J Sex Med 2017;14:1549-1557. Copyright © 2017 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Surgical strategy for the treatment of sporadic medullary thyroid carcinoma: our experience.

PubMed

Lupone, G; Antonino, A; Rosato, A; Zenone, P; Iervolino, E M; Grillo, M; De Palma, M

2012-01-01

Medullary thyroid carcinoma (MTC) is a rare disease which accounts for approximately 5-9% of all thyroid cancers and originates from the calcitonin-screening parafollicular C cells. MTC can be divided into two subgroups: sporadic (75%) or inherited (25%). The majority of patients with invasive MTC have metastasis to regional lymph nodes at the time of diagnosis, as evidenced by the frequent finding of persistently elevated calcitonin levels after thyroidectomy and the high rates of recurrence in the cervical lymph nodes reported in retrospective studies. The purpose of the study is to review our single institution's experience with MTC since 1998 and to evaluate surgical strategy, patterns of lymph node metastases and calcitonin response to compartment-oriented lymphadenectomy in patients with primary or recurrent sporadic medullary thyroid carcinoma. A retrospective review of 26 patients treated for MTC at the "Antonio Cardarelli" Hospital referral center, in Naples, between 1998 and 2012. There were 18 female and 8 male patients, median age at presentation was 55 years, and median follow-up for survivors was 5 years. Total thyroidectomy was performed in all 26 patients; central compartment (CC) node dissection (level VI) in 12 (46%) patients; central plus lateral compartment (LC) node dissection (levels II, III, and IV) in 7 (27%) patients. 4 patients (15%) underwent reoperation for loco-regional recurrent/persistent MTC. Results. After a median post-surgical follow-up of 5 years (range 1-10 years), 63 % of patients were living disease-free, 15% were living with disease and/or persistently elevated calcitonin levels after surgery, 11% were deceased due to MTC and 11 % were lost to follow-up. We agree with most authors advocating for a total thyroidectomy and prophylactic central neck dissection in the setting of clinically detected MTC. Lateral neck dissection may be best reserved for patients with positive preoperative imaging. Nevertheless MTC has a high rate of lymph node metastases that are sub optimally detected preoperatively in the central compartment by neck ultrasound or intra-operatively by the surgeon, and reoperation is associated with a higher rate of surgical complications. In our limited experience, patients with thyroid confined nodular pathology, without nodal disease and unknown preoperative diagnosis of MTC, underwent only total thyroidectomy with a good prognosis.

Risk factors for trachomatous trichiasis in children: cross-sectional household surveys in Southern Sudan.

PubMed

Ngondi, Jeremiah; Reacher, Mark H; Matthews, Fiona E; Brayne, Carol; Gatpan, Gideon; Becknell, Steven; Kur, Lucia; King, Jonathan; Callahan, Kelly; Emerson, Paul M

2009-03-01

We have previously documented blinding trachoma to be a serious public health problem in Southern Sudan, with an unusually high prevalence of trachomatous trichiasis (TT) among children. We aimed to investigate risk factors for TT in children in Southern Sudan. Cross-sectional surveys were undertaken in 11 districts between 2001 and 2006, and eligible participants were examined for trachoma signs. Risk factors were assessed through interviews and observations. Using logistic regression, associations between TT in children and potential risk factors were investigated. In total, 11155 children aged 1-14 years from 3950 households were included in the analysis. Overall prevalence of TT was 1.5% (95% CI 1.1-2.1). Factors independently associated with increased odds of TT in children aged 1-14 years were: increasing age (P(trend)<0.001); female gender (odds ratio=1.5; 95% CI 1.1-2.1); increasing proportion of children in the household with trachomatous inflammation-intense (TI) (P(trend)=0.002); and increasing number of adults in the household with TT (P(trend)<0.001). Our study revealed risk factors for TT in children consistent with those previously reported for TT in adults. While the associations of TT in children with TI in siblings and TT in adult relatives merit further investigation, there is an urgent need for trachoma prevention interventions and trichiasis surgery services that are tailored to cater for young children in Southern Sudan.

A clinical pathway for the postoperative management of hypocalcemia after pediatric thyroidectomy reduces blood draws.

PubMed

Patel, Neha A; Bly, Randall A; Adams, Seth; Carlin, Kristen; Parikh, Sanjay R; Dahl, John P; Manning, Scott

2018-02-01

Postoperative calcium management is challenging following pediatric thyroidectomy given potential limitations in self-reporting symptoms and compliance with phlebotomy. A protocol was created at our tertiary children's institution utilizing intraoperative parathyroid hormone (PTH) levels to guide electrolyte management during hospitalization. The objective of this study was to determine the effect of a new thyroidectomy postoperative management protocol on two primary outcomes: (1) the number of postoperative calcium blood draws and (2) the length of hospital stay. Institutional review board approved retrospective study (2010-2016). Consecutive pediatric total thyroidectomy and completion thyroidectomy ± neck dissection cases from 1/1/2010 through 8/5/2016 at a single tertiary children's institution were retrospectively reviewed before and after initiation of a new management protocol. All cases after 2/1/2014 comprised the experimental group (post-protocol implementation). The pre-protocol control group consisted of cases prior to 2/1/2014. Multivariable linear and Poisson regression models were used to compare the control and experimental groups for outcome measure of number of calcium lab draws and hospital length of stay. 53 patients were included (n = 23, control group; n = 30 experimental group). The median age was 15 years. 41 patients (77.4%) were female. Postoperative calcium draws decreased from a mean of 5.2 to 3.6 per day post-protocol implementation (Rate Ratio = 0.70, p < .001), adjusting for covariates. The mean number of total inpatient calcium draws before protocol initiation was 13.3 (±13.20) compared to 7.2 (±4.25) in the post-protocol implementation group. Length of stay was 2.1 days in the control group and 1.8 days post-protocol implementation (p = .29). Patients who underwent concurrent neck dissection had a longer mean length of stay of 2.32 days compared to 1.66 days in those patients who did not undergo a neck dissection (p = .02). Hypocalcemia was also associated with a longer mean length of stay of 2.41 days compared to 1.60 days in patients who did not develop hypocalcemia (p < .01). The number of calcium blood draws was significantly reduced after introduction of a standardized protocol based on intraoperative PTH levels. The hospital length of stay did not change. Adoption of a standardized postoperative protocol based on intraoperative PTH levels may reduce the number of blood draws in children undergoing thyroidectomy. Copyright © 2017 Elsevier B.V. All rights reserved.

Immunogenicity and safety of an investigational combined haemophilus influenzae type B-Neisseria meningitidis serogroups C and Y-tetanus toxoid conjugate vaccine.

PubMed

Nolan, Terry; Richmond, Peter; Marshall, Helen; McVernon, Jodie; Alexander, Karyn; Mesaros, Narcisa; Aris, Emmanuel; Miller, Jacqueline; Poolman, Jan; Boutriau, Dominique

2011-03-01

Neisseria meningitidis serogroups B, C, and Y cause most meningococcal disease in industrialized countries. A Haemophilus influenzae type b-meningococcal serogroups C and Y-tetanus toxoid conjugate vaccine (HibMenCY-TT) was evaluated. A total of 1104 infants (randomized 3:1:1) were vaccinated at 2, 4, and 6 months with HibMenCY-TT, MenC-CRM197 + Hib-TT, or Hib-TT. At 12 to 15 months, HibMenCY-TT and MenC-CRM-primed children received HibMenCY-TT; Hib-TT-primed received N. meningitidis serogroup B Hib-outer membrane protein complex. Antibody concentrations and rabbit/human complement serum bactericidal antibody titers (rSBA/hSBA) were determined. Safety was monitored after each dose (diary cards for first 31 days) until 6 months postdose 4. Postdose 3, rates of antipolyribosylribitol phosphate ≥ 1 μg/mL and rSBA-MenC ≥1:128 in HibMenCY-TT recipients were noninferior to licensed controls. Percentages reaching 0.15 μg/mL (1.0 μg/mL postdose 3) and antipolyribosylribitol phosphate GMC were significantly higher after HibMenCY-TT than Hib-TT postdose 2 and postdose 3. The GMC remained significantly higher before and after dose 4. Proportions of HibMenCY-TT recipients with rSBA ≥ 1:8 were 95.6% (MenC), 98.6% (MenY) postdose-2, ≥ 99% for MenC/Y postdose 3 and 4; hSBA ≥ 1:4 were 95.5% (MenC), 89.8% (MenY) postdose 2, >97% for MenC/Y postdose 3 and 4. HibMenCY-TT had a similar safety profile to control vaccines. HibMenCY-TT induced noninferior Hib and MenC responses compared with monovalent Hib and MenC conjugates with a comparable safety profile. Bactericidal antibodies against MenC/Y were induced after 2 doses of HibMenCY-TT.

INDUCTION OF NEOPLASMS IN THYROID GLANDS OF RATS BY SUBTOTAL THYROIDECTOMY AND BY THE INJECTION OF ONE MICROCURIE OF I$sup 13$$sup 1$

DOE Office of Scientific and Technical Information (OSTI.GOV)

Goldberg, R.C.; Lindsay, S.; Nichols, C.W. Jr.

1964-01-01

Female Long-Evans rats were subjected to subtotal thyroidectomy, subtotal thyroidectomy plus injection of 1 mu e of I/sup 131/, subtotal thyroidectomy plus injection of 1 mu c of I/sup 131/ plus feeding of a diet containing desiccated thyroid, subtotal thyroidectomy plus feeding of a diet containing desiccated thyroid, injection of 1 mu c of I/sup 131/, feeding of a diet containing desiccated thyroid, and injection of 1 mu c of I/sup 131/ plus feeding of a diet containing desiccated thyroid. Single and multiple adenomas were found in rats subjected to subtotal thyroidectomy and in those subtotally thyroidectomized and given injectionsmore » of 1 mu c of I/sup 131/. In rats subjected to these same treatments but, in addition, fed the thyroid-containing diet, significantly fewer adenomas were encountered. Four papillary carcinomas and one follicular carcinoma were found in rats subjected to subtotal thyroidectomy and/or given injections of 1 mu c I/sup 131/. No carcinoma was observed in control rats. Two papillary carcinomas were found in glands following subtotal thyroidectomy alone, a finding suggesting that thyrotropic hormone stimulation may cause the development of both benign and malignant thyroid neoplasms. One papillary and one follicular carcinoma developed in the intact thyroid glands of rats that received only 1 mu c of I/sup 131/. These malignant neoplasms were possibly induced solely by the I/sup 131/ irradiation. One papillary carcinoma developed in a rat that had been subjected to subtotal thyroidectomy, given an injection of 1 mu c of I/sup 131/, and fed the desiccated thyroid-containing diet. This neoplasm appeared to be the result of either prolonged thyrotropic hormone stimulation or I/sup 131/ irradiation. (auth)« less

Curing Chronic Hepatitis C: A Cost Comparison of the Combination Simeprevir Plus Sofosbuvir vs. Protease-Inhibitor-Based Triple Therapy.

PubMed

Langness, Jacob A; Tabano, David; Wieland, Amanda; Tise, Sarah; Pratt, Lindsay; Harrington, Lauren Ayres; Lin, Sonia; Ghuschcyan, Vahram; Nair, Kavita V; Everson, Gregory T

Interferon-free, multi-direct acting antiviral (DAA) therapy for chronic hepatitis C virus (HCV) infection is highly effective and well tolerated, but costly. To gain perspective on the evolving economics of HCV therapy, we compared the cost per cure of a multi-DAA regimen with the prior standard of triple therapy. Patients infected with HCV genotype 1 who were treated through the University of Colorado Hepatology Clinic between May 2011 and December 2014 comprised the study population. The multi-DAA regimen of simeprevir plus sofosbuvir (SMV/SOF) was compared to the triple therapy regimen consisting of peginterferon and ribavirin, with either boceprevir or telaprevir (TT). Sustained-virologic response (SVR) rates, total costs per treatment and adverse events were recorded. Total cost per SVR were compared for the two treatments, controlling for patient demographics and clinical characteristics. One hundred eighty-three patients received SMV/SOF (n = 70) or TT (n = 113). Patients receiving SMV/SOF were older, more treatment experienced, and had a higher stage of fibrosis. SVRs were 86% and 59%, average total costs per patient were $152,775 and $95,943, and average total costs per SVR were $178,237 vs. $161,813.49 for SMV/SOF and TT groups, respectively. Medication costs accounted for 98% of SMV/SOF and 85% of TT treatment costs. The high cure rate of multi-DAA treatment of HCV is offset by the high costs of the DAAs, such that the cost per cure from TT to multi-DAA therapy has been relatively constant. In order to cure more patients, either additional financial resources will need to be allocated to the treatment of HCV or drug costs will need to be reduced.

Sublingual pyramidal lobe. Complications of subtotal thyroidectomy for Graves' disease

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sternberg, J.L.

1986-11-01

A potential complication of subtotal thyroidectomy where a large pyramidal lobe is present is described. The pyramidal lobe normally is immobilized inferiorly by its attachment to the thyroidal isthmus. When the isthmus is removed and the pyramidal lobe is left in situ during subtotal thyroidectomy its superior attachments will allow the pyramidal lobe to become situated sublingually. This may produce gagging and nausea. To avoid the complication, it is recommended that the pyramidal lobe be removed during subtotal thyroidectomy. If the patient also is thyrotoxic, I-131 can be used to treat this complication successfully.

Comparison of a gasless unilateral axillo-breast and axillary approach in robotic thyroidectomy.

PubMed

Song, Chang Myeon; Cho, Yong Hee; Ji, Yong Bae; Jeong, Jin Hyeok; Kim, Dong Sun; Tae, Kyung

2013-10-01

New approaches to robotic thyroidectomy help to prevent neck scarring and improve surgical ergonomics. The purpose of this study was to compare the efficacy and advantages of a gasless unilateral axillary (GUA) approach and an axillo-breast (GUAB) approach in robotic thyroidectomy. We retrospectively reviewed the data of 131 patients who underwent robotic thyroidectomy with or without central neck dissection using a GUAB (90 cases) or GUA (41 cases) approach between September 2009 and December 2011. We excluded patients who underwent simultaneous lateral neck dissection and cases within the learning curve. We compared patient and tumor characteristics, surgical outcomes, perioperative complications, and cosmetic satisfaction between the two approaches. Robotic thyroidectomy was successful in all patients. There were no differences in terms of patient and tumor characteristics, extent of thyroidectomy and central neck dissection, operative time, and postoperative complications between the two approaches. Cosmetic satisfaction was excellent in both groups. There was no difference in satisfaction with the cosmetic result in the neck area, but the GUA patients expressed higher satisfaction with the appearance of the breast. The surgical outcomes of GUA and GUAB approaches are similar in robotic thyroidectomy. Both are safe, effective, and yield cosmetically excellent results when performed by an experienced robotic thyroid surgeon. However, a GUA approach is associated with superior cosmetic satisfaction with the appearance of the breast.

Serotonin 2A Receptor SNP rs7330461 Association with Treatment Response to Pomaglumetad Methionil in Patients with Schizophrenia

PubMed Central

Nisenbaum, Laura K.; Downing, AnnCatherine M.; Zhao, Fangyi; Millen, Brian A.; Munsie, Leanne; Kinon, Bruce J.; Adams, David H.; Gomez, Juan Carlos; Penny, Michelle Ann

2016-01-01

This study aims to confirm the initial pharmacogenetic finding observed within the clinical proof-of-concept trial of an enhanced response to treatment with pomaglumetad methionil (LY2140023 monohydrate) in Caucasian schizophrenia patients homozygous for T/T at single nucleotide polymorphism rs7330461 in the serotonin (5-hydroxytryptamine) 2A receptor gene compared to A/A homozygous patients. The effect of the rs7330461 genotype on the response to pomaglumetad methionil treatment was assessed in three additional clinical trials and in an integrated analysis. Overall, this study includes data from 1115 Caucasian patients for whom genotyping information for rs7330461 was available, consisting of 513 A/A homozygous, 466 A/T heterozygous and 136 T/T homozygous patients. Caucasian T/T homozygous patients showed significantly (p ≤ 0.05) greater improvement in Positive and Negative Syndrome Scale (PANSS) total scores during treatment with pomaglumetad methionil 40 mg twice daily compared to A/A homozygous patients. Additionally, T/T homozygous patients receiving pomaglumetad methionil had significantly (p ≤ 0.05) greater improvements in PANSS total scores compared to placebo and similar improvements as T/T homozygous patients receiving standard-of-care (SOC) treatment. The findings reported here in conjunction with prior reports show that in Caucasian patients with schizophrenia, the T/T genotype at rs7330461 is consistently associated with an increased treatment response to pomaglumetad methionil compared to the A/A genotype. PMID:26861400

Serotonin 2A Receptor SNP rs7330461 Association with Treatment Response to Pomaglumetad Methionil in Patients with Schizophrenia.

PubMed

Nisenbaum, Laura K; Downing, AnnCatherine M; Zhao, Fangyi; Millen, Brian A; Munsie, Leanne; Kinon, Bruce J; Adams, David H; Gomez, Juan Carlos; Penny, Michelle Ann

2016-02-05

This study aims to confirm the initial pharmacogenetic finding observed within the clinical proof-of-concept trial of an enhanced response to treatment with pomaglumetad methionil (LY2140023 monohydrate) in Caucasian schizophrenia patients homozygous for T/T at single nucleotide polymorphism rs7330461 in the serotonin (5-hydroxytryptamine) 2A receptor gene compared to A/A homozygous patients. The effect of the rs7330461 genotype on the response to pomaglumetad methionil treatment was assessed in three additional clinical trials and in an integrated analysis. Overall, this study includes data from 1115 Caucasian patients for whom genotyping information for rs7330461 was available, consisting of 513 A/A homozygous, 466 A/T heterozygous and 136 T/T homozygous patients. Caucasian T/T homozygous patients showed significantly (p ≤ 0.05) greater improvement in Positive and Negative Syndrome Scale (PANSS) total scores during treatment with pomaglumetad methionil 40 mg twice daily compared to A/A homozygous patients. Additionally, T/T homozygous patients receiving pomaglumetad methionil had significantly (p ≤ 0.05) greater improvements in PANSS total scores compared to placebo and similar improvements as T/T homozygous patients receiving standard-of-care (SOC) treatment. The findings reported here in conjunction with prior reports show that in Caucasian patients with schizophrenia, the T/T genotype at rs7330461 is consistently associated with an increased treatment response to pomaglumetad methionil compared to the A/A genotype.

One-Hour PTH after Thyroidectomy Predicts Symptomatic Hypocalcemia

PubMed Central

Nocon, Cheryl; Nagar, Sapna; Kaplan, Edwin L.; Angelos, Peter; Grogan, Raymon H.

2015-01-01

Background A major morbidity following total thyroidectomy is hypocalcemia. While many clinical factors and laboratory studies have been correlated with both biochemical and symptomatic hypocalcemia, the ideal use and timing of these tests the remains unclear. We hypothesize one-hour (PACU) PTH will identify patients at risk for symptomatic hypocalcemia. Methods This prospective study evaluated 196 patients undergoing total thyroidectomy. Serum calcium and PTH levels were measured one hour after surgery and on postoperative day 1 (POD1). Performance of a central compartment lymph node dissection, parathyroid autotransplantation, indication for procedure, pathology, and presence of parathyroid tissue in the pathology specimen were recorded. Results Of 196 patients, 9 (4.6%) developed symptomatic hypocalcemia. 34 (17.3%) had a 1-hour PACU PTH ≤ 10 pg/dL while 31 (15.8%) had a POD1 PTH of ≤ 10. Five (56%) of the nine symptomatic patients underwent central compartment lymph node dissection, 4 (44%) had parathyroid autotransplantation and 4 (44%) had a PACU PTH ≤10. PACU and POD1 PTH levels were correlated (R2=0.682). Multivariate regression identified central compartment dissection, autotransplantation, and PACU or POD1 PTH correlated with symptomatic hypocalcemia. PACU PTH, POD1 PTH, PACU Ca, malignant final pathology, and Age ≤ 45 years correlated with biochemical hypocalcemia. Conclusion 1-hour postoperative PACU PTH is equivalent to POD1 PTH in predicting the development of symptomatic hypocalcemia. Biochemical hypocalcemia was not predictive of symptoms in the immediate post-operative period. Lymph node dissection and parathyroid autotransplantation correlated with symptomatic hypocalcemia and improve the sensitivity of biochemical screening alone. PMID:27020834

One-hour PTH after thyroidectomy predicts symptomatic hypocalcemia.

PubMed

White, Michael G; James, Benjamin C; Nocon, Cheryl; Nagar, Sapna; Kaplan, Edwin L; Angelos, Peter; Grogan, Raymon H

2016-04-01

A major morbidity after total thyroidectomy is hypocalcemia. Although many clinical factors and laboratory studies have been correlated with both biochemical and symptomatic hypocalcemia, the ideal use and timing of these tests remain unclear. We hypothesize 1-h (PACU) parathyroid hormone (PTH) will identify patients at risk for symptomatic hypocalcemia. This prospective study evaluated 196 patients undergoing total thyroidectomy. Serum calcium and PTH levels were measured 1 h after surgery and on postoperative day 1 (POD1). Performance of a central compartment lymph node dissection, parathyroid autotransplantation, indication for procedure, pathology, and presence of parathyroid tissue in the pathology specimen were recorded. Of 196 patients, nine (4.6%) developed symptomatic hypocalcemia. Thirty four (17.3%) had a 1-h PACU PTH ≤10 pg/dL, whereas 31 (15.8%) had a POD1 PTH of ≤10. Five (56%) of the nine symptomatic patients underwent central compartment lymph node dissection, four (44%) had parathyroid autotransplantation, and four (44%) had a PACU PTH ≤10. PACU and POD1 PTH levels were correlated (R(2) = 0.682). Multivariate regression identified central compartment dissection, autotransplantation, and PACU or POD1 PTH correlated with symptomatic hypocalcemia. PACU PTH, POD1 PTH, PACU Ca, malignant final pathology, and age ≤45 y correlated with biochemical hypocalcemia. A 1-h postoperative PACU PTH is equivalent to POD1 PTH in predicting the development of symptomatic hypocalcemia. Biochemical hypocalcemia was not predictive of symptoms in the immediate postoperative period. Lymph node dissection and parathyroid autotransplantation correlated with symptomatic hypocalcemia and improve the sensitivity of biochemical screening alone. Copyright © 2016 Elsevier Inc. All rights reserved.

Identification of occult tumors by whole-specimen mapping in solitary papillary thyroid carcinoma.

PubMed

Park, Seog Yun; Jung, Yuh-S; Ryu, Chang Hwan; Lee, Chang Yoon; Lee, You Jin; Lee, Eun Kyung; Kim, Seok-Ki; Kim, Tae Sung; Kim, Tae Hyun; Jang, Jeyun; Park, Daeyoon; Dong, Seung Myung; Kang, Jae-Goo; Lee, Jin Soo; Ryu, Junsun

2015-08-01

We undertook this study to estimate an accurate incidence and spread patterns of occult papillary thyroid carcinoma (PTC) in patients with a preoperative diagnosis of solitary PTC by using whole-specimen mapping of all specimens after a total thyroidectomy. Enrolled prospectively in this whole-thyroid mapping study are 82 consecutive patients who underwent a total thyroidectomy under a preoperative diagnosis of solitary PTC. All thyroidectomy specimens were serially sectioned in 2 mm thickness and whole-thyroid mapping was carried out for additional foci of occult PTC. The frequencies of occult lesions detected in the whole and contralateral lobe were determined, and clinicopathologic factors associated with multifocality were assessed. Whole-thyroid mapping revealed 66 occult PTC lesions missed by preoperative ultrasound in 37 (45.1%) of the 82 patients. The great majority (92.5%) of the occult PTC was smaller than 3 mm in size and 25 patients (30.5%) had contralateral lesions. We found that the male sex was an independent predictor of multifocality (odds ratio (OR), 3.00; 95% CI, 1.11-8.14), adjusting for preoperative findings. Analysis with pathologic parameters showed that the male sex (OR, 5.03; 95% CI, 1.68-15.08) and extrathyroidal extensions (OR, 3.03; 95% CI, 1.03-8.95) were associated with multifocal PTC. However, none of the clinicopathologic factors evaluated predicted contralateral PTC. Our study demonstrates the diagnostic limitations of ultrasound for the detection of multifocal PTC and the need to consider the possibility of occult lesions in the management of solitary PTC, especially in male patients. © 2015 Society for Endocrinology.

Nonthyroid Metastasis to the Thyroid Gland: Case Series and Review with Observations by Primary Pathology.

PubMed

Russell, Jonathon O; Yan, Kenneth; Burkey, Brian; Scharpf, Joseph

2016-12-01

Nonthyroid metastases to the thyroid gland can cause morbidity, including dysphagia, dysphonia, and airway compromise. Because metastatic malignancies portend a poor prognosis, obtaining equipoise between treatment morbidity and local disease progression is paramount. We reviewed cases of nonthyroid metastases to determine treatment and prognostic recommendations. Case series with chart review. Tertiary care hospital. We searched PubMed for reported cases between 1994 and September 2013 using search terms as follows: any combination of primary tumor locations and thyroid, as well as the terms thyroid and metastasis. Only unique cases of nonthyroid metastases were included. Combined with 17 additional tumors at our own institution, we found 818 unique nonthyroid metastases, of which 384 had management and survival data available. Renal cell carcinoma was most common, presenting in 293 (35.8%) patients, followed by lung and gastrointestinal malignancies. Patients were treated with total thyroidectomy (34.0%), subtotal thyroidectomy including lobectomy (32.6%), and no surgery (33.5%). Surgical management was associated with improved survival duration (P < .01). Locoregional recurrence was less likely in patients treated with total versus partial thyroidectomy (4.8% vs 13%). Extent of surgical management did not have a significant effect on patient survival. Delayed presentation was associated with improved survival duration (P = .01). Nonthyroid metastases to the thyroid gland are unusual tumors. Surgical intervention is associated with improved survival, but expected morbidity of untreated tumors is difficult to assess. Site of origin, time to diagnosis, and surgical approach are related to survival and recurrence rates. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Thyroid storm complicated by fulminant hepatic failure: case report and literature review.

PubMed

Hambleton, Catherine; Buell, Joseph; Saggi, Bob; Balart, Luis; Shores, Nathan J; Kandil, Emad

2013-11-01

Thyroid storm is a presentation of severe thyrotoxicosis that has a mortality rate of up to 20% to 30%. Fulminant hepatic failure (FHF) entails encephalopathy with severe coagulopathy in the setting of liver disease. It carries a high mortality rate, with an approximately 60% rate of overall survival for patients who undergo orthotopic liver transplantation (OLT). Fulminant hepatic failure is a rare but serious complication of thyroid storm. There have been only 6 previously reported cases of FHF with thyroid storm. We present a patient from our institution with thyroid storm and FHF. A literature review was performed to analyze the outcomes of the 6 additional cases of concomitant thyroid storm and FHF. Our patient underwent thyroidectomy followed by OLT. Her serum levels of thyroid-stimulating hormone, triiodothyronine, thyroxine, and transaminase normalized, and she was ready for discharge within 10 days of surgery. She has survived without complication. There is a 40% mortality rate for the reported patients treated medically with these conditions. Of the 7 total cases of reported FHF and thyroid storm, 2 patients died. Only 2 of the 7 patients underwent thyroidectomy and OLT--both at our institution. Both patients survived without complications. Thyroid storm and FHF each independently carry high mortality rates, and managing patients with both conditions simultaneously is an extraordinary challenge. These cases should compel clinicians to investigate liver function in hyperthyroid patients and to be wary of its rapid decline in patients who present in thyroid storm with symptoms of liver dysfunction. Patients with rapidly progressing thyroid storm and FHF should be considered for total thyroidectomy and OLT.

Juvenile idiopathic arthritis patients and their skeletal status: possible role of vitamin D receptor gene polymorphism.

PubMed

Kostik, M M; Smirnov, A M; Demin, G S; Scheplyagina, L A; Larionova, V I

2014-01-01

We evaluated bone mineralization and metabolism changes related to vitamin D receptor (VDR) polymorphic genotypes in children with juvenile idiopathic arthritis. One hundred and ninety eight children (82 boys and 116 girls) were included in our study. Bone mineral density (BMD) was measured by lumbar spine DXA. Osteocalcin, CTX, parathyroid hormone, total and ionized calcium, inorganic phosphate, total alkaline phosphatase activity was utilized for assessment of bone metabolism. Molecular testing: TaqI (rs731236) and Cdx2 (rs11568820) polymorphisms of VDR were detected by RFLP. No differences in TaqI and Cdx2 haplotypes, genotypes and alleles distribution related with normal and low BMD (Zscore <-2SD) were found. Children with low linear growth (<10th percentile) had more allele T-contained genotypes of TagI VDR (p = 0.037), compare with medium or high linear growth children. Children with high linear growth (>90th percentile) had the highest frequency of allele A-contained genotypes (GA+AA) of Cdx2 VDR (p = 0.009). Girls with TT TaqI VDR, who never been treated by glucocorticoides had lower BMD-Zscore than C allele carriers (TT = -0.94SD [IQR: -2.1;-0.5], TC+CC = -0.62SD [IQR: -1.26;0.39], p = 0.03). Girls with Tanner I with TT had higher total and ionized Ca level than carriers of C allele (Ca: TT = 2.43 ± 0.15 mmol/l, TC+CC = 2.28 ± 0.2 mmol/l, p = 0.024; Ca(2+): TT = 1.15 ± 0.08 mmol/l, TC+CC = 1.06 ± 0.13 mmol/l, p = 0.026). Presence of TT genotype negatively correlated with BMD-Zscore (r = -0.28, p = 0.04), and positively with frequency of LBMD (r = 0.3, p = 0.037). Boy with GG Cdx2 genotype had lower total Ca (GG = 2.3 ± 0.17 mmol/l, GA+AA = 2.43 ± 0.17 mmol/l, p = 0.004) compare with carriers of A allele. Pubertal boys (Tanner IV-V) with GG had higher CTX (GG = 1.75 ± 0.11 ng/ml, GA+AA = 1.06 ± 0.07 ng/ml, p = 0.04. TT genotype of TaqI and GG genotype of Cdx2 VDR is a negative factor impact bone mineralization metabolism and linear growth.

Cost savings of patients with a MACIS score lower than 6 when radioactive iodine is not given.

PubMed

Pace-Asciak, Pia Z; Payne, Richard J; Eski, Spiro J; Walfish, Paul; Damani, Manzur; Freeman, Jeremy L

2007-09-01

To assess the cost savings if the current policy of treating patients with a MACIS (metastases, age, completeness of resection, invasion, and size) score lower than 6 using radioactive iodine (RAI) was changed to reflect the findings of recent studies. Retrospective medical record review. Mount Sinai Hospital, Toronto, Ontario. Between January 1, 2002, and July 1, 2005, 199 consecutive patients with a MACIS score lower than 6 who received RAI treatment after total thyroidectomy. Patient demographics were analyzed. Costs for the dose of RAI, hospital stay, and health insurance claims were included in the calculations. For 199 consecutive patients, the cost for sodium iodide 131 treatment totaled Can$161 588, and the required 2-day stay in isolation totaled Can$764 558. The overall cost to the health care system was Can$934 106, which translates into approximately Can$4694 per patient. By following the recommendations of recent evidence-based studies and by ceasing to treat patients with a MACIS score lower than 6 after total thyroidectomy using RAI, cost savings can be accrued for health care systems involved in the treatment of thyroid cancer. Alternate strategies, such as treating patients who need RAI therapy on an outpatient basis and reducing the dose of RAI, can lower costs as well.

Effects of oral administration of levothyroxine sodium on serum concentrations of thyroid gland hormones and responses to injections of thyrotropin-releasing hormone in healthy adult mares.

PubMed

Sommardahl, Carla S; Frank, Nicholas; Elliott, Sarah B; Webb, Latisha L; Refsal, Kent R; Denhart, Joseph W; Thompson, Donald L

2005-06-01

To determine the effects of levothyroxine sodium (L-T4) on serum concentrations of thyroid gland hormones and responses to injections of thyrotropin-releasing hormone (TRH) in euthyroid horses. 12 healthy adult mares. 8 horses received an incrementally increasing dosage of L-T4 (24, 48, 72, or 96 mg of L-T4/d) for weeks 1 to 8. Each dose was provided for 2 weeks. Four additional horses remained untreated. Serum concentrations of total triiodothyronine (tT3), total thyroxine (tT4), free T3 (fT3), free T4 (fT4), and thyroid-stimulating hormone (TSH) were measured in samples obtained at weeks 0, 2, 4, 6, and 8; 1.2 mg of TRH was then administered i.v., and serum concentrations of thyroid gland hormones were measured 2 and 4 hours after injection. Serum reverseT3 (rT3) concentration was also measured in the samples collected at weeks 0 and 8. Treated horses lost a significant amount of weight (median, 19 kg). Significant treatment-by-time effects were detected for serum tT3, tT4, fT3, fT4, and TSH concentrations, and serum tT4 concentrations were positively correlated (r, 0.95) with time (and therefore dosage) in treated horses. Mean +/- SD serum rT3 concentration significantly increased in treated horses (3.06 +/- 0.51 nmol/L for week 8 vs 0.74 +/- 0.22 nmol/L for week 0). Serum tT3, tT4, fT3, and TSH concentrations in response to TRH injections differed significantly between treated and untreated horses. Administration of levothyroxine sodium increased serum tT4 concentrations and blunted responses toTRH injection in healthy euthyroid horses.

Serum Testosterone Concentrations and Urinary Bisphenol A, Benzophenone-3, Triclosan, and Paraben Levels in Male and Female Children and Adolescents: NHANES 2011–2012

PubMed Central

Scinicariello, Franco; Buser, Melanie C.

2016-01-01

Background: Exposure to environmental phenols (e.g., bisphenol A, benzophenone-3, and triclosan) and parabens is widespread in the population. Many of these chemicals have been shown to have anti-androgenic effects both in vitro and in vivo. Objective: We examined the association of bisphenol A (BPA), benzophenone-3 (BP-3), triclosan (TCS), and parabens with serum total testosterone (TT) levels in child and adolescent participants (ages 6–19 years) in the National Health and Nutrition Examination Survey (NHANES) 2011–2012. Methods: We performed multivariable linear regression to estimate associations between natural log–transformed serum TT and quartiles of urinary BPA, BP-3, TCS, and parabens in male and female children (ages 6–11 years) and adolescents (ages 12–19 years). Results: BP-3 and BPA were associated with significantly lower TT in male adolescents, and BPA was associated with significantly higher TT in female adolescents. TT was not consistently associated with TCS or total parabens in children or adolescents of either sex. Conclusions: To our knowledge, this is the first study to report an association of both BP-3 and BPA with serum TT in adolescents. Associations between BPA and TT differed according to sex in adolescents, with inverse associations in boys and positive associations in girls. BP-3 was associated with significantly lower TT in adolescent boys only. However, because of the limitations inherent to the cross-sectional study design, further studies are needed to confirm and elucidate on our findings. Citation: Scinicariello F, Buser MC. 2016. Serum testosterone concentrations and urinary bisphenol A, benzophenone-3, triclosan, and paraben levels in male and female children and adolescents: NHANES 2011–2012. Environ Health Perspect 124:1898–1904; http://dx.doi.org/10.1289/EHP150 PMID:27383665

Distinct Genetic Signatures for Variability in Total and Free Serum Thyroxine Levels in Four Sets of Recombinant Inbred Mice

PubMed Central

Lu, Lu; Aliesky, Holly A.; Williams, Robert W.; Rapoport, Basil

2011-01-01

C3H/He and BALB/c mice have elevated serum thyroxine levels associated with low deiodinase type-1 activity whereas C57BL/6 (B6) mice have low thyroxine levels and elevated deiodinase type-1 activity. High-resolution genetic maps are available for four sets of recombinant inbred (RI) mice derived from B6 parents bred to C3H/He, BALB/c, DBA/2, or A strains. Total and free T4 (T-T4 and F-T4) levels in females from these RI sets (BXH, CXB, BXD, and AXBXA) were analyzed to test two hypotheses: first, serum T4 variability is linked to the deiodinase type-1 gene; second, because of their shared B6 parent, the RI sets will share linkages responsible for T-T4 or F-T4 variability. A number of chromosomes (Chr) and loci were linked to T-T4 (Chr 1, 4, 13, 11) or F-T4 (Chr 1, 6, 13, 18, 19). Linkage between T-T4 and Chr 4 was limited to CXB and BXH strains, but the locus was distinct from the deiodinase type-1 gene. Surprisingly, many linkages were unique providing “genetic signatures” for T-T4 or F-T4 in each set of RI mice. Indeed, the strongest linkage between T-T4 (or F-T4) and a Chr 2 locus (logarithm of the odds scores >4.4) was only observed in AXBXA strains. Some loci corresponded to genes/Chr associated in humans with variable TSH or T-T4 levels. Unlike inbred mice, human populations are extremely diverse. Consequently, our data suggest that the contributions of unique chromosomes/loci controlling T-T4 and F-T4 in distinct human subgroups are likely to be “buried” in genetic analyses of heterogeneous human populations. PMID:21209025

Clinical correlates of sex hormones in women: The study of health in Pomerania.

PubMed

Kische, Hanna; Gross, Stefan; Wallaschofski, Henri; Völzke, Henry; Dörr, Marcus; Nauck, Matthias; Haring, Robin

2016-09-01

Despite associations of sex hormones in women with increased cardiometabolic risk and mortality, the clinical correlates of altered sex hormone concentrations in women are less clearly understood. We investigated a broad range of clinical correlates of sex hormones in women from a large population-based sample. Data from 2560 women from two cohorts of the Study of Health in Pomerania were used. Stepwise multivariable regression models were implemented to investigate a broad range of behavioral, socio-demographic, and cardiometabolic clinical correlates related to total testosterone (TT), free testosterone (fT), androstenedione (ASD), dehydroepiandrosterone-sulfate (DHEAS), estrone (E1), estradiol (E2), and sex hormone-binding globulin (SHBG). Waist circumference and BMI (β-coefficient: -0.03; 95% CI: -0.04; 0.03) were inversely related to SHBG, and BMI was positively related to TT (β-coefficient: 0.005; 95% CI: 0.001; 0.009), fT, E1, and E2. Smoking was positively related to TT (β-coefficient: 0.04; 95% CI: 0.01; 0.06), ASD, and fT. Systolic blood pressure (TT: β-coefficient: 0.002; 95% CI: 0.001; 0.003), hypertension (TT: β-coefficient: 0.05; 95% CI: 0.003; 0.11), low-density lipoprotein (LDL) cholesterol (TT: β-coefficient: 0.02; 95% CI: 0.01; 0.05), and total cholesterol (TT: β-coefficient: -0.03; 95% CI: 0.01; 0.05) were positively related to TT and ASD. Finally, type 2 diabetes mellitus (T2DM), and metabolic syndrome (MetS) were positively related to fT, but inversely related to SHBG. Our population-based study, with sex hormone concentrations measured by liquid chromatography tandem mass spectrometry, revealed associations between clinical correlates including waist circumference, smoking, cohabitation, systolic blood pressure, cholesterol, and MetS with sex hormones. Thus, sex hormones and SHBG may play a role in the cardiovascular risk profile of women. Copyright © 2016 Elsevier Inc. All rights reserved.

Triple antithrombotic therapy following an acute coronary syndrome: prevalence, outcomes and prognostic utility of the HAS-BLED score.

PubMed

Smith, J Gustav; Wieloch, Mattias; Koul, Sasha; Braun, Oscar Ö; Lumsden, Jonathan; Rydell, Emil; Ohman, Jenny; Scherstén, Fredrik; Svensson, Peter J; van der Pals, Jesper

2012-10-01

The aim of this study was to evaluate the prevalence of triple antithrombotic therapy (TT) (warfarin, aspirin and clopidogrel) in patients following an acute coronary syndrome (ACS), the bleeding risk compared to double antiplatelet therapy (DAPT) (aspirin and clopidogrel) and evaluate the accuracy of the HAS-BLED risk score in predicting serious bleeding events in TT patients. We retrospectively identified all ACS patients on TT upon discharge from the Coronary Care Unit at Skane University Hospital between 2005 and 2010. TT patients were compared to age- and sex-matched control patients discharged with DAPT. Major bleeding was defined in accordance with the HAS-BLED derivation study. A total of 2,423 patients were screened, of whom 159 (6.6%) were on TT. The mean age was 67.2 (±0.9) years. The most common indication for TT was atrial fibrillation (n=63, 39.6%) followed by apical akinesia (n=60, 37.8%), and the mean duration of TT was 3.7 (±0.3) months. Upon termination of TT, warfarin was discontinued in 82 (52.2%) patients and clopidogrel in 57 (36.3%) patients. The cumulative incidence of spontaneous bleeding events was significantly higher with TT compared to DAPT at one year (10.2% vs. 3.2%; p=0.01). The HAS-BLED score significantly predicted spontaneous bleeding events in TT patients (area under the receiver operating characteristic [ROC] curve 0.67; 95% CI=0.54-0.79; p=0.048). TT was relatively common following acute coronary syndrome and was associated with a threefold increase in major bleeding compared to DAPT at one year. The HAS-BLED risk score predicted bleeding events with moderate accuracy.

Is it possible to identify a risk factor condition of hypocalcemia in patients candidates to thyroidectomy for benign disease?

PubMed

Del Rio, Paolo; Iapichino, Gioacchino; De Simone, Belinda; Bezer, Lamia; Arcuri, MariaFrancesca; Sianesi, Mario

2010-01-01

Hypocalcaemia is the most frequent complication after total thyroidectomy. The incidence of postoperative hypocalcaemia is reported with different percentages in literature. We report 227 patients undergoing surgery for benign thyroid disease. After obtaining patient's informed consent, we collected and analyzed prospectively the following data: calcium serum levels pre and postoperative in the first 24 hours after surgery according to sex, age, duration of surgery, number of parathyroids identified by the surgeon, surgical technique (open and minimally invasive video-assisted thyroidectomy, i.e., MIVAT). We have considered cases treated consecutively from the same two experienced endocrine surgeons. Hypocalcaemia is assumed when the value of serum calcium is below 7.5 mg/dL. Pre-and post-operative mean serum calcium, with confidence intervals at 99% divided by sex, revealed a statistically significant difference in the ANOVA test (p < 0.01) in terms of incidence. Female sex has higher incidence of hypocalcemia. The evaluation of the mean serum calcium in pre-and post-operative period, with confidence intervals at 95%, depending on the number of identified parathyroid glands by surgeon, showed that the result is not correlated with values of postoperative serum calcium. Age and pre-and postoperative serum calcium values with confidence intervals at 99% based on sex of patients, didn't show statistically significant differences. We haven't highlighted a significant difference in postoperative hypocalcemia in patients treated with conventional thyroidectomy versus MIVAT. A difference in pre- and postoperative mean serum calcium occurs in all patients surgically treated. The only statistical meaningful risk factor for hypocalcemia has been the female sex.

Thyroidectomy as Primary Treatment Optimizes BMI in Patients with Hyperthyroidism

PubMed Central

Schneider, David F.; Nookala, Ratnam; Jaraczewski, Taylor J.; Chen, Herbert; Solorzano, Carmen C.; Sippel, Rebecca S.

2014-01-01

Objective The purpose of this study was to determine how the timing of thyroidectomy influenced postoperative weight change. Methods We conducted a two institution study, identifying patients treated with total thyroidectomy for hyperthyroidism. Patients were classified as “early” if they were referred for surgery as the first treatment option or “delayed” if they were previously treated with radioactive iodine. Groups were compared with the student's t-test or Chi-squared test where appropriate. Results There were 204 patients undergoing thyroidectomy for hyperthyroidsim. 171 patients were classified as early and 33 were delayed. Overall, patients gained 6.0% ± 0.8 of their preoperative body weight at last follow-up. Preoperative BMIs were similar between groups (p= 0.98), and the median follow-up time was 388 days (range 15 – 1,584 days). Both groups gained weight until they achieved a normal TSH postoperatively. After achieving a normal TSH, the early group stabilized or lost weight (-0.2 lbs/day) while the delayed group continued to gain weight (0.02 lbs/day, p = 0.61). At last follow-up, there were significantly more patients in the delayed group who increased their BMI category compared to the early group (42.4% vs. 21.6%, p = 0.01). Twice as many patients in the delayed group moved up or into an unhealthy BMI category (overweight or obese) compared to the early group (39.4% vs. 19.3%, p = 0.01). Conclusions Compared to patients initially treated with radioactive iodine, patients with hyperthyroidism who underwent surgery as the first treatment were less likely to become overweight or obese postoperatively. PMID:24522995

Thyroidectomy as primary treatment optimizes body mass index in patients with hyperthyroidism.

PubMed

Schneider, David F; Nookala, Ratnam; Jaraczewski, Taylor J; Chen, Herbert; Solorzano, Carmen C; Sippel, Rebecca S

2014-07-01

The purpose of this study was to determine how the timing of thyroidectomy influenced postoperative weight change. We conducted a two-institution study, identifying patients treated with total thyroidectomy for hyperthyroidism. Patients were classified as 'early' if they were referred for surgery as the first treatment option, or 'delayed' if they were previously treated with radioactive iodine (RAI). Groups were compared with the Student's t-test or χ (2) test where appropriate. There were 204 patients undergoing thyroidectomy for hyperthyroidism. Of these, 171 patients were classified as early and 33 were classified as delayed. Overall, patients gained 6.0 % ± 0.8 of their preoperative body weight at last follow-up. Preoperative body mass indexes (BMIs) were similar between groups (p = 0.98), and the median follow-up time was 388 days (range 15-1,584 days). Both groups gained weight until they achieved a normal thyroid-stimulating hormone (TSH) postoperatively. After achieving a normal TSH, the early group stabilized or lost weight (-0.2 lbs/day), while the delayed group continued to gain weight (0.02 lbs/day; p = 0.61). At last follow-up, there were significantly more patients in the delayed group who increased their BMI category compared with the early group (42.4 vs. 21.6 %; p = 0.01). Twice as many patients in the delayed group moved up or into an unhealthy BMI category (overweight or obese) compared with the early group (39.4 vs. 19.3 %; p = 0.01). Compared with patients initially treated with RAI, patients with hyperthyroidism who underwent surgery as the first treatment were less likely to become overweight or obese postoperatively.

Thyroid gland invasion in total laryngectomy and total laryngopharyngectomy: a systematic review and meta-analysis of the English literature.

PubMed

Kumar, R; Drinnan, M; Robinson, M; Meikle, D; Stafford, F; Welch, A; Zammit-Maempel, I; Paleri, V

2013-10-01

Advanced laryngeal and hypopharyngeal squamous cell carcinomas carry an inherent risk of invading thyroid parenchyma leading to the incorporation of a hemithyroidectomy or total thyroidectomy as part of a total laryngectomy. In some centres, thyroid gland removal occurs routinely during surgery for T3 and T4 laryngopharyngeal carcinoma. However, the incidence of invasion is low, and therefore, thyroid-sparing surgery must be considered for select cases. The primary goal of the review is to assess the true incidence of thyroid gland invasion in laryngopharyngeal carcinoma. Utilising this data we aim to identify risk factors and clinical predictors of thyroid gland invasion to facilitate in a more targeted approach in the surgical management of advanced laryngopharyngeal carcinoma. A systematic review and meta-analysis of all published data and review of case series at Newcastle upon Tyne Hospitals (NuTH). MEDLINE (1946-2012) and EMBASE (1980-2012) were searched. A single reviewer conducted the systematic review with a follow-up ancestry search. Studies publishing case series of T3 and T4 laryngeal and hypopharyngeal carcinoma treated by total laryngectomy or laryngopharyngectomy and partial or total thyroidectomy, with pathological assessment for thyroid gland invasion rates were selected. Articles published prior to 1977 were excluded due to the advent of whole organ sectioning. The literature search identified 16 studies suitable for inclusion, with 1180 cases. The NuTH case series identified 107 patients. The overall pooled incidence of thyroid gland invasion in 1287 patients is 10.7% (95% CI 7.6-14.2). Patients with primary subglottic tumours (relative risk 7.5; 95% CI 4.3-13.0) and disease extension into the subglottis (relative risk 4.3; 95% CI 2.5-7.2) have a significantly higher relative risk of thyroid gland invasion. Radiorecurrent tumours and hypopharyngeal tumours did not have an increased risk of thyroid gland invasion. Advanced laryngeal and hypopharyngeal carcinomas involving the subglottis carry a significantly elevated risk of thyroid gland invasion compared with those that spare this subsite. The overall incidence of thyroid gland invasion is low, and therefore, thyroidectomy should be reserved for cases considered to be at risk as opposed to a being a routine measure for all total laryngectomies. © 2013 John Wiley & Sons Ltd.

Polymorphism of inflammatory genes and arsenic methylation capacity are associated with urothelial carcinoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wu, Chia-Chang; Department of Urology, Taipei Medical University—Shuang Ho Hospital, Taipei, Taiwan; Huang, Yung-Kai

2013-10-01

Chronic exposure to arsenic can generate reactive oxidative species, which can induce certain proinflammatory cytokines such as tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and interleukin-8 (IL-8). TNF-α, IL-6 and IL-8 have been shown to be involved in the development and progression of various cancers, including bladder cancer. This study aimed to investigate the joint effect of the polymorphism of TNF-α − 308 G/A, IL-6 − 174 G/C, IL-8 − 251 T/A and urinary arsenic profiles on urothelial carcinoma (UC) risk. This study evaluated 300 pathologically-confirmed cases of UC and 594 cancer-free controls. Urinary arsenic species were detected using high-performance liquidmore » chromatography-linked hydride generator and atomic absorption spectrometry. The polymorphism of TNF-α − 308 G/A, IL-6 − 174 G/C and IL-8 − 251 T/A was determined using polymerase chain reaction-restriction fragment length polymorphism. The joint effects on UC risk were estimated by odds ratios and 95% confidence intervals using unconditional logistic regression. We found that the TNF-α − 308 A/A and IL-8 − 251 T/T polymorphisms were significantly associated with UC. Moreover, significant dose–response joint effect of TNF-α − 308 A/A or IL-8 − 251 T/T genotypes and arsenic methylation indices were seen to affect UC risk. The present results also showed a significant increase in UC risk in subjects with the IL-8 − 251 T/T genotype for each SD increase in urinary total arsenic and MMA%. In contrast, a significant decrease in UC risk was found in subjects who carried the IL-8 − 251 T/T genotype for each SD increase in DMA%. - Highlights: • Joint effect of the TNF-α -308 A/A genotype and urinary total arsenic affected UC. • Joint effect of the IL-8 -251 T/T genotype and urinary total arsenic affected UC. • Urinary total arsenic level, TNF-α -308 A/A and IL-8 -251 T/T genotype affected UC.« less

Enhanced Influenza Surveillance Using Telephone Triage and Electronic Syndromic Surveillance in the Department of Veterans Affairs, 2011-2015.

PubMed

Lucero-Obusan, Cynthia; Winston, Carla A; Schirmer, Patricia L; Oda, Gina; Holodniy, Mark

Telephone triage (TT) is a method whereby medical professionals speak by telephone to patients to assess their symptoms or health concerns and offer advice. These services are often administered through an electronic TT system, which guides TT professionals during the encounter through the use of structured protocols and algorithms to help determine the severity of the patients' health issue and refer them to appropriate care. TT is also an emerging data source for public health surveillance of infectious and noninfectious diseases, including influenza. We calculated Spearman correlation coefficients to compare the weekly number of US Department of Veterans Affairs (VA) TT calls with other conventional influenza measures for the 2011-2012 through 2014-2015 influenza seasons, for which there were a total of 35 666 influenza-coded TT encounters. Influenza-coded calls were strongly correlated with weekly VA influenza-coded hospitalizations (0.85), emergency department visits (0.90), influenza-like illness outpatient visits (0.92), influenza tests performed (0.86), positive influenza tests (0.82), and influenza antiviral prescriptions (0.89). The correlation between VA-TT and Centers for Disease Control and Prevention (CDC) national data for weekly influenza hospitalizations, influenza tests performed, and positive influenza tests was also strong. TT correlates well with VA health care use and CDC data and is a timely data source for monitoring influenza activity.

Hypocalcaemia and permanent hypoparathyroidism after total/bilateral thyroidectomy in the BAETS Registry

PubMed Central

2017-01-01

The UK Registry of Endocrine and Thyroid Surgeons (UKRETS) has been operated by the British Association of Endocrine and Thyroid Surgeons (BAETS) and Dendrite Clinical Systems Ltd. in a web-based electronic format since 2004. Data on over 90,000 endocrine procedures have been collected to date. Analysis of those cases undergoing bilateral thyroid resections in the interval July 2010 to June 2015 demonstrates that hypocalcaemia remains the commonest complication of thyroid surgery. After first-time total thyroidectomy, 23.6% of patients develop hypocalcaemia, defined as a serum calcium <2.10 mmol/L (or <1.20 mmol/L ionized calcium) on the first post-operative day. Most require treatment with calcium +/− vitamin D supplements, with around 38% of all patients being treated by the time of discharge from the index admission. By 6 months post-operative, 7.3% of patients remain on calcium/vitamin D supplements, reflecting persistent (though not necessarily permanent) hypoparathyroidism. Risk factors for persistent hypocalcaemia are principally concomitant level VI lymph node dissection [odds ratio (OR) =2.73]; re-operative surgery (OR =1.44); and inter-surgeon variation. PMID:29322024

Transaxillary Robotic Thyroid Surgery: A Preliminary European Experience

PubMed Central

Lallemant, Benjamin; Chambon, Guillaume; Galy-Bernadoy, Camille; Chapuis, Héliette; Guedj, Anne-Marie; Pham, Huy Trang; Lallemant, Jean-Gabriel; Rupp, Damien

2013-01-01

Background Robot-assisted endoscopic transaxillary thyroidectomy is an emerging surgical technique that needs to be evaluated in European patients. We evaluate the feasibility and preliminary results of our experience of this technique in a cohort of patients from within a single European university hospital (Nîmes, France). Methods We performed a retrospective review of the first 23 patients, treated consecutively between September 2010 and June 2012. Results Nine patients underwent total thyroidectomy and 14 patients lobectomies. All procedures were completed successfully with a mean total operative time of 134 min. We observed a single case of internal jugular vein injury during the console time. No instances of persistent complications were observed; however, minor postoperative events occurred in 5 patients. Pathological diagnoses included benign follicular adenoma in 18 patients, benign adenoma with lymphoid thyroiditis in 1 patient, and benign adenoma with Graves' disease in 4 patients. Conclusions Robotic thyroid surgery is feasible in European patients and can be safely performed on selected patients. This technique has infrequent minor complications and provides a high level of satisfaction. PMID:24783048

Importance of latency and amplitude values of recurrent laryngeal nerve during thyroidectomy in diabetic patients.

PubMed

Ozemir, Ibrahim Ali; Ozyalvac, Ferman; Yildiz, Gorkem; Eren, Tunc; Aydin-Ozemir, Zeynep; Alimoglu, Orhan

2016-11-01

Diabetes mellitus may cause degeneration in the myelin and/or axonal structures of peripheral nerves. The aim of this study was to investigate the effects of diabetic neuropathy on intraoperative neuromonitoring findings such as latency and amplitude values of the recurrent laryngeal nerves during thyroidectomy. To our knowledge this is the first study to report comparison of the electrophysiologic features of diabetic and non-diabetic patients. One-hundred-and-eleven consecutive patients who received neuromonitoring during thyroidectomy between 2013 and 2015 were included to study. The patients were divided into two groups according to the presence of diabetes mellitus. Pre-thyroidectomy and post thyroidectomy motor response latency and amplitude values of recurrent laryngeal nerves were compared between groups. Neuromonitoring findings, demographic data and postoperative complications were evaluated. The diabetic group consisted of 29 (26.1%) patients while 82 (73.9%) patients were in non-diabetic group. The mean post-thyroidectomy amplitude values (millivolts-mV) of the recurrent laryngeal nerve were significantly lower in diabetic group (0.51 ± 0.26 mV vs. 0,70 ± 0,46 mV, p < 0.05), whereas the latency values were significantly higher (2.50 ± 0.86 ms vs. 1.85 ± 0.59 ms, p < 0.01) compared to non-diabetic group. Additionally, post-thyroidectomy latency values were significantly increased compared to the pre-thyroidectomy latency values (2.50 ± 0.86 ms vs. 2.02 ± 0.43 ms) in diabetic group patients (p < 0.05). Although postoperative complication rates were higher in diabetic group (10.3% vs. 5.9%), there were no statistical significance differences. Prolonged latency and decreased amplitude values in recurrent laryngeal nerves of diabetic patients show that diabetic neuropathy of the recurrent laryngeal nerves develop similarly to the peripheral nerves. Increased post-thyroidectomy latency values reveal that the recurrent laryngeal nerve is more susceptible to surgical trauma in diabetic patients. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Robot-assisted Sistrunk's operation, total thyroidectomy, and neck dissection via a transaxillary and retroauricular (TARA) approach in papillary carcinoma arising in thyroglossal duct cyst and thyroid gland.

PubMed

Byeon, Hyung Kwon; Ban, Myung Jin; Lee, Jeon Mi; Ha, Jong Gyun; Kim, Eun Sung; Koh, Yoon Woo; Choi, Eun Chang

2012-12-01

Carcinomas arising in the thyroglossal duct cysts are rare, accounting only for about 0.7-1.5 % of all thyroglossal duct cysts. Synchronous occurrence of thyroglossal duct carcinoma and thyroid carcinoma is reported to be even rarer. Traditionally, surgical treatments of such coexisting thyroglossal duct cyst carcinoma (TGDCa) and papillary thyroid carcinoma (PTC) were typically performed through a single transverse or double incisions on the overlying skin. A longer, extended cervical incision might be required if neck dissection is necessary. Though this method provides the operator with the optimal surgical view, the detrimental cosmetic effect on the patient of possessing a scar cannot be avoided, despite the effort of the surgeon to camouflage the scar by placing the incision in natural skin creases. Recently, the authors have previously reported the feasibility of robot-assisted neck dissections via a transaxillary and retroauricular ("TARA") approach or modified face-lift approach in early head and neck cancers. On the basis of the forementioned surgical technique, we demonstrate our novel technique for robot-assisted Sistrunk's operation via retroauricular approach as well as robot-assisted neck dissection with total thyroidectomy via transaxillary approach. This is a case presentation of a 22-year-old woman with synchronous TGDCa and PTC with minimal lymph node metastasis who underwent resection of TGDCa and total thyroidectomy with left neck level III and IV lymph node dissection as well as central compartment lymph node dissection (CCND) via TARA approach with a robotic surgery system after approval from the institutional review board at Severance Hospital, Yonsei University College of Medicine. The incision was just like the TARA approach in head and neck cancer, which has been reported by our institute. The operation was proceeded as follows. First, excision of the TGDCa through the retroauricular incision was done followed by total thyroidectomy with CCND via transaxillary approach. Finally, neck dissection of left level III, IV was conducted via transaxillary approach. The da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA) was introduced via retroauricular or transaxillary port. A 30° dual-channel endoscope was used, and the two instrument arms were equipped with 5 mm Maryland forceps and a 5 mm spatula monopolar cautery for TGDCa excision via retroauricular approach. When conducting total thyroidectomy and neck dissection via transaxillary approach, three instrument arms were utilized, each equipped with 5 mm Maryland forceps, ProGrasp forceps and a 5 mm spatula monopolar cautery or Harmonic curved shears. The rest of the surgery was completed with the robotic system (see Video). The operative procedure was successfully completed utilizing the robotic surgical system with no conversion to open surgery. The operation time for TGDCa excision was 97 min, including the time for skin flap elevation (15 min), setting up the robotic system (5 min), and console time using the robotic system (77 min). Also, the total operation time for the consecutive total thyroidectomy with CCND and level III, IV dissection was 142 min including the time for skin flap elevation (27 min), setting up the robotic system (3 min), and console time using the robotic system (112 min). There were no intraoperative complications. The retroauricular approach for the removal of the TGDCa allowed for an excellent magnified surgical view revealing important structures of the local anatomy. It also created sufficient space for the cutting of the relevant portion of the hyoid bone. Handling of the robotic instruments through the incision was technically feasible and safe without any mutual collisions throughout the operation. The patient's postoperative parathyroid hormone (PTH) level was within normal range and functions of her both vocal cords were intact. The histopathologic results of the specimens revealed thyroglossal duct cyst with internal papillary carcinoma measuring 1.1 cm with infiltrative tumor margins and papillary microcarcinoma measuring 0.9 cm within the left thyroid lobe with extrathyroidal soft tissue extension. There was no evidence of tumor in the right lobe and the pyramidal lobe of the thyroid gland. As for the lymph nodes resected, 7 out of 9 paratracheal nodes and 2 out of 7 left level III, IV nodes revealed metastatic carcinomas. The patient was discharged on the 8th day after the operation with no complications. The patient was extremely satisfied with the cosmetic results. The patient has received high-dose radioiodine ablation (RAI) therapy and is currently doing well with no evidence of recurrence. Although there is still a great deal of controversy regarding the treatment of TGDCa, there is little debate that for the cases of synchronous TGDCa and PTC, total thyroidectomy in addition to the Sistrunk procedure must be performed. As for the patient in our case where left level IV lymph node metastasis was detected under preoperative ultrasonography (USG), if the usual method of surgical procedure was to be selected, double incisions or a single extended transverse incision must be adopted for the Sistrunk's operation and total thyroidectomy with lateral neck dissection. The conventional method to remove neck masses was to do so by placing an incision on the overlying skin. This 'open' approach to viewing the lesion has an advantage of providing the operator with the best surgical view, but the recognizable surgical scar that results from the surgery can be displeasing for patients. Therefore the surgeon can try to make a small incision and camouflage the scar by placing the incision in natural skin creases, yet the cosmetic results can still be displeasing for the patient due to its visibility and permanence. This can be an even greater problem if the patient is young and an active member of his/her society and if the lesion is benign or low-grade malignancy which can be simply dissected and excised. Therefore it is the surgeon's best interest to perform an operation successfully with a 'least obvious' or 'hidden' scar whenever possible. Accordingly, we have adopted a novel approach, the transaxillary and retroauricular approach, in view of our increasing surgical experience with various indications such as submandibular gland (SMG) resections and neck dissections in head and neck cancer or thyroid papillary carcinoma. Some investigators have demonstrated that robot-assisted neck dissections performed on patients with thyroid cancer and lateral neck node metastasis are feasible and safe. We conducted total thyroidectomy with bilateral CCND and level III and IV dissection using the same approach. Although the technical feasibility and safety of neck dissection or SMG resection via retroauricular approach has already been reported previously at our institute, Sistrunk's operation via retroauricular approach will be challenging. In spite of that, we were able to demonstrate successfully Sistrunk's operation including the hyoid bone resection through the retroauricular approach. There are however, certain areas of potential difficulties which must be considered with caution during the operation procedure. First, when removing the TGDCa through the retroauricular port, identification of the ipsilateral hyoid bone is primarily important and it is also crucial that dissection along the capsule must be done carefully so as not to rupture the tumor. It is essential that sufficient working space must be created for the comfortable movement of the robotic arms through the retroauricular port and in order to do so, sufficient skin flap elevation in both superior and inferior directions must be performed. It is necessary to elevate the superior skin flap up to the level of the inferior border of the mandible but during this process, the platysma muscle must be identified and meticulous dissection along the subplatysmal plane must be carried out so as not to damage the marginal mandibular branch of the facial nerve. Another area of potential pitfalls concerns the total thyroidectomy with neck dissection through the transaxillary port. Sufficient amount of working space must be secured in order to perform comfortably the contralateral thyroidectomy and neck dissection and in order to do so, skin flap elevation must be done at least 2 cm further based on the ipsilateral omohyoid muscle and the contralateral thyroid gland must be adequately exposed. Using the robotic surgical system in removing the thyroglossal duct cyst, the free movement of wristed instrumentation through the retroauricular incision allowed for efficient dissection and easy handling of the tissue. In this particular case we could not identify the tract beyond the hyoid and up to the foramen cecum, but we anticipate that there would be no technical problems of dissection and excision had it been so. To our knowledge, Sistrunk's operation and total thyroidectomy with lateral neck dissection via TARA approach utilizing the robotic surgical system has never been attempted before. It has some advantages over the conventional surgery in terms of cosmesis. However, careful consideration in selecting appropriate cases is required and prospective trials should be conducted to recognize long-term outcomes and to overcome potential limitations.

Occult lymph node metastasis and risk of regional recurrence in papillary thyroid cancer after bilateral prophylactic central neck dissection: A multi-institutional study.

PubMed

Lee, Young Chan; Na, Se Young; Park, Gi Cheol; Han, Ju Hyun; Kim, Seung Woo; Eun, Young Gyu

2017-02-01

The impact of occult lymph node metastasis on regional recurrence after prophylactic central neck dissection for preoperative, nodal-negative papillary thyroid cancer is controversial. We investigated risk factors for regional lymph node recurrence in papillary thyroid cancer patients who underwent total thyroidectomy and bilateral prophylactic central neck dissection. Analysis was according to clinicopathologic characteristics and occult lymph node metastasis patterns. This multicenter study enrolled 211 consecutive patients who underwent total thyroidectomy with bilateral prophylactic central neck dissection for papillary thyroid cancer without evidence of central lymph node metastasis on preoperative imaging. Clinicopathologic features and central lymph node metastasis patterns were analyzed for predicting regional recurrence. Multivariate Cox regression analysis was used to identify independent factors for recurrence. Median follow-up time was 43 months (24-95 months). Ten patients (4.7%) showed regional lymph node recurrence. The estimated 5-year, regional recurrence-free survival was 95.2%. Tumor size ≥1 cm, central lymph node metastasis, lymph node ratio, and prelaryngeal lymph node metastasis were associated with regional recurrence in univariate analysis (P < .05). In multivariate analysis, a lymph node ratio ≥ 0.26 was a significant risk factor for regional lymph node recurrence (odds ratio = 11.63, P = .003). Lymph node ratio ≥ 0.26 was an independent predictor of worse recurrence-free survival on Cox regression analysis (hazard ratio = 11.49, P = .002). Although no significant association was observed between the presence of occult lymph node metastasis and regional recurrence, lymph node ratio ≥ 0.26 was an independent predictor of regional lymph node recurrence in papillary thyroid cancer patients who underwent total thyroidectomy and bilateral prophylactic central neck dissection. Copyright © 2016 Elsevier Inc. All rights reserved.

Papillary Thyroid Microcarcinomas: Big Decisions for a Small Tumor

PubMed Central

Haymart, Megan Rist; Cayo, Max; Chen, Herbert

2016-01-01

Background The clinical significance of papillary thyroid microcarcinoma (PTMC) is debated, and therefore the rise in incidence of PTMC creates management dilemmas. The following study evaluates factors influencing decisions to treat. Materials and Methods Between 1994 and 2007, 1361 patients underwent thyroid surgery at a single institution. Of these patients, 107 were diagnosed with PTMC. The type of surgical intervention, likelihood of referral to an endocrinologist, use of radioactive iodine, and administration of suppressive doses of levothyroxine (LT4) were analyzed in relation to patient and tumor characteristics. Results Multifocality and larger size were predictive of which patients underwent total thyroidectomy on multivariable logistic regression (P = .004 and P = .001, respectively). Larger mean tumor size, 0.62 ± 0.004 versus 0.34 ± 0.006 cm, was independently associated with increased likelihood of endocrine referral (P = .029). Multifocality, diagnosis via FNA preoperatively, larger mean size of PTMC, and endocrine referral were independently associated with increased likelihood of receiving radioactive iodine (RAI). On multivariable analysis, only total thyroidectomy and endocrine referral were independently associated with treatment with suppressive doses of LT4 (P = .001 and .001, respectively). In the 47 patients with unifocal PTMC <0.8 cm diameter, the mean size of tumor focus was larger in the subgroup undergoing total thyroidectomy (P = .004). Surprisingly, in these very low risk PTMC patients, the likelihood of RAI for remnant ablation was independently associated with younger patient age (P = .029). In the subgroup with unifocal <0.8 cm disease, the mean age of patients receiving RAI was 34 ± 3.3 years versus 48 ± 2.3 years in those not receiving RAI (P = .003). Conclusions The decision tree in the management of PTMC is beginning at the time of surgery, and referral to endocrinology is associated with a more aggressive course. Younger age is predictive of RAI administration in the lowest-risk PTMC patients. PMID:19653044

Characterization of a human antigen specific helper factor

DOE Office of Scientific and Technical Information (OSTI.GOV)

Richardson, B.

1986-03-01

While antigen (Ag) specific helper factors have been characterized in mice, similar molecules have not been identified in humans. To characterize human antigen specific helper molecules, an IL-2 dependent tetanus toxoid (T.T.) reactive T cell line was fused with a 6-thioguanine resistant CEM line, and hybrids selected in medium containing hypoxanthine and azaserine. Hybrids were screened by culturing the cells with /sup 35/S-Met then reacting the supernatants with T.T. or hepatitis vaccine immobilized on nitrocellulose. One hybrid, TT6BA-O, was identified which secreted a Met-containing molecule which bound T.T. but not hepatitis vaccine. Supernatants from TT6BA-O, but not the parent CEMmore » line, when added to autologous peripheral blood mononuclear cells (PBMC's) stimulated secretion of T.T. specific antibodies (Abs). Specificity controls demonstrated that TT6BA-O supernatant did not induce antibodies to diphtheria toxoid, hepatitis vaccine or pneumococcal polysaccharide, and total immunoglobulin (lg) synthesis was minimally increased. In contrast, pokeweed mitogen stimulated significant lg synthesis as well as Ab's to pneumococcal polysaccharide and T.T. TT6BA-O supernatant induced anti-T.T.Ab's in autologous PBMC's but not PBMC's from 3 unrelated donors, suggesting that the activity of the helper factor is restricted, possibly by the MHC. The molecular weight of the helper factor was estimated at 100,000-150,000 by Sephacryl S-300 chromatography. Finally, the helper factor could be demonstrated to bind and elute from sephorose-immobilized T.T. and anti-DR antisera, but not anti-lg antisera or the T40/25 monoclonal antibody, which binds a nonpolymorphic determinant on the human T cell receptor. These results demonstrate that human Ag specific helper factors exist, bind antigen and bear class II MHC determinants.« less

Characterization of Cholesterol Homeostasis in Telomerase-immortalized Tangier Disease Fibroblasts Reveals Marked Phenotype Variability*

PubMed Central

Kannenberg, Frank; Gorzelniak, Kerstin; Jäger, Kathrin; Fobker, Manfred; Rust, Stephan; Repa, Joyce; Roth, Mike; Björkhem, Ingemar; Walter, Michael

2013-01-01

We compared the consequences of an ABCA1 mutation that produced an apparent lack of atherosclerosis (Tangier family 1, N935S) with an ABCA1 mutation with functional ABCA1 knockout that was associated with severe atherosclerosis (Tangier family 2, Leu548:Leu575-End), using primary and telomerase-immortalized fibroblasts. Telomerase-immortalized Tangier fibroblasts of family 1 (TT1) showed 30% residual cholesterol efflux capacity in response to apolipoprotein A-I, whereas telomerase-immortalized Tangier fibroblasts of family 2 (TT2) showed only 20%. However, there were a number of secondary differences that were often stronger and may help to explain the more rapid development of atherosclerosis in family 2. First, the total cellular cholesterol content increase was 2–3-fold and 3–5-fold in TT1 and TT2 cells, respectively. The corresponding increase in esterified cholesterol concentration was 10- and 40-fold, respectively. Second, 24-, 25-, and 27-hydroxycholesterol concentrations were moderately increased in TT1 cells, but were increased as much as 200-fold in TT2 cells. Third, cholesterol biosynthesis was moderately decreased in TT1 cells, but was markedly decreased in TT2 cells. Fourth, potentially atheroprotective LXR-dependent SREBP1c signaling was normal in TT1, but was rather suppressed in TT2 cells. Cultivated primary Tangier fibroblasts were characterized by premature aging in culture and were associated with less obvious biochemical differences. In summary, these results may help to understand the differential atherosclerotic susceptibility in Tangier disease and further demonstrate the usefulness of telomerase-immortalized cells in studying this cellular phenotype. The data support the contention that side chain-oxidized oxysterols are strong suppressors of cholesterol biosynthesis under specific pathological conditions in humans. PMID:24196952

Characterization of cholesterol homeostasis in telomerase-immortalized Tangier disease fibroblasts reveals marked phenotype variability.

PubMed

Kannenberg, Frank; Gorzelniak, Kerstin; Jäger, Kathrin; Fobker, Manfred; Rust, Stephan; Repa, Joyce; Roth, Mike; Björkhem, Ingemar; Walter, Michael

2013-12-27

We compared the consequences of an ABCA1 mutation that produced an apparent lack of atherosclerosis (Tangier family 1, N935S) with an ABCA1 mutation with functional ABCA1 knockout that was associated with severe atherosclerosis (Tangier family 2, Leu(548):Leu(575)-End), using primary and telomerase-immortalized fibroblasts. Telomerase-immortalized Tangier fibroblasts of family 1 (TT1) showed 30% residual cholesterol efflux capacity in response to apolipoprotein A-I, whereas telomerase-immortalized Tangier fibroblasts of family 2 (TT2) showed only 20%. However, there were a number of secondary differences that were often stronger and may help to explain the more rapid development of atherosclerosis in family 2. First, the total cellular cholesterol content increase was 2-3-fold and 3-5-fold in TT1 and TT2 cells, respectively. The corresponding increase in esterified cholesterol concentration was 10- and 40-fold, respectively. Second, 24-, 25-, and 27-hydroxycholesterol concentrations were moderately increased in TT1 cells, but were increased as much as 200-fold in TT2 cells. Third, cholesterol biosynthesis was moderately decreased in TT1 cells, but was markedly decreased in TT2 cells. Fourth, potentially atheroprotective LXR-dependent SREBP1c signaling was normal in TT1, but was rather suppressed in TT2 cells. Cultivated primary Tangier fibroblasts were characterized by premature aging in culture and were associated with less obvious biochemical differences. In summary, these results may help to understand the differential atherosclerotic susceptibility in Tangier disease and further demonstrate the usefulness of telomerase-immortalized cells in studying this cellular phenotype. The data support the contention that side chain-oxidized oxysterols are strong suppressors of cholesterol biosynthesis under specific pathological conditions in humans.

Maternal antibodies against tetanus toxoid do not inhibit potency of antibody responses to autologous antigen in newborn rhesus monkeys.

PubMed

Veazey, Ronald S; Lu, Yingjie; Xu, Huanbin; Ziani, Widade; Doyle-Meyers, Lara A; Ratterree, Marion S; Wang, Xiaolei

2018-02-01

Our previous study suggested newborns have competent immune systems with the potential to respond to foreign antigens and vaccines. In this study, we examined infant immune responses to tetanus toxoid (TT) vaccination in the presence of maternal antibody to TT. We examined changes in plasma levels of tetanus toxoid-specific IgG1 (anti-TT IgG1) in a total of eight infant rhesus macaques from birth through 6 months of age using a commercial Monkey Anti-TT IgG1 ELISA kit. A significant correlation between anti-TT IgG1 levels in vaccinated dams and their paired newborn infants was detected in control (non-vaccinated) infants as previously reported. Maternal anti-TT IgG1 levels declined rapidly within 1 month of birth in non-vaccinated infants (n=4). In four infants vaccinated with TT at birth, we found two had rapid and robust antibody responses to vaccination. Interestingly, the other two first showed declining TT antibody levels for 2 weeks followed by increasing levels without additional vaccine boosts, indicating all four had good antibody responses to primary TT vaccination at birth, despite the presence of high levels of maternal antibodies to TT in all four infants. Our data indicate that newborn macaques have competent immune systems that are capable of generating their own primary antibody responses to vaccination, at least to tetanus antigens. Maternal antibodies thus do not significantly impair antibody response to the vaccination, even when received on the day of birth in infant rhesus macaques. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

[The relevance of junctional rhythm during neurocardiogenic reaction provoked by tilt testing].

PubMed

Zyśko, Dorota; Gajek, Jacek; Agrawal, Anil Kumar; Rudnicki, Jerzy

2012-01-01

During neurocardiogenic reaction provoked by tilt testing (TT), different arrhythmias such as sinus bradycardia, sinus arrest, atrioventricular block or junctional rhythm or beats (JR) may occur. The characteristics of the JR during neurocardiogenic reaction have not yet been systematically assessed. It is not known whether the presence of JR during neurocardiogenic reaction is related to clinical characteristics of syncopal patients or the outcome of TT. To assess whether clinical outcome of TT and clinical data are related to the presence of JR during TT. The study group consisted of 532 patients aged 43.3 ± 18.2 years with positive TT, divided into four groups on the basis of the presence of JR and/or a ventricular pause (VP) during neurocardiogenic reaction: group VP(-)/JR(+) - JR present and VP absent, group VP(+)/JR(+) - both JR and VP present, group VP(+)/JR(-) - JR absent and VP present, and group VP(-)/JR(-) - both JR and VP absent. The control group consisted of 53 patients with no history of syncope or presyncope, including 46 patients with negative TT and seven patients with false positive TT. Total loss of consciousness during TT occurred in group VP(-)/JR(+) less frequently than in groups VP(+)/JR(+) and VP(+)/JR(-), and more frequently than in group VP(-)/JR(-) (80% vs 96% vs 94% vs 62%; p 〈 0.05 for both comparisons). Group VP(-)/JR(+) was significantly younger than group VP(-)/JR(-) (37.3 ± 16.3 years vs 45.8 ± 18.9 years; p 〈 0.05) and had a lower number of syncopal events than group VP(+)/JR(+) and VP(+)/JR(-) (median [IQ]: 2.5 (1-6) vs 4 (2-12) and 4 (2-10), respectively; p 〈 0.05) and lower rate of traumatic injuries than group VP(+)/JR(+) and VP(+)/JR(-) (22% vs 45% and 39%, respectively; p 〈 0.05). Logistic regression analysis revealed that the presence of JR was associated with younger age, male gender, history of blood-instrumentation-injection phobia and higher number of syncopal spells in medical history. The ROC curve analysis revealed that a junctional rate of no more than 49 bpm was related to the total loss of consciousness during TT (p 〈 0.05). 1. JR frequently occurs during positive TT and in no subjects with negative TT. 2. Among patients with JR, two groups may be chosen on the basis of a VP occurrence, and these groups differ in respect to clinical characteristics and TT outcome. 3. Relatively rapid JR without VP is related to consciousness preservation during neurocardiogenic reaction at TT and fewer syncopal spells as well as syncope associated with injury in the past. 4. In patients with JR and VP, the JR is slower, of shorter duration, and more frequently single or pairs of junctional beats occur, which indicates high parasympathetic activity, whereas relatively rapid and stable JR may be the symptom of simultaneously increased sympathetic and parasympathetic activity.

Prevention of Thyroidectomy Scars in Asian Adults With Low-Level Light Therapy.

PubMed

Park, Young Joon; Kim, Sang Jin; Song, Hyo Sang; Kim, Sue Kyoung; Lee, Jeonghun; Soh, Euy Young; Kim, You Chan

2016-04-01

Abnormal wound-healing after thyroidectomy with a resulting scar is a common dermatologic consultation. Despite many medical and surgical approaches, prevention of postoperative scars is challenging. This study validated the efficacy and safety of low-level light therapy (LLLT) using an 830/590 nm light-emitting diode (LED)-based device for prevention of thyroidectomy scars. Thirty-five patients with linear surgical suture lines after thyroidectomy were treated with 830/590 nm LED-LLLT. Daily application of 60 J/cm (11 minutes) for 1 week starting on postoperative day 1 was followed by treatment 3 times per week for 3 additional weeks. The control group (n = 15) remained untreated. Scar-prevention effects were evaluated 1 and 3 months after thyroidectomy with colorimetric evaluation using a tristimulus-color analyzer. The Vancouver Scar Scale (VSS) score, global assessment, and a subjective satisfaction score (range: 1-4) were also determined. Lightness (L*) and chrome values (a*) decreased significantly at the 3-month follow-up visit in the treatment group compared with those of controls. The average VSS and GAS scores were lower in the treatment group, whereas the subjective score was not significantly different. Light-emitting diode based LLLT treatment suppressed the formation of scars after thyroidectomy and could be safely used without noticeable adverse effects.

A case-control, mono-center, open-label, pilot study to evaluate the feasibility of therapeutic touch in preventing radiation dermatitis in women with breast cancer receiving adjuvant radiation therapy.

PubMed

Younus, Jawaid; Lock, Michael; Vujovic, Olga; Yu, Edward; Malec, Jitka; D'Souza, David; Stitt, Larry

2015-08-01

Therapeutic touch (TT) is a non-invasive commonly used complementary therapy. TT is based on the use of hand movements and detection of energy field congestion to correct imbalances. Improvement in subjective symptoms in a variety of clinical trials has been seen with TT. The effect of TT during radiotherapy for breast cancer is unknown. Women undergoing adjuvant radiation for Stage I/II breast cancer post conservative surgery were recruited for this cohort study. TT treatments were administered three times per week following radiation therapy. Feasibility was defined as an a priori threshold of 15 of 17 patients completing all TT treatments. The preventive effectiveness of TT was evaluated by documenting the 'time to develop' and the 'worst grade of radiation' dermatitis. Toxicity was assessed using NCIC CTC V3 dermatitis scale. Cosmetic rating was performed using the EORTC Breast Cosmetic Rating. The quality of life, mood and energy, and fatigue were assessed by EORTC QLQ C30, POMS, and BFI, respectively. The parameters were assessed at baseline, and serially during treatment. A total of 49 patients entered the study (17 in the TT Cohort and 32 in the Control Cohort). Median age in TT arm was 63 years and in control arm was 59 years. TT was considered feasible as all 17 patients screened completed TT treatment. There were no side effects observed with the TT treatments. In the TT Cohort, the worst grade of radiation dermatitis was grade II in nine patients (53%). Median time to develop the worst grade was 22 days. In the Control Cohort, the worst grade of radiation dermatitis was grade III in 1 patient. However, the most common toxicity grade was II in 15 patients (47%). Three patients did not develop any dermatitis. Median time to develop the worst grade in the control group was 31 days. There was no difference between cohorts for the overall EORTC cosmetic score and there was no significant difference in before and after study levels in quality of life, mood and fatigue. This study is the first evaluation of TT in patients with breast cancer using objective measures. Although TT is feasible for the management of radiation induced dermatitis, we were not able to detect a significant benefit of TT on NCIC toxicity grade or time to develop the worst grade for radiation dermatitis. In addition, TT did not improve quality of life, mood, fatigue and overall cosmetic outcome. Copyright © 2014 Elsevier Ltd. All rights reserved.

Long-term surveillance of papillary thyroid cancer patients who do not undergo postoperative radioiodine remnant ablation: is there a role for serum thyroglobulin measurement?

PubMed

Durante, Cosimo; Montesano, Teresa; Attard, Marco; Torlontano, Massimo; Monzani, Fabio; Costante, Giuseppe; Meringolo, Domenico; Ferdeghini, Marco; Tumino, Salvatore; Lamartina, Livia; Paciaroni, Alessandra; Massa, Michela; Giacomelli, Laura; Ronga, Giuseppe; Filetti, Sebastiano

2012-08-01

Serum thyroglobulin (Tg) assays are considered fundamental in postoperative surveillance of differentiated thyroid cancer (DTC) patients. However, the postsurgical profile of Tg levels has never been specifically investigated in patients who do not undergo radioiodine remnant ablation (RRA). Our objective was to explore the evolution of Tg levels over time in DTC patients treated with total or near-total thyroidectomy without RRA. We retrospectively analyzed 290 consecutively diagnosed cases of low-risk (American Thyroid Association criteria) DTC treated with thyroidectomy alone and followed yearly with neck ultrasonography and serum Tg assays. We compared final Tg values in this group and a matched group of 495 RRA-positive patients. Temporal trends of serial Tg levels were also analyzed in 78 of the RRA-negative patients monitored with a high-sensitivity immunoradiometric assay. After follow-up of 2.5-22 yr (median 5 yr), final Tg levels were undetectable (<1 ng/ml) in 274 of 290 RRA-negative patients (95%) and 492 of 495 RRA-positive controls (99%). In the subset of 78 RRA-negative patients, undetectable Tg levels (<0.2 ng/ml) were recorded in 60% at the first postoperative evaluation (3-12 months) and in 79% after 5 yr. Tg levels increased in the single patient who experienced disease recurrence during the observation period. In most RRA-negative patients, postoperative serum Tg values spontaneously drop to undetectable levels within 5-7 yr after thyroidectomy. Thus, in later phases, Tg assays may be a valuable tool for follow-up even in patients who do not undergo RRA.

Comprehensive Clinical Assessment of 740 Cases of Surgically Treated Thyroid Cancer in Children of Belarus

PubMed Central

Demidchik, Yuri E.; Demidchik, Eugene P.; Reiners, Christoph; Biko, Johannes; Mine, Mariko; Saenko, Vladimir A.; Yamashita, Shunichi

2006-01-01

Objective: A retrospective study was designed to evaluate the results of surgical treatment and follow-up data in thyroid cancer patients less than 15 years old at the time of surgery. Summary Background Data: Pediatric thyroid carcinomas have a high rate of lymph nodal and distant metastases. Risk factors for recurrences and postoperative morbidity have not been assessed yet in a representative series. Methods: The group included 740 pediatric patients with thyroid cancer. Total thyroidectomy was performed in 426 (57.6%), lobectomy in 248 (33.5%), subtotal thyroidectomy in 58 (7.8%) cases, and 8 patients (1.1%) underwent partial lobectomy. Results: The mean follow-up period was 115.8 months (range, 1.5–236.4 months). Recurrence was diagnosed in 204 cases (27.6%), including 73 local relapses (9.9%), 90 distant metastases (12.2%), and a combination of local and distant recurrences in 41 (5.5%) patients. Multivariate statistical assessment revealed the following independent parameters significantly associated with the risk of recurrent nodal disease: a young age at diagnosis, multifocal carcinomas, N1 status, and lack of neck lymph node dissection. For lung metastases, the significant risk factors were female gender, young age at diagnosis, and presence of symptoms. The observed 5- and 10-year survival for the entire group was 99.5% and 98.8%, respectively. Postoperative hypoparathyroidism was significantly associated with multifocal tumors, central compartment removal, and ipsilateral dissection. Conclusions: Total thyroidectomy followed by radioiodine therapy is an optimal treatment strategy that makes it possible to achieve a cure in a vast majority of pediatric patients with differentiated thyroid carcinomas. Risk of recurrence is strongly associated with tumor stage, extent of surgery, the young patient's age, and presence of symptoms at diagnosis. PMID:16552205

A Radish Basic Helix-Loop-Helix Transcription Factor, RsTT8 Acts a Positive Regulator for Anthocyanin Biosynthesis

PubMed Central

Lim, Sun-Hyung; Kim, Da-Hye; Kim, Jae K.; Lee, Jong-Yeol; Ha, Sun-Hwa

2017-01-01

The MYB-bHLH-WDR (MBW) complex activates anthocyanin biosynthesis through the transcriptional regulation. RsMYB1 has been identified as a key player in anthocyanin biosynthesis in red radish (Raphanus sativus L.), but its partner bHLH transcription factor (TF) remains to be determined. In this study, we isolated a bHLH TF gene from red radish. Phylogenetic analysis indicated that this gene belongs to the TT8 clade of the IIIF subgroup of bHLH TFs, and we thus designated this gene RsTT8. Subcellular localization analysis showed that RsTT8-sGFP was localized to the nuclei of Arabidopsis thaliana protoplasts harboring the RsTT8-sGFP construct. We evaluated anthocyanin biosynthesis and RsTT8 expression levels in three radish varieties (N, C, and D) that display different red phenotypes in the leaves, root flesh, and root skins. The root flesh of the C variety and the leaves and skins of the D variety exhibit intense red pigmentation; in these tissues, RsTT8 expression showed totally positive association with the expression of RsMYB1 TF and of five of eight tested anthocyanin biosynthesis genes (i.e., RsCHS, RsCHI, RsF3H, RsDFR, and RsANS). Heterologous co-expression of both RsTT8 and RsMYB1 in tobacco leaves dramatically increased the expression of endogenous anthocyanin biosynthesis genes and anthocyanin accumulation. Furthermore, a yeast two-hybrid assay showed that RsTT8 interacts with RsMYB1 at the MYB-interacting region (MIR), and a transient transactivation assay indicated that RsTT8 activates the RsCHS and RsDFR promoters when co-expressed with RsMYB1. Complementation of the Arabidopsis tt8-1 mutant, which lacks red pigmentation in the leaves and seeds, with RsTT8 restored red pigmentation, and resulted in high anthocyanin and proanthocyanidin contents in the leaves and seeds, respectively. Together, these results show that RsTT8 functions as a regulatory partner with RsMYB1 during anthocyanin biosynthesis. PMID:29167678

The protective and toxic effects of rhubarb tannins and anthraquinones in treating hexavalent chromium-injured rats: the Yin/Yang actions of rhubarb.

PubMed

Zeng, Ling-na; Ma, Zhi-jie; Zhao, Yan-ling; Zhang, Lin-dong; Li, Rui-sheng; Wang, Jia-bo; Zhang, Ping; Yan, Dan; Li, Qi; Jiang, Bing-qian; Pu, Shi-biao; Lü, Yang; Xiao, Xiao-he

2013-02-15

Chromium nephrotoxicity (CrNT) is thought to occur through the oxidant lesion mechanism. There is still a lack of specific remedies against CrNT. We primarily screened Chinese herbal medicines with a potential protective effect against CrNT, e.g., rhubarb (Rheum palmatum L.). However, the active constituents in rhubarb and its mechanisms remain unclear. In this study, the total rhubarb extract (TR) was successively separated into three parts: total anthraquinone extract (TA), total tannin extract (TT) and remaining component extract (RC). The effects of each extract on the potassium dichromate (K(2)Cr(2)O(7))-induced nephrotoxicity in rats were comparatively assessed. The results showed that only the administration of TT protected the kidney function in K(2)Cr(2)O(7)-injured rats. Besides, TT showed significant activity to scavenge hydroxyl radicals, which is considered to be the dominant lesion product generated by hexavalent chromium. TT also showed a reduced ability to transform toxic high valence chromium ions into non-toxic low valence ions. And TT was able to further precipitate chromium ions. These results suggested that rhubarb tannins treat CrNT as a free radical scavenger, reductant, and metal precipitant. The multiple protective routes of the plant tannins reveal a superior option for development into a promising natural remedy against CrNT. In addition, the opposite effects of rhubarb anthraquinones in treating CrNT were observed compared to rhubarb tannins, which suggested the duo-directional effects (Yin and Yang) of herbal medicines should be addressed. Copyright © 2012 Elsevier B.V. All rights reserved.

[The rational application of Da Vinci surgical system in thyroidectomy].

PubMed

He, Q Q

2017-08-01

Da Vinci surgical system is the most advanced minimally invasive surgical platform in the world, and this system has been widely used in cardiac surgery, urology surgery, gynecologic surgery and general surgery. Although the application of this system was relatively late in thyroid surgery, the number of thyroidectomy with Da Vinci surgical system is increasing quickly. Having reviewed recent studies and summarized clinical experience, compared with traditional open operation, the robotic thyroidectomy has the same surgical safety and effectiveness in selective patients with thyroid cancer. In this paper, several aspects on this novel operation were demonstrated, including surgical indications and contraindications, the approaches, surgical procedures and postoperative complications, in order to promote the rational application of Da Vinci surgical system in thyroidectomy.

Thoracic irrigation prevents retained hemothorax: A prospective propensity scored analysis.

PubMed

Kugler, Nathan W; Carver, Thomas W; Milia, David; Paul, Jasmeet S

2017-12-01

Thoracic trauma resulting in hemothorax (HTx) is typically managed with thoracostomy tube (TT) placement; however, up to 20% of patients develop retained HTx which may necessitate further intervention for definitive management. Although optimal management of retained HTx has been extensively researched, little is known about prevention of this complication. We hypothesized that thoracic irrigation at the time of TT placement would significantly decrease the rate of retained HTx necessitating secondary intervention. A prospective, comparative study of patients with traumatic HTx who underwent bedside TT placement was conducted. The control group consisted of patients who underwent standard TT placement, whereas the irrigation group underwent standard TT placement with immediate irrigation using 1 L of warmed sterile 0.9% saline. Patients who underwent emergency thoracotomy, those with TTs removed within 24 hours, or those who died within 30 days of discharge were excluded. The primary end point was secondary intervention defined by additional TT placement or operative management for retained HTx. A propensity-matched analysis was performed with scores estimated using a logistic regression model based on age, sex, mechanism of injury, Abbreviated Injury Scale chest score, and TT size. In over a 30-month period, a total of 296 patients underwent TT placement for the management of traumatic HTx. Patients were predominantly male (79.6%) at a median age of 40 years and were evenly split between blunt (48.8%) and penetrating (51.2%) mechanisms. Sixty (20%) patients underwent thoracic irrigation at time of initial TT placement. The secondary intervention rate was significantly lower within the study group (5.6% vs. 21.8%; OR, 0.16; p < 0.001). No significant differences in TT duration, ventilator days, or length of stay were noted between the irrigation and control cohort. Thoracic irrigation at the time of initial TT placement for traumatic HTx significantly reduced the need for secondary intervention for retained HTx. Therapeutic Study, Level III.

Immunogenicity and safety of an investigational quadrivalent meningococcal ACWY tetanus toxoid conjugate vaccine in healthy adolescents and young adults 10 to 25 years of age.

PubMed

Baxter, Roger; Baine, Yaela; Ensor, Kathleen; Bianco, Veronique; Friedland, Leonard R; Miller, Jacqueline M

2011-03-01

An investigational quadrivalent Neisseria meningitidis serogroups A, C, W-135, and Y tetanus toxoid conjugate vaccine (MenACWY-TT) has been developed to expand available options for vaccination against invasive meningococcal disease. A total of 784 healthy adolescents and young adults 11 to 25 years of age were randomized (3:1) to receive a single dose of the MenACWY-TT vaccine or a licensed MenACWY diphtheria toxoid conjugate vaccine (MenACWY-DT). An additional nonrandomized group of 88 subjects 10 years of age received the MenACWY-TT vaccine only (MenACWY-TT/10). Immunogenicity was assessed 1 month postvaccination by human complement serum bactericidal assay (hSBA) for all serogroups. Solicited local and general symptoms were recorded for 8 days postvaccination and safety outcomes for 6 months. One month postvaccination, 81.9% to 96.1% of subjects had hSBA titers ≥ 1:8 in the MenACWY-TT group compared with 70.7% to 98.8% in the MenACWY-DT group. Exploratory analyses showed the proportion of subjects with hSBA titers ≥ 1:4 and ≥ 1:8 to be higher in the MenACWY-TT group than in the MenACWY-DT group for serogroups A, W-135, and Y. GMTs adjusted for age strata and baseline titer 1 month postvaccination were higher in the MenACWY-TT group than in the MenACWY-DT group for all 4 serogroups. The percentage of subjects reporting solicited local and general symptoms of any or Grade 3 severity or serious adverse events was similar between the 2 groups. Immune response and reactogenicity in the MenACWY-TT/10 group was similar to that in the MenACWY-TT group, except for higher hSBA-MenA GMTs in the MenACWY-TT/10 group. The investigational MenACWY-TT vaccine was immunogenic in adolescents and young adults, with an acceptable safety profile.

Positive Pacing Strategies Are Utilized by Elite Male and Female Para-cyclists in Short Time Trials in the Velodrome.

PubMed

Wright, Rachel L

2015-01-01

In para-cycling, competitors are classed based on functional impairment resulting in cyclists with neurological and locomotor impairments competing against each other. In Paralympic competition, classes are combined by using a factoring adjustment to race times to produce the overall medallists. Pacing in short-duration track cycling events is proposed to utilize an "all-out" strategy in able-bodied competition. However, pacing in para-cycling may vary depending on the level of impairment. Analysis of the pacing strategies employed by different classification groups may offer scope for optimal performance; therefore, this study investigated the pacing strategy adopted during the 1-km time trial (TT) and 500-m TT in elite C1 to C3 para-cyclists and able-bodied cyclists. Total times and intermediate split times (125-m intervals; measured to 0.001 s) were obtained from the C1-C3 men's 1-km TT (n = 28) and women's 500-m TT (n = 9) from the 2012 Paralympic Games and the men's 1-km TT (n = 19) and women's 500-m TT (n = 12) from the 2013 UCI World Track Championships from publically available video. Split times were expressed as actual time, factored time (for the para-cyclists) and as a percentage of total time. A two-way analysis of variance was used to investigate differences in split times between the different classifications and the able-bodied cyclists in the men's 1-km TT and between the para-cyclists and able-bodied cyclists in the women's 500-m TT. The importance of position at the first split was investigated with Kendall's Tau-b correlation. The first 125-m split time was the slowest for all cyclists, representing the acceleration phase from a standing start. C2 cyclists were slowest at this 125-m split, probably due to a combination of remaining seated in this acceleration phase and a high proportion of cyclists in this group being trans-femoral amputees. Not all cyclists used aero-bars, preferring to use drop, flat or bullhorn handlebars. Split times increased in the later stages of the race, demonstrating a positive pacing strategy. In the shorter women's 500-m TT, rank at the first split was more strongly correlated with final position than in the longer men's 1-km TT. In conclusion, a positive pacing strategy was adopted by the different para-cycling classes.

Protective effect of an aphrodisiac herb Tribulus terrestris Linn on cadmium-induced testicular damage

PubMed Central

Rajendar, B.; Bharavi, K.; Rao, G. S.; Kishore, P.V.S; Kumar, P. Ravi; Kumar, C.S.V Satish; Patel, T. Pankaj

2011-01-01

Aim: The aim of the present study was to investigate whether Tribulus terrestris Linn (TT) could protect the cadmium (Cd)-induced testicular tissue peroxidation in rats and to explore the underlying mechanism of the same. Materials and Methods: In vitro and in vivo studies were conducted to know the protective effect of ethanolic extract of TT (eTT) in Cd toxicity. In in vitro studies, total antioxidant and ferrous metal ion chelating activity of TT was studied. In vivo studies were conducted in rats. A total of 40 Wistar strain adult male rats were divided into four groups. Group 1 served as control, while group 2 to 4 received CdCl2 (3 mg/kg b. wt. s/c once a week). In addition to Cd, group 3 and 4 rats also received eTT (5 mg/kg b.wt. daily as oral gavage) and α-tocopherol (75 mg/kg daily by oral gavage), respectively. At the end of 6th week, all the rats were sacrificed and the separated testes were weighted and processed for estimation of tissue peroxidation markers, antioxidant markers, functional markers, and Cd concentration. The testes were also subjected to histopathological screening. Results: In in vitro studies, the percentage of metal ion chelating activity of 50 μg/ml of eTT and α-tocopherol were 2.76 and 9.39, respectively, and the antioxidant capacity of eTT was equivalent to 0.063 μg of α-tocopherol/μg of eTT. In in vivo studies, administration of Cd significantly reduced the absolute and relative testicular weight, antioxidant markers such as superoxide dismutase and glutathione, and functional markers such as LDH and ALP, along with significant increase in peroxidation markers such as malondialdehyde and protein carbonyls in testicular tissue. Testes of Cd only-treated group showed histological insults like necrotic changes in seminiferous tubules and interstitium, shrunken tubules with desquamated basal lamina, vacuolization and destruction of sertoli cells, and degenerating Leydig cells. This group also had higher Cd levels in testicular tissue. Co-treatment with eTT and α-tocopherol significantly reduced the Cd burden in the testes along with reversal of the Cd-induced changes. Conclusions: eTT exhibited protective effect against Cd-induced testicular damage. The protective effect appears to be mediated through inhibition of testicular tissue peroxidation by antioxidant and metal chelator activity and also, may be indirectly by stimulating the testosterone production from Leydig cells. PMID:22022002

Positive Pacing Strategies Are Utilized by Elite Male and Female Para-cyclists in Short Time Trials in the Velodrome

PubMed Central

Wright, Rachel L.

2016-01-01

In para-cycling, competitors are classed based on functional impairment resulting in cyclists with neurological and locomotor impairments competing against each other. In Paralympic competition, classes are combined by using a factoring adjustment to race times to produce the overall medallists. Pacing in short-duration track cycling events is proposed to utilize an “all-out” strategy in able-bodied competition. However, pacing in para-cycling may vary depending on the level of impairment. Analysis of the pacing strategies employed by different classification groups may offer scope for optimal performance; therefore, this study investigated the pacing strategy adopted during the 1-km time trial (TT) and 500-m TT in elite C1 to C3 para-cyclists and able-bodied cyclists. Total times and intermediate split times (125-m intervals; measured to 0.001 s) were obtained from the C1-C3 men's 1-km TT (n = 28) and women's 500-m TT (n = 9) from the 2012 Paralympic Games and the men's 1-km TT (n = 19) and women's 500-m TT (n = 12) from the 2013 UCI World Track Championships from publically available video. Split times were expressed as actual time, factored time (for the para-cyclists) and as a percentage of total time. A two-way analysis of variance was used to investigate differences in split times between the different classifications and the able-bodied cyclists in the men's 1-km TT and between the para-cyclists and able-bodied cyclists in the women's 500-m TT. The importance of position at the first split was investigated with Kendall's Tau-b correlation. The first 125-m split time was the slowest for all cyclists, representing the acceleration phase from a standing start. C2 cyclists were slowest at this 125-m split, probably due to a combination of remaining seated in this acceleration phase and a high proportion of cyclists in this group being trans-femoral amputees. Not all cyclists used aero-bars, preferring to use drop, flat or bullhorn handlebars. Split times increased in the later stages of the race, demonstrating a positive pacing strategy. In the shorter women's 500-m TT, rank at the first split was more strongly correlated with final position than in the longer men's 1-km TT. In conclusion, a positive pacing strategy was adopted by the different para-cycling classes. PMID:26834643

The effects of adding fat to diets of lactating dairy cows on total-tract neutral detergent fiber digestibility: A meta-analysis.

PubMed

Weld, K A; Armentano, L E

2017-03-01

The objective of this meta-analysis was to determine the effects of supplemental fat on fiber digestibility in lactating dairy cattle. Published papers that evaluated the effects of adding fat to the diets of lactating dairy cattle on total-tract neutral detergent fiber digestibility (ttNDFd) and dry matter intake (DMI) were compiled. The final data set included 108 fat-supplemented treatment means, not including low-fat controls, from 38 publications. The fat-supplemented treatment means exhibited a wide range of ttNDFd (49.4% ± 9.3, mean ± standard deviation) and DMI (21.3 kg/d ± 3.5). Observations were summarized as the difference between the treatment means for fat-supplemented diets minus their respective low-fat control means. Additionally, those differences were divided by the difference in diet fatty acid (FA) concentration between the treatment and control diets. Treatment means were categorized by the type of fat supplement. Supplementing 3% FA in the diet as medium-chain fats (containing predominately 12- and 14-carbon saturated FA) or unsaturated vegetable oil decreased ttNDFd by 8.0 and 1.2 percentage units, respectively. Adding 3% calcium salts of long-chain FA or saturated fats increased ttNDFd by 3.2 and 1.3 percentage units, respectively. No other fat supplement type affected ttNDFd. Except for saturated fats and animal-vegetable fats, supplementing dietary fat decreased DMI. When the values for changes in ttNDFd are regressed on changes in DMI there was a positive relationship, though the coefficient of determination is only 0.20. When changes in ttNDFd were regressed on changes in DMI, within individual fat supplement types, there was no relationship within calcium salt supplements. There was a positive relationship between changes in ttNDFd and changes in DMI for saturated fats. Neither relationship suggested that the increased ttNDFd with calcium salts or saturated FA was due to decreased DMI for these fat sources. A subset of the means included measured ruminal neutral detergent fiber digestion. Analysis of this smaller data set did not suggest that ruminal neutral detergent fiber digestibility is depressed by fat supplementation more than ttNDFd. Adding fats, other than those with medium-chain FA, consistently increased digestible energy density of the diet. However, due to reduced DMI, this increased energy density may not result in increased digestible nutrient intake. Copyright © 2017 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Evaluation of thyroid function in dogs suffering from recurrent flank alopecia.

PubMed Central

Daminet, S; Paradis, M

2000-01-01

Thyroid function was assessed in euthyroid dogs (n = 20), dogs suffering from canine recurrent flank alopecia (CRFA, n = 18), and hypothyroid dogs (n = 21). Blood samples obtained from all dogs in each group were assayed for total thyroxine (TT4), thyrotropin (TSH), and thyroglobulin autoantibody (TgAA) serum concentrations. Total T4 and TSH serum concentrations were significantly decreased and increased, respectively, in the hypothyroid group compared with the other 2 groups. No significant differences in TT4 and TSH serum values were found between the euthyroid and CRFA groups. Thyroglobulin autoantibodies were detected in 10, 11.1, and 61.9% of euthyroid dogs, dogs with CRFA, and hypothyroid dogs, respectively. In conclusion, dogs suffering from CRFA have a normal thyroid function, and the determination of TT4 and TSH serum concentrations allows differentiation of these dogs from dogs with hypothyroidism, in most cases. Occasionally, the 2 diseases can be concomitant. PMID:10992988

Sex hormone-binding globulin is associated with androgen deficiency features independently of total testosterone.

PubMed

Rastrelli, Giulia; Corona, Giovanni; Cipriani, Sarah; Mannucci, Edoardo; Maggi, Mario

2018-04-01

It is recognized that total testosterone (TT) does not sufficiently describe androgen status when sex hormone-binding globulin (SHBG) is altered. However, in humans, evidence supporting the existence of a hypogonadism due to low T bioactivity is scanty. The aim of the study was to assess whether changes in SHBG levels, independently of TT, are associated with subjective and objective androgen-dependent parameters. Cross-sectional observation. Two thousand six hundred and twenty-two men (aged 51.1 ± 13.5 years) attending a Sexual Medicine and Andrology Outpatient Clinic for sexual dysfunctions. All patients underwent a standardized diagnostic protocol before starting any treatment. Clinical and biochemical parameters have been collected. Higher ANDROTEST score has been used as a comprehensive marker of more severe hypogonadal symptoms. Prostate-specific antigen (PSA) and haematocrit have been used as objective surrogate markers of T bioactivity. After adjusting for TT and lifestyle, SHBG showed a significant positive association with ANDROTEST score (B = 0.79 [0.61; 0.96], P < .0001). Conversely, higher SHBG, independently of TT, was negatively related to PSA (B = -0.86 [-0.83; -0.89]; P < .0001) and haematocrit (B = -0.64 [-0.88; -0.40]; P < .0001), after adjustment for the aforementioned confounders along with age and body mass index. Furthermore, a relationship between SHBG and lipids or blood pressure was found, with lower SHBG levels associated with a worse metabolic profile, independently of TT. Higher SHBG, independently of TT, is associated with either subjective or objective androgen deficiency features. This indicates that besides a hypogonadism due to an impaired T production, a hypogonadism due to a lower biological activity of T does exist. © 2017 John Wiley & Sons Ltd.

Preorchiectomy Leydig Cell Dysfunction in Patients With Testicular Cancer.

PubMed

Bandak, Mikkel; Jørgensen, Niels; Juul, Anders; Lauritsen, Jakob; Gundgaard Kier, Maria Gry; Mortensen, Mette Saksø; Daugaard, Gedske

2017-02-01

Little is known about preorchiectomy Leydig cell function in patients with testicular germ cell cancer (TGCC). The aim was to estimate the prevalence of preorchiectomy Leydig cell dysfunction and evaluate factors associated with this condition in a cohort of patients with TGCC. We evaluated luteinizing hormone (LH), total testosterone (TT), calculated free T (cFT), estradiol, and sex hormone-binding globulin (SHBG) preorchiectomy in 561 patients with TGCC and compared with 561 healthy controls. We calculated TT/LH and cFT/LH ratios and constructed bivariate charts of TT/LH and cFT/LH from the controls. Logistic regression analysis with an abnormal cFT/LH ratio as outcome and clinical stage, tumor size, age, histology, presence of contralateral germ cell neoplasia in situ (GCNIS), and bilateral tumors as covariates was performed. In patients who were negative for human chorionic gonadotropin (hCG) (n = 374), TT (P = .004), cFT (P < .001), TT/LH ratio (P = .003), and cFT/LH ratio (P = .002) were lower than in controls. A total of 95 (25%) and 91 (24%) of hCG-negative patients had abnormal values when using combined evaluation of TT/LH and cFT/LH, respectively. Increasing tumor size, contralateral GCNIS, and increasing age were associated with Leydig cell dysfunction. In patients positive for hCG (n = 187), all reproductive hormones except SHBG were different from controls (P < .001). Patients with TGCC are at increased risk of Leydig cell dysfunction before orchiectomy. Contralateral GCNIS, increasing age, and increasing tumor size are associated with Leydig cell dysfunction. We hypothesize that patients with preexisting Leydig cell dysfunction are at increased risk of testosterone deficiency following treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

Minimally invasive, nonendoscopic thyroidectomy: a cosmetic alternative to robotic-assisted thyroidectomy.

PubMed

Govednik, Cara M; Snyder, Samuel K; Quinn, Courtney E; Saxena, Saurabh; Jupiter, Daniel C

2014-10-01

The desire to improve cosmesis has driven the introduction of robotic-assisted and video-assisted thyroidectomy techniques. We report on minimally invasive thyroidectomy (MIT) through a 2-cm incision without the added need for video assistance and hypothesize similar clinical results to standard open thyroidectomy. Between May 2012 and December 2013, 62 nonendoscopic MIT were evaluated for demographics, clinical outcomes, and patient satisfaction on a 1-10 scale. The results were compared with a case-matched control group who underwent conventional open thyroidectomy by the same surgeon. The 124 study patients demonstrated no differences between groups for demographics or clinical outcomes except a smaller thyroid lobe in the MIT group (9.2 vs 11.7 g; P = .05). There were longer operative times in the MIT group (135.4 vs 119.6 minutes; P = .07) that were not equivalent by equivalence testing (P = .534). In MIT patients, transient recurrent laryngeal nerve injury occurred per nerves at risk (1.1% vs 3.4%; P = .62) with no permanent injuries in either group. There was no difference in symptomatic hypocalcemia (9.7% vs 11.3%; P = .77) and postoperative hematoma (0% vs 3.2%; P = .50). On follow-up, the measured MIT scar was significantly shorter (2.22 vs 3.98 cm; P < .00001), which resulted in significantly improved cosmetic satisfaction ratings (9.56 vs 8.66; P = .03). In selected patients, MIT through a 2-cm incision without endoscopic assistance is a safe alternative to standard open thyroidectomy in the hands of an experienced endocrine surgeon. The operating time is slightly increased, but clinical results are equivalent and patient satisfaction is significantly improved. Copyright © 2014 Elsevier Inc. All rights reserved.

Evidence for spin correlation in tt production

DOE PAGES

Abazov, Victor Mukhamedovich

2012-01-19

We present a measurement of the ratio of events with correlated t and t spins to the total number of tt events. This ratio f is evaluated using a matrix-element-based approach in 729 tt candidate events with a single lepton ℓ (electron or muon) and at least four jets. The analyzed pp collisions data correspond to an integrated luminosity of 5.3 fb -1 and were collected with the D0 detector at the Fermilab Tevatron collider operating at a center-of-mass energy \\(\\sqrt{s}=1.96\\) TeV. Combining this result with a recent measurement of f in dileptonic final states, we find f in agreementmore » with the standard model. In addition, the combination provides evidence for the presence of spin correlation in tt events with a significance of more than 3 standard deviations.« less

Harmonic scalpel in multinodular goiter surgery: impact on surgery and cost analysis.

PubMed

Sebag, Frederic; Fortanier, Cécile; Ippolito, Guiseppe; Lagier, Aude; Auquier, Pascal; Henry, Jean-Francois

2009-04-01

The aim of this study was to evaluate the potential advantages and the general operative cost of the Harmonic Scalpel (HS) in surgery for multinodular goiter (MNG). Patients undergoing total thyroidectomy (TT) for MNG were prospectively allocated in a conventional tie-and-clip (TC) group (n = 50) and an HS group (n = 50). All pre- and postoperative data were recorded. The economic evaluation was based on a microcost measurement and aimed to consider all the resources consumed for each patient during the surgical procedure. To compare the results, we used the nonparametric unpaired two-tailed Mann-Whitney test. There were 81 women and 19 men (mean age, 55 +/- 15 years). Mean preoperative TSH level was 1.2 (SD, 1.1) (TC) and 1.3 (SD, 2) (HS) (P = NS). Mean body mass index was 24.72 (SD, 8) (TC) and 25.6 (SD, 8) (HS) (P = NS). Four patients experienced a transient hypocalcemia (2 in each group). One patient had a postoperative hematoma requiring surgical evacuation (HS). One patient experienced a transient recurrent nerve palsy (TC). Mean length of surgery was 104 (SD, 32) (TC) and 84 minutes (SD, 17) (HS) (P = .0001). Mean length of hospitalization was 2 days in both groups (SD, 1) (P = NS). Mean operative cost per patient was 990 euro (SD, 191) in the TC group and 1,024 euro (SD, 143) in the HS group (P = NS). Safety and efficiency of the HS is comparable to the tie-and-clip technique in thyroid surgery. The use of the HS in MNG surgery allows for a significant reduction in the length of the procedure with a comparable cost.

Solo-Surgeon Retroauricular Approach Endoscopic Thyroidectomy.

PubMed

Lee, Doh Young; Baek, Seung-Kuk; Jung, Kwang-Yoon

2017-01-01

This study aimed to evaluate the feasibility and efficacy of solo-surgeon retroauricular thyroidectomy. For solo-surgery, we used an Endoeye Flex Laparo-Thoraco Videoscope (Olympus America, Inc.). A Vitom Karl Storz holding system (Karl Storz GmbH & Co.) composed of several bars connected by a ball-joint system was used for fixation of endoscope. A snake retractor and a brain-spoon retractor were used on the sternocleidomastoid. Endoscopic thyroidectomy using the solo-surgeon technique was performed in 10 patients having papillary thyroid carcinoma. The mean patient age was 36.0 ± 11.1 years, and all patients were female. There were no postoperative complications such as vocal cord paralysis and hematoma. When compared with the operating times and volume of drainage of a control group of 100 patients who underwent surgery through the conventional retroauricular approach between May 2013 and December 2015, the operating times and volume of drainage were not significantly different (P = .781 and .541, respectively). Solo-surgeon retroauricular thyroidectomy is safe and feasible when performed by a surgeon competent in endoscopic thyroidectomy.

Pediatric pulmonary arterial hypertension and hyperthyroidism: a potentially fatal combination.

PubMed

Trapp, Christine M; Elder, Robert W; Gerken, Adrienne T; Sopher, Aviva B; Lerner, Shulamit; Aranoff, Gaya S; Rosenzweig, Erika B

2012-07-01

Patients with pulmonary arterial hypertension (PAH) who develop hyperthyroidism are at risk for acute cardiopulmonary decompensation and death. We present a series of eight idiopathic PAH/heritable PAH pediatric patients who developed hyperthyroidism between 1999 and 2011. Institutional Review Board approval was obtained; informed consent was waived due to the retrospective nature of the series. All eight patients were receiving iv epoprostenol; five of the eight patients presented with acute cardiopulmonary decompensation in the setting of hyperthyroidism. In the remaining three patients, hyperthyroidism was detected during routine screening of thyroid function tests. The one patient who underwent emergency thyroidectomy was the only survivor of those who presented in cardiopulmonary decline. Aggressive treatment of the hyperthyroid state, including emergency total thyroidectomy and escalation of targeted PAH therapy and β-blockade when warranted, may prove lifesaving in these patients. Prompt thyroidectomy or radioactive iodine ablation should be considered for clinically stable PAH patients with early and/or mild hyperthyroidism to avoid potentially life-threatening cardiopulmonary decompensation. Although the association between hyperthyroidism and PAH remains poorly understood, the potential impact of hyperthyroidism on the cardiopulmonary status of PAH patients must not be ignored. Hyperthyroidism must be identified early in this patient population to optimize intervention before acute decompensation. Thyroid function tests should be checked routinely in patients with PAH, particularly those on iv epoprostenol, and urgently in patients with acute decompensation or symptoms of hyperthyroidism.

Robotic and endoscopic transoral thyroidectomy: feasibility and description of the technique in the cadaveric model.

PubMed

Kahramangil, Bora; Mohsin, Khuzema; Alzahrani, Hassan; Bu Ali, Daniah; Tausif, Syed; Kang, Sang-Wook; Kandil, Emad; Berber, Eren

2017-12-01

Numerous new approaches have been described over the years to improve the cosmetic outcomes of thyroid surgery. Transoral approach is a new technique that aims to achieve superior cosmetic outcomes by concealing the incision in the oral cavity. Transoral thyroidectomy through vestibular approach was performed in two institutions on cadaveric models. Procedure was performed endoscopically in one institution, while the robotic technique was utilized at the other. Transoral thyroidectomy was successfully performed at both institutions with robotic and endoscopic techniques. All vital structures were identified and preserved. Transoral thyroidectomy has been performed in animal and cadaveric models, as well as in some clinical studies. Our initial experience indicates the feasibility of this approach. More clinical studies are required to elucidate its full utility.

Management of thyroid cancer: United Kingdom National Multidisciplinary Guidelines.

PubMed

Mitchell, A L; Gandhi, A; Scott-Coombes, D; Perros, P

2016-05-01

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. This paper provides recommendations on the management of thyroid cancer in adults and is based on the 2014 British Thyroid Association guidelines. Recommendations • Ultrasound scanning (USS) of the nodule or goitre is a crucial investigation in guiding the need for fine needle aspiration cytology (FNAC). (R) • FNAC should be considered for all nodules with suspicious ultrasound features (U3-U5). If a nodule is smaller than 10 mm in diameter, USS guided FNAC is not recommended unless clinically suspicious lymph nodes on USS are also present. (R) • Cytological analysis and categorisation should be reported according to the current British Thyroid Association Guidance. (R) • Ultrasound scanning assessment of cervical nodes should be done in FNAC-proven cancer. (R) • Magnetic resonance imaging (MRI) or computed tomography (CT) should be done in suspected cases of retrosternal extension, fixed tumours (local invasion with or without vocal cord paralysis) or when haemoptysis is reported. When CT with contrast is used pre-operatively, there should be a two-month delay between the use of iodinated contrast media and subsequent radioactive iodine (I131) therapy. (R) • Fluoro-deoxy-glucose positron emission tomography imaging is not recommended for routine evaluation. (G) • In patients with thyroid cancer, assessment of extrathyroidal extension and lymph node disease in the central and lateral neck compartments should be undertaken pre-operatively by USS and cross-sectional imaging (CT or MRI) if indicated. (R) • For patients with Thy 3f or Thy 4 FNAC a diagnostic hemithyroidectomy is recommended. (R) • Total thyroidectomy is recommended for patients with tumours greater than 4 cm in diameter or tumours of any size in association with any of the following characteristics: multifocal disease, bilateral disease, extrathyroidal spread (pT3 and pT4a), familial disease and those with clinically or radiologically involved nodes and/or distant metastases. (R) • Subtotal thyroidectomy should not be used in the management of thyroid cancer. (G) • Central compartment neck dissection is not routinely recommended for patients with papillary thyroid cancer without clinical or radiological evidence of lymph node involvement, provided they meet all of the following criteria: classical type papillary thyroid cancer, patient less than 45 years old, unifocal tumour, less than 4 cm, no extrathyroidal extension on ultrasound. (R) • Patients with metastases in the lateral compartment should undergo therapeutic lateral and central compartment neck dissection. (R) • Patients with follicular cancer with greater than 4 cm tumours should be treated with total thyroidectomy. (R) • I131 ablation should be carried out only in centres with appropriate facilities. (R) • Serum thyroglobulin (Tg) should be checked in all post-operative patients with differentiated thyroid cancer (DTC), but not sooner than six weeks after surgery. (R) • Patients who have undergone total or near total thyroidectomy should be started on levothyroxine 2 µg per kg or liothyronine 20 mcg tds after surgery. (R) • The majority of patients with a tumour more than 1 cm in diameter, who have undergone total or near-total thyroidectomy, should have I131 ablation. (R) • A post-ablation scan should be performed 3-10 days after I131 ablation. (R) • Post-therapy dynamic risk stratification at 9-12 months is used to guide further management. (G) • Potentially resectable recurrent or persistent disease should be managed with surgery whenever possible. (R) • Distant metastases and sites not amenable to surgery which are iodine avid should be treated with I131 therapy. (R) • Long-term follow-up for patients with differentiated thyroid cancer (DTC) is recommended. (G) • Follow-up should be based on clinical examination, serum Tg and thyroid-stimulating hormone assessments. (R) • Patients with suspected medullary thyroid cancer (MTC) should be investigated with calcitonin and carcino-embryonic antigen levels (CEA), 24 hour catecholamine and nor metanephrine urine estimation (or plasma free nor metanephrine estimation), serum calcium and parathyroid hormone. (R) • Relevant imaging studies are advisable to guide the extent of surgery. (R) • RET (Proto-oncogene tyrosine-protein kinase receptor) proto-oncogene analysis should be performed after surgery. (R) • All patients with known or suspected MTC should have serum calcitonin and biochemical screening for phaeochromocytoma pre-operatively. (R) • All patients with proven MTC greater than 5 mm should undergo total thyroidectomy and central compartment neck dissection. (R) • Patients with MTC with lateral nodal involvement should undergo selective neck dissection (IIa-Vb). (R) • Patients with MTC with central node metastases should undergo ipsilateral prophylactic lateral node dissection. (R) • Prophylactic thyroidectomy should be offered to RET-positive family members. (R) • All patients with proven MTC should have genetic screening. (R) • Radiotherapy may be useful in controlling local symptoms in patients with inoperable disease. (R) • Chemotherapy with tyrosine kinase inhibitors may help in controlling local symptoms. (R) • For individuals with anaplastic thyroid carcinoma, initial assessment should focus on identifying the small proportion of patients with localised disease and good performance status, which may benefit from surgical resection and other adjuvant therapies. (G) • The surgical intent should be gross tumour resection and not merely an attempt at debulking. (G).

Hypocalcaemia-induced tetany secondary to total thyroidectomy: a nursing case review.

PubMed

Bakon, Shannon; Craft, Judy; Christensen, Martin

2017-07-05

Presentations to the emergency department with a diagnosis of hypocalcaemia-induced tetany secondary to total thyroidectomy are rare. A patient presented to the emergency department of a regional Australian hospital with hypocalcaemia-induced tetany. A case study was employed to reflect on the care provided and identify knowledge practice deficits within this unusual patient presentation. Calcium plays a central role within the nervous system and is vital for both cardiac and muscular contraction. The clinical manifestations of electrolyte disturbances such as hypocalcaemia can be life threatening, and therefore, appropriate assessment, monitoring and management are essential to ensure positive patient outcomes. Understanding the importance of calcium imbalance for the emergency and critical care nurse is paramount in preventing complications associated with cardiac conduction and muscle tone, especially the potential for airway compromise. Education is central to this and may include clinical case reviews, the application of pathophysiological presentations of electrolyte imbalance and a review of electrolyte administration guidelines. Understanding the role of calcium within the body will assist emergency and critical care nurses to assess, monitor and intervene appropriately, thereby preventing the life-threatening manifestations of hypocalcaemia. © 2017 British Association of Critical Care Nurses.

Management of thyroid carcinoma with radioactive 131I.

PubMed

Paryani, S B; Chobe, R J; Scott, W; Wells, J; Johnson, D; Kuruvilla, A; Schoeppel, S; Deshmukh, A; Miller, R; Dajani, L; Montgomery, C T; Puestow, E; Purcell, J; Roura, M; Sutton, D; Mallett, R; Peer, J

1996-08-01

To evaluate the role of radioactive 131I in the management of patients with well differentiated carcinoma of the thyroid. Between 1965 and 1995, a total of 117 patients with well-differentiated carcinoma of the thyroid underwent either lobectomy or thyroidectomy followed by 100-150 mCi of 131I. With a median follow-up of 8 years, only four patients (3%) developed a recurrence of their disease. The 5-year actuarial survival was 97% with a 10-year survival of 91%. There were no severe side effects noted after 131I therapy. Radioactive 131I is a safe and effective procedure for the majority of patients with well-differentiated thyroid carcinoma. We currently recommend that all patients undergo a subtotal or total thyroidectomy followed by 131I thyroid scanning approximately 4 weeks after surgery. If the thyroid scan shows no residual uptake and all disease is confined to the thyroid, we recommend following patients with annual thyroid scans and serum thyroglobulin levels. If there is any residual uptake detected in the neck or if the tumor extends beyond the thyroid, we recommend routine thyroid ablation of 100-150 mCi of radioactive 131I.

Effect of a Low Iodine Diet vs. Restricted Iodine Diet on Postsurgical Preparation for Radioiodine Ablation Therapy in Thyroid Carcinoma Patients.

PubMed

Lim, Chi Young; Kim, Jung-Yeon; Yoon, Mi-Jin; Chang, Hang Seok; Park, Cheong Soo; Chung, Woong Youn

2015-07-01

The radioiodine ablation therapy is required for patients who underwent a total thyroidectomy. Through a comparative review of a low iodine diet (LID) and a restricted iodine diet (RID), the study aims to suggest guidelines that are suitable for the conditions of Korea. The study was conducted with 101 patients. With 24-hour urine samples from the patients after a 2-week restricted diet and after a 4-week restricted diet, the amount of iodine in the urine was estimated. The consumed radioiodine amounts for 2 hours and 24 hours were calculated. This study was conducted with 47 LID patients and 54 RID patients. The amounts of iodine in urine, the 2-week case and 4-week case for each group showed no significant differences. The amounts of iodine in urine between the two groups were both included in the range of the criteria for radioiodine ablation therapy. Also, 2 hours and 24 hours radioiodine consumption measured after 4-week restrictive diet did not show statistical differences between two groups. A 2-week RID can be considered as a type of radioiodine ablation therapy after patients undergo a total thyroidectomy.

Clinical implications of the BRAF mutation in papillary thyroid carcinoma and chronic lymphocytic thyroiditis.

PubMed

Kim, Woon Won; Ha, Tae Kwun; Bae, Sung Kwon

2018-01-09

The purpose of this study was to examine the possible prognostics and clinicopathologic characteristics underlying the BRAFV600E mutation and papillary thyroid carcinoma (PTC) coexisting or in absence of chronic lymphocytic thyroiditis (CLT). This study was conducted on 172 patients who had undergone total thyroidectomy or unilateral total thyroidectomy for PTC; the patients were then examined for the BRAFV600E mutation using specimens obtained after their surgery from January 2013 to August 2015. BRAF mutations were found in 130 of 172 patients (75.6%). CLT was present in 27.9% of patients (48/172). The incidence of the BRAFV600E mutation was significantly increased in the group with no CLT (P = 0.001). The findings of the multivariate analysis pertaining to the coexistence of CLT and PTC showed no significant correlation other than the BRAFV600E mutation. No significant difference was noted in the clinicopathologic factors between the two groups based on the coexistence of CLT in univariate and multivariate analyses. The BRAFV600E mutation is less frequent in PTC coexisting with CLT presumably because CLT and the BRAFV600E mutation operate independently in the formation and progression of thyroid cancer.

Thyroid stimulation with recombinant human thyrotropin in healthy cats, cats with non-thyroidal illness and in cats with low serum thyroxin and azotaemia after treatment of hyperthyroidism.

PubMed

van Hoek, Ingrid M; Vandermeulen, Eva; Peremans, Kathelijne; Daminet, Sylvie

2010-02-01

This study investigated the recombinant human thyrotropin (rhTSH) stimulation test in healthy cats (group 1), cats with non-thyroidal illness (group 2) and cats with low serum total T(4) (TT(4)) and azotaemia after (131)I treatment (group 3). Serum TT(4) responses and thyroidal pertechnetate uptake after administration of 25 microg rhTSH IV were assessed. Baseline serum TT(4) was significantly lower in group 3 compared with group 1, but not between other group pairs. Serum TT(4) increased significantly in groups 1 and 2 but not in group 3 after rhTSH administration. Post-rhTSH serum TT(4) concentrations differed significantly between groups 1 and 3 and groups 2 and 3, but not between groups 1 and 2. Thyroid/salivary gland uptake ratio (T/S uptake ratio) differed only significantly between groups 1 and 3. Stimulation with rhTSH is valuable to differentiate euthyroidism from iatrogenic hypothyroidism in cats. Copyright 2009 ESFM and AAFP. Published by Elsevier Ltd. All rights reserved.

Measurement of the $${{t\\bar{t}Z}}$$ and $${{t\\bar{t}W}}$$ production cross sections in multilepton final states using 3.2 fb $$^{-1}$$ of $${pp}$$ collisions at $$\\sqrt{s} = 13$$ TeV with the ATLAS detector

DOE PAGES

Aaboud, M.; Aad, G.; Abbott, B.; ...

2017-01-20

A measurement of the tt¯Z and tt¯W production cross sections in final states with either two same-charge muons, or three or four leptons (electrons or muons) is presented. The analysis uses a data sample of proton–proton collisions at √s = 13 TeV recorded with the ATLAS detector at the Large Hadron Collider in 2015, corresponding to a total integrated luminosity of 3.2 fb –1. The inclusive cross sections are extracted using likelihood fits to signal and control regions, resulting in σ tt¯Z = 0.9±0.3 pb and σ tt¯W = 1.5±0.8 pb, in agreement with the Standard Model predictions.

Thyroidectomy

MedlinePlus

... via an incision high in the neck. The robotic approach allows a thyroidectomy to be performed while avoiding an incision in the center of your neck. After the procedure After surgery, you're moved to a recovery room where ...

Robotic and endoscopic transoral thyroidectomy: feasibility and description of the technique in the cadaveric model

PubMed Central

Kahramangil, Bora; Mohsin, Khuzema; Alzahrani, Hassan; Bu Ali, Daniah; Tausif, Syed; Kang, Sang-Wook; Kandil, Emad

2017-01-01

Background Numerous new approaches have been described over the years to improve the cosmetic outcomes of thyroid surgery. Transoral approach is a new technique that aims to achieve superior cosmetic outcomes by concealing the incision in the oral cavity. Methods Transoral thyroidectomy through vestibular approach was performed in two institutions on cadaveric models. Procedure was performed endoscopically in one institution, while the robotic technique was utilized at the other. Results Transoral thyroidectomy was successfully performed at both institutions with robotic and endoscopic techniques. All vital structures were identified and preserved. Conclusions Transoral thyroidectomy has been performed in animal and cadaveric models, as well as in some clinical studies. Our initial experience indicates the feasibility of this approach. More clinical studies are required to elucidate its full utility. PMID:29302476

Reduction of human anti-tetanus toxoid antibody in hu-PBL-SCID mice by immunodominant peptides of tetanus toxoid

PubMed Central

Jackson, D J; Elson, C J; Kumpel, B M

2004-01-01

Immunotherapy of murine autoimmune and allergic diseases by administration of peptides corresponding to the dominant T cell epitope is a reality. However, problems remain in applying this therapy to reduce antibody responses in humans. To overcome these difficulties, a preclinical system was developed to test the effect of immunodominant peptides from a common antigen, tetanus toxoid (TT), on the long-term human anti-TT response. Individuals whose T cells proliferated against dominant TT peptides were identified. Peripheral blood leucocytes (PBL) from these donors were injected intraperitoneally (i.p.) into mice with severe combined immunodeficiency (SCID) that had been depleted of murine natural killer (NK) cells (hu-PBL-SCID mice). Peptides or PBS were injected i.p. before a further injection of PBL and immunization with TT. The concentration of human IgG and anti-TT in murine plasma was followed for 10 weeks. The total IgG was similar in both groups. By contrast, there was a statistically significant reduction in IgG anti-TT from eight weeks onwards. It is considered that the hu-PBL-SCID model system may provide a means by which the efficacy of peptide immunotherapy for reduction of pathological antibodies in humans can be examined. PMID:15270840

Multiple Active Compounds from Viscum album L. Synergistically Converge to Promote Apoptosis in Ewing Sarcoma

PubMed Central

Twardziok, Monika; Kleinsimon, Susann; Rolff, Jana; Jäger, Sebastian; Eggert, Angelika

2016-01-01

Ewing sarcoma is the second most common bone cancer in children and adolescents, with poor prognosis and outcome in ~70% of initial diagnoses and 10–15% of relapses. Hydrophobic triterpene acids and hydrophilic lectins and viscotoxins from European mistletoe (Viscum album L.) demonstrate anticancer properties, but have not yet been investigated for Ewing sarcoma. Commercial Viscum album L. extracts are aqueous, excluding the insoluble triterpenes. We recreated a total mistletoe effect by combining an aqueous extract (viscum) and a triterpene extract (TT) solubilized with cyclodextrins. Ewing sarcoma cells were treated with viscum, TT and viscumTT in vitro, ex vivo and in vivo. In vitro and ex vivo treatment of Ewing sarcoma cells with viscum inhibited proliferation and induced apoptosis in a dose-dependent fashion, while viscumTT combination treatment generated a synergistic effect. Apoptosis occurred via intrinsic and extrinsic apoptotic pathways, evidenced by activation of both CASP8 and CASP9. We show that viscumTT treatment shifts the balance of apoptotic regulatory proteins towards apoptosis, mainly via CLSPN, MCL1, BIRC5 and XIAP downregulation. ViscumTT also demonstrated strong antitumor activity in a cell line- and patient-derived mouse model, and may be considered an adjuvant therapy option for pediatric patients with Ewing sarcoma. PMID:27589063

Comparison of conventional versus Hybrid knife peroral endoscopic myotomy methods for esophageal achalasia: a case-control study.

PubMed

Tang, Xiaowei; Gong, Wei; Deng, Zhiliang; Zhou, Jieqiong; Ren, Yutang; Zhang, Qiang; Chen, Zhenyu; Jiang, Bo

2016-01-01

Peroral endoscopic myotomy (POEM) has been developed to treat achalasia as a novel less invasive modality. We aimed to compare the efficacy and safety of conventional knife versus Hybrid knife (HK) during POEM procedure. Between June 2012 and July 2014, 31 patients underwent POEM using HK in our department (HK group), and 36 patients underwent POEM using conventional method (injection needle and triangular tip [TT] knife, TT group). Procedure-related parameters, symptom relief, adverse events were compared between two groups. There were no significant differences in the age, sex and other baseline characteristics between the two groups. The mean procedural time was significantly shorter in HK group than TT group (53.0 ± 17.2 vs. 67.6 ± 28.4 min, p = 0.015). The mean frequency of devices exchange was 4.7 ± 1.7 in HK group and 10.9 ± 1.8 in TT group (p = 0.000). No serious adverse events occurred postoperatively in both groups. At one-year follow-up, a total of 94% treatment success was achieved in all patients (93.5% in HK group and 94.4% in TT group, p = 0.877). HK in POEM can shorten the procedural time, and achieve similar treatment success compared to conventional TT knife.

Efficacy of a Home-Based Exercise Program After Thyroidectomy for Thyroid Cancer Patients.

PubMed

Kim, Kyunghee; Gu, Mee Ock; Jung, Jung Hwa; Hahm, Jong Ryeal; Kim, Soo Kyoung; Kim, Jin Hyun; Woo, Seung Hoon

2018-02-01

The objective of this study was to determine the effect of a home-based exercise program on fatigue, anxiety, quality of life (QoL), and immune function of thyroid cancer patients taking thyroid hormone replacement after thyroidectomy. This quasi-experimental study with a non-equivalent control group included 43 outpatients taking thyroid hormone replacement after thyroidectomy (22 in the experimental group and 21 in the control group). After education about the home-based exercise program, subjects in the experimental group underwent 12 weeks of aerobic, resistance, and flexibility exercise. A comparative analysis was conducted between the two groups. Patients in the experimental group were significantly less fatigued or anxious (p < 0.01). They reported significantly improved QoL (p < 0.05) compared to those in the control group. Natural killer cell activity was significantly higher in the exercise group compared to that in the control group (p < 0.05). A home-based exercise program is effective in reducing fatigue and anxiety, improving QoL, and increasing immune function in patients taking thyroid hormone replacement after thyroidectomy. Therefore, such a home-based exercise program can be used as an intervention for patients who are taking thyroid hormone replacement after thyroidectomy.

Definition of Human Epitopes Recognized in Tetanus Toxoid and Development of an Assay Strategy to Detect Ex Vivo Tetanus CD4+ T Cell Responses

PubMed Central

da Silva Antunes, Ricardo; Paul, Sinu; Sidney, John; Weiskopf, Daniela; Dan, Jennifer M.; Phillips, Elizabeth; Mallal, Simon; Crotty, Shane; Sette, Alessandro; Lindestam Arlehamn, Cecilia S.

2017-01-01

Despite widespread uses of tetanus toxoid (TT) as a vaccine, model antigen and protein carrier, TT epitopes have been poorly characterized. Herein we defined the human CD4+ T cell epitope repertoire by reevaluation of previously described epitopes and evaluation of those derived from prediction of HLA Class II binding. Forty-seven epitopes were identified following in vitro TT stimulation, with 28 epitopes accounting for 90% of the total response. Despite this diverse range of epitopes, individual responses were associated with only a few immunodominant epitopes, with each donor responding on average to 3 epitopes. For the top 14 epitopes, HLA restriction could be inferred based on HLA typing of the responding donors. HLA binding predictions re-identified the vast majority of known epitopes, and identified 24 additional novel epitopes. With these epitopes, we created a TT epitope pool, which allowed us to characterize TT responses directly ex vivo using a cytokine-independent Activation Induced Marker (AIM) assay. These TT responses were highly Th1 or Th2 polarized, which was dependent upon the original priming vaccine, either the cellular DTwP or acellular DTaP formulation. This polarization remained despite the original priming having occurred decades past and a recent booster immunization with a reduced acellular vaccine formulation. While TT responses following booster vaccination were not durably increased in magnitude, they were associated with a relative expansion of CD4+ effector memory T cells. PMID:28081174

Definition of Human Epitopes Recognized in Tetanus Toxoid and Development of an Assay Strategy to Detect Ex Vivo Tetanus CD4+ T Cell Responses.

PubMed

da Silva Antunes, Ricardo; Paul, Sinu; Sidney, John; Weiskopf, Daniela; Dan, Jennifer M; Phillips, Elizabeth; Mallal, Simon; Crotty, Shane; Sette, Alessandro; Lindestam Arlehamn, Cecilia S

2017-01-01

Despite widespread uses of tetanus toxoid (TT) as a vaccine, model antigen and protein carrier, TT epitopes have been poorly characterized. Herein we defined the human CD4+ T cell epitope repertoire by reevaluation of previously described epitopes and evaluation of those derived from prediction of HLA Class II binding. Forty-seven epitopes were identified following in vitro TT stimulation, with 28 epitopes accounting for 90% of the total response. Despite this diverse range of epitopes, individual responses were associated with only a few immunodominant epitopes, with each donor responding on average to 3 epitopes. For the top 14 epitopes, HLA restriction could be inferred based on HLA typing of the responding donors. HLA binding predictions re-identified the vast majority of known epitopes, and identified 24 additional novel epitopes. With these epitopes, we created a TT epitope pool, which allowed us to characterize TT responses directly ex vivo using a cytokine-independent Activation Induced Marker (AIM) assay. These TT responses were highly Th1 or Th2 polarized, which was dependent upon the original priming vaccine, either the cellular DTwP or acellular DTaP formulation. This polarization remained despite the original priming having occurred decades past and a recent booster immunization with a reduced acellular vaccine formulation. While TT responses following booster vaccination were not durably increased in magnitude, they were associated with a relative expansion of CD4+ effector memory T cells.

Internal quality control practice of thyroid disease related tests and imprecision analysis in China.

PubMed

Hu, Li-Tao; Wang, Zhi-Guo

2014-01-01

Internal quality control (IQC) has a long and well-established role in clinical laboratories and the quality of laboratories has achieved great improvement in China. However, the practice of IQC varies significantly between institutions and many problems still exists. Consequently, the Chinese National Center for Clinical Laboratories has been undertaking monthly nation-wide surveys of current IQC practice of tests since 2010 to monitor laboratory quality. Thyroid disease related tests were chosen for this research. Different numbers of laboratories in China participating national external quality assessment (EQA) schemes of Total Thyroxine (TT4), Total Triiodothyronine (TT3), Free Thyroxine (FT4) and Free Triiodothyronine (FT3) tests, and Thyroid Stimulating Hormone (TSH) measurements, were required to report the IQC information though the national external quality assessment (EQA) network platform. Survey data showed significant variability in all aspects of IQC practice. More than half of the laboratories are using a single concentration level of IQC material and up to 28.6% of the laboratories only use 1(2s) or 1(3s) to monitor IQC results for FT3, TT3, FT4, TT4, and TSH. The medians of the average time intervals of two control tests for FT3, TT3, FT4, TT4, and TSH are 33.6, 35.4, 33.6, 35.4, and 33.6 hours, respectively, more or less 1.4 days. When quality specifications based on biological variation are applied to imprecision evaluation, only 46.3%, 52.1%, 31.3%, 12.8%, and 5.86% laboratories meet the minimum performance for FT3, TT3, FT4, and TT4, 24.5%, 23.6%, 12.8%, and 5.86% of the all meet the desirable performance, and 4.4%, 3.9%, 2.5% and 3.0% of the all meet the optimal performance. While it shows a higher percentage of acceptable laboratories (98.1%, 87.9% and 39.0% meeting the minimum, desirable and optimal performance, respectively) for TSH. Not-well-designed IQC practices may affect the effectiveness of laboratory IQC and, thus, the adequacy of a laboratory to monitor system performance. Consequently, IQC practice should be designed according to performance of measure method and instrument. Both clinical laboratories and the government should make efforts to improve quality of clinical testing to ensure the patients' safety.

A randomized controlled trial [corrected] administration of tetanus toxoid (TT) versus tetanus and reduced diphtheria (Td) in pregnant women.

PubMed

Salama, Maha M; Hady, Osama A W; Ashour, Wael; Mostafa, Amal; El Alkamy, Sahar; El Sayed, Nehad; El Yazeed, Remon Abu

2009-07-01

The present study was designed as a randomized clinical trial to compare the immunogenicity, reactogenicity, and efficacy of tetanus toxoid (TT) and the combined tetanus and reduced diphtheria (Td) in pregnant women in four rural communities in Egypt. The pregnant women in each four villages received either TT or Td randomly. Both TT and Td vaccines are manufactured by the Egyptian Company for Biological Products & Vaccines (VACSERA) in Egypt. A total of 131 pregnant women were enrolled during the time of antenatal care visit (at 20 weeks gestational age of pregnancy) in one of four health units in Abu Homos district, Beheira Governorate, Egypt. Unimmunized women received two random doses of either TT or Td 8 weeks apart during their pregnancy. Outpatient follow-up for adverse reactions occurred at the third day after each vaccine dose as either local effects such as pain, redness, and swelling or systematic effects such as fever, malaise, and headache or body aches which was served as primary safety endpoint. Blood was collected three times from each woman for determination of antibody titer against tetanus and diphtheria by using enzyme-linked immunosorbent assay technique. The first sample was collected immediately before the first dose, the second before the second dose, and the third sample 1 week after delivery. Active surveillance home visits to all study participants were done twice: the first home visit during the first week after delivery and the second 1 month after labor to report the health status of the mother and the baby. A total of 122 pregnant women received two ordinary doses with interdose intervals within the allowable range and three blood samples were collected in each protocol analysis (62 in the TT group and 60 in the Td group). There was no statistically significant difference between groups in the percentage of reporting a primary safety endpoint (fever, malaise, body ache, headache) or local reactions at the site of injection as redness and swelling, at third day after each dose. While in the Td group, after doses I and II, there was significant reporting pain at injection site as compared with TT group, home visits clinical examination revealed that the mothers and children were normal on in both groups. However, in the TT group, some children suffered from physiological jaundice. In all women in the two groups, protective immunity for tetanus was acquired, which reflected in neutralization of antibodies at titer (>0.10 IU/ml) after complete vaccination; however, the tetanus geometric mean titers postdoses I and II were significantly higher in TT vaccines group (P < 0.001). The postvaccination seroprotection titer (>0.10 IU/ml) in diphtheria was significantly higher in Td group than the TT group; diphtheria geometric mean titers of postdose II were significantly higher in Td vaccines as compared to the other group (P < 0.0001). From this results, we can conclude that the use of Td vaccine improves immunogenicity for both tetanus and diphtheria more than the use of TT vaccine alone and we can recommend to replace TT in immunization of pregnant women.

Late effect of subtotal thyroidectomy and radioactive iodine therapy on calcitonin secretion and bone mineral density in women treated for Graves' disease

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lowery, W.D.; Thomas, C.G. Jr.; Awbrey, B.J.

1986-12-01

This study was designed to evaluate the effect of subtotal thyroidectomy and/or radioactive iodine therapy on plasma immunocalcitonin (iCT) levels and bone densities in patients treated for Graves' disease. Forty-eight women whose ages ranged from 29 to 79 years (mean, 55 years) were evaluated. All were at least 10 years beyond treatment. Fourteen patients had undergone subtotal thyroidectomy, 22 had received radioactive iodine therapy, and 12 had received both. Serum calcitonin levels were measured with the patient fasting and at 30 minutes and 2 hours after the ingestion of 15 mg of calcium in orange juice. Single photon absorptiometry wasmore » used to measure bone mineral density of the middle and distal radius. The mean fasting plasma levels of iCT for patients undergoing subtotal thyroidectomy was 27 +/- 2 mumol/L; women treated with radioactive iodine, 26 +/- 2; women undergoing subtotal thyroidectomy followed by radioactive iodine, 24 +/- 2, and for normal control women, 48.5 +/- 4.7. The mean stimulated iCT level of each of the patient groups was significantly lower than that of the normal controls (p = 0.01). There were no significant differences among the groups. Although there was an increased loss of bone mineral density in postmenopausal patients, with age and race as covariates, the bone densities of the distal radius in women undergoing subtotal thyroidectomy and/or receiving radioactive iodine were not significantly lower than those of normal control subjects (p greater than 0.05). These findings are consistent with other observations that patients treated by thyroidectomy and/or radioactive iodine for Graves' disease have lower basal levels of calcitonin and decreased calcitonin response to a provocative stimulus. Whether this loss of calcitonin reserve is a significant factor in development of postmenopausal osteoporosis remains unanswered.« less

Cardiovascular morbidity and mortality in surgically treated hyperthyroidism - a nation-wide cohort study with a long-term follow-up.

PubMed

Ryödi, Essi; Salmi, Jorma; Jaatinen, Pia; Huhtala, Heini; Saaristo, Rauni; Välimäki, Matti; Auvinen, Anssi; Metso, Saara

2014-05-01

Previous studies suggest that patients with hyperthyroidism remain at an increased risk of cardiovascular morbidity even after restoring euthyroidism. The mechanisms of the increased risk and its dependency on the different treatment modalities of hyperthyroidism remain unclear. The aim of this long-term follow-up study was to compare the rate of hospitalizations for cardiovascular causes and the mortality in hyperthyroid patients treated surgically with an age- and gender-matched reference population. A population-based cohort study was conducted among 4334 hyperthyroid patients (median age 46 years) treated with thyroidectomy in 1986-2007 in Finland and among 12,991 reference subjects. Firstly, the hospitalizations due to cardiovascular diseases (CVD) were analysed until thyroidectomy. Secondly, the hazard ratios for any new hospitalization due to CVDs after the thyroidectomy were calculated in Cox regression analysis adjusted with the prevalent CVDs at the time of thyroidectomy. The risk of hospitalization due to all CVDs started to increase already 5 years before the thyroidectomy, and by the time of the operation, it was 50% higher in the hyperthyroid patients compared to the controls (P < 0·001). After the thyroidectomy, the hospitalizations due to all CVDs (HR 1·15), hypertension (HR 1·23), heart failure (HR 1·17) and valvular diseases or cardiomyopathies (HR 1·55) remained more frequent among the patients than among the controls for 20 years after thyroidectomy. The increased morbidity was not clearly related to the aetiology of hyperthyroidism. Despite the increased CVD morbidity among the patients, there was no difference in cardiovascular mortality. The present study shows that hyperthyroidism increases the risk of hospitalization due to CVDs and the risk is sustained up to two decades after effective surgical treatment. However, there was no excess CVD mortality in the middle-aged patient cohort studied. © 2013 John Wiley & Sons Ltd.

Marker-based or model-based RSA for evaluation of hip resurfacing arthroplasty? A clinical validation and 5-year follow-up.

PubMed

Lorenzen, Nina Dyrberg; Stilling, Maiken; Jakobsen, Stig Storgaard; Gustafson, Klas; Søballe, Kjeld; Baad-Hansen, Thomas

2013-11-01

The stability of implants is vital to ensure a long-term survival. RSA determines micro-motions of implants as a predictor of early implant failure. RSA can be performed as a marker- or model-based analysis. So far, CAD and RE model-based RSA have not been validated for use in hip resurfacing arthroplasty (HRA). A phantom study determined the precision of marker-based and CAD and RE model-based RSA on a HRA implant. In a clinical study, 19 patients were followed with stereoradiographs until 5 years after surgery. Analysis of double-examination migration results determined the clinical precision of marker-based and CAD model-based RSA, and at the 5-year follow-up, results of the total translation (TT) and the total rotation (TR) for marker- and CAD model-based RSA were compared. The phantom study showed that comparison of the precision (SDdiff) in marker-based RSA analysis was more precise than model-based RSA analysis in TT (p CAD < 0.001; p RE = 0.04) and TR (p CAD = 0.01; p RE < 0.001). The clinical precision (double examination in 8 patients) comparing the precision SDdiff was better evaluating the TT using the marker-based RSA analysis (p = 0.002), but showed no difference between the marker- and CAD model-based RSA analysis regarding the TR (p = 0.91). Comparing the mean signed values regarding the TT and the TR at the 5-year follow-up in 13 patients, the TT was lower (p = 0.03) and the TR higher (p = 0.04) in the marker-based RSA compared to CAD model-based RSA. The precision of marker-based RSA was significantly better than model-based RSA. However, problems with occluded markers lead to exclusion of many patients which was not a problem with model-based RSA. HRA were stable at the 5-year follow-up. The detection limit was 0.2 mm TT and 1° TR for marker-based and 0.5 mm TT and 1° TR for CAD model-based RSA for HRA.

Higher Prevalence of “Low T3 Syndrome” in Patients With Chronic Fatigue Syndrome: A Case–Control Study

PubMed Central

Ruiz-Núñez, Begoña; Tarasse, Rabab; Vogelaar, Emar F.; Janneke Dijck-Brouwer, D. A.; Muskiet, Frits A. J.

2018-01-01

Chronic fatigue syndrome (CFS) is a heterogeneous disease with unknown cause(s). CFS symptoms resemble a hypothyroid state, possibly secondary to chronic (low-grade) (metabolic) inflammation. We studied 98 CFS patients (21–69 years, 21 males) and 99 age- and sex-matched controls (19–65 years, 23 males). We measured parameters of thyroid function, (metabolic) inflammation, gut wall integrity and nutrients influencing thyroid function and/or inflammation. Most remarkably, CFS patients exhibited similar thyrotropin, but lower free triiodothyronine (FT3) (difference of medians 0.1%), total thyroxine (TT4) (11.9%), total triiodothyronine (TT3) (12.5%), %TT3 (4.7%), sum activity of deiodinases (14.4%), secretory capacity of the thyroid gland (14.9%), 24-h urinary iodine (27.6%), and higher % reverse T3 (rT3) (13.3%). FT3 below the reference range, consistent with the “low T3 syndrome,” was found in 16/98 CFS patients vs. 7/99 controls (OR 2.56; 95% confidence interval = 1.00–6.54). Most observations persisted in two sensitivity analyses with more stringent cutoff values for body mass index, high-sensitive C-reactive protein (hsCRP), and WBC. We found possible evidence of (chronic) low-grade metabolic inflammation (ferritin and HDL-C). FT3, TT3, TT4, and rT3 correlated positively with hsCRP in CFS patients and all subjects. TT3 and TT4 were positively related to hsCRP in controls. Low circulating T3 and the apparent shift from T3 to rT3 may reflect more severely depressed tissue T3 levels. The present findings might be in line with recent metabolomic studies pointing at a hypometabolic state. They resemble a mild form of “non-thyroidal illness syndrome” and “low T3 syndrome” experienced by a subgroup of hypothyroid patients receiving T4 monotherapy. Our study needs confirmation and extension by others. If confirmed, trials with, e.g., T3 and iodide supplements might be indicated. PMID:29615976

Correlation between varus knee malalignment and patellofemoral osteoarthritis.

PubMed

Otsuki, Shuhei; Nakajima, Mikio; Okamoto, Yoshinori; Oda, Shuhei; Hoshiyama, Yoshiaki; Iida, Go; Neo, Masashi

2016-01-01

To evaluate the relationship between patellofemoral osteoarthritis (OA) and varus OA of the knee with a focus on the location of joint space narrowing. Eighty-five patients scheduled to undergo total knee arthroplasty caused by varus OA were enrolled in this study. The relationship between patellofemoral OA and varus knee malalignment was elucidated. To determine the alignment of the patellofemoral joint in varus knees, patellar tilt, and the tibial tuberosity-trochlear groove (TT-TG) distance were measured, and patellofemoral OA was classified using computed tomography. The femorotibial angles in patients with stage II-IV patellofemoral OA were significantly larger than those in patients with stage I patellofemoral OA, and the patellar tilt in patients with stage II-IV patellofemoral OA and the TT-TG distance in patients with stage IV patellofemoral OA were significantly larger than those in patients with stage I patellofemoral OA. The TT-TG distance was strongly correlated with patellar tilt (R(2) = 0.41, P < 0.001). Patellofemoral joint space narrowing was mainly noted at the lateral facet, and it was found on both sides as patellofemoral OA worsened. Varus knee malalignment was induced by patellofemoral OA, especially at the lateral facet. Patellar tilt and the TT-TG distance are considered critical factors for the severity of patellofemoral OA. Understanding the critical factors for patellofemoral OA in varus knees such as the TT-TG distance and patellar will facilitate the prevention of patellofemoral OA using procedures such as high tibial osteotomy and total knee arthroplasty to correct knee malalignment. Retrospective cohort study, Level III.

A paired comparison analysis of third-party rater thyroidectomy scar preference.

PubMed

Rajakumar, C; Doyle, P C; Brandt, M G; Moore, C C; Nichols, A; Franklin, J H; Yoo, J; Fung, K

2017-01-01

To determine the length and position of a thyroidectomy scar that is cosmetically most appealing to naïve raters. Images of thyroidectomy scars were reproduced on male and female necks using digital imaging software. Surgical variables studied were scar position and length. Fifteen raters were presented with 56 scar pairings and asked to identify which was preferred cosmetically. Twenty duplicate pairings were included to assess rater reliability. Analysis of variance was used to determine preference. Raters preferred low, short scars, followed by high, short scars, with long scars in either position being less desirable (p < 0.05). Twelve of 15 raters had acceptable intra-rater and inter-rater reliability. Naïve raters preferred low, short scars over the alternatives. High, short scars were the next most favourably rated. If other factors influencing incision choice are considered equal, surgeons should consider these preferences in scar position and length when planning their thyroidectomy approach.

Transformation with TT8 and HB12 RNAi Constructs in Model Forage (Medicago sativa, Alfalfa) Affects Carbohydrate Structure and Metabolic Characteristics in Ruminant Livestock Systems.

PubMed

Li, Xinxin; Zhang, Yonggen; Hannoufa, Abdelali; Yu, Peiqiang

2015-11-04

Lignin, a phenylpropanoid polymer present in secondary cell walls, has a negative impact on feed digestibility. TT8 and HB12 genes were shown to have low expression levels in low-lignin tissues of alfalfa, but to date, there has been no study on the effect of down-regulation of these two genes in alfalfa on nutrient chemical profiles and availability in ruminant livestock systems. The objectives of this study were to investigate the effect of transformation of alfalfa with TT8 and HB12 RNAi constructs on carbohydrate (CHO) structure and CHO nutritive value in ruminant livestock systems. The results showed that transformation with TT8 and HB12 RNAi constructs reduced rumen, rapidly degraded CHO fractions (RDCA4, P = 0.06; RDCB1, P < 0.01) and totally degraded CHO fraction (TRDCHO, P = 0.08). Both HB12 and TT8 populations had significantly higher in vitro digestibility of neutral detergent fiber (NDF) at 30 h of incubation (ivNDF30) compared to the control (P < 0.01). The TT8 populations had highest ivDM30 and ivNDF240. Transformation of alfalfa with TT8 and HB12 RNAi constructs induced molecular structure changes. Different CHO functional groups had different sensitivities and different responses to the transformation. The CHO molecular structure changes induced by the transformation were associated with predicted CHO availability. Compared with HB12 RNAi, transformation with TT8 RNAi could improve forage quality by increasing the availability of both NDF and DM. Further study is needed on the relationship between the transformation-induced structure changes at a molecular level and nutrient utilization in ruminant livestock systems when lignification is much higher.

Estimation of antigenic tetanus toxoid extracted from biodegradable microspheres.

PubMed

Xing, D K; McLellan, K; Corbel, M J; Sesardic, D

1996-03-01

Microspheres made from poly (lactic/glycolic acid) polymers have been considered as a new delivery system for single-dose tetanus toxoid (TT) vaccines. One of the most critical properties of the proposed vaccines is the loading and distribution of TT as this will have a profound effect on immunogenicity. As the concentration of TT in microspheres is very low sensitive assay methods are required. An assay incorporating monoclonal antibody (MAb) recognizing a neutralizing epitope and cross-reacting with TT was developed (MAp capture ELISA) which provided a sensitivity of 0.001 Lf/ml. An extraction procedure was devised which did not destroy the antigenicity and gave a recovery of 90.6 +/- 3.39% when applied to different preparations. The extracted TT was then quantified by MAb capture ELISA which was estimated to be 250-fold more sensitive than single-site ELISA for toxoid. The loading of 20 microspheres preparations (12 filled and 8 placebo) was determined by both protein micro-BCA assay and the developed assay for TT. The TT content obtained for the 12 filled microspheres preparations from different sources varied up to 400-fold (range 0.01-4.0 Lf/mg microspheres). The utility of the MAb capture ELISA for detection of total antigenic content in microspheres was confirmed by the observation that the determine TT loading correlated with the theoretical loading predicted from the protein content for the best preparations. Preparations with high loading gave the greatest peak response. There was no relationship between dose and the in vivo immunogenic response, suggesting that encapsulated vaccines with differential loading, release properties and presence of excipients will have different response curves in vivo. Hence, the present assay, when combined with information on toxoid release rate and presence and effect of excipients may be of value in predicting in vivo response.

Carbohydrate dependence during prolonged simulated cycling time trials.

PubMed

Torrens, Samuel L; Areta, José L; Parr, Evelyn B; Hawley, John A

2016-04-01

We determined the effect of suppressing lipolysis via administration of Nicotinic acid (NA) and pre-exercise feeding on rates of whole-body substrate utilisation and cycling time trial (TT) performance. In a randomised, single-blind, crossover design, eight trained male cyclists/triathletes completed two series of TTs in which they performed a predetermined amount of work calculated to last ~60, 90 and 120 min. TTs were undertaken after a standardised breakfast (2 g kg(-1) BM of carbohydrate (CHO)) and ingestion of capsules containing either NA or placebo (PL). Plasma [free fatty acids] were suppressed with NA, but increased in the later stages of TT90 and TT120 with PL (p < 0.05). There was no treatment effect on time to complete TT60 (60.4 ± 4.1 vs. 59.3 ± 3.4 min) or TT90 (90.4 ± 9.1 vs. 89.5 ± 6.6 min) for NA and PL, respectively. However, TT120 was slower with NA (123.1 ± 5.7 vs. 120.1 ± 8.7 min, p < 0.001), which coincided with a decline in plasma [glucose] during the later stages of this ride (p < 0.05). For TTs of the same duration, the rates of whole-body CHO oxidation were unaffected by NA, but decreased with increasing TT time (p < 0.05). CHO was the predominant substrate for all TTs contributing between 83 and 94 % to total energy expenditure, although there was a small use of lipid-based fuels for all rides. (1) NA impaired cycling TT performance lasting 120 min, (2) cycling TTs lasting from 60 to 120 min are CHO dependent, and (3) there is an obligatory use of lipid-based fuels in TTs lasting 1-2 h.

Informed consent: do information pamphlets improve post-operative risk-recall in patients undergoing total thyroidectomy: prospective randomized control study.

PubMed

Alsaffar, Hussain; Wilson, Lindsay; Kamdar, Dev P; Sultanov, Faizullo; Enepekides, Danny; Higgins, Kevin M

2016-02-13

Informed consent consists of basic five elements: voluntarism, capacity, disclosure, understanding, and ultimate decision-making. Physician disclosure, patient understanding, and information retention are all essential in the doctor-patient relationship. This is inclusive of helping patients make and manage their decisions and expectations better and also to deal with any consequences and/or complications that arise. This study investigates whether giving patients procedure-specific handouts pre-operatively as part of the established informed consent process significantly improves overall risk-recall following surgery. These handouts outline the anticipated peri-operative risks and complications associated with total thyroidectomy, as well as the corrective measures to address complications. In addition, the influence of potential confounders affecting risk-recall, such as anxiety and pre-existing memory disturbance, are also examined. Consecutive adult (≥18 years old) patients undergoing total thyroidectomy at a single academic tertiary care referral centre are included. Participants are randomly assigned into either the experimental group (with pamphlets) or the control group by a computerized randomization system (Clinstat). All participants filled out a Hospital Anxiety and Depression Scale (HADS) and they are tested by the physician for short-term memory loss using the Memory Impairment Screen (MIS) exam. All patients are evaluated at one week post-operatively. The written recall questionnaire test is also administered during this clinical encounter. Forty-nine patients are included--25 of them receive verbal consent only, while another 24 patients received both verbal consent and patient education information pamphlets. The overall average of correct answers for each group was 83% and 80% in the control and intervention groups, respectively, with no statistically significant differences. There are also no statistically significant differences between the two groups, in both interview duration, in time between interviews, and in recall tests. No correlation is also apparent between the pre-op HADS score and the recall questionnaire overall score. A pre-operative thyroid surgical information pamphlet alone might not be sufficient to enhance patient test scores and optimally educate the patient on their expected care pathway in thyroid surgery. Supplementation with alternative means of patient education perhaps using emerging technologies needs to be further investigated.

Pediatric Pulmonary Arterial Hypertension and Hyperthyroidism: A Potentially Fatal Combination

PubMed Central

Trapp, Christine M.; Elder, Robert W.; Gerken, Adrienne T.; Sopher, Aviva B.; Lerner, Shulamit; Rosenzweig, Erika B.

2012-01-01

Context: Patients with pulmonary arterial hypertension (PAH) who develop hyperthyroidism are at risk for acute cardiopulmonary decompensation and death. Cases and Setting: We present a series of eight idiopathic PAH/heritable PAH pediatric patients who developed hyperthyroidism between 1999 and 2011. Institutional Review Board approval was obtained; informed consent was waived due to the retrospective nature of the series. All eight patients were receiving iv epoprostenol; five of the eight patients presented with acute cardiopulmonary decompensation in the setting of hyperthyroidism. In the remaining three patients, hyperthyroidism was detected during routine screening of thyroid function tests. The one patient who underwent emergency thyroidectomy was the only survivor of those who presented in cardiopulmonary decline. Evidence Synthesis: Aggressive treatment of the hyperthyroid state, including emergency total thyroidectomy and escalation of targeted PAH therapy and β-blockade when warranted, may prove lifesaving in these patients. Prompt thyroidectomy or radioactive iodine ablation should be considered for clinically stable PAH patients with early and/or mild hyperthyroidism to avoid potentially life-threatening cardiopulmonary decompensation. Conclusions: Although the association between hyperthyroidism and PAH remains poorly understood, the potential impact of hyperthyroidism on the cardiopulmonary status of PAH patients must not be ignored. Hyperthyroidism must be identified early in this patient population to optimize intervention before acute decompensation. Thyroid function tests should be checked routinely in patients with PAH, particularly those on iv epoprostenol, and urgently in patients with acute decompensation or symptoms of hyperthyroidism. PMID:22622024

Parathyroid gland angiography with indocyanine green fluorescence to predict parathyroid function after thyroid surgery

PubMed Central

Vidal Fortuny, J.; Belfontali, V.; Sadowski, S. M.; Karenovics, W.; Guigard, S.

2016-01-01

Background Postoperative hypoparathyroidism remains the most common complication following thyroidectomy. The aim of this pilot study was to evaluate the use of intraoperative parathyroid gland angiography in predicting normal parathyroid gland function after thyroid surgery. Methods Angiography with the fluorescent dye indocyanine green (ICG) was performed in patients undergoing total thyroidectomy, to visualize vascularization of identified parathyroid glands. Results Some 36 patients underwent ICG angiography during thyroidectomy. All patients received standard calcium and vitamin D supplementation. At least one well vascularized parathyroid gland was demonstrated by ICG angiography in 30 patients. All 30 patients had parathyroid hormone (PTH) levels in the normal range on postoperative day (POD) 1 and 10, and only one patient exhibited asymptomatic hypocalcaemia on POD 1. Mean(s.d.) PTH and calcium levels in these patients were 3·3(1·4) pmol/l and 2·27(0·10) mmol/l respectively on POD 1, and 4·0(1.6) pmol/l and 2·32(0·08) mmol/l on POD 10. Two of the six patients in whom no well vascularized parathyroid gland could be demonstrated developed transient hypoparathyroidism. None of the 36 patients presented symptomatic hypocalcaemia, and none received treatment for hypoparathyroidism. Conclusion PTH levels on POD 1 were normal in all patients who had at least one well vascularized parathyroid gland demonstrated during surgery by ICG angiography, and none required treatment for hypoparathyroidism. PMID:26864909

[Surgical treatment of multinodular goiter at the Instituto Nacional de la Nutrición Salvador Zubirán].

PubMed

López, L H; Herrera, M F; Gamino, R; González, O; Pérez-Enriquez, B; Rivera, R; Gamboa-Domínguez, A; Angeles-Angeles, A; Rull, J A

1997-01-01

Surgical treatment is the first option for patients with obstructive multinodular goiter. The extent of the resection and the use of postoperative hormonal therapy are, on the other hand, still under debate. To analyze the results of surgical treatment in 101 patient with multinodular goiter seen from 1980 to 1995. The clinical/pathologic charts of all patients were reviewed with emphasis to the clinical diagnosis, extent of resection, final histology, type and number of complications, and long-term follow-up. The mean follow-up was three years (range 0.5-12). Ten males and 91 females with a mean age of 46 years were included. Surgery was recommended for a nodule suspicious of malignancy in 60 patients, for airway compression in 33, and for cosmetic reasons in eight. Unilateral lobectomy was performed in 30, bilateral subtotal thyroidectomy in 55 and total thyroidectomy in 16. Postoperative hormone therapy was administrated to 83 patients. Surgical complications occurred in six patients. Four developed permanent hypoparathyroidism and two vocal cord paralysis. There was no operative mortality. A final diagnosis of multinodular goiter was established in 89 whereas 12 had cancer. There were three asymptomatic recurrences in the group with benign lesions (they had undergone unilateral lobectomy followed by hormonal therapy). Bilateral subtotal thyroidectomy was the best treatment for multinodular goiter in our series. This procedure had few complications and there was no recurrence of the disease.

Evaluation of SAMe-TT2R2 Score on Predicting Success With Extended-Interval Warfarin Monitoring.

PubMed

Hwang, Andrew Y; Carris, Nicholas W; Dietrich, Eric A; Gums, John G; Smith, Steven M

2018-06-01

In patients with stable international normalized ratios, 12-week extended-interval warfarin monitoring can be considered; however, predictors of success with this strategy are unknown. The previously validated SAMe-TT 2 R 2 score (considering sex, age, medical history, treatment, tobacco, and race) predicts anticoagulation control during standard follow-up (every 4 weeks), with lower scores associated with greater time in therapeutic range. To evaluate the ability of the SAMe-TT 2 R 2 score in predicting success with extended-interval warfarin follow-up in patients with previously stable warfarin doses. In this post hoc analysis of a single-arm feasibility study, baseline SAMe-TT 2 R 2 scores were calculated for patients with ≥1 extended-interval follow-up visit. The primary analysis assessed achieved weeks of extended-interval follow-up according to baseline SAMe-TT 2 R 2 scores. A total of 47 patients receiving chronic anticoagulation completed a median of 36 weeks of extended-interval follow-up. The median baseline SAMe-TT 2 R 2 score was 1 (range 0-5). Lower SAMe-TT 2 R 2 scores appeared to be associated with greater duration of extended-interval follow-up achieved, though the differences between scores were not statistically significant. No individual variable of the SAMe-TT 2 R 2 score was associated with achieved weeks of extended-interval follow-up. Analysis of additional patient factors found that longer duration (≥24 weeks) of prior stable treatment was significantly associated with greater weeks of extended-interval follow-up completed ( P = 0.04). Conclusion and Relevance: This pilot study provides limited evidence that the SAMe-TT 2 R 2 score predicts success with extended-interval warfarin follow-up but requires confirmation in a larger study. Further research is also necessary to establish additional predictors of successful extended-interval warfarin follow-up.

Susceptibility to Myxobolus cerebralis among Tubifex tubifex populations from ten major drainage basins in Colorado where Cutthroat Trout are endemic.

PubMed

Nehring, R Barry; Lukacs, P M; Baxa, D V; Stinson, M E T; Chiaramonte, L; Wise, S K; Poole, B; Horton, A

2014-03-01

Establishment of Myxobolus cerebralis (Mc) resulted in declines of wild Rainbow Trout Oncorhynchus mykiss populations in streams across Colorado during the 1990s. However, the risk for establishment and spread of this parasite into high-elevation habitats occupied by native Cutthroat Trout O. clarkii was unknown. Beginning in 2003, tubificid worms were collected from all major drainages where Cutthroat Trout were endemic and were assayed by quantitative PCR to determine the occurrence and distribution of the various lineages of Tubifex tubifex (Tt) oligochaetes. Over a 5-year period, 40 groups of Tt oligochaetes collected from 27 streams, 3 natural lakes, 2 private ponds, and a reservoir were evaluated for their relative susceptibility to Mc. Exposure groups were drawn from populations of pure lineage III Tt, mixed-lineage populations where one or more of the highly resistant (lineage I) or nonsusceptible lineages (V or VI) were the dominant oligochaete and susceptible lineage III worms were the subdominant worm, or pure lineage VI Tt. Experimental replicates of 250 oligochaetes were exposed to 50 Mc myxospores per worm. The parasite amplification ratio (total triactinomyxons [TAMs] produced / total myxospore exposure) was very high among all pure lineage III Colorado exposure groups, averaging 363 compared with 8.24 among the mixed-lineage exposure groups. Lineage III oligochaetes from Mt. Whitney Hatchery in California, which served as the laboratory standard for comparative purposes, had an average parasite amplification ratio of 933 among 10 exposed replicates over a 5-year period. Lineage I oligochaetes were highly resistant to infection and did not produce any TAMs. Lineages V and VI Tt did not become infected and did not produce any TAMs. These results suggest that the risk of establishment of Mc is high for aquatic habitats in Colorado where Cutthroat Trout and lineage III Tt are sympatric.

Synergism between exposure to mercury and use of iodine supplements on thyroid hormones in pregnant women

DOE Office of Scientific and Technical Information (OSTI.GOV)

Llop, Sabrina, E-mail: llop_sab@gva.es; Spanish Consortium for Research on Epidemiology and Public Health; Lopez-Espinosa, Maria-Jose

Objective: To evaluate the association between mercury exposure and thyroid-stimulating hormone (TSH), total triiodothyronine (TT3) and free thyroxine (FT4) levels during pregnancy as well as to explore if there is any synergic action between mercury and intake of iodine from different sources. Methods: The study population was 1407 pregnant women participating in the Spanish INMA birth cohort study. Total mercury concentrations were analyzed in cord blood. Thyroid hormones (THs) were measured in serum samples collected at 13.2±1.5 weeks of gestation. The association between mercury and TH levels was evaluated with multivariate linear regression models. Effect modification caused by iodine intakemore » from supplements and diet was also evaluated. Results: The geometric means of TSH, TT3, FT4 and mercury were 1.1 μU/L, 2.4 nmol/L, 10.5 pmol/L and 7.7 μg/L, respectively. Mercury levels were marginally significantly associated with TT3 (β: −0.05; 95%CI: −0.10, 0.01), but were neither associated with TSH nor FT4. The inverse association between mercury and TT3 levels was stronger among the iodine supplement consumers (−0.08; 95%CI: −0.15, −0.02, interaction p-value=0.07). The association with FT4 followed the same pattern, albeit not significant. Conclusion: Prenatal mercury exposure was inversely associated with TT3 levels among women who took iodine supplements during pregnancy. These results could be of public health concern, although further research is needed. - Highlights: • We studied the relationship between mercury and thyroid hormones among pregnant. • Mercury was marginally significantly associated with TT3, but not with TSH or FT4. • This association was stronger among the iodine supplement. • These results could be of public health concern, but further research is needed.« less

Influences of biological variables and geographic location on circulating concentrations of thyroid hormones in wild bottlenose dolphins (Tursiops truncatus).

PubMed

Fair, Patricia A; Montie, Eric; Balthis, Len; Reif, John S; Bossart, Gregory D

2011-11-01

Thyroid hormones (TH) are key regulators of metabolism and development, yet our understanding of the variability in serum TH concentrations in free-ranging marine mammals is limited. Thus, we examined the interrelationships between TH and age, sex, reproductive status, geographic location, and ocean temperatures in wild bottlenose dolphins (Tursiops truncatus). Circulating concentrations of TH (total thyroxine (tT(4)), free T(4) (fT(4)), and total triiodothyronine (tT(3))) were determined in a total of 195 dolphins; 80 from the coastal waters of Charleston, South Carolina (CHS) and 115 from the Indian River Lagoon, Florida (IRL). Age had the most influence on circulating TH concentrations in dolphins at both sites with decreasing concentrations (p<0.0001) observed with increasing age for all TH. No significant differences were found between males and non-reproductive females. Geographic location significantly influenced tT(4) and tT(3) concentrations; CHS dolphins had higher concentrations than IRL animals. These TH differences between CHS and IRL dolphins may be attributed to the colder year-round water temperature that CHS dolphins inhabit compared to IRL dolphins and could constitute an adaptive response to their colder environment. Results from this study highlight the importance of establishing reference values for dolphins in different geographic locations to support valid comparisons. This initial assessment provides a foundation of how biological and environmental variables could affect circulating TH in dolphins, which will help to elucidate the impacts of disease, pollution, and climate change on the thyroid hormone system of aquatic mammals. Published by Elsevier Inc.

Is there a difference in testosterone levels and its regulators in men carrying BRCA mutations?

PubMed Central

Goldberg, Hanan; Grievink, Liat Shavit; Mano, Roy; Ber, Yaara; Ozalbo, Rachely; Tuval, Sivan; Baniel, Jack; Margel, David

2017-01-01

Background Male BRCA mutation carriers are at risk for an early onset aggressive prostate cancer. No data exist on the association of testosterone levels among these patients. We aimed to analyze testosterone and associated hormonal levels among male BRCA carriers and non-carriers. Patients and methods Overall 87 male carriers and 43 non-carriers aged 40-70 were prospectively enrolled. Clinical data were collected and all patients were tested for total testosterone (TT), prostate specific antigen (PSA), follicle stimulating hormone (FSH), luteinizing hormone (LH), free androgen index (FAI), sex hormone binding globulin (SHBG) and prolactin. Multivariate linear regression analysis was performed to predict TT levels. Results The median age, mean BMI, comorbidities, PSA, FSH, LH and SHBG levels in both groups were similar. However, mean TT and FAI were higher in the carriers (16.7 nmol/l vs 13.5 nmol/l, p=0.03 and 39.5 vs 34.8, p=0.05, respectively), while prolactin was significantly lower. Multivariate analysis demonstrated that while BMI was inversely correlated to TT levels in both groups, LH was a predictor only in non-carriers. Conclusions Carriers have higher TT and FAI levels and lower prolactin levels; but LH does not predict their TT levels. Further research in a larger cohort of BRCA carriers with and without prostate cancer should be performed. PMID:29262604

Influence of polymorphisms in insulin-like growth factor-1 on the risk of osteoporosis in a Chinese postmenopausal female population

PubMed Central

Li, Feng; Xing, Wen-Hua; Yang, Xue-Jun; Jiang, Hai-Yan; Xia, Hong

2015-01-01

We conducted a case-control study in a Chinese postmenopausal population, and explore the potential role of the promoter region variation of the IGF-1 gene in bone mineral density and osteoporosis risk. 485 postmenopausal women with a primary diagnosis of osteoporosis and 485 age-matched controls were selected between 2012 and 2014. The Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) was used for rs35767, rs2288377 and rs5742612 of IGF-1 genotyping. By conditional regression analysis, individuals carrying TT genotype and CT+TT genotype of rs35767 were found to be correlated with an elevated risk of osteoporosis, with adjusted ORs (95% CI) of 1.90 (1.23-2.93) and 1.35 (1.04-1.76), respectively. Our study found that CT+TT genotype of rs35767 was significantly associated with moderate increased risk of osteoporosis in smokers and drinkers, and the ORs (95% CI) were 2.11 (1.06-4.20) and 2.36 (1.29-4.32), respectively. We found that those carrying CT+TT genotype of rs35767 had a significant lower BMD levels at L1-L4 vertebrae, femoral neck, total hip and trochanter compared to those with CC genotype. Our study suggests that TT genotype and CT+TT genotype of IGF-I rs35767 were associated with risk of osteoporosis and BMD levels. PMID:26191288

Thyroxine-Based Screening for Congenital Hypothyroidism in Neonates with Down Syndrome.

PubMed

Erlichman, Ira; Mimouni, Francis B; Erlichman, Matityahu; Schimmel, Michael S

2016-06-01

To ascertain whether thyroxine (T4)-based screening programs for congenital hypothyroidism (initial measurement of total T4 [tT4] followed by thyroid stimulating hormone [TSH] measurement in patients with tT4 <10th percentile) identifies congenital hypothyroidism in all neonates with Down syndrome. Retrospective cohort study of 159 neonates with Down syndrome, born during the period 1998-2007 were included. Screening test results were compared with those of the general population. All primary care physicians of these infants were contacted and infants' thyroid status verified. tT4 concentrations in children with Down syndrome were significantly lower, and TSH higher than those in the general population; tT4 concentrations did not correlate with screening TSH concentrations. Twenty children with Down syndrome were treated with L-thyroxin within the first month of life although only 10 babies had been identified by the routine screening test. T4-based screening does not identify many cases of congenital hypothyroidism in neonates with Down syndrome. We recommend that neonates with Down syndrome be screened by simultaneous measurements of both tT4 and TSH. Copyright © 2016 Elsevier Inc. All rights reserved.

Long-term esophageal motility changes after thyroidectomy: associations with aerodigestive disorders.

PubMed

Scerrino, G; Inviati, A; Di Giovanni, S; Paladino, N C; Di Giovanni, S; Paladino, N C; Di Paola, V; Raspanti, C; Melfa, G I; Cupido, F; Mazzola, S; Porrello, C; Bonventre, S; Gullotta, G

2017-01-01

Patients undergoing thyroidectomy often complain aerodigestive disorders. In a previous study we showed the associations between voice impairment and proximal acid reflux, swallowing impairment and Upper Esophageal Sphyncter (UES) incoordination and the decrease in UES pressure in thirty-six patients observed before and soon afterwards uncomplicated thyroidectomy. This study investigated the state of post-thyroidectomy esophageal motility changes and its associations with these disorders after 18-24 months. The thirty-six patients prospectively recruited according to selection criteria (thyroid volume ≤60 ml, benign disease, age 18-65 years, previous neck surgery, thyroiditis, pre- or postoperative vocal cord palsy) underwent voice (VIS) and swallowing (SIS) impairment scores, esophageal manometry and pH monitoring once again. After 18-24 months, both VIS and SIS recovered (respectively: p=0,022; p=0,0001); UES pressure increased (p=0,0001) nearing the preoperative values. The persistence of swallowing complaints were associated with the persistence of esophageal incoordination (p=0,03); the association between voice impairment and proximal acid reflux was confirmed (p<0,001). Our study confirms that aerodigestive disorders after uncomplicated thyroidectomy, largely transient, are strictly connected with upper esophageal motility changes. In this viewpoint, the innervation of upper aerodigestive anatomical structures (larynx, pharynx, upper esophagus) and its variations should be focused.

Evaluation of the thyroid status of Basenji dogs in Australia.

PubMed

Seavers, A; Snow, D H; Mason, K V; Malik, R

2008-11-01

To determine the thyroid status of Basenji dogs in Australia. Jugular or cephalic venipuncture blood samples were taken from 113 Basenji, comprising 47 males, 5 castrates, 48 entire and 13 spayed bitches, and sent on ice in plain and EDTA tubes to a single laboratory to determine haematocrit and serum concentrations of total thyroid hormone (thyroxine, TT4), thyroid-stimulating hormone (TSH) and cholesterol. In a subgroup of 8 dogs with abnormal elevated TSH concentrations and subnormal TT4 concentrations, 5 were further examined by dynamic endocrine testing using recombinant human (rh) TSH (54 microg). Ages ranged from 1 to 14 years and weight range was 6.5 to 14.0 kg. TT4 concentrations (nmol/L) ranged from 2 to 27, with a median of 13 and a mean +/- SD of 13.0 +/- 5.7. Importantly, 85/113 (75%) of TT4 values were lower than the normal laboratory reference range (17-37). TSH concentrations (ng/mL) ranged from 0.05 to 5.37, with a median of 0.16 and a mean +/- SD of 0.3 +/- 0.6. Basenji have a similar reference range for serum TSH, but a considerably lower reference range for TT4 (2-27 nmol/L) than most breeds and crossbreds, resembling the sight hounds in this respect. Given the difficulty of accurately measuring TT4 concentrations that are so low, concomitant serial TSH determinations are essential to properly asses thyroid function. Taken alone, TT4 determinations are only of use when the value is within the reference range, in which case a diagnosis of hypothyroidism is likely excluded.

Comparison of Cramer classification between Toxtree, the OECD QSAR Toolbox and expert judgment.

PubMed

Bhatia, Sneha; Schultz, Terry; Roberts, David; Shen, Jie; Kromidas, Lambros; Marie Api, Anne

2015-02-01

The Threshold of Toxicological Concern (TTC) is a pragmatic approach in risk assessment. In the absence of data, it sets up levels of human exposure that are considered to have no appreciable risk to human health. The Cramer decision tree is used extensively to determine these exposure thresholds by categorizing non-carcinogenic chemicals into three different structural classes. Therefore, assigning an accurate Cramer class to a material is a crucial step to preserve the integrity of the risk assessment. In this study the Cramer class of over 1000 fragrance materials across diverse chemical classes were determined by using Toxtree (TT), the OECD QSAR Toolbox (TB), and expert judgment. Disconcordance was observed between TT and the TB. A total of 165 materials (16%) showed different results from the two programs. The overall concordance for Cramer classification between TT and expert judgment is 83%, while the concordance between the TB and expert judgment is 77%. Amines, lactones and heterocycles have the lowest percent agreement with expert judgment for TT and the TB. For amines, the expert judgment agreement is 45% for TT and 55% for the TB. For heterocycles, the expert judgment agreement is 55% for TT and the TB. For lactones, the expert judgment agreement is 56% for TT and 50% for the TB. Additional analyses were conducted to determine the concordance within various chemical classes. Critical checkpoints in the decision tree are identified. Strategies and guidance on determining the Cramer class for various chemical classes are discussed. Copyright © 2014 Elsevier Inc. All rights reserved.

Juvenile hyperthyroidism in a cat.

PubMed

Gordon, Jana M; Ehrhart, E J; Sisson, D D; Jones, M A

2003-01-01

An 8-month-old, male domestic shorthaired cat presented for chronic weight loss, intermittent dyspnea, chronic diarrhea, hyperactivity, and weakness. The cat had a palpable thyroid nodule and increased serum total thyroxine and 3,5,3' triiodothyronine levels. The cat was diagnosed with hyperthyroidism, and a unilateral thyroidectomy was performed followed by radioactive iodine at a later date. The clinical signs resolved following radioactive iodine, and the cat subsequently developed clinical hypothyroidism.

Effect of a Low Iodine Diet vs. Restricted Iodine Diet on Postsurgical Preparation for Radioiodine Ablation Therapy in Thyroid Carcinoma Patients

PubMed Central

Lim, Chi Young; Kim, Jung-Yeon; Yoon, Mi-Jin; Chang, Hang Seok; Park, Cheong Soo

2015-01-01

Purpose The radioiodine ablation therapy is required for patients who underwent a total thyroidectomy. Through a comparative review of a low iodine diet (LID) and a restricted iodine diet (RID), the study aims to suggest guidelines that are suitable for the conditions of Korea. Materials and Methods The study was conducted with 101 patients. With 24-hour urine samples from the patients after a 2-week restricted diet and after a 4-week restricted diet, the amount of iodine in the urine was estimated. The consumed radioiodine amounts for 2 hours and 24 hours were calculated. Results This study was conducted with 47 LID patients and 54 RID patients. The amounts of iodine in urine, the 2-week case and 4-week case for each group showed no significant differences. The amounts of iodine in urine between the two groups were both included in the range of the criteria for radioiodine ablation therapy. Also, 2 hours and 24 hours radioiodine consumption measured after 4-week restrictive diet did not show statistical differences between two groups. Conclusion A 2-week RID can be considered as a type of radioiodine ablation therapy after patients undergo a total thyroidectomy. PMID:26069126

Greater Efficacy of Total Thyroidectomy versus Radioiodine Therapy on Hyperthyroidism and Thyroid-Stimulating Immunoglobulin Levels in Patients with Graves' Disease Previously Treated with Antithyroid Drugs.

PubMed

Kautbally, Shakeel; Alexopoulou, Orsalia; Daumerie, Chantal; Jamar, François; Mourad, Michel; Maiter, Dominique

2012-07-01

We compared the effects of total thyroidectomy (TTx) and radioiodine (RAI) administration on the course of thyroid hormones and thyroid-stimulating immunoglobulins (TSI) in patients with Graves' disease. We retrospectively studied 80 patients initially treated with antithyroid drugs and requiring either RAI (8.3 ± 1.7 mCi of (131)I; n = 40) or TTx (n = 40) as second-line therapy. The TTx and RAI groups were not different, except for larger goiter, higher FT3 and more frequent Graves' orbitopathy at diagnosis in the surgery group (p < 0.05). A persistent remission of hyperthyroidism was observed in 97% of operated patients versus 73% of the RAI patients at 3 years (p < 0.01). TTx was followed by a rapid and steady decrease in TSI during the first 9 months, while a surge of antibodies was observed during the first 6 months after RAI, followed by a slow decrease over the next 18 months. At the last visit, high TSI levels were still observed in 18 and 60% of patients in the surgery and RAI groups, respectively (p < 0.001). TTx is more efficient than RAI to induce a rapid and permanent correction of hyperthyroidism and TSI decrease in patients previously treated with antithyroid drugs.

CK-MM Polymorphism is Associated With Physical Fitness Test Scores in Military Recruits.

PubMed

Sprouse, Courtney; Tosi, Laura L; Gordish-Dressman, Heather; Abdel-Ghani, Mai S; Panchapakesan, Karuna; Niederberger, Brenda; Devaney, Joseph M; Kelly, Karen R

2015-09-01

Muscle-specific creatine kinase is thought to play an integral role in maintaining energy homeostasis by providing a supply of creatine phosphate. The genetic variant, rs8111989, contributes to individual differences in physical performance, and thus the purpose of this study was to determine if rs8111989 variant is predictive of Physical Fitness Test (PFT) scores in male, military infantry recruits. DNA was extracted from whole blood, and genotyping was performed in 176 Marines. Relationships between PFT measures (run, sit-ups, and pull-ups) and genotype were determined. Participants with 2 copies of the T allele for rs8111989 variant had higher PFT scores for run time, pull-ups, and total PFT score. Specifically, participants with 2 copies of the TT allele (variant) (n = 97) demonstrated an overall higher total PFT score as compared with those with one copy of the C allele (n = 79) (TT: 250 ± 31 vs. 238 ± 31; p = 0.02), run score (TT: 82 ± 10 vs. 78 ± 11; p = 0.04) and pull-up score (TT: 78 ± 11 vs. 65 ± 21; p = 0.04) or those with the CC/CT genotype. These results demonstrate an association between physical performance measures and genetic variation in the muscle-specific creatine kinase gene (rs8111989). Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

How does bone quality differ between healthy-weight and overweight adolescents and young adults?

PubMed

Hoy, Christa L; Macdonald, Heather M; McKay, Heather A

2013-04-01

Overweight youth have greater bone mass than their healthy-weight peers but sustain more fractures. However, it is unclear whether and how excess body fat influences bone quality in youth. We determined whether overweight status correlated with three-dimensional aspects of bone quality influencing bone strength in adolescent and young adult females and males. We categorized males (n=103; mean age, 17 years) and females (n=85; mean age, 18 years) into healthy-weight and overweight groups. We measured lean mass (LM) and fat mass (FM) with dual-energy x-ray absorptiometry (DXA). We used high-resolution peripheral quantitative CT to assess the distal radius (7% site) and distal tibia (8% site). Bone quality measures included total bone mineral density (Tt.BMD), total area (Tt.Ar), trabecular bone volume fraction (BV/TV), trabecular number (Tb.N), separation (Tb.Sp), and thickness (Tb.Th). We used multiple regression to compare bone quality between healthy-weight and overweight adolescents adjusting for age, ethnicity, limb length, LM, and FM. Overweight males had higher (10%-21%) Tt.BMD, BV/TV, and Tb.N and lower Tb.Sp at the tibia and lower Tt.Ar at the radius than healthy-weight males. No differences were observed between overweight and healthy-weight females. LM attenuated the differences in bone quality between groups in males while FM negatively predicted Tt.BMD, BV/TV, Tb.N, and Tb.Th. Our data suggest overweight males have enhanced bone quality compared with healthy-weight males; however, when group differences are interpreted in the context of the mechanostat theory, it appears bone quality of overweight adolescents adapts to LM and not to greater FM.

MTHFR C677T genotype influences the isotopic enrichment of one-carbon metabolites in folate-compromised men consuming d9-choline.

PubMed

Yan, Jian; Wang, Wei; Gregory, Jesse F; Malysheva, Olga; Brenna, J Thomas; Stabler, Sally P; Allen, Robert H; Caudill, Marie A

2011-02-01

Homozygosity for the variant 677T allele in the methylenetetrahydrofolate reductase (MTHFR) gene increases the requirement for folate and may alter the metabolic use of choline. The choline adequate intake is 550 mg/d for men, although the metabolic consequences of consuming extra choline are unclear. Deuterium-labeled choline (d9-choline) as tracer was used to determine the differential effects of the MTHFR C677T genotype and the effect of various choline intakes on the isotopic enrichment of choline derivatives in folate-compromised men. Mexican American men with the MTHFR 677CC or 677TT genotype consumed a diet providing 300 mg choline/d plus supplemental choline chloride for total choline intakes of 550 (n = 11; 4 with 677CC and 7 with 677TT) or 1100 (n = 12; 4 with 677CC and 8 with 677TT) mg/d for 12 wk. During the last 3 wk, 15% of the total choline intake was provided as d9-choline. Low but measurable enrichments of the choline metabolites were achieved, including that of d3-phosphatidylcholine (d3-PtdCho)--a metabolite produced in the de novo pathway via choline-derived methyl groups. Men with the MTHFR 677TT genotype had a higher urinary enrichment ratio of betaine to choline (P = 0.041), a higher urinary enrichment of sarcosine (P = 0.041), and a greater plasma enrichment ratio of d9-betaine to d9-PtdCho with the 1100 mg choline/d intake (P = 0.033). These data show for the first time in humans that choline itself is a source of methyl groups for de novo PtdCho biosynthesis and indicate that the MTHFR 677TT genotype favors the use of choline as a methyl donor.

Quality of information available on the World Wide Web for patients undergoing thyroidectomy: review.

PubMed

Muthukumarasamy, S; Osmani, Z; Sharpe, A; England, R J A

2012-02-01

This study aimed to assess the quality of information available on the World Wide Web for patients undergoing thyroidectomy. The first 50 web-links generated by internet searches using the five most popular search engines and the key word 'thyroidectomy' were evaluated using the Lida website validation instrument (assessing accessibility, usability and reliability) and the Flesch Reading Ease Score. We evaluated 103 of a possible 250 websites. Mean scores (ranges) were: Lida accessibility, 48/63 (27-59); Lida usability, 36/54 (21-50); Lida reliability, 21/51 (4-38); and Flesch Reading Ease, 43.9 (2.6-77.6). The quality of internet health information regarding thyroidectomy is variable. High ranking and popularity are not good indicators of website quality. Overall, none of the websites assessed achieved high Lida scores. In order to prevent the dissemination of inaccurate or commercially motivated information, we recommend independent labelling of medical information available on the World Wide Web.

A misdiagnosed Riedel's thyroiditis successfully treated by thyroidectomy and tamoxifen.

PubMed

Wang, Chih-Jung; Wu, Ta-Jen; Lee, Chung-Ta; Huang, Shih-Ming

2012-12-01

Riedel's thyroiditis, known as invasive fibrous thyroiditis, is a very rare form of chronic thyroiditis. It is hard to make the diagnosis without surgical biopsy. We present a case of Riedel's thyroiditis in a 52-year-old female with past history of Hashimoto's thyroiditis. She suffered from bilateral neck pain, which radiated to both lower jaws. The erythrocyte sedimentation rate was 125 mm/hour. Subacute thyroiditis superimposed on Hashimoto's thyroiditis was diagnosed and treated with steroid. However the response was poor and she had a history of severe peptic ulcer. To avoid inducing the peptic ulcer by steroid, she received bilateral subtotal thyroidectomy. During surgery, the thyroid had severe adhesion to surrounding soft tissue and the pathology showed Riedel's thyroiditis. The neck pain improved after thyroidectomy. Tamoxifen has been given for 8 months and the size of remnant thyroid decreased to 8 mm. We concluded that combined thyroidectomy and tamoxifen successfully cured a patient with Riedel's thyroiditis. Copyright © 2012. Published by Elsevier B.V.

[Surgical aspects of radicalism in the treatment of the thyroid gland cancer].

PubMed

Sterniuk, Iu M; Niederle, B

2007-07-01

The results of surgical treatment of 149 patients, suffering differentiated cancer of the thyroid gland (CTG) and 89--with medullar pathology were analyzed. In differentiated CTG the recurrence after performance of subtotal resection of the organ had occurred in (41.2 +/- 12.3)% observations, after thyroidectomy performance without cervical lymph nodes (LN) dissection--in (31.1 +/- 5.9)%, after thyroidectomy with LN dissection--in (11.3 +/- 3.8)%. The operation radicalism for differentiated CTG secures, as minimum, by application of thyroidectomy with central LN dissection. For optimization of indications for dissection of lateral and mediastinal LN diagnostic lymphadenectomy is performed or the process stage is analyzed. Radicalism of surgical intervention for medullar cancer necessitates as minimal procedure thyroidectomy, dissection of central and also, for prophylaxis, lateral LN during the first stage of the operation, securing in 60% of patients the treatment radicalism. While application of radical surgical tactics only during performance of subsequent (for recurrence) operations the essential lowering of calcitonin level is observed only in 17.6% of patients.

Tracking voice change after thyroidectomy: application of spectral/cepstral analyses.

PubMed

Awan, Shaheen N; Helou, Leah B; Stojadinovic, Alexander; Solomon, Nancy Pearl

2011-04-01

This study evaluates the utility of perioperative spectral and cepstral acoustic analyses to monitor voice change after thyroidectomy. Perceptual and acoustic analyses were conducted on speech samples (sustained vowel /α/ and CAPE-V sentences) provided by 70 participants (36 women and 34 men) at four study time points: prior to thyroid surgery and 2 weeks, 3 months and 6 months after thyroidectomy. Repeated measures analyses of variance focused on the relative amplitude of the dominant harmonic in the voice signal (cepstral peak prominence, CPP), the ratio of low-to-high spectral energy, and their respective standard deviations (SD). Data were also examined for relationships between acoustic measures and perceptual ratings of overall severity of voice quality. Results showed that perceived overall severity and the acoustic measures of the CPP and its SD (CPPsd) computed from sentence productions were significantly reduced at 2-week post-thyroidectomy for 20 patients (29% of the sample) who had self-reported post-operative voice change. For this same group of patients, the CPP and CPPsd computed from sentence productions improved significantly from 2-weeks post-thyroidectomy to 6-months post-surgery. CPP and CPPsd also correlated well with perceived overall severity (r = -0.68 and -0.79, respectively). Measures of CPP from sustained vowel productions were not as effective as those from sentence productions in reflecting voice deterioration in the post-thyroidectomy patients at the 2-week post-surgery time period, were weaker correlates with perceived overall severity, and were not as effective in discriminating negative voice outcome (NegVO) from normal voice outcome (NormVO) patients as compared to the results from the sentence-level stimuli. Results indicate that spectral/cepstral analysis methods can be used with continuous speech samples to provide important objective data to document the effects of dysphonia in a post-thyroidectomy patient sample. When used in conjunction with patient's self-report and other general measures of vocal dysfunction, the acoustic measures employed in this study contribute to a complete profile of the patient's vocal condition.

Hypocalcaemia following thyroidectomy unresponsive to oral therapy.

PubMed

Etheridge, Zac C; Schofield, Christopher; Prinsloo, Peter J J; Sturrock, Nigel D C

2014-01-01

Hypocalcaemia due to hypoparathyroidism following thyroidectomy is a relatively common occurrence. Standard treatment is with oral calcium and vitamin D replacement therapy; lack of response to oral therapy is rare. Herein we describe a case of hypoparathyroidism following thyroidectomy unresponsive to oral therapy in a patient with a complex medical history. We consider the potential causes in the context of calcium metabolism including: poor adherence, hungry bone syndrome, malabsorption, vitamin D resistance, bisphosphonate use and functional hypoparathyroidism secondary to magnesium deficiency. Malabsorption due to intestinal hurry was likely to be a contributory factor in this case and very large doses of oral therapy were required to avoid symptomatic hypocalcaemia.

Prospective study of the changes in thyrotropin binding inhibitory immunoglobulins in Graves' disease treated by subtotal thyroidectomy or radioactive iodine

DOE Office of Scientific and Technical Information (OSTI.GOV)

Teng, C.S.; Yeung, R.T.T.; Khoo, R.K.K.

1980-06-01

The effects of subtotal thyroidectomy and radioactive iodine on thyroid-stimulating immunoglobulins, as measured by a receptor assay, more appropriately termed TSH binding inhibitory immunoglobulins (TBII), were studied in 74 patients with Graves' disease. Fourty-four patients received radioactive iodine therapy, while 30 were subjected to subtotal thyroidectomy. After radioactive iodine, more patients were TBII-positive (90.5% vs 81.8%) than before treatment, and the mean TBII index decreased dramatically, the maximum decrease being 3 months. The mean TBI index subsequently returned gradually to the pretreatment level. Subtotal thyroidectomy had a different effect on TBII activity. TBII indices were positive in 89.3% of thesemore » patients before any treatment but were positive in only 40% (12 patients) after antithyroid drugs had been given before surgery. After surgery, TBII indices remained positive in 7 patients, while the remaining 5 patients became TBII negative. Seventeen patients (56.7%) were TBII negative before operation and remained so after surgery. One patient who was TBII negative before operation became TBII positive 2 months after operation. Interestingly, postoperative relapse of hyperthyroidism occurred in 3 patients who were TIBII positive, while hypothyroidism occurred in patients who were TBII negative. Thus, the TBII activity after subtotal thyroidectomy might be an important factor in determining the outcome of surgery.« less

Measurement of the top quark mass in the t t ¯ → dilepton channel from s = 8  TeV ATLAS data

DOE Office of Scientific and Technical Information (OSTI.GOV)

Aaboud, M.

Here, the top quark mass is measured in the tt¯→ dilepton channel (lepton=e,μ) using ATLAS data recorded in the year 2012 at the LHC. The data were taken at a proton–proton centre-of-mass energy of √s=8 TeV and correspond to an integrated luminosity of about 20.2 fb –1. Exploiting the template method, and using the distribution of invariant masses of lepton–b-jetb-jet pairs, the top quark mass is measured to be m top = 172.99 ± 0.41 (stat) ± 0.74 (syst) GeV, with a total uncertainty of 0.84 GeV0.84 GeV. Lastly, a combination with previous ATLAS m top measurements from √s=7 TeVmore » data in the tt¯→ dilepton and tt¯→ lepton + jets channels results in m top = 172.84 ± 0.34 (stat) ± 0.61 (syst) GeV with a total uncertainty of 0.70 GeV.« less

Quiet eye training improves surgical knot tying more than traditional technical training: a randomized controlled study.

PubMed

Causer, Joe; Harvey, Adrian; Snelgrove, Ryan; Arsenault, Gina; Vickers, Joan N

2014-08-01

We examined the effectiveness of technical training (TT) and quiet eye training (QE) on the performance of one-handed square knot tying in surgical residents. Twenty surgical residents were randomly assigned to the 2 groups and completed pretest, training, retention, and transfer tests. Participants wore a mobile eye tracker that simultaneously recorded their gaze and hand movements. Dependent variables were knot tying performance (%), QE duration (%), number of fixations, total movement time (s), and hand movement phase time (s). The QE training group had significantly higher performance scores, a longer QE duration, fewer fixations, faster total knot tying times, and faster movement phase times compared with the TT group. The QE group maintained performance in the transfer test, whereas the TT group significantly decreased performance from retention to transfer. QE training significantly improved learning, retention, and transfer of surgical knot tying compared with a traditional technical approach. Both performance effectiveness (performance outcome) and movement efficiency (hand movement times) were improved using QE modeling, instruction, and feedback. Copyright © 2014 Elsevier Inc. All rights reserved.

Measurement of the top quark mass in the t t ¯ → dilepton channel from s = 8  TeV ATLAS data

DOE PAGES

Aaboud, M.

2016-08-24

Here, the top quark mass is measured in the tt¯→ dilepton channel (lepton=e,μ) using ATLAS data recorded in the year 2012 at the LHC. The data were taken at a proton–proton centre-of-mass energy of √s=8 TeV and correspond to an integrated luminosity of about 20.2 fb –1. Exploiting the template method, and using the distribution of invariant masses of lepton–b-jetb-jet pairs, the top quark mass is measured to be m top = 172.99 ± 0.41 (stat) ± 0.74 (syst) GeV, with a total uncertainty of 0.84 GeV0.84 GeV. Lastly, a combination with previous ATLAS m top measurements from √s=7 TeVmore » data in the tt¯→ dilepton and tt¯→ lepton + jets channels results in m top = 172.84 ± 0.34 (stat) ± 0.61 (syst) GeV with a total uncertainty of 0.70 GeV.« less

Differences in Brain Glucose Metabolism During Preparation for 131I Ablation in Thyroid Cancer Patients: Thyroid Hormone Withdrawal Versus Recombinant Human Thyrotropin.

PubMed

Jeong, Hyeonseok S; Choi, Eun Kyoung; Song, In-Uk; Chung, Yong-An; Park, Jong-Sik; Oh, Jin Kyoung

2017-01-01

In preparation for 131 I ablation, temporary withdrawal of thyroid hormone is commonly used in patients with thyroid cancer after total thyroidectomy. The current study aimed to investigate brain glucose metabolism and its relationships with mood or cognitive function in these patients using 18 F-fluoro-2-deoxyglucose positron emission tomography ( 18 F-FDG-PET). A total of 40 consecutive adult patients with thyroid carcinoma who had undergone total thyroidectomy were recruited for this cross-sectional study. At the time of assessment, 20 patients were hypothyroid after two weeks of thyroid hormone withdrawal, while 20 received thyroid hormone replacement therapy and were euthyroid. All participants underwent brain 18 F-FDG-PET scans and completed mood questionnaires and cognitive tests. Multivariate spatial covariance analysis and univariate voxel-wise analysis were applied for the image data. The hypothyroid patients were more anxious and depressed than the euthyroid participants. The multivariate covariance analysis showed increases in glucose metabolism primarily in the bilateral insula and surrounding areas and concomitant decreases in the parieto-occipital regions in the hypothyroid group. The level of thyrotropin was positively associated with the individual expression of the covariance pattern. The decreased 18 F-FDG uptake in the right cuneus cluster from the univariate analysis was correlated with the increased thyrotropin level and greater depressive symptoms in the hypothyroid group. These results suggest that temporary hypothyroidism, even for a short period, may induce impairment in glucose metabolism and related affective symptoms.

Increases in thyroid nodule fine-needle aspirations, operations, and diagnoses of thyroid cancer in the United States.

PubMed

Sosa, Julie Ann; Hanna, John W; Robinson, Karen A; Lanman, Richard B

2013-12-01

To provide population-based estimates of trends in thyroid nodule fine-needle aspirations (FNA) and operative volumes, we used multiple claims databases to quantify rates of these procedures and their association with the increasing incidence of thyroid cancer in the United States. Private and public insurance claims databases were used to estimate procedure volumes from 2006 to 2011. Rates of FNA and thyroid operations related to thyroid nodules were defined by CPT4 codes associated with International Classification of Diseases, Ninth Revision Clinical Modification codes for nontoxic uni- or multinodular goiter and thyroid neoplasms. Use of thyroid FNA more than doubled during the 5-year study period (16% annual growth). The number of thyroid operations performed for thyroid nodules increased by 31%. Total thyroidectomies increased by 12% per year, whereas lobectomies increased only 1% per year. In 2011, total thyroidectomies accounted for more than half (56%) of the operations for thyroid neoplasms in the United States. Thyroid operations became increasingly (62%) outpatient procedures. Thyroid FNA and operative procedures have increased rapidly in the United States, with an associated increase in the incidence of thyroid cancer. The more substantial increase in number of total versus partial thyroid resections suggests that patients undergoing thyroid operation are perceived to have a greater risk of cancer as determined by preoperative assessments, but this trend could also increase detection of incidental microcarcinomas. Copyright © 2013 Mosby, Inc. All rights reserved.

Early discharge after total thyroidectomy: a retrospective feasibility study.

PubMed

Tartaglia, F; Giuliani, A; Sorrenti, S; Tromba, L; Carbotta, S; Maturo, A; Carbotta, G; De Anna, L; Merola, R; Livadoti, G; Pelle, F; Ulisse, S

2016-01-01

The continued hospitalization after total thyroidectomy is often due to the onset of hypocalcemic complications more than 24 hours after surgery. So it would be important to predict which patients will not develop the hypocalcemic complication to discharge them early. This was the aim of our study. Our retrospective study was conducted on 327 consecutive thyroidectomized patients, operated on for benign and malignant diseases. We evaluated the values of preoperative serum calcium levels (Cal0) and of the first postoperative day (Cal1) and two new variables were calculated (dCal and dCaln). The same thing was made on a subgroup of 111 patients in whom also parathiroyd hormone (PTH) values were detected. Statistical analysis was performed with the goal of determining if we could establish a safe criterion for discharge at 24 hours after surgery and if there is a correlation between suitability for discharge and diagnosis. As to discharge, the predictive power of the discriminant function applied was significant both on the total of patients and in the subgroup of 111 patients, but it was clinically unacceptable because it would expose us to a 21% to 27% error rate. It is not possible to identify a threshold, below which to consider patients surely dischargeable. The diagnosis does not appear correlated with the suitability for discharge. On the basis of serum calcium and PTH levels in the first postoperative day, it is impossible to predict which patients can be discharged 24 hours after surgery without incurring in hypocalcemic complications.

Evaluation of a modified knee rotation angle in MRI scans with and without trochlear dysplasia: a parameter independent of knee size and trochlear morphology.

PubMed

Dornacher, Daniel; Trubrich, Angela; Guelke, Joachim; Reichel, Heiko; Kappe, Thomas

2017-08-01

Regarding TT-TG in knee realignment surgery, two aspects have to be considered: first, there might be flaws in using absolute values for TT-TG, ignoring the knee size of the individual. Second, in high-grade trochlear dysplasia with a dome-shaped trochlea, measurement of TT-TG has proven to lack precision and reliability. The purpose of this examination was to establish a knee rotation angle, independent of the size of the individual knee and unaffected by a dysplastic trochlea. A total of 114 consecutive MRI scans of knee joints were analysed by two observers, retrospectively. Of these, 59 were obtained from patients with trochlear dysplasia, and another 55 were obtained from patients presenting with a different pathology of the knee joint. Trochlear dysplasia was classified into low grade and high grade. TT-TG was measured according to the method described by Schoettle et al. In addition, a modified knee rotation angle was assessed. Interobserver reliability of the knee rotation angle and its correlation with TT-TG was calculated. The knee rotation angle showed good correlation with TT-TG in the readings of observer 1 and observer 2. Interobserver correlation of the parameter showed excellent values for the scans with normal trochlea, low-grade and high-grade trochlear dysplasia, respectively. All calculations were statistically significant (p < 0.05). The knee rotation angle might meet the requirements for precise diagnostics in knee realignment surgery. Unlike TT-TG, this parameter seems not to be affected by a dysplastic trochlea. In addition, the dimensionless parameter is independent of the knee size of the individual. II.

Metformin Does Not Suppress Serum Thyrotropin by Increasing Levothyroxine Absorption

PubMed Central

Al-Alusi, Mostafa A.; Du, Lin; Li, Ning; Yeh, Michael W.; He, Xuemei; Braverman, Lewis E.

2015-01-01

Background: Levothyroxine (LT4) absorption is affected by concomitant ingestion of certain minerals, medications, and foods. It has been hypothesized that metformin may suppress serum thyrotropin (TSH) concentrations by enhancing LT4 absorption or by directly affecting the hypothalamic–pituitary axis. This study examined the effect of metformin ingestion on LT4 absorption, as assessed by serum total thyroxine (TT4) concentrations. Methods: A modified Food and Drug Administration LT4 bioequivalence protocol was applied to healthy, metformin-naïve, euthyroid adult volunteers. Following an overnight fast, 600 μg LT4 was administered orally. Serum TT4 concentrations were measured at baseline and at 0.5, 1, 1.5, 2, 4, and 6 h following LT4 administration. Measurements were performed before and after one week of metformin ingestion (850 mg three times daily). Peak serum TT4 concentrations, time to peak TT4 concentrations, and area under the concentration-time curve (AUC) were calculated. Results: Twenty-six subjects (54% men, 27% white, age 33 ± 10 years) were studied. There were no significant differences in peak serum TT4 concentrations (p = 0.13) and time to peak TT4 concentrations (p = 0.19) before and after one week of metformin use. A trend toward reduced TT4 AUC was observed after metformin ingestion (pre-metformin 3893 ± 568 μg/dL-min, post-metformin 3765 ± 588 μg/dL-min, p = 0.09). Conclusions: LT4 absorption is unchanged by concomitant metformin ingestion. Mechanisms other than increased LT4 absorption may be responsible for the suppressed TSH concentrations observed in patients ingesting both drugs. PMID:26191653

A comparison of caffeine versus pseudoephedrine on cycling time-trial performance.

PubMed

Spence, Angela L; Sim, Marc; Landers, Grant; Peeling, Peter

2013-10-01

Both caffeine (CAF) and pseudoephedrine (PSE) are proposed to be central nervous system stimulants. However, during competition, CAF is a permitted substance, whereas PSE is a banned substance at urinary levels >150 μg · ml(-1). As a result, this study aimed to compare the effect of CAF versus PSE use on cycling time trial (TT) performance to explore whether the legal stimulant was any less ergogenic than the banned substance. Here, 10 well-trained male cyclists or triathletes were recruited for participation. All athletes were required to attend the laboratory on four separate occasions--including a familiarization trial and three experimental trials, which required participants to complete a simulated 40 km (1,200 kJ) cycling TT after the ingestion of either 200 mg CAF, 180 mg PSE or a nonnutritive placebo (PLA). The results showed that the total time taken and the mean power produced during each TT was not significantly different (p > .05) between trials, despite a 1.3% faster overall time (~57 s) after CAF consumption. Interestingly, the time taken to complete the second half of the TT was significantly faster (p < .05) in CAF as compared with PSE (by 99 s), with magnitude based inferences suggesting a 91% beneficial effect of CAF during the second half of the TT. This investigation further confirms the ergogenic benefits of CAF use during TT performances and further suggests this legal CNS stimulant has a better influence than a supra-therapeutic dose of PSE.

Possible role of serum testosterone, gonadotropins and prolactin in patients with premature ejaculation.

PubMed

Abu El-Hamd, M; Farah, A

2018-02-01

Premature ejaculation (PE) is the most common male sexual dysfunction. This study aimed to investigate the role of serum testosterone, gonadotropins and prolactin in patients with PE. In a prospective a case-controlled study, it was conducted on 90 male patients with PE and 90 male healthy participants as controls. Patients were evaluated by Premature Ejaculation Diagnostic Tool (PEDT) and intravaginal ejaculatory latency time (IELT). Patients with mean IELT values ≤60 s and PEDT total scores ≥11 were considered to have PE. Serum levels of total testosterone (TT), free testosterone (FT), follicle-stimulating hormone (FSH), luteinising hormone (LH) and prolactin (PL) were investigated in patients with PE and controls. There was no statistically significant difference between patients with PE and controls regarding the serum levels of TT, FT, FSH, LH and PL (p value ˃.05). There was no significant correlation between the sex hormones levels (TT, FT, FSH, LH and PL) and (age, body mass index (BMI), IELTS and total PEDT scores of the patients; p value ˃.05). This study concluded that there was no disturbance in serum levels of testosterone, gonadotropins and prolactin in patients with PE and controls. These hormones could not relate to pathogenesis of PE. © 2017 Blackwell Verlag GmbH.

Plasma exchange in the treatment of thyroid storm secondary to type II amiodarone-induced thyrotoxicosis.

PubMed

Zhu, Ling; Zainudin, Sueziani Binte; Kaushik, Manish; Khor, Li Yan; Chng, Chiaw Ling

2016-01-01

Type II amiodarone-induced thyrotoxicosis (AIT) is an uncommon cause of thyroid storm. Due to the rarity of the condition, little is known about the role of plasma exchange in the treatment of severe AIT. A 56-year-old male presented with thyroid storm 2months following cessation of amiodarone. Despite conventional treatment, his condition deteriorated. He underwent two cycles of plasma exchange, which successfully controlled the severe hyperthyroidism. The thyroid hormone levels continued to fall up to 10h following plasma exchange. He subsequently underwent emergency total thyroidectomy and the histology of thyroid gland confirmed type II AIT. Management of thyroid storm secondary to type II AIT can be challenging as patients may not respond to conventional treatments, and thyroid storm may be more harmful in AIT patients owing to the underlying cardiac disease. If used appropriately, plasma exchange can effectively reduce circulating hormones, to allow stabilisation of patients in preparation for emergency thyroidectomy. Type II AIT is an uncommon cause of thyroid storm and may not respond well to conventional thyroid storm treatment.Prompt diagnosis and therapy are important, as patients may deteriorate rapidly.Plasma exchange can be used as an effective bridging therapy to emergency thyroidectomy.This case shows that in type II AIT, each cycle of plasma exchange can potentially lower free triiodothyronine levels for 10h.Important factors to consider when planning plasma exchange as a treatment for thyroid storm include timing of each session, type of exchange fluid to be used and timing of surgery.

Single port thoracoscopic treatment of thoracic duct injury after thyroidectomy with neck dissection

PubMed Central

Teksoz, Serkan; Ersen, Ezel; Ferahman, Sina; Kaynak, Kamil; Dionigi, Gianlorenzo; Bukey, Yusuf

2017-01-01

Chylous leakage is a complication of thyroidectomy accompanied by bilateral neck dissection with incidence of 0.5–6.2%. A 51-year-old female patient underwent total thyroidectomy, bilateral and central neck dissection for papillary thyroid carcinoma. In post-operative 4th day, left sided chylous leakage was observed as 1,500 cc/day through neck drain. Leakage did not cease after 1-month conservative treatment so single port thoracoscopic intervention was performed. Under general anesthesia, patient was placed in left lateral decubitus position. An Alexis® retractor was placed through sixth intercostal space. Thoracic cavity was visualized with 30º scope. Posteroinferior edge of lower lobe was retracted superior posteriorly with a Foerster clamp to display inferior pulmonary ligament, which was then divided with electrocautery. Posterior mediastinal pleura between azygous vein and chest wall was incised to mobilize the vein. After that, mediastinal pleura between azygous vein and esophagus was cut longitudinally and esophagus was retracted anteriorly to dissect towards aorta. By dissection, thoracic duct was revealed as a thin tubular structure with occasional peristalsis. After isolation of the duct, it was clipped using Hem-o-lok®. Finally, fibrin sealant was applied to decrease risk of recurrence. One chest tube was placed to ensure adequate drainage of thoracic cavity and complete re-expansion of lung. Neck drain and chest tube was extracted in postoperative second and fourth day respectively and patient was discharged at 8th day. Single port thoracoscopy is a safe choice for treatment of chylous leakages due to cervical ductus thoracicus injury with faster recovery. PMID:29142855

Eyelash Epilation in the Absence of Trichiasis: Results of a Population-Based Prevalence Survey in the Western Division of Fiji.

PubMed

Macleod, Colin; Yalen, Chelsea; Butcher, Robert; Mudaliar, Umesh; Natutusau, Kinisimere; Rainima-Qaniuci, Mere; Haffenden, Chris; Watson, Conall; Cocks, Naomi; Cikamatana, Luisa; Roberts, Chrissy H; Marks, Michael; Rafai, Eric; Mabey, David C W; Kama, Mike; Solomon, Anthony W

2017-01-01

The WHO definition of trachomatous trichiasis (TT) is "at least one eyelash touching the globe, or evidence of recent epilation of in-turned eyelashes", reflecting the fact that epilation is used as a self-management tool for TT. In Fiji's Western Division, a high TT prevalence (8.7% in those aged ≥15 years) was reported in a 2012 survey, yet a 2013 survey found no TT and Fijian ophthalmologists rarely see TT cases. Local anecdote suggests that eyelash epilation is a common behaviour, even in the absence of trichiasis. Epilators may have been identified as TT cases in previous surveys. We used a preliminary focus group to design an interview questionnaire, and subsequently conducted a population-based prevalence survey to estimate the prevalence of epilation in the absence of trichiasis, and factors associated with this behaviour, in the Western Division of Fiji. We sampled 695 individuals aged ≥15 years from a total of 457 households in 23 villages. 125 participants (18%) reported epilating their eyelashes at least once within the past year. Photographs were obtained of the eyes of 121/125 (97%) individuals who epilated, and subsequent analysis by an experienced trachoma grader found no cases of trachomatous conjunctival scarring or trichiasis. The age- and sex- adjusted prevalence of epilation in those aged ≥15 years was 8.6% (95% CI 5.7-11.3%). iTaukei ethnicity, female gender, and a higher frequency of drinking kava root were independently associated with epilation. Epilation occurs in this population in the absence of trichiasis, with sufficient frequency to have markedly inflated previous estimates of local TT prevalence. Individuals with epilated eyelashes should be confirmed as having epilated in-turned eyelashes in an eye with scarring of the conjunctiva before being counted as cases of TT.

Eyelash Epilation in the Absence of Trichiasis: Results of a Population-Based Prevalence Survey in the Western Division of Fiji

PubMed Central

Butcher, Robert; Mudaliar, Umesh; Natutusau, Kinisimere; Rainima-Qaniuci, Mere; Haffenden, Chris; Watson, Conall; Cocks, Naomi; Cikamatana, Luisa; Roberts, Chrissy H.; Marks, Michael; Rafai, Eric; Mabey, David C. W.; Kama, Mike; Solomon, Anthony W.

2017-01-01

Background The WHO definition of trachomatous trichiasis (TT) is “at least one eyelash touching the globe, or evidence of recent epilation of in-turned eyelashes”, reflecting the fact that epilation is used as a self-management tool for TT. In Fiji’s Western Division, a high TT prevalence (8.7% in those aged ≥15 years) was reported in a 2012 survey, yet a 2013 survey found no TT and Fijian ophthalmologists rarely see TT cases. Local anecdote suggests that eyelash epilation is a common behaviour, even in the absence of trichiasis. Epilators may have been identified as TT cases in previous surveys. Methods We used a preliminary focus group to design an interview questionnaire, and subsequently conducted a population-based prevalence survey to estimate the prevalence of epilation in the absence of trichiasis, and factors associated with this behaviour, in the Western Division of Fiji. Results We sampled 695 individuals aged ≥15 years from a total of 457 households in 23 villages. 125 participants (18%) reported epilating their eyelashes at least once within the past year. Photographs were obtained of the eyes of 121/125 (97%) individuals who epilated, and subsequent analysis by an experienced trachoma grader found no cases of trachomatous conjunctival scarring or trichiasis. The age- and sex- adjusted prevalence of epilation in those aged ≥15 years was 8.6% (95% CI 5.7–11.3%). iTaukei ethnicity, female gender, and a higher frequency of drinking kava root were independently associated with epilation. Conclusion Epilation occurs in this population in the absence of trichiasis, with sufficient frequency to have markedly inflated previous estimates of local TT prevalence. Individuals with epilated eyelashes should be confirmed as having epilated in-turned eyelashes in an eye with scarring of the conjunctiva before being counted as cases of TT. PMID:28114364

α-Fetoprotein is a surrogate marker for predicting treatment failure in telaprevir-based triple combination therapy for genotype 1b chronic hepatitis C Japanese patients with the IL28B minor genotype.

PubMed

Shimada, Noritomo; Tsubota, Akihito; Atsukawa, Masanori; Abe, Hiroshi; Ika, Makiko; Kato, Keizo; Sato, Yoshiyuki; Kondo, Chisa; Sakamoto, Choitsu; Tanaka, Yasuhito; Aizawa, Yoshio

2014-03-01

Even when treated with telaprevir-based triple therapy, some patients fail to achieve a sustained virological response. This study identified factors related closely to treatment failure. A total of 146 Japanese genotype 1b chronic hepatitis C patients were enrolled in this prospective, multicenter study and received a 24-week regimen of triple therapy. The end-of-treatment response rate was significantly lower in patients with the interleukin 28B (IL28B) (rs8099917) non-TT genotype (85.2%) than in those with the TT genotype (100%, P = 0.0002). Multiple logistic regression analysis identified high α-fetoprotein levels as an independent factor related to non-end-of-treatment response in patients with the non-TT genotype. A cut-off value of 20 ng/ml was determined for a non-end-of-treatment response; sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 75.0%, 95.7%, 75.0%, 75.0%, and 92.6%, respectively. Multiple logistic regression analysis for a sustained virological response identified the IL28B TT genotype, low α-fetoprotein levels, non-responders, and a rapid virological response. The sustained virological response rate was significantly lower in patients with the non-TT genotype (59.3%) than in those with the TT genotype (96.7%, P < 0.0001). In patients with the non-TT genotype, α-fetoprotein was the most significant predictor for non-sustained virological response by univariate analysis. A cut-off value of 7.4 ng/ml α-fetoprotein was determined for non-sustained virological response; sensitivity, specificity, PPV, NPV, and accuracy were 63.6%, 87.5%, 77.8%, 77.8%, and 77.8%, respectively. For the non-TT patients, serum α-fetoprotein levels may be a surrogate marker for predicting treatment failure in telaprevir-based therapy for genotype 1b chronic hepatitis C. © 2013 Wiley Periodicals, Inc.

The impact of antenatal care, iron-folic acid supplementation and tetanus toxoid vaccination during pregnancy on child mortality in Bangladesh.

PubMed

Abir, Tanvir; Ogbo, Felix Akpojene; Stevens, Garry John; Page, Andrew Nicolas; Milton, Abul Hasnat; Agho, Kingsley Emwinyore

2017-01-01

Appropriate antenatal care (ANC) is an important preventive public health intervention to ensure women's and newborn health outcomes. The study aimed to investigate the impact of ANC, iron-folic acid (IFA) supplementation and tetanus toxoid (TT) vaccination during pregnancy on child mortality in Bangladesh. A cross-sectional study of three datasets from the Bangladesh Demographic and Health Surveys for the years 2004, 2007 and 2011 were pooled and used for the analyses. A total weighted sample of 16,721 maternal responses (5,364 for 2004; 4,872 for 2007 and 6,485 for 2011) was used. Multivariate logistic models that adjusted for cluster and sampling weights were used to examine the impact of ANC, IFA supplementation and TT vaccination during pregnancy on the death of a child aged 0-28 days (neonatal), 1-11 months (post-neonatal) and 12-59 months (child). Multivariable analyses revealed that the odds of postnatal and under-5 mortality was lower in mothers who had ANC [Odds Ratio (OR) = 0.60, 95% confidence interval (95% CI): 0.43-0.85], IFA supplementation [OR = 0.66, 95% CI: (0.45-0.98)] and ≥2 TT vaccinations (OR = 0.43, 95% CI: 0.49-0.78) for post-natal mortality; and for under-5 mortality, any form of ANC (OR = 0.69, 95% CI: 0.51-0.93), IFA supplementation (OR = 0.67, 95% CI: 0.48-0.94) and ≥2 TT vaccinations (OR = 0.50, 95% CI: 0.36-0.69). When combined, TT vaccination with IFA supplementation, and TT vaccination without IFA supplementation were protective across all groups. The study found that ANC, IFA supplementation, and TT vaccination during pregnancy reduced the likelihood of child mortality in Bangladesh. The findings suggest that considerable gains in improving child survival could be achieved through ensuring universal coverage of ANC, promoting TT vaccination during pregnancy and IFA supplementation among pregnant women in Bangladesh.

Breast cancer metastases to the thyroid gland - an uncommon sentinel for diffuse metastatic disease: a case report and review of the literature.

PubMed

Plonczak, Agata M; DiMarco, Aimee N; Dina, Roberto; Gujral, Dorothy M; Palazzo, Fausto F

2017-09-22

Metastases to the thyroid are rare. The most common primary cancer to metastasize to the thyroid is renal cell carcinoma, followed by malignancies of the gastrointestinal tract, lungs, and skin, with breast cancer metastases to the thyroid being rare. Overall, the outcomes in malignancies that have metastasized to the thyroid are poor. There are no prospective studies addressing the role of surgery in metastatic disease of the thyroid. Isolated thyroidectomy has been proposed as a local disease control option to palliate and prevent the potential morbidity of tumor extension related to the airway. Here, we present a case of a patient with breast cancer metastases to the thyroid gland and discuss the role of thyroidectomy in the context of the current literature. A 62-year-old Afro-Caribbean woman was diagnosed as having bilateral breast carcinoma in 2004, for which she underwent bilateral mastectomy. The pathology revealed multifocal disease on the right, T2N0(0/20)M0 grade 1 and 2 invasive ductal carcinoma, and on the left side, T3N1(2/18)M0 grade 1 invasive ductal carcinoma. Surgery was followed by adjuvant chemotherapy and regional radiotherapy. The disease was under control on hormonal therapy until 2016, when she developed cervical lymphadenopathy. The fine-needle aspiration cytology of the thyroid was reported as papillary thyroid cancer; and the fine-needle biopsy of the left lateral nodal disease was more suggestive of breast malignancy. She underwent a total thyroidectomy and a clearance of the central compartment lymph nodes and a biopsy of the lateral nodal disease. The histopathological analysis was consistent with metastatic breast cancer in the thyroid and lymph nodes with no evidence of a primary thyroid malignancy. A past history of a malignancy elsewhere should raise the index of suspicion of metastatic disease in patients presenting with thyroid lumps with or without cervical lymphadenopathy. Detection of metastases to the thyroid generally indicates poor prognosis, obviating the need of surgery in an already compromised patient. An empirical thyroidectomy should be considered in select patients for local disease control.

Gene-Silencing-Induced Changes in Carbohydrate Conformation in Relation to Bioenergy Value and Carbohydrate Subfractions in Modeled Plant (Medicago sativa) with Down-Regulation of HB12 and TT8 Transcription Factors

PubMed Central

Li, Xinxin; Hannoufa, Abdelali; Zhang, Yonggen; Yu, Peiqiang

2016-01-01

Gene silencing with RNA interference (RNAi) technology may be capable of modifying internal structure at a molecular level. This structural modification could affect biofunctions in terms of biodegradation, biochemical metabolism, and bioactive compound availability. The objectives of this study were to (1) Detect gene silencing-induced changes in carbohydrate molecular structure in an alfalfa forage (Medicago sativa spp. sativa: alfalfa) with down-regulation of genes that encode transcription factors TT8 and HB12; (2) Determine gene silencing-induced changes in nutrient bioutilization and bioavailability in the alfalfa forage (Medicago sativa); and (3) Quantify the correlation between gene silencing-induced molecular structure changes and the nutrient bioutilization and bioavailability in animals of ruminants. The experimental treatments included: T1 = Non-transgenic and no-gene silenced alfalfa forage (code “NT”); T2 = HB12-RNAi forage with HB12 gene down regulation (code “HB12”); T3 = TT8-RNAi forage with TT8 gene down regulation (code “TT8”). The HB12 and TT8 gene silencing-induced molecular structure changes were determined by non-invasive and non-destructive advanced molecular spectroscopy in a middle infrared radiation region that focused on structural, non-structural and total carbohydrate compounds. The nutrient bioutilization and bioavailability of the modified forage were determined using NRC-2001 system in terms of total digestive nutrient (TDN), truly digestible fiber (tdNDF), non-fiber carbohydrate (tdNDF), fatty acid (tdFA), crude protein (tdCP) and bioenergy profiles (digestible energy, metabolizable energy, net energy) for ruminants. The carbohydrate subfractions were evaluated using the updated CNCPS 6.0 system. The results showed that gene silencing significantly affected tdNFC (42.3 (NT) vs. 38.7 (HB12) vs. 37.4% Dry Matter (TT8); p = 0.016) and tdCP (20.8 (NT) vs. 19.4 (HB12) vs. 22.3% DM (TT8); p = 0.009). The gene-silencing also affected carbohydrate CA4 (7.4 (NT) vs. 4.2 (HB12) and 4.4% carbohydrate (CHO) (TT8), p = 0.063) and CB1 fractions (5.3 (NT) vs. 2.0 (HB12) and 2.6% CHO (TT8), p = 0.006). The correlation study showed that the structural CHO functional group peak area intensity at ca. 1315 cm−1 was significantly correlated to the TDN1x (r = −0.83, p = 0.042) and the tdNFC (r = −0.83, p = 0.042), the structural CHO functional group height intensity at ca. 1370 cm−1 was significantly correlated to the tdNDF (r = −0.87, p = 0.025). The A_Non-stCHO to A_StCHO ratio and A_Non-stCHO to A_CHO ratio were significantly correlated to the tdFA (r = 0.83–0.91, p < 0.05). As to carbohydrate fractions, both CA4 and CB1 correlated with carbohydrate spectral intensity of the H_1415 and the H_1315 (p = 0.039; p = 0.059, respectively), CB3 tended to correlate with the H_1150, H_1100 and H_1025 (p < 0.10). In conclusion, RNAi-mediated silencing of HB12 and TT8 modified not only inherent CHO molecular structure but also the biofunctions. The CHO molecular structure changes induced by RNAi gene silencing were associated with biofunctions in terms of the carbohydrate subfractions and nutrient digestion. PMID:27187372

Gene-Silencing-Induced Changes in Carbohydrate Conformation in Relation to Bioenergy Value and Carbohydrate Subfractions in Modeled Plant (Medicago sativa) with Down-Regulation of HB12 and TT8 Transcription Factors.

PubMed

Li, Xinxin; Hannoufa, Abdelali; Zhang, Yonggen; Yu, Peiqiang

2016-05-13

Gene silencing with RNA interference (RNAi) technology may be capable of modifying internal structure at a molecular level. This structural modification could affect biofunctions in terms of biodegradation, biochemical metabolism, and bioactive compound availability. The objectives of this study were to (1) Detect gene silencing-induced changes in carbohydrate molecular structure in an alfalfa forage (Medicago sativa spp. sativa: alfalfa) with down-regulation of genes that encode transcription factors TT8 and HB12; (2) Determine gene silencing-induced changes in nutrient bioutilization and bioavailability in the alfalfa forage (Medicago sativa); and (3) Quantify the correlation between gene silencing-induced molecular structure changes and the nutrient bioutilization and bioavailability in animals of ruminants. The experimental treatments included: T1 = Non-transgenic and no-gene silenced alfalfa forage (code "NT"); T2 = HB12-RNAi forage with HB12 gene down regulation (code "HB12"); T3 = TT8-RNAi forage with TT8 gene down regulation (code "TT8"). The HB12 and TT8 gene silencing-induced molecular structure changes were determined by non-invasive and non-destructive advanced molecular spectroscopy in a middle infrared radiation region that focused on structural, non-structural and total carbohydrate compounds. The nutrient bioutilization and bioavailability of the modified forage were determined using NRC-2001 system in terms of total digestive nutrient (TDN), truly digestible fiber (tdNDF), non-fiber carbohydrate (tdNDF), fatty acid (tdFA), crude protein (tdCP) and bioenergy profiles (digestible energy, metabolizable energy, net energy) for ruminants. The carbohydrate subfractions were evaluated using the updated CNCPS 6.0 system. The results showed that gene silencing significantly affected tdNFC (42.3 (NT) vs. 38.7 (HB12) vs. 37.4% Dry Matter (TT8); p = 0.016) and tdCP (20.8 (NT) vs. 19.4 (HB12) vs. 22.3% DM (TT8); p = 0.009). The gene-silencing also affected carbohydrate CA4 (7.4 (NT) vs. 4.2 (HB12) and 4.4% carbohydrate (CHO) (TT8), p = 0.063) and CB1 fractions (5.3 (NT) vs. 2.0 (HB12) and 2.6% CHO (TT8), p = 0.006). The correlation study showed that the structural CHO functional group peak area intensity at ca. 1315 cm(-1) was significantly correlated to the TDN1x (r = -0.83, p = 0.042) and the tdNFC (r = -0.83, p = 0.042), the structural CHO functional group height intensity at ca. 1370 cm(-1) was significantly correlated to the tdNDF (r = -0.87, p = 0.025). The A_Non-stCHO to A_StCHO ratio and A_Non-stCHO to A_CHO ratio were significantly correlated to the tdFA (r = 0.83-0.91, p < 0.05). As to carbohydrate fractions, both CA4 and CB1 correlated with carbohydrate spectral intensity of the H_1415 and the H_1315 (p = 0.039; p = 0.059, respectively), CB3 tended to correlate with the H_1150, H_1100 and H_1025 (p < 0.10). In conclusion, RNAi-mediated silencing of HB12 and TT8 modified not only inherent CHO molecular structure but also the biofunctions. The CHO molecular structure changes induced by RNAi gene silencing were associated with biofunctions in terms of the carbohydrate subfractions and nutrient digestion.

Bone geometry in young male and female football players: a peripheral quantitative computed tomography (pQCT) study.

PubMed

Lozano-Berges, Gabriel; Matute-Llorente, Ángel; Gómez-Bruton, Alejandro; González-Agüero, Alex; Vicente-Rodríguez, Germán; Casajús, José A

2018-05-08

The present study shows that football practice during growth may improve bone geometry in male and female football players. However, only females had better bone strength in comparison with controls. The aim of this study was to compare bone geometry in adolescent football players and controls. A total of 107 football players (71 males/36 females; mean age 12.7 ± 0.6/12.7 ± 0.6 years) and 42 controls (20 males/22 females; mean age 13.1 ± 1.4/12.7 ± 1.3 years) participated in this study. Total and trabecular volumetric bone mineral content (Tt.BMC/Tb.BMC), cross-sectional area (Tt.Ar/Tb.Ar), and bone strength index (BSI) were measured at 4% site of the non-dominant tibia by peripheral quantitative computed tomography (pQCT). Moreover, Tt.BMC, cortical BMC (Ct.BMC), Tt.Ar, cortical Ar (Ct.Ar), cortical thickness (Ct.Th), periosteal circumference (PC), endosteal circumference (EC), fracture load in X-axis, and polar strength strain index (SSIp) were measured at 38% site of the tibia. Multivariate analyses of covariance were used to compare bone pQCT variables between football players and controls using the tibia length and maturity offset as covariates. Female football players demonstrated 13.8-16.4% higher BSI, Ct.Th, fracture load in X-axis, and SSIp than controls (p < .0036). Males showed no significant differences in bone strength when compared to controls (p > .0036). In relation to bone mineral content and area, male football players showed 8.8% higher Tt.Ar and Tb.Ar at the 4% site of the tibia when compared to controls; whereas 13.8-15.8% higher Tt.BMC, Ct.BMC, and Ct.Ar at the 38% site of the tibia were found in female football players than controls (p < .0036). In this study, female adolescent football players presented better bone geometry and strength values than controls. In contrast, only bone geometry was higher in male football players than controls.

Use of total lymphoid irradiation (TLI) in studies of the T cell dependence of autoantibody production in rheumatoid arthritis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tanay, A.; Strober, S.; Logue, G.L.

1984-02-01

The effect of total lymphoid irradiation (TLI) on T cell-dependent and -independent humoral immune responses was studied in patients with intractable rheumatoid arthritis (RA). The serum levels of several autoantibodies and of antibodies to diphtheria (DT) and tetanus (TT) toxoids and to pneumococcal polysaccharide (PPS; 12 antigenic types) were studied before and after TLI. In addition, the patients were given a booster injection of DT and TT and a single injection of pneumococcal vaccine after radiotherapy. Antibody levels to DT and TT decreased about twofold after TLI and did not rise significantly after a booster injection. However, there was nomore » reduction in antibody levels to PPS after TLI, and a significant rise in titers was observed after a single vaccination. The serum levels of rheumatoid factor (RF), anti-nuclear antibody (ANA), and granulocyte associated IgG rose slightly after TLI. Thus, the autoantibodies and antibodies to polysaccharides appear to be relatively independent of helper T cell function, which is markedly reduced after TLI. On the other hand, antibodies to protein antigens such as DT and TT appear to be more closely dependent upon T helper function in man, as has been reported in rodents. The findings suggest that T cell-independent autoantibody responses alone do not maintain the joint disease activity in RA, because improvement in joint disease after TLI has been reported.« less

Thyroid hormone concentrations in captive and free-ranging West Indian manatees (Trichechus manatus).

PubMed

Ortiz, R M; MacKenzie, D S; Worthy, G A

2000-12-01

Because thyroid hormones play a critical role in the regulation of metabolism, the low metabolic rates reported for manatees suggest that thyroid hormone concentrations in these animals may also be reduced. However, thyroid hormone concentrations have yet to be examined in manatees. The effects of captivity, diet and water salinity on plasma total triiodothyronine (tT(3)), total thyroxine (tT(4)) and free thyroxine (fT(4)) concentrations were assessed in adult West Indian manatees (Trichechus manatus). Free-ranging manatees exhibited significantly greater tT(4) and fT(4) concentrations than captive adults, regardless of diet, indicating that some aspect of a captive existence results in reduced T(4) concentrations. To determine whether this reduction might be related to feeding, captive adults fed on a mixed vegetable diet were switched to a strictly sea grass diet, resulting in decreased food consumption and a decrease in body mass. However, tT(4) and fT(4) concentrations were significantly elevated over initial values for 19 days. This may indicate that during periods of reduced food consumption manatees activate thyroid-hormone-promoted lipolysis to meet water and energetic requirements. Alterations in water salinity for captive animals did not induce significant changes in thyroid hormone concentrations. In spite of lower metabolic rates, thyroid hormone concentrations in captive manatees were comparable with those for other terrestrial and marine mammals, suggesting that the low metabolic rate in manatees is not attributable to reduced circulating thyroid hormone concentrations.

Varicocele is associated with hypogonadism and impaired erectile function: a prospective comparative study.

PubMed

Ji, B; Jin, X-B

2017-08-01

We conducted this prospective comparative study to examine the hypothesis that varicocele was associated with hypogonadism and impaired erectile function as reflected in International Index of Erectile Function-5 (IIEF-5) scores as well as nocturnal penile tumescence and rigidity (NPTR) parameters. From December 2014 to December 2015, a total of 130 males with varicocele complaining of infertility or scrotal discomfort and 130 age-matched healthy males chosen from volunteer healthy hospital staff as controls were recruited in this study. Serum testosterone (TT) levels and IIEF-5 scores as well as NPTR parameters were evaluated and compared between varicocele and control subjects. All participants were further grouped into hypogonadism based on the cut-off value 300 ng/dL. A total of 45 of 130 patients were identified as hypogonadism, while it was not found in control subjects. A multivariate logistic regression with likelihood ratio test revealed that TT levels as well as grade III and II varicocele posed significant indicators for hypogonadism occurrence (chi-square of likelihood ratio = 12.40, df = 3, p < .01). Furthermore, TT levels and infertility duration were associated with IIEF-5 scores in a multivariate linear regression analysis (adjusted R 2  = 0.545). In conclusion, the correlation of grade III and II varicocele with an increased risk of hypogonadism was confirmed in this study and an impaired erectile function correlated with TT levels and infertility duration was also observed. © 2016 Blackwell Verlag GmbH.

Effective four-fermion operators in top physics: A roadmap

NASA Astrophysics Data System (ADS)

Aguilar-Saavedra, J. A.

2011-02-01

We write down a minimal basis for dimension-six gauge-invariant four-fermion operators, with some operator replacements with respect to previous ones which make it simpler for calculations. Using this basis we classify all four-fermion operator contributions involving one or two top quarks. Taking into account the different fermion chiralities, possible colour contractions and independent flavour combinations, a total number of 572 gauge-invariant operators are involved. We apply this to calculate all three-body top decay widths t→dud, t→dei+ν, t→uuu, t→uej+ei-, t→uνν (with i,j,k generation indices) mediated by dimension-six four-fermion operators, including the interference with the Standard Model amplitudes when present. All single top production cross sections in pp, pp¯ and ee collisions are calculated as well, namely ud→dt, dd→ut, ud→dt, uu→ut, uu→ut, ee→ut and the charge conjugate processes. We also compute all top pair production cross sections, uu→tt¯, dd→tt¯, uu→tt and ee→tt¯. Our results are completely general, without assuming any particular relation among effective operator coefficients.

Tracking Voice Change after Thyroidectomy: Application of Spectral/Cepstral Analyses

ERIC Educational Resources Information Center

Awan, Shaheen N.; Helou, Leah B.; Stojadinovic, Alexander; Solomon, Nancy Pearl

2011-01-01

This study evaluates the utility of perioperative spectral and cepstral acoustic analyses to monitor voice change after thyroidectomy. Perceptual and acoustic analyses were conducted on speech samples (sustained vowel /[alpha]/ and CAPE-V sentences) provided by 70 participants (36 women and 34 men) at four study time points: prior to thyroid…

Graves' Disease that Developed Shortly after Surgery for Thyroid Cancer.

PubMed

Yu, Hea Min; Park, Soon Hyun; Lee, Jae Min; Park, Kang Seo

2013-09-01

Graves' disease is an autoimmune disorder that may present with various clinical manifestations of hyperthyroidism. Patients with Graves' disease have a greater number of thyroid nodules and a higher incidence of thyroid cancer compared with patients with normal thyroid activity. However, cases in which patients are diagnosed with recurrence of Graves' disease shortly after partial thyroidectomy for thyroid cancer are very rare. Here we report a case of hyperthyroid Graves' disease that occurred after partial thyroidectomy for papillary thyroid cancer. In this case, the patient developed hyperthyroidism 9 months after right hemithyroidectomy, and antithyroglobulin autoantibody and thyroid stimulating hormone receptor stimulating autoantibody were positive. Therefore, we diagnosed Graves' disease on the basis of the laboratory test results and thyroid ultrasonography findings. The patient was treated with and maintained on antithyroid drugs. The mechanism of the recurrence of Graves' disease in this patient is still unclear. The mechanism may have been the improper response of the immune system after partial thyroidectomy. To precisely determine the mechanisms in Graves' disease after partial thyroidectomy, further studies based on a greater number of cases are needed.

Applications of Evolving Robotic Technology for Head and Neck Surgery.

PubMed

Sharma, Arun; Albergotti, W Greer; Duvvuri, Umamaheswar

2016-03-01

Assess the use and potential benefits of a new robotic system for transoral radical tonsillectomy, transoral supraglottic laryngectomy, and retroauricular thyroidectomy in a cadaver dissection. Three previously described robotic procedures (transoral radical tonsillectomy, transoral supraglottic laryngectomy, and retroauricular thyroidectomy) were performed in a cadaver using the da Vinci Xi Surgical System. Surgical exposure and access, operative time, and number of collisions were examined objectively. The new robotic system was used to perform transoral radical tonsillectomy with dissection and preservation of glossopharyngeal nerve branches, transoral supraglottic laryngectomy, and retroauricular thyroidectomy. There was excellent exposure without any difficulties in access. Robotic operative times (excluding set-up and docking times) for the 3 procedures in the cadaver were 12.7, 14.3, and 21.2 minutes (excluding retroauricular incision and subplatysmal elevation), respectively. No robotic arm collisions were noted during these 3 procedures. The retroauricular thyroidectomy was performed using 4 robotic ports, each with 8 mm instruments. The use of updated and evolving robotic technology improves the ease of previously described robotic head and neck procedures and may allow surgeons to perform increasingly complex surgeries. © The Author(s) 2015.

Profile of patients with completion thyroidectomy and assessment of their suitability for outpatient surgery.

PubMed

Wu, Gaosong; Pai, Sara I; Agrawal, Nishant; Richmon, Jeremy; Dackiw, Alan; Tufano, Ralph P

2011-11-01

Outpatient thyroid surgery for thyroid lobectomy has been shown to be safe and feasible. The safety of outpatient completion thyroidectomy in patients who have previously undergone thyroid lobectomy has not been extensively evaluated in the medical literature to date. The authors sought to evaluate postoperative complications associated with completion thyroidectomy in their institution to determine if it would be safe and feasible to perform as an outpatient procedure. Case series with chart review. Tertiary care teaching hospital. Two hundred four consecutive patients, who underwent completion thyroidectomy after previous thyroid lobectomy from January 2000 to June 2010, comprised the study population. Medical records were reviewed for preoperative and postoperative serum calcium levels, preoperative and postoperative fiber-optic laryngoscopic examination of vocal fold mobility, associated comorbidities, length of hospital stay, drain use, seroma or hematoma formation, final thyroid pathology, and postoperative follow-up. Overall, 9 patients (4.4%) developed postoperative complications, including transient symptomatic hypocalcemia in 4 patients (2.0%), transient laboratory hypocalcemia in 3 patients (1.5%), seroma formation in 1 patient (0.5%), and hematoma development in 1 patient (0.5%). There were no cases with permanent or temporary vocal fold paralysis. No significant difference was found in the overall complication rate before and after 4 hours of observation (P = .50). Selected patients who undergo completion thyroidectomy after previous thyroid lobectomy can be safely discharged after 4 hours of postoperative observation with appropriate instructions.

Malignancy in solitary thyroid nodule: A clinicoradiopathological evaluation.

PubMed

Jena, Amitabh; Patnayak, Rashmi; Prakash, Jaya; Sachan, Alok; Suresh, V; Lakshmi, Amarchala Yadagiri

2015-01-01

Thyroid nodules are common. They can be either benign or malignant. Solitary thyroid nodules (STN) have a high likelihood of being malignant. They should be characterized properly for optimum management. In this study, we have analyzed our departmental data over a period of 5 years. All the patients who presented to the outpatient department with a clinically detected STN were included in the study group. Our approach was individualized. Preoperative ultrasonography (USG) and fine-needle aspiration cytology were planned in all these patients. Hemi thyroidectomy and total thyroidectomy with and without neck dissection were performed wherever appropriate. There were 162 cases of clinically detected STN. USG findings were available in 146 cases. Postoperative histopathology was reported as malignant in 58 cases. Malignant STN was more likely in males. Ultrasonographically detected solid STN were more prone for malignancy as compared to multinodular goiter (P = 0.000) Presence of micro calcification and cervical lymphadenopathy were more commonly noted in malignant thyroid swellings. Solitary thyroid nodules do have a high likelihood of harboring a malignancy. Solid echogenicity, micro calcification and cervical lymphadenopathy on USG were seen more frequently in malignant nodules.

Ultrasound and thyroiditis in patient candidates for thyroidectomy.

PubMed

Del Rio, P; De Simone, B; Fumagalli, M; Viani, L; Totaro, A; Sianesi, M

2015-03-01

Thyroiditis is often associated with nodules based on the Bethesda classification system, and the presence of thyroiditis can make thyroid surgery difficult using both conventional techniques and minimally invasive videoassisted approaches (MIVAT). We analyzed 326 patients who underwent total thyroidectomy in 2012. We collected all data in dedicated database. The patients were divided in 4 groups: group 1 no affected by thyroiditis, group 2 affected by thyroiditis, group 3 only histological diagnosis of thyroiditis, group 4all patients affected by thyroiditis. Group 1 included 201 cases, group 2 included 64 patients, group 3 included 61 patients. No statistically significant difference between group 2 and 3 about Ultrasound (US) examination. Statistically significant difference in incidence of "THYR 3-4" between group 1 and group 4. No differences in MIVAT vs. Conventional group. US examination of the thyroid is essential for the diagnostic study of the gland also in the selection of a surgical approach. Thyroiditis is a relative contraindication to MIVAT but the experience of the endocrine surgeon is the most important factor to reduce intra and postoperative complications together a correct collaboration in multidisciplinart endocrinological team.

Ambulatory thyroidectomy: an anesthesiologist's perspective.

PubMed

Murray, Benjamin; Tandon, Sankalap; Dempsey, Ged

2017-01-01

Thyroidectomy has been performed on an inpatient basis because of concerns regarding postoperative complications. These include cervical hematoma, bilateral recurrent laryngeal nerve injury and symptomatic hypocalcemia. We have reviewed the current available evidence and aimed to collate published data to generate incidence of the important complications. We performed a literature search of Medline, EMBASE and the Cochrane database of randomized trials. One hundred sixty papers were included. Twenty-one papers fulfilled inclusion criteria. Thirty thousand four hundred fifty-three day-case thyroid procedures were included. Ten papers were prospective and 11 retrospective. The incidences of complications were permanent vocal cord paralysis 7/30259 (0.02%), temporary hypocalcemia 129/4444 (2.9%), permanent hypocalcemia 405/29203 (1.39%), cervical hematoma 145/30288 (0.48%) and readmission rate 105/29609 (0.35%). Analysis of cervical hematoma data demonstrated that in only 3/14 cases the hematoma presented as an inpatient, and in the remaining 11/14, it occurred late, with a range of 2-9 days. There is a paucity of data relating to anesthetic techniques associated with ambulatory thyroidectomy. Cost comparison between outpatient and inpatient thyroidectomy was reported in three papers. Cost difference ranged from $676 to $2474 with a mean saving of $1301 with ambulatory thyroidectomy. There is a body of evidence that suggests that ambulatory thyroidectomy in the hands of experienced operating teams within an appropriate setting can be performed with acceptable risk profile. In most circumstances, this will be limited to hemithyroidectomies to reduce or avoid the potential for additional morbidity. We have found little evidence to support the use of one anesthetic technique over another. The rates of hospital admission and readmission related to anesthetic factors appear to be low and predominantly related to pain and postoperative nausea and vomiting. A balanced anesthetic technique incorporating appropriate analgesic and antiemetic regimens is essential to avoid unnecessary hospital admission/readmission.

Agreement on urgency assessment between secretaries and general practitioners: an observational study in out-of-hours general practice service in Belgium.

PubMed

Philips, H; Van Bergen, J; Huibers, L; Colliers, A; Bartholomeeusen, S; Coenen, S; Remmen, R

2015-10-01

In some European countries telephone triage (TT) during out-of-hours primary care showed to be safe and effective. Other countries, such as Belgium, may not have trained auxiliary personnel while their national health services want to establish TT. To compare urgency levels assessed by secretaries and general practitioners in one general practice cooperative in Belgium. Percentage of correct-, under-, and over-triage were calculated in total and per reason for encounter. Inter-rater agreement was investigated. The secretaries correctly triaged (same urgency level) 77% of the telephone calls, under-triaged 10% and over-triaged 13%.'Shortness of breath', 'skin cuts', 'chest pain', 'feeling unwell' and 'syncope' were often under-triaged. Before introducing TT, auxiliary staff should be trained and protocols should be used.

Treatment of severe life threatening hypocalcemia with recombinant human teriparatide in patients with postoperative hypoparathyroidism - a case series.

PubMed

Andrysiak-Mamos, Elżbieta; Żochowska, Ewa; Kaźmierczyk-Puchalska, Agnieszka; Popow, Michał; Kaczmarska-Turek, Dorota; Pachucki, Janusz; Bednarczuk, Tomasz; Syrenicz, Anhelli

2016-01-01

Hypocalcaemia is a common postoperative complication, both after the resection of parathyroid adenoma associated with primary hyperparathyroidism and after total thyroidectomy due to thyroid cancer or nodular goitre. For a few years, in patients with postoperative hypoparathyroidism and severe hypocalcaemia, who cannot discontinue intravenous calcium preparations even with the use of high vitamin D doses, attempts have been made to add recombinant human parathormone (rhPTH) to the treatment schedule. In this work, for the first time in Poland, we demonstrate the potential use of teriparatide for the treatment of severe hypocalcaemia based on three different cases of postoperative hypoparathyroidism. Case 1. Female (52) with postoperative hypoparathyroidism, after total thyroidectomy and the removal of lower left parathyroid gland due to hyperparathyroidism, several weeks after the surgery still required intravenous calcium infusions because of tetany symptoms. Just one month of teriparatide treatment at 20 μg/0.08 mL given in daily subcutaneous injections proved sufficient to control calcium levels with oral calcium and vitamin D preparations during the next few days until total resolution of hypocalcaemia symptoms and the achievement and maintenance of laboratory normocalcaemia in the following weeks. Female (33) with hypoparathyroidism following total thyroidectomy in 1996 because of papillary thyroid cancer, with congenital tubulopathy associated with renal loss of calcium and magnesium, and the symptoms of tetany recurring since the day of surgery, requiring intravenous calcium administration every 2-3 days. Currently, the patient has been hospitalised because of venous port infection, the only venous access, which made intravenous therapy impossible. Because of the life-threatening condition of the patient, bridging teriparatide treatment was prepared (20 μg/0.08 mL). Complete resolution of clinical symptoms of hypocalcaemia was obtained with teriparatide doses given every 8-12 hours, which made dose reduction possible. Case 3. Female (52) after major oncological surgery because of laryngopharyngeal and cervical oesophageal cancer with the removal of parathyroid glands, fed through PEG, was admitted to hospital with the symptoms of tetany. Despite treatment intensification, the patient experienced a hypocalcaemic crisis during hospitalisation. Teriparatide treatment at 2 × 20 μg/day resulted in the resolution of tetany symptoms, with gradual normalisation of calcium-phosphate balance parameters during the following days. Based on the analysis of these cases, the conclusion was drawn that the use of recombinant human teriparatide allows for the control of severe hypocalcaemia requiring intravenous infusions of calcium in patients with postoperative hypoparathyroidism. (Endokrynol Pol 2016; 67 (4): 403-412).

Galleria mellonella larvae are capable of sensing the extent of priming agent and mounting proportionatal cellular and humoral immune responses.

PubMed

Wu, Gongqing; Xu, Li; Yi, Yunhong

2016-06-01

Larvae of Galleria mellonella are useful models for studying the innate immunity of invertebrates or for evaluating the virulence of microbial pathogens. In this work, we demonstrated that prior exposure of G. mellonella larvae to high doses (1×10(4), 1×10(5) or 1×10(6) cells/larva) of heat-killed Photorhabdus luminescens TT01 increases the resistance of larvae to a lethal dose (50 cells/larva) of viable P. luminescens TT01 infection administered 48h later. We also found that the changes in immune protection level were highly correlated to the changes in levels of cellular and humoral immune parameters when priming the larvae with different doses of heat-killed P. luminescens TT01. Priming the larvae with high doses of heat-killed P. luminescens TT01 resulted in significant increases in the hemocytes activities of phagocytosis and encapsulation. High doses of heat-killed P. luminescens TT01 also induced an increase in total hemocyte count and a reduction in bacterial density within the larval hemocoel. Quantitative real-time PCR analysis showed that genes coding for cecropin and gallerimycin and galiomycin increased in expression after priming G. mellonella with heat-killed P. luminescens TT01. All the immune parameters changed in a dose-dependent manner. These results indicate that the insect immune system is capable of sensing the extent of priming agent and mounting a proportionate immune response. Copyright © 2016 European Federation of Immunological Societies. Published by Elsevier B.V. All rights reserved.

Fahr's Syndrome and Secondary Hypoparathyroidism.

PubMed

Dos Santos, Vitorino Modesta; Da Mata, Ana Medeiros De Farias; Ribeiro, Kelle Regina Alves; Calvo, Isadora Cartaxo De Sousa

2016-01-01

A typical case of Fahr's syndrome is described in a 76-year-old Brazilian female who underwent a total thyroidectomy three decades ago. Six years before the current admission, she started with generalized tonic-clonic seizures. Associated disorders involved extra-pyramidal, cognitive, nocturnal terror and mood changes. With suspicion of hypocalcemia due to secondary hypoparathyroidism, laboratory determinations confirmed the diagnoses. Furthermore, imaging studies of the central nervous system detected multiple calcifications, with characteristic distribution of Fahr's syndrome. Clinical management was successful.

Greater Efficacy of Total Thyroidectomy versus Radioiodine Therapy on Hyperthyroidism and Thyroid-Stimulating Immunoglobulin Levels in Patients with Graves' Disease Previously Treated with Antithyroid Drugs

PubMed Central

Kautbally, Shakeel; Alexopoulou, Orsalia; Daumerie, Chantal; Jamar, François; Mourad, Michel; Maiter, Dominique

2012-01-01

Aims We compared the effects of total thyroidectomy (TTx) and radioiodine (RAI) administration on the course of thyroid hormones and thyroid-stimulating immunoglobulins (TSI) in patients with Graves' disease. Methods We retrospectively studied 80 patients initially treated with antithyroid drugs and requiring either RAI (8.3 ± 1.7 mCi of 131I; n = 40) or TTx (n = 40) as second-line therapy. Results The TTx and RAI groups were not different, except for larger goiter, higher FT3 and more frequent Graves' orbitopathy at diagnosis in the surgery group (p < 0.05). A persistent remission of hyperthyroidism was observed in 97% of operated patients versus 73% of the RAI patients at 3 years (p < 0.01). TTx was followed by a rapid and steady decrease in TSI during the first 9 months, while a surge of antibodies was observed during the first 6 months after RAI, followed by a slow decrease over the next 18 months. At the last visit, high TSI levels were still observed in 18 and 60% of patients in the surgery and RAI groups, respectively (p < 0.001). Conclusions TTx is more efficient than RAI to induce a rapid and permanent correction of hyperthyroidism and TSI decrease in patients previously treated with antithyroid drugs. PMID:24783007

Minimally invasive video-assisted thyroid surgery: how can we improve the learning curve?

PubMed

Castagnola, G; Giulii Cappone, M; Tierno, S M; Mezzetti, G; Centanini, F; Vetrone, I; Bellotti, C

2012-10-01

Minimally invasive video-assisted thyroidectomy (MIVAT) is a technically demanding procedure and requires a surgical team skilled in both endocrine and endoscopic surgery. A time consuming learning and training period is mandatory at the beginning of the experience. The aim of our report is to focus some aspects of the learning curve of the surgeon who practices video-assisted thyroid procedures for the first time, through the analysis of our preliminary series of 36 cases. From September 2004 to April 2005 we selected 36 patients for minimally invasive video-assisted surgery of the thyroid. The patients were considered eligible if they presented with a nodule not exceeding 35 mm in maximum diameter; total thyroid volume within normal range; absence of biochemical and echographic signs of thyroiditis. We analyzed surgical results, conversion rate, operating time, post-operative complications, hospital stay, cosmetic outcome of the series. We performed 36 total thyroidectomy. The procedure was successfully carried out in 33/36 cases. Post-operative complications included 3 transient recurrent nerve palsies and 2 transient hypocalcemias; no definitive hypoparathyroidism was registered. All patients were discharged 2 days after operation. The cosmetic result was considered excellent by most patients. Advances in skills and technology have enabled surgeons to reproduce most open surgical techniques with video-assistance or laparoscopically. Training is essential to acquire any new surgical technique and it should be organized in detail to exploit it completely.

Not all occult papillary carcinomas are minimal

DOE Office of Scientific and Technical Information (OSTI.GOV)

Allo, M.D.; Christianson, W.; Koivunen, D.

1988-12-01

Occult papillary carcinomas are characterized as small papillary tumors of less than 1.5 cm in maximum diameter, with or without bulky metastatic deposits in cervical nodes. The primary lesion is usually not palpable, and although the clinical behavior usually follows a benign course, tumors with unfavorable histologic features (invasiveness, multifocality) or extrathyroidal disease or a combination of both may not do so. In this report six cases are presented to illustrate this entity. No patient had a history of irradiation to the head or neck. All had primary lesions smaller than 1.5 cm. None had a palpable nodule or abnormalmore » thyroid scan results, and the diagnosis of thyroid cancer was based on cervical lymph node or lung biopsy specimens, which revealed papillary thyroid cancer. All of the patients underwent total or near-total thyroidectomies and were found to have small, invasive papillary lesions with additional metastases to cervical nodes noted at the time of thyroidectomy. Adjunctive treatment consisted of a 5 mCi iodine-131 scan, ablative iodine-131 therapy, and suppression with L-thyroxine. Although distant metastasis to lung or other organs is uncommon and the mortality rate is low (as in larger papillary cancers), these invasive lesions--despite their small size--have a high propensity for recurrence and should be considered to behave more like encapsulated papillary tumors with extrathyroidal extension than like their small, unencapsulated intrathyroidal counterparts.« less

Role of Cholestyramine in Refractory Hyperthyroidism: A Case Report and Literature Review

PubMed Central

Alswat, Khaled A.

2015-01-01

Patient: Female, 52 Final Diagnosis: Refractory iodine induced hyperthyroidism Symptoms: Neck swelling • shortness of breath Medication: Cholestyramine Clinical Procedure: Total thyroidectomy Specialty: Endocrinology and Metabolic Objective: Unusual clinical course Background: Hyperthyroidism is a common disease that usually responds to the conventional therapy of anti-thyroidal medications (methimazole or PTU) and beta-blocker. Refractory hyperthyroidism is a rare condition in which hyperthyroidism fails to respond to the above therapy. Cholestyramine has been shown to decrease thyroid hormone level when added to the ongoing anti-thyroidal medications. Case Report: A 52-year-old woman with past medical history of enlarging goiter presented with obstructive symptoms of worsening shortness of breath and snoring. Admission thyroid function test showed mild hyperthyroidism (suppressed TSH, slightly high FT4, and high normal FT3) that worsened after she received a CT scan with contrast and failed to respond to a 3-week course of high-dose dexamethasone, high-dose carbimazole, and up-titrated propranolol. Five days after cholestyramine was added, her FT4 decreased by 30% and normalized after 12 days. The patient underwent total thyroidectomy as definitive treatment for the hyperthyroidism and for the obstructive symptoms. Conclusions: Cholestyramine is an effective additional treatment for hyperthyroidism and may be an effective treatment for refractory iodine-induced hyperthyroidism. The possibility of self-remission (natural course) is less likely given the dramatic and rapid response to cholestyramine. PMID:26207323

Effect of cultivar and variety on phenolic compounds and antioxidant activity of cherry wine.

PubMed

Xiao, Zuobing; Fang, Lingling; Niu, Yunwei; Yu, Haiyan

2015-11-01

To compare the influence of cultivar and variety on the phenolic compounds and antioxidant activity (AA) of cherry wines, total phenolic (TP), total flavonoid (TF), total anthocyanin (TA), total tannin (TT), five individual phenolic acids, and AA were determined. An ultra-performance liquid chromatography tandem mass spectrometry (HPLC-DAD/ESI-MS) method was developed for the determination of gallic acid (GAE), p-hydroxybenzoic acid (PHB), chlorogenic acid (CHL), vanillic acid (VAN), and caffeic acid (CAF). A principal component analysis (PCA) and a cluster analysis (CA) were used to analyze differences related to cultivar and variety. The TP, TF, TA, TT, and AA of samples sourced from the Shandong province of China were higher than those from the Jiangsu province. The PCA and CA results showed that phenolic compounds in cherry wines were closely related to cultivar and variety and that cultivar had more influence on the phenolic compounds of cherry wines than variety. Copyright © 2015 Elsevier Ltd. All rights reserved.

Post thyroidectomy suture granuloma: a cytological diagnosis.

PubMed

Javalgi, Anita P; Arakeri, Surekha U

2013-04-01

There are known post thyroidectomized complications, a suture granuloma being less frequent, with its late complication mimicking recurrent thyroid cancer. A suture granuloma is a benign, granulomatous inflammatory reaction that occurs due to the use of non absorbable suture. It constitutes one of the late complications which altogether make up less than 2% of its incidence. A suture granuloma is similar to a foreign body reaction and it usually develops slowly as a painless, palpable asymptomatic mass over the years. It mimics a cancer recurrence or a lymph node metastasis. Here, we are reporting a case of a post thyroidectomy suture granuloma in a 46 years old lady who presented with a painless swelling in the lateral neck, with a past history of thyroidectomy 5 years back.

Automatic segmentation software in locally advanced rectal cancer: READY (REsearch program in Auto Delineation sYstem)-RECTAL 02: prospective study.

PubMed

Gambacorta, Maria A; Boldrini, Luca; Valentini, Chiara; Dinapoli, Nicola; Mattiucci, Gian C; Chiloiro, Giuditta; Pasini, Danilo; Manfrida, Stefania; Caria, Nicola; Minsky, Bruce D; Valentini, Vincenzo

2016-07-05

To validate autocontouring software (AS) in a clinical practice including a two steps delineation quality assurance (QA) procedure.The existing delineation agreement among experts for rectal cancer and the overlap and time criteria that have to be verified to allow the use of AS were defined.Median Dice Similarity Coefficient (MDSC), Mean slicewise Hausdorff Distances (MSHD) and Total-Time saving (TT) were analyzed.Two expert Radiation Oncologists reviewed CT-scans of 44 patients and agreed the reference-CTV: the first 14 consecutive cases were used to populate the software Atlas and 30 were used as Test.Each expert performed a manual (group A) and an automatic delineation (group B) of 15 Test patients.The delineations were compared with the reference contours.The overlap between the manual and automatic delineations with MDSC and MSHD and the TT were analyzed.Three acceptance criteria were set: MDSC ≥ 0.75, MSHD ≤1mm and TT sparing ≥ 50%.At least 2 criteria had to be met, one of which had to be TT saving, to validate the system.The MDSC was 0.75, MSHD 2.00 mm and the TT saving 55.5% between group A and group B. MDSC among experts was 0.84.Autosegmentation systems in rectal cancer partially met acceptability criteria with the present version.

Effects of prolonged fasting on plasma cortisol and TH in postweaned northern elephant seal pups

NASA Technical Reports Server (NTRS)

Ortiz, R. M.; Wade, C. E.; Ortiz, C. L.

2001-01-01

Northern elephant seal (Mirounga angustirostris) pups rely on the oxidation of fat stores as their primary source of energy during their 8- to 12-wk postweaning fast; however, potential endocrine mechanisms involved with this increased fat metabolism have yet to be examined. Therefore, 15 pups were serially blood sampled in the field during the first 7 wk of their postweaning fast to examine the changes in plasma concentrations of cortisol and thyroid hormones (TH), which are involved in fat metabolism in other mammals. Cortisol increased, indicating that it contributed to an increase in lipolysis. Increased total triiodothyronine (tT(3)) and thyroxine (tT(4)) may not reflect increased thyroid gland activity, but rather alterations in hormone metabolism. tT(3)-to-tT(4) ratio decreased, suggesting a decrease in thyroxine (T(4)) deiodination, whereas the negative correlation between total proteins and free T(4) suggests that the increase in free hormone is attributed to a decrease in binding globulins. Changes in TH are most similar to those observed during hibernation than starvation in mammals, suggesting that the metabolic adaptations to natural fasting are more similar to hibernation despite the fact these animals remain active throughout the fasting period.

Searching the inclusive l{gamma}Ee{sub T}+b-quark signature for radiative top quark decay and non-standard-model processes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Aaltonen, T.; Maki, T.; Mehtala, P.

We compare the inclusive production of events containing a lepton (l), a photon ({gamma}), significant transverse momentum imbalance (Ee{sub T}), and a jet identified as containing a b-quark, to SM predictions. The search uses data produced in proton-antiproton collisions at {radical}(s)=1.96 TeV corresponding to 1.9 fb{sup -1} of integrated luminosity taken with the CDF detector. We find 28 l{gamma}bEe{sub T} events versus an expectation of 31.0{sub -3.5}{sup +4.1} events. If we further require events to contain at least three jets and large total transverse energy, the largest SM source is radiative top-quark pair production, tt+{gamma}. In the data we observemore » 16 tt{gamma} candidate events versus an expectation from SM sources of 11.2{sub -2.1}{sup +2.3}. Assuming the difference between the observed number and the predicted non-top-quark total of 6.8{sub -2.0}{sup +2.2} is due to SM top-quark production, we estimate the tt{gamma} cross section to be 0.15{+-}0.08 pb.« less

Hormonal changes associated with the transition between nursing and natural fasting in northern elephant seals (Mirounga angustirostris)

NASA Technical Reports Server (NTRS)

Ortiz, Rudy M.; Houser, Dorian S.; Wade, Charles E.; Ortiz, C. Leo

2003-01-01

To better interpret previously described hormonal changes observed during the natural postweaning fast (2-3 months) endured by pups of the northern elephant seal (Mirounga angustirostris), we compared plasma cortisol, thyroid hormones, and leptin in pups (n=5) measured during nursing and fasting periods. Blood samples were taken at four times; early (9 days postpartum) and late (18-22 days postpartum) nursing, and early (second week postweaning) and late (eighth week postweaning) fasting. Plasma cortisol increased 39% between early and late nursing and almost 4-fold by late fasting. After the early nursing period, cortisol and body mass were negatively correlated (y=28.3-0.19 x; R=0.569; p=0.027). Total thyroxine (tT(4)), free T(4) (fT(4)), total triiodothyronine (tT3) and reverse T(3) (rT(3)) were greatest at early nursing and reduced by late nursing and remained so throughout the fast, with the exception of tT(4), which increased between late nursing (17.7+/-2.1 ng mL(-1)) and late fasting (30.1+/-2.8 ng mL(-1)) periods. Leptin remained unaltered among the four sampling periods and was not correlated with body mass. Pups appear to exhibit a shift in the relationship between cortisol and body mass suggesting a potential role for cortisol in the regulation of body fat. The higher concentrations of tT(3) and tT(4) during early nursing may reflect enhanced growth and development during this period, however the increase late in fasting is likely physiologically insignificant and an artifact of reduced metabolic clearance of these hormones. Transition of the pups from nursing to fasting states is characterized by a striking lack of change in cortisol, thyroid hormones, and leptin suggesting that any metabolic alterations associated with this transition may occur independent of these hormones.

Detection of Parathyroid Autofluorescence Using Near-Infrared Imaging: A Multicenter Analysis of Concordance Between Different Surgeons.

PubMed

Kahramangil, Bora; Dip, Fernando; Benmiloud, Fares; Falco, Jorge; de La Fuente, Martin; Verna, Silvina; Rosenthal, Raul; Berber, Eren

2018-04-01

Parathyroid glands (PGs) exhibit autofluorescence (AF) when excited by near-infrared laser. This multicenter study aims to analyze how this imaging could facilitate the detection of PGs during thyroidectomy and parathyroidectomy procedures. This was a retrospective Institutional Review Board-approved analysis of prospectively collected data at three centers. Near-infrared fluorescence imaging (NIFI) was used to detect AF from PGs during thyroidectomy and parathyroidectomy procedures. Logistic regression analysis was performed to assess the utility of NIFI to identify PGs and concordance at these centers. Overall, 210 patients underwent total thyroidectomy (n = 95), thyroid lobectomy (n = 41), and parathyroidectomy (n = 74) (n = 70 per center). Using NIFI, AF was detected from 98% of visually identified PGs. Upon initial exploration, 46% of PGs were not visible to the naked eye due to coverage by soft tissue, but AF from these glands could be detected by NIFI without any further dissection. Overall, a median of one PG per patient was detected by NIFI in this fashion before being identified visually (p = nonsignificant between centers). On logistic regression, smaller PGs were more likely to be missed visually, but localized by AF on NIFI (odds ratio with increasing size, 0.91; p = 0.02). In our experience, NIFI facilitated PG identification by detecting their AF, before conventional recognition by the surgeon, in 37-67% of the time. Despite the variability in this rate across centers, there was a concordance in detecting AF from 97 to 99% of the PGs using NIFI. We suggest the incorporation of AF on NIFI alongside conventional visual cues to aid identification of PGs during neck operations.

Low postoperative nonstimulated thyroglobulin as a criterion to spare radioiodine ablation.

PubMed

Mourão, Gabriela Franco; Rosario, Pedro Weslley; Calsolari, Maria Regina

2016-01-01

This study evaluated the recurrence rate in patients with papillary thyroid carcinoma (PTC) who had low nonstimulated thyroglobulin (Tg), measured with a second-generation assay, after total thyroidectomy and who were not submitted to ablation with (131)I. The objective was to define whether low postoperative nonstimulated Tg can be used as a criterion to spare patients with PTC from therapy with (131)I. This was a prospective study including 222 patients with PTC (except for microcarcinoma restricted to the thyroid and tumor with extensive extrathyroid invasion (pT4), aggressive histology, extensive lymph node (LN) involvement, or known residual disease). After thyroidectomy, all patients had nonstimulated Tg<0.3 ng/ml, negative antithyroglobulin antibodies (TgAb) and neck ultrasonography (US) showing no anomalies. Because of this finding, the patients were not submitted to ablation with (131)I. The time of follow-up ranged from 15 to 102 months (median 62 months). Of the 222 patients, 217 (97.7%) continued to have nonstimulated Tg <0.3 ng/ml and negative US. Tg was undetectable in the last assessment in 185 of these patients and detectable in 32. Five patients (2.2%) exhibited an increase in Tg, and LN metastases were detected in 4 (structural recurrence). One patient progressed to an increase in Tg, but disease was not detected by the imaging methods (biochemical recurrence). The results obtained here suggest that patients with PTC who have low nonstimulated Tg (measured with a second-generation assay and in the absence of TgAb) and negative neck US after thyroidectomy do not require ablation with (131)I. © 2016 Society for Endocrinology.

Antiangiogenic Tyrosine Kinase Inhibitors: Occurrence and Risk Factors of Hemoptysis in Refractory Thyroid Cancer.

PubMed

Lamartina, Livia; Ippolito, S; Danis, M; Bidault, F; Borget, I; Berdelou, A; Al Ghuzlan, A; Hartl, D; Blanchard, P; Terroir, M; Deandreis, D; Schlumberger, M; Baudin, E; Leboulleux, S

2016-07-01

Antiangiogenic tyrosine kinase inhibitors (TKIs) are the mainstay of advanced thyroid cancer (TC) treatment. Concern is rising about TKI-related toxicity. To determine the incidence and to investigate the risk factors of hemoptysis in TC patients during TKI treatment. We analyzed consecutive TC patients treated with TKI in our center between 2005 and 2013 and performed an independent review of computed tomography scan images for airway invasion assessment. Occurrence of grade 1-2 or grade 3-5 hemoptysis according to Common Terminology Criteria for Adverse Events version 4.03 and risk factors for hemoptysis were investigated. A total of 140 patients (89 males; median age, 52 y) with medullary (56%), differentiated (33%), and poorly differentiated (11%) TC were enrolled. Thyroidectomy±neck dissection was performed in 123 patients and neck/mediastinum external-beam radiotherapy in 41 (32% with therapeutic purpose and 68% with adjuvant purpose). Patients received from 1 to 4 lines of TKI (median 1). Median follow-up was 24 months. Airway invasion was found in 65 (46%) cases. Hemoptysis occurred in 9 patients: grade 1-2 in 7 cases (5%) and grade 3-5 in 2 (1.4%) cases (fatal in 1). Hemoptysis was associated with presence of airway invasion (P = .04), poorly differentiated pathology (P = .03), history of therapeutic external-beam radiotherapy (P = .003), and thyroidectomy without neck dissection (P = .02). Airway invasion, poorly differentiated pathology, therapeutic external-beam radiotherapy, and thyroidectomy without neck dissection are associated with and increased risk of hemoptysis in TC patients during antiangiogenic TKI treatment. Further research is needed to confirm this data and to sort out interactions between these risk factors. A careful assessment of airway invasion is mandatory before TKI introduction.

Graves' disease in children: long-term outcomes of medical therapy.

PubMed

Rabon, Shona; Burton, Amy M; White, Perrin C

2016-10-01

Management options are limited for the treatment of Graves' disease, and there is controversy regarding optimal treatment. We describe the demographic and biochemical characteristics of children with Graves' disease and the outcomes of its management. This is a retrospective study reviewing medical records from 2001 to 2011 at a tertiary-care paediatric hospital. Diagnostic criteria included elevated free T4 and total T3, suppressed TSH, and either positive thyroid-stimulating immunoglobulin or thyroid receptor antibodies or clinical signs suggestive of Graves' disease, for example exophthalmos. Patients were treated with antithyroid drugs (ATD), radioactive iodine, or thyroidectomy. The main outcome measures were remission after medical therapy for at least 6 months and subsequent relapse. A total of 291 children met diagnostic criteria. A total of 62 were male (21%); 117 (40%) were Hispanic, 90 (31%) Caucasian, and 59 (20%) African American. Mean age (±standard deviation) at diagnosis was 12·3 ± 3·8 (range 3-18·5) years. At diagnosis, 268 patients were started on an antithyroid drug and 23 underwent thyroid ablation or thyroidectomy. Fifty-seven (21%) children achieved remission and 16 (28%) of these patients relapsed, almost all within 16 months. Gender and ethnicity did not affect rates of remission or relapse. Of 251 patients treated with methimazole, 53 (21%) had an adverse reaction, including rash, arthralgias, elevated transaminases, or neutropenia. Most children with Graves' disease treated with ATD do not experience remission, but most remissions do not end in relapse. Adverse reactions to methimazole are common but generally mild. © 2016 John Wiley & Sons Ltd.

Clinicopathologic risk factors for right paraesophageal lymph node metastasis in patients with papillary thyroid carcinoma.

PubMed

Yu, Q A; Ma, D K; Liu, K P; Wang, P; Xie, C M; Wu, Y H; Dai, W J; Jiang, H C

2018-03-17

To investigate risk factors associated with right paraesophageal lymph node (RPELN) metastasis in patients with papillary thyroid carcinoma (PTC) and to determine the indications for right lymph node dissection. Clinicopathologic data from 829 patients (104 men and 725 women) with PTC, operated on by the same thyroid surgery team at the First Affiliated Hospital of Harbin Medical University from January 2013 to May 2017, were analyzed. Overall, 309 patients underwent total thyroidectomy with bilateral lymph node dissection, 488 underwent right thyroid lobe and isthmic resection with right central compartment lymph node dissection, and 32 underwent near-total thyroidectomy (ipsilateral thyroid lobectomy with contralateral near-total lobectomy) with bilateral lymph node dissection. The overall rate of central compartment lymph node metastasis was 43.5% (361/829), with right central compartment lymph node and RPELN metastasis rates of 35.5% (294/829) and 19.1% (158/829), respectively. Tumor size, number, invasion, and location, lymph node metastasis, right central compartment lymph node metastasis, and right lateral compartment lymph node metastasis were associated with RPELN in the univariate analysis, whereas age and sex were not. Multivariate analysis identified tumors with a diameter ≥ 1 cm, multiple tumors, tumors located in the right lobe, right central compartment lymph node metastasis, and right lateral compartment lymph node metastasis as independent risk factors for RPELN metastasis. Lymph node dissection, including RPELN dissection, should be performed for patients with PTC with a tumor diameter ≥ 1 cm, multiple tumors, right-lobe tumors, right central compartment lymph node metastasis, or suspected lateral compartment lymph node metastasis.

Modified robotic-assisted thyroidectomy: an initial experience with the retroauricular approach.

PubMed

Kandil, Emad; Saeed, Ahmad; Mohamed, Salah E; Alsaleh, Nuha; Aslam, Rizwan; Moulthrop, Thomas

2015-03-01

New approaches for robotic-assisted thyroidectomy, including the retroauricular approach, were recently described. We have modified the established surgical approach for retroauricular robotic thyroidectomy. Herein, we report our initial experience to identify challenges and limitations of this new surgical approach. Prospective case series. This study was performed under institutional review board approval for patients who underwent retroauricular robotic hemithyroidectomy at an academic North American institution. The retroauricular approach was modified by using the space between the two heads of the sternocleidomastoid muscle as our working space. Additionally, selected patients underwent concomitant neck lift surgery with robotic thyroid surgery. Clinical characteristics, total operative time, blood loss, surgical outcomes, and length of hospital stay were evaluated. Twelve female patients were included in this study. Mean age was 45 ± 4.43 years, and mean body mass index was 28.6 ± 2.15. Mean thyroid nodule size was 1.15 ± 0.26 cm(3). All cases were completed successfully via single retroauricular incision. There was no conversion to an open approach. Four out of 12 patients (33%) underwent additional concomitant neck lift surgery, with a mean total operative time of 156 ± 15.88 minutes. The mean operative time for the remaining eight patients who underwent the robotic approach without additional neck lift surgery was 145.4 ± 10.08 minutes. There were no cases of permanent vocal cord paralysis or permanent hypoparathyroidism. Mean blood loss was 22.4 ± 4.32 mL. Four patients (33%) were discharged home on the same day of surgery, and the remaining eight patients were discharged after an overnight stay. Single-incision retroauricular robotic hemithyroidectomy can be a safe and feasible alternative to other remote access techniques. Neck lift surgery can be performed safely in a select group of patients. However, future studies are warranted to further evaluate the benefits and limitations of this novel approach. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

The impact of antenatal care, iron–folic acid supplementation and tetanus toxoid vaccination during pregnancy on child mortality in Bangladesh

PubMed Central

Abir, Tanvir; Ogbo, Felix Akpojene; Stevens, Garry John; Page, Andrew Nicolas; Milton, Abul Hasnat; Agho, Kingsley Emwinyore

2017-01-01

Background Appropriate antenatal care (ANC) is an important preventive public health intervention to ensure women’s and newborn health outcomes. The study aimed to investigate the impact of ANC, iron–folic acid (IFA) supplementation and tetanus toxoid (TT) vaccination during pregnancy on child mortality in Bangladesh. Method A cross-sectional study of three datasets from the Bangladesh Demographic and Health Surveys for the years 2004, 2007 and 2011 were pooled and used for the analyses. A total weighted sample of 16,721 maternal responses (5,364 for 2004; 4,872 for 2007 and 6,485 for 2011) was used. Multivariate logistic models that adjusted for cluster and sampling weights were used to examine the impact of ANC, IFA supplementation and TT vaccination during pregnancy on the death of a child aged 0–28 days (neonatal), 1–11 months (post-neonatal) and 12–59 months (child). Results Multivariable analyses revealed that the odds of postnatal and under-5 mortality was lower in mothers who had ANC [Odds Ratio (OR) = 0.60, 95% confidence interval (95% CI): 0.43–0.85], IFA supplementation [OR = 0.66, 95% CI: (0.45–0.98)] and ≥2 TT vaccinations (OR = 0.43, 95% CI: 0.49–0.78) for post-natal mortality; and for under-5 mortality, any form of ANC (OR = 0.69, 95% CI: 0.51–0.93), IFA supplementation (OR = 0.67, 95% CI: 0.48–0.94) and ≥2 TT vaccinations (OR = 0.50, 95% CI: 0.36–0.69). When combined, TT vaccination with IFA supplementation, and TT vaccination without IFA supplementation were protective across all groups. Conclusion The study found that ANC, IFA supplementation, and TT vaccination during pregnancy reduced the likelihood of child mortality in Bangladesh. The findings suggest that considerable gains in improving child survival could be achieved through ensuring universal coverage of ANC, promoting TT vaccination during pregnancy and IFA supplementation among pregnant women in Bangladesh. PMID:29091923

A cluster randomized non-inferiority field trial on the immunogenicity and safety of tetanus toxoid vaccine kept in controlled temperature chain compared to cold chain.

PubMed

Juan-Giner, Aitana; Domicent, Camille; Langendorf, Céline; Roper, Martha H; Baoundoh, Paul; Fermon, Florence; Gakima, Primitive; Zipursky, Simona; Tamadji, Mbaihol; Grais, Rebecca F

2014-10-29

In resource-poor settings, cold chain requirements present barriers for vaccine delivery. We evaluated the immunogenicity and safety of tetanus toxoid (TT) vaccine in "Controlled Temperature Chain" (CTC; up to 40 °C for <30 days before administration), compared to standard cold chain (SCC; 2-8 °C). Prior to the study, stability parameters of TT-CTC were shown to meet international requirements. A cluster randomized, non-inferiority trial was conducted in Moïssala district, Chad, December 2012-March 2013. Thirty-four included clusters were randomized to CTC or SCC. Women aged 14-49 years, eligible for TT vaccination and with a history of ≤1 TT dose, received two TT doses 4 weeks apart. Participants were blinded to allocation strategy. Tetanus antibody titers were measured using standard ELISA at inclusion and 4 weeks post-TT2. Primary outcome measures were post-vaccination seroconversion and fold-increase in geometric mean concentrations (GMC). Non-inferiority was by seroconversion difference (TTSCC-TTCTC) <5% and ratio of GMCs (TTSCC/TTCTC) <1.5. Adverse events were monitored at health centers and at next contact with participants. A total of 2128 women (CTC=1068; SCC=1060) were recruited. Primary intention to vaccinate analysis included 1830 participants; 272 of these were included in the seroconversion analysis. Seroconversion was reached by >95% of participants; upper 95%CI of the difference was 5.6%. Increases in GMC were over 4-fold; upper 95%CI of GMC ratio was 1.36 in the adjusted analysis. Few adverse events were recorded. This study demonstrates the immunogenicity and safety of TT in CTC at <40 °C for <30 days. The high proportion of participants protected at baseline results in a reduction of power to detect a 5% non-inferiority margin. However, results at a 10% non-inferiority margin, the comparable GMC increases and vaccine's stability demonstrated in the preliminary phase indicate that CTC can be an alternative strategy for TT delivery in situations where cold chain cannot be maintained. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

To drain or not to drain? Predictors of tube thoracostomy insertion and outcomes associated with drainage of traumatic hemothoraces.

PubMed

Wells, Bryan J; Roberts, Derek J; Grondin, Sean; Navsaria, Pradeep H; Kirkpatrick, Andrew W; Dunham, Michael B; Ball, Chad G

2015-09-01

Historical data suggests that many traumatic hemothoraces (HTX) can be managed expectantly without tube thoracostomy (TT) drainage. The purpose of this study was to identify predictors of TT, including whether the quantity of pleural blood predicted tube placement, and to evaluate outcomes associated with TT versus expected management (EM) of traumatic HTXs. A retrospective cohort study of all trauma patients with HTXs and an Injury Severity Score (ISS) ≥12 managed at a level I trauma centre between April 1, 2005 and December 31, 2012 was completed. Mixed-effects models with a subject-specific random intercept were used to identify independent risk factors for TT. Logistic and log-linear regression were used to compute odds ratios (ORs) for mortality and empyema and percent increases in length of hospital and intensive care unit stay between patients managed with TT versus EM, respectively. A total of 635 patients with 749 HTXs were included in the study. Overall, 491 (66%) HTXs were drained while 258 (34%) were managed expectantly. Independent predictors of TT placement included concomitant ipsilateral flail chest [OR 3.03; 95% confidence interval (CI) 1.04-8.80; p=0.04] or pneumothorax (OR 6.19; 95% CI 1.79-21.5; p<0.01) and the size of the HTX (OR per 10cc increase 1.12; 95% CI 1.04-1.21; p<0.01). Although the adjusted odds of mortality were not significantly different between groups (OR 3.99; 95% CI 0.87-18.30; p=0.08), TT was associated with a 47.14% (95% CI, 25.57-69.71%; p<0.01) adjusted increase in hospital length of stay. Empyemas (n=29) only occurred among TT patients. Expectant management of traumatic HTX was associated with a shorter length of hospital stay, no empyemas, and no increase in mortality. Although EM of smaller HTXs may be safe, these findings must be confirmed by a large multi-centre cohort study and randomized controlled trials before they are used to guide practice. Copyright © 2015 Elsevier Ltd. All rights reserved.

Incidental diagnosis of tumor thrombosis on FDG PET/CT imaging.

PubMed

Erhamamci, S; Reyhan, M; Nursal, G N; Torun, N; Yapar, A F

2015-01-01

Clinical data are presented on patients with tumor thrombosis (TT) incidentally detected on FDG PET/CT imaging, as well as determining its prevalence and metabolic characteristics. Out of 12,500 consecutive PET/CT examinations of patients with malignancy, the PET/CT images of 15 patients with TT as an incidental finding were retrospectively investigated. A visual and semiquantitative analyses was performed on the PET/CT scans. An evaluation was made of the pattern of FDG uptake in the involved vessel as linear or focal via visual analyses. For the semiquantitative analyses, the metabolic activity was measured using SUVmax by drawing the region of interest at the site of the thrombosis and tumor (if any). The prevalence of occult TT was 0.12%. A total of 15 patients had various malignancies including renal (1 patient), liver (4), pancreas (2), stomach (1), colon (1), non-Hodgkin lymphoma (1), leiomyosarcoma (1), endometrial (1), ovarian (1), malign melanoma (1) and parotid (1). Nineteen vessels with TT were identified in 15 patients; three patients had more than one vessel. Various vessels were affected; the most common was the inferior vena cava (n=7) followed by the portal (n=5), renal (n=3), splenic (n=1), jugular (n=1), common iliac (n=1) and ovarian vein (n=1). The FDG uptake pattern was linear in 12 and focal in 3 patients. The mean SUVmax values in the TT and primary tumors were 8.40±4.56 and 13.77±6.80, respectively. Occult TT from various malignancies and locations was found incidentally in 0.12% of patients. Interesting cases with malign melanoma and parotid carcinoma and with TT in ovarian vein were first described by FDG PET/CT. Based on the linear FDG uptake pattern and high SUVmax value, PET/CT may accurately detect occult TT, help with the assessment of treatment response, contribute to correct tumor staging, and provide additional information on the survival rates of oncology patients. Copyright © 2015 Elsevier España, S.L.U. and SEMNIM. All rights reserved.

Laser interstitial thermal therapy for medically intractable mesial temporal lobe epilepsy.

PubMed

Kang, Joon Y; Wu, Chengyuan; Tracy, Joseph; Lorenzo, Matthew; Evans, James; Nei, Maromi; Skidmore, Christopher; Mintzer, Scott; Sharan, Ashwini D; Sperling, Michael R

2016-02-01

To describe mesial temporal lobe ablated volumes, verbal memory, and surgical outcomes in patients with medically intractable mesial temporal lobe epilepsy (mTLE) treated with magnetic resonance imaging (MRI)-guided stereotactic laser interstitial thermal therapy (LiTT). We prospectively tracked seizure outcome in 20 patients at Thomas Jefferson University Hospital with drug-resistant mTLE who underwent MRI-guided LiTT from December 2011 to December 2014. Surgical outcome was assessed at 6 months, 1 year, 2 years, and at the most recent visit. Volume-based analysis of ablated mesial temporal structures was conducted in 17 patients with mesial temporal sclerosis (MTS) and results were compared between the seizure-free and not seizure-free groups. Following LiTT, proportions of patients who were free of seizures impairing consciousness (including those with auras only) are as follows: 8 of 15 patients (53%, 95% confidence interval [CI] 30.1-75.2%) after 6 months, 4 of 11 patients (36.4%, 95% CI 14.9-64.8%) after 1 year, 3 of 5 patients (60%, 95% CI 22.9-88.4%) at 2-year follow-up. Median follow-up was 13.4 months after LiTT (range 1.3 months to 3.2 years). Seizure outcome after LiTT suggests an all or none response. Four patients had anterior temporal lobectomy (ATL) after LiTT; three are seizure-free. There were no differences in total ablated volume of the amygdalohippocampus complex or individual volumes of hippocampus, amygdala, entorhinal cortex, parahippocampal gyrus, and fusiform gyrus between seizure-free and non-seizure-free patients. Contextual verbal memory performance was preserved after LiTT, although decline in noncontextual memory task scores were noted. We conclude that MRI-guided stereotactic LiTT is a safe alternative to ATL in patients with medically intractable mTLE. Individualized assessment is warranted to determine whether the reduced odds of seizure freedom are worth the reduction in risk, discomfort, and recovery time. Larger prospective studies are needed to confirm our preliminary findings, and to define optimal ablation volume and ideal structures for ablation. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

Enhanced inhibitory effects of TBT chloride on the development of F1 rats.

PubMed

Asakawa, H; Tsunoda, M; Kaido, T; Hosokawa, M; Sugaya, C; Inoue, Y; Kudo, Y; Satoh, T; Katagiri, H; Akita, H; Saji, M; Wakasa, M; Negishi, T; Tashiro, T; Aizawa, Y

2010-05-01

Neurotoxicity is one of the major effects of tributyltin (TBT). The effects on the next generation of F(1) rats exposed to TBT via the placenta and their dams' milk may be stronger than those on adults. Pregnant Wister rats were exposed to TBT at 0 and 125 ppm in their food. Half of the female F(1) rats in both groups were exposed to TBT at 125 ppm in their food from 9 to 15 weeks of age. Female F(1) rats were divided into the following groups: the control-control (CC) group, with no exposure; the TBT-control (TC) group, exposed to TBT via the placenta and their dams' milk; the control-TBT (CT) group, exposed to TBT via their food from 9 to 15 weeks of age; and the TBT-TBT (TT) group, exposed to TBT via the placenta, their dams' milk, and their food (n = 10/group). After administration, an open-field test and prepulse inhibition (PPI) test were performed at 15 weeks of age. The mean body weights of the TC and TT groups were significantly lower than that of the CC group from 9 to 15 weeks of age. The mean relative thymus weight of the TC and TT groups was significantly lower than that of the CC group. In the open-field test, a marked decrease in the total locomotion distance was observed in the TT group. The mean values in the TT and TC groups were significantly lower than that in the CC group. For the locomotion distance between 15 and 20 min, the mean values in the CT, TC, and TT groups were significantly lower than that in the CC group. The mean locomotor distance between 25 and 30 min in the TT group was significantly lower than that in the CC and TC groups. The mean values of instances of wall rearing in the TC, CT, and TT groups were significantly lower than that in the CC group. The mean value of face washing or body washing in the TT group was significantly lower than that in the CT group. There were no significant differences in indexes of the PPI test. Exposure to TBT via the placenta and their dams' milk inhibited the development of F(1) rats, which continued after weaning. Inhibition of the rats' activity induced by exposure to TBT via the placenta and their dams' milk and/or via their food was suggested. The effects were most evident in the TT group.

Novel electrogram device with web-based service centre for ambulatory ECG monitoring.

PubMed

Tan, B Y; Ho, K L; Ching, C K; Teo, W S

2010-07-01

Arrhythmias are often intermittent, and a normal electrocardiogram (ECG) may not be diagnostic. The purpose of this study was to evaluate the usefulness of HeartWave500 (HW), a novel web-based ambulatory ECG monitoring device. A total of 120 patients from the National Heart Centre, Singapore were prospectively randomised in a three to one ratio to either HW or a standard transtelephonic (TT) event recorder. HW records five leads and transmits to an internet server, while TT transmits audio data to a central station. Monitoring was conducted for two weeks. The diagnostic yield was calculated in two ways: the percentage of patients successfully diagnosed as a function of time, and the absolute number of new diagnoses per patient per week. 33 patients (14 male, 19 female; mean age 49.6 + or - 11.1 years) were randomised to TT. 87 patients (32 male, 55 female; mean age 43.7 + or - 12.2 years) were randomised to HW. At the end of two weeks, the percentage of patients diagnosed with any arrhythmia was similar for both groups (66.7 percent for TT versus 67.8 percent for HW). There was a trend toward significance for the number of diagnoses per patient per week for Week 2 between TT and HW (0.58 + or - 0.75 versus 0.34 + or - 0.55, p is 0.06). Transmitted ECGs were read earlier for HW (18 minutes versus 1107 minutes, Mann-Whitney non-parametric test, p is less than 0.05). Transmitted recordings that were unreadable were also significantly lower for HW (8.0 percent versus 17.6 percent, chi-square test, p is less than 0.05). HW and TT have similar diagnostic yields. There is a trend toward a shorter monitoring time for HW. The ability of HW to record and transmit via the web, the earlier review of data and low unreadable data make HW an attractive alternative to TT.

Differential effects of donor and recipient IL28B and DDX58 SNPs on severity of HCV after liver transplantation.

PubMed

Biggins, Scott W; Trotter, James; Gralla, Jane; Burton, James R; Bambha, Kiran M; Dodge, Jennifer; Brocato, Megan; Cheng, Linling; McQueen, Matt; Forman, Lisa; Chang, Michael; Kam, Igal; Everson, Gregory; Spritz, Richard A; Klintmalm, Goran; Rosen, Hugo R

2013-05-01

IL28B single nucleotide polymorphisms are strongly associated with spontaneous HCV clearance and treatment response in non-transplant populations. A DDX58 single nucleotide polymorphism is associated with the antiviral response of innate lymphocytes. We aimed at evaluating the associations of donor and recipient IL28B (rs12979860 and rs8099917) and DDX58 (rs10813831) genotypes with severity of HCV recurrence after liver transplantation. In a case-control study of 523 liver transplantation recipients with HCV, we matched severe with mild recurrent HCV based on 2-year clinical and histologic follow-up. A total of 440 liver transplantation recipients (severe, n=235; mild, n=205) with recipient DNA and 225 (severe, n=123; mild, n=102) with both recipient and donor DNA were analyzed. IL28B [rs12979860, non-CC (vs. CC) and rs8099917, non-TT (vs. TT)] in the recipient-only analysis had higher risk of severe recurrent HCV [OR 1.57 and 1.58, p<0.05]. However, for the 225 with donor and recipient DNA, IL28B rs12979860 CC (vs. non-CC) and rs8099917 TT (vs. non-TT) and DDX58 rs10813831 non-GG (vs. GG) were associated with more (not less) severe recurrent HCV. The greatest risk of severe recurrent HCV was for rs12979860 CC donors in non-CC recipients (OR 7.02, p <0.001, vs. non-CC donor/recipient) and for rs8099917 TT donors in non-TT recipients (OR 5.78, p=0.001, vs. non-TT donor/recipient). These associations persisted after controlling for donor age, donor race, and donor risk index. IL28B and DDX58 single nucleotide polymorphisms that are favorable when present in the non-transplant setting or in the recipient are unfavorable when present in a donor liver graft. Copyright © 2013 European Association for the Study of the Liver. All rights reserved.

Robotic Thyroid Surgery: Current Perspectives and Future Considerations.

PubMed

Aidan, Patrick; Arora, Asit; Lorincz, Balazs; Tolley, Neil; Garas, George

2018-05-22

Robotic transaxillary thyroidectomy, pioneered in South Korea, is firmly established throughout the Far East but remains controversial in Western practice. This relates to important population differences (anthropometry and culture) compounded by the smaller mean size of thyroid nodules operated on in South Korea due to a national thyroid cancer screening programme. There is now level 2 evidence (including from Western World centres) to support the safety, feasibility, and equivalence of the robotic approach to its open counterpart in terms of recurrent laryngeal nerve injury, hypoparathyroidism, haemorrhage, and oncological outcomes for differentiated thyroid cancer. Moreover, robotic thyroidectomy has been shown to be superior to open surgery for certain patient-reported outcome measures, namely scar cosmesis and pain. Downsides include its high cost, longer operative time, and risk of complications not encountered in open thyroidectomy (brachial plexus neurapraxia). Careful patient selection is paramount as this procedure is not for every patient, surgeon, or hospital. It should only be undertaken by high-volume surgeons operating as part of a multidisciplinary robotic team in specialised centres. Novel robotic approaches utilising the retroauricular and transoral routes for thyroidectomy have recently been described but further studies are required to establish their respective role in modern thyroid surgery. © 2018 S. Karger AG, Basel.

Endoscopic thyroidectomy with the da Vinci robot system using the bilateral axillary breast approach (BABA) technique: our initial experience.

PubMed

Lee, Kyu Eun; Rao, Jaideepraj; Youn, Yeo-Kyu

2009-06-01

Robotic surgery is useful in areas with difficult access like the pelvis. The ideal indications for robotic surgery are still to be established. The neck area, especially the thyroid gland poses a difficult challenge for many endoscopic surgeons. Robotic surgery is useful in this area due to its excellent magnification and endowrist function. We present our initial experience with robotic endoscopic thyroidectomy using the bilateral axillary breast approach (BABA). Between March and May 2008, 15 patients diagnosed with papillary thyroid cancer underwent robotic-assisted endoscopic thyroidectomy using the BABA technique. The mean operating time was 218 minutes. There was a steady decrease in operative time from the initial case to the 15th case. The blood loss was minimal. The recurrent laryngeal nerve and parathyroid glands were identified in great detail with ease and preserved in all cases. There were no postoperative complications in any case. Robotic endoscopic thyroidectomy using the BABA technique is a feasible procedure and can be performed safely. It provides an excellent operative field view enabling easy identification of vital structures. It also gives the desired cosmetic results and minimal postoperative pain similar to conventional endoscopic thyroid surgery using the BABA technique.

Health economic changes as a result of implementation of targeted therapy for metastatic renal cell carcinoma: national results from DARENCA study 2.

PubMed

Soerensen, Anne V; Donskov, Frede; Kjellberg, Jakob; Ibsen, Rikke; Hermann, Gregers G; Jensen, Niels V; Fode, Kirsten; Geertsen, Poul F

2015-09-01

Limited data exist on the economic consequences of implementing targeted therapy (TT) for metastatic renal cell carcinoma (RCC) in a real-world setting. To analyze health care and productivity costs for TT implementation in a national cohort of patients. Costs were measured per patient per year during a 2-yr follow-up during 2002-2005 (immunotherapy only) and 2006-2009 (TT implementation). All Danish patients with a diagnosis code for RCC and a procedure code for TT or immunotherapy were linked to the Danish National Patient Registry (contains information on all contacts with primary and secondary health sector). Health care and productivity costs were retrieved from the Danish case-mix system and Coherent Social Statistics, respectively. Drug costs were calculated separately from procedure codes and retail prices. Generalized linear models were used to analyze costs adjusted for age, gender, and civil status. A total of 439 patients were included for 2006-2009 and 192 for 2002-2005. Comparison of the health care cost per patient per year between 2006-2009 and 2002-2005 revealed lower inpatient costs (€11 899 vs €19 944, adjusted relative risk [RR] 0.64), higher outpatient costs (€14 308 vs €6209, RR 2.39), lower radiotherapy costs (€194 vs €633, RR 0.31), higher radiology costs (€676 vs €191, RR 3.73), and higher separately calculated drug costs (€12 040 vs €3103, RR 3.82, all p<0.001) for the former. Total health care costs per patient per year did not significantly differ (€27 676 vs €27 856, RR 1.05, p=0.5) between the two periods. Income from employment did not significantly differ between 2006-2009 and 2002-2005 (RR 1.11, p=0.11) and costs associated with loss of productivity were €7852 and €8265, respectively. A different pattern of health care costs were observed but total health care costs per patient per year did not significantly differ after implementation of TT for patients with mRCC. In this nationwide study, we found changes in the pattern of health care costs for patients with metastatic kidney cancer after implementation of targeted therapy compared to an immunotherapy control period; however, total health care costs and income from employment were without significant changes. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Identification of late-onset hypogonadism in middle-aged and elderly men from a community of China

PubMed Central

Liu, Zhi-Yong; Zhou, Ren-Yuan; Lu, Xin; Zeng, Qin-Song; Wang, Hui-Qing; Li, Zheng; Sun, Ying-Hao

2016-01-01

In this study, we investigated the essential criteria for late-onset hypogonadism (LOH) syndrome based on the presence of symptoms associated with low testosterone levels in Han Chinese men. Blood tests for total testosterone (TT) and sex hormone–binding globulin (SHBG) were performed, and the aging male symptoms (AMS) questionnaire was conducted in a randomly selected cohort composed of 944 Chinese men aged 40 to 79 years from nine urban communities. Three sexual symptoms (decreased ability/frequency of sexual activity, decreased number of morning erections, and decreased libido) were confirmed to be related to the total and free testosterone levels. The thresholds for TT were approximately 12.55 nmol l−1 for a decreased ability/frequency to perform sex, 12.55 nmol l−1 for decreased frequency of morning erections, and 14.35 nmol l−1 for decreased sexual desire. The calculated free testosterone (CFT) thresholds for these three sexual symptoms were 281.14, 264.90, and 287.21 pmol l−1, respectively. TT <13.21 nmol l−1 (OR = 1.4, 95%CI: 1.0–1.9, P = 0.037) or CFT <268.89 pmol l−1 (OR = 1.5, 95%CI: 1.1–20, P = 0.020) was associated with an increase in the aforementioned three sexual symptoms. The prevalence of LOH was 9.1% under the criteria, including all three sexual symptoms with TT levels <13.21 nmol l−1 and CFT levels <268.89 pmol l−1. Our results may improve the diagnostic accuracy of LOH in older men. PMID:26354142

Autoimmune Alternating Hypo- and Hyperthyroidism in Children

PubMed Central

Mathew, Revi P.; Moore, Daniel J.

2013-01-01

Two children presented with autoimmune alternating hypo- and hyperthyroidism related to the presence of blocking and stimulating thyroid antibodies. It was difficult to control their thyroid function adequately with an appropriate single drug regimen, and both children underwent total thyroidectomy with subsequent stable management with levothyroxine replacement therapy postsurgically. Although this phenomenon is well described in adults, this report is the first of such occurrence in children. The possible mechanism for the variation in the type of clinical presentation and options for management are discussed. PMID:21700620

Post Thyroidectomy Suture Granuloma: A Cytological Diagnosis

PubMed Central

Javalgi, Anita P.; Arakeri, Surekha U.

2013-01-01

There are known post thyroidectomized complications, a suture granuloma being less frequent, with its late complication mimicking recurrent thyroid cancer. A suture granuloma is a benign, granulomatous inflammatory reaction that occurs due to the use of non absorbable suture. It constitutes one of the late complications which altogether make up less than 2% of its incidence. A suture granuloma is similar to a foreign body reaction and it usually develops slowly as a painless, palpable asymptomatic mass over the years. It mimics a cancer recurrence or a lymph node metastasis. Here, we are reporting a case of a post thyroidectomy suture granuloma in a 46 years old lady who presented with a painless swelling in the lateral neck, with a past history of thyroidectomy 5 years back. PMID:23730655

Subjective Measures of Exercise Intensity to Gauge Substrate Partitioning in Persons With Paraplegia

PubMed Central

Kressler, Jochen; Cowan, Rachel E.; Ginnity, Kelly; Nash, Mark S.

2012-01-01

Background: The Borg Rating of Perceived Exertion (RPE) Scale and talk test (TT) are commonly recommended for persons to gauge exercise intensity. It is not known whether they are suitable to estimate substrate partitioning between carbohydrate and fat in persons with SCI. Objective: Investigate substrate partitioning/utilization patterns associated with RPE and TT. Methods: Twelve participants with chronic paraplegia underwent 2 arm crank exercise tests on nonconsecutive days within 2 weeks. Test 1 was a graded exercise test (GXT) to volitional exhaustion. Test 2 was a 15-minute self-selected steady state (SS) voluntary arm exercise bout simulating a brief, yet typical exercise session. Results: For the GXT, very light intensity exercise (RPE < 9) and TT stage before last positive were associated with highest contribution of fat oxidation (~35%-50%) to total energy expenditure (TEE). Fat oxidation was low at all stages, with the highest rate (0.13 ± 0.07 g/min) occurring at stage 1 (10 W). Corresponding average RPE was 7 ± 2 and the TT was positive for all participants at this stage. For the SS, fuel partitioning throughout exercise was dominated by carbohydrate oxidation (1.47 ± 0.08 g/min), accounting for almost all (~94%) of TEE with only a minute contribution from fat oxidation (0.02 ± 0.004 g/min). A positive TT was associated with an average contribution of fat oxidation of ~10%. Conclusions: RPE but not the TT appears suitable to predict exercise intensities associated with the highest levels of fat oxidation. However, such intensities are below authoritative intensity thresholds for cardiorespiratory fitness promotion, and therefore the applicability of such a prediction for exercise prescriptions is likely limited to individuals with low exercise tolerance. PMID:23459243

Transplant Tourism Following the Declaration of Istanbul: Poor Outcomes and Nephrologist Dilemma.

PubMed

AlBugami, Meteb M; AlOtaibe, Fahad E; AlAbadi, Abdulnaser M; Hamawi, Khaled; Bel'eed-Akkari, Khalid

2017-10-14

Transplant tourism (TT) violates many international laws and documents. Despite all efforts, TT seems to be increasing. The aim of this study is to review outcomes of recipients of commercially transplanted kidneys since the Declaration of Istanbul. All recipients of kidney transplantation done abroad and then returned to our center, from September 2008 to December 2015, were included (tourists). Demographics and outcomes were collected from patients' charts. All data were compared with all recipients of living donor kidney transplants done at our center (locals). A total of 86 tourists and 365 locals were included. Both groups had similar age and gender. Re-grafting rates were the same, however, more preemptive transplants were done abroad. TT was increasing over time. Tourists presented early after TT, median 17.5 (IQR 7 - 30) days, and 47.7% were encountered initially in the emergency department. 1-year graft and patient survivals were significantly lower among tourists compared with locals (87.2% vs. 98.0%, P<0.001 and 90.7% vs. 98.0%, P<0.001, respectively). Tourists had a significantly higher rate of acute cellular rejection (19.8% vs. 7.1%, P<0.001), and they sustained significantly higher rates of serious viral, bacterial and fungal infections compared with the locals. TT seems to be increasing despite international condemnation and efforts to stop it. Outcomes are significantly worse when compared to local transplant recipients. Concerted effort is needed to better inform patients about the ethical and physical harms related to TT, and to point them towards ethically sound and medically safer alternatives. This article is protected by copyright. All rights reserved.

Concomitant use of warfarin and ticagrelor as an alternative to triple antithrombotic therapy after an acute coronary syndrome.

PubMed

Braun, Oscar Ö; Bico, Besim; Chaudhry, Uzma; Wagner, Henrik; Koul, Sasha; Tydén, Patrik; Scherstén, Fredrik; Jovinge, Stefan; Svensson, Peter J; Gustav Smith, J; van der Pals, Jesper

2015-01-01

Treatment with warfarin in combination with clopidogrel has been shown to reduce the incidence of major bleeding as compared to triple antithrombotic therapy (TT; warfarin, clopidogrel and aspirin). However, there are uncertainties regarding the risk for thrombosis since poor-responsiveness to clopidogrel is common. Ticagrelor is a more potent platelet inhibitor, but data supporting concurrent use of ticagrelor and warfarin (dual antithrombotic therapy, DT) is limited. This study therefore sought to evaluate the risk of bleeding and thrombosis associated with DT after an acute coronary syndrome (ACS). We identified all ACS patients on DT upon discharge from Helsingborg Hospital and Skåne University Hospital in Malmö and Lund, Sweden, during 2013. Patients on DT were compared with historical controls discharged with TT. Major bleeding was defined in accordance with the HAS-BLED derivation study. Patients were retrospectively followed for three months. In total, 107 DT patients were identified and compared with 159 controls on TT. Mean HAS-BLED bleeding risk score and duration of treatment were similar between the groups (HAS-BLED 2.2+/-0.8 vs 2.2+/-1.0 units, p=NS; duration 2.7+/-0.8 vs 2.5+/-0.9months, p=NS; DT vs TT). The incidence of spontaneous major bleeding was similar between the groups, as was a composite of all thrombotic events, i.e. peripheral embolism, stroke/TIA and acute coronary syndrome (bleeding 8/106 (7.5%) vs 11/157 (7.0%), p=NS; thrombosis 5/106 (4.7%) vs 5/157 (3.2%), p=NS; DT vs TT). Rates of thrombotic and bleeding events were similar in patients with TT and patients with ticagrelor and warfarin. Copyright © 2014 Elsevier Ltd. All rights reserved.

Outcome of peroral endoscopic myotomy in achalasia cardia: Experience with a new triangular knife.

PubMed

Nabi, Zaheer; Ramchandani, Mohan; Chavan, Radhika; Kalapala, Rakesh; Darisetty, Santosh; Reddy, D Nageshwar

2018-01-01

Peroral endoscopic myotomy (POEM) is a technically demanding procedure. Recently, a new triangular knife with integrated water jet function (TTJ) has been introduced. The present study was aimed to analyze and compare the operating time, efficacy, and adverse events (AEs) between the conventional (TT knife) and new knife (TTJ). All patients with achalasia cardia (AC) who underwent POEM between August 2015 and November 2016 were analyzed retrospectively. Operating time (OT), technical success, and AEs were assessed and compared between TT and TTJ knife. A total of 193 patients with AC underwent POEM during the specified period. Both groups had equivalent number of different subtypes of AC (I, II, and III). There was no difference in technical success between the two groups (TT, 99% vs TT, 98.9%). OT was significantly less in the TTJ group as compared to TT group (53.8 ± 15.2 vs 66.26 ± 19.2; P = 0.0001). On subanalysis, OT taken for submucosal tunneling was significantly less with TTJ knife (34.6 ± 10.1 vs 45.83 ± 14.80), whereas OT was similar for myotomy and clipping in both the groups. Significantly fewer use of coagulation forceps and exchanges of accessories were required in TTJ knife group (2.92 ± 1.77 vs 10.5 ± 3.58; P = 0.0001). There were no major AEs. Minor AEs were noted in 21.5% and 31% of patients in TTJ and TT knife groups, respectively. New triangular knife reduces procedure time and technical difficulty with POEM. POEM is an efficacious treatment for achalasia and can be safely executed in an endoscopy unit.

Outcome of peroral endoscopic myotomy in achalasia cardia: Experience with a new triangular knife

PubMed Central

Nabi, Zaheer; Ramchandani, Mohan; Chavan, Radhika; Kalapala, Rakesh; Darisetty, Santosh; Reddy, D. Nageshwar

2018-01-01

Background and Aim: Peroral endoscopic myotomy (POEM) is a technically demanding procedure. Recently, a new triangular knife with integrated water jet function (TTJ) has been introduced. The present study was aimed to analyze and compare the operating time, efficacy, and adverse events (AEs) between the conventional (TT knife) and new knife (TTJ). Patients and Methods: All patients with achalasia cardia (AC) who underwent POEM between August 2015 and November 2016 were analyzed retrospectively. Operating time (OT), technical success, and AEs were assessed and compared between TT and TTJ knife. Results: A total of 193 patients with AC underwent POEM during the specified period. Both groups had equivalent number of different subtypes of AC (I, II, and III). There was no difference in technical success between the two groups (TT, 99% vs TT, 98.9%). OT was significantly less in the TTJ group as compared to TT group (53.8 ± 15.2 vs 66.26 ± 19.2; P = 0.0001). On subanalysis, OT taken for submucosal tunneling was significantly less with TTJ knife (34.6 ± 10.1 vs 45.83 ± 14.80), whereas OT was similar for myotomy and clipping in both the groups. Significantly fewer use of coagulation forceps and exchanges of accessories were required in TTJ knife group (2.92 ± 1.77 vs 10.5 ± 3.58; P = 0.0001). There were no major AEs. Minor AEs were noted in 21.5% and 31% of patients in TTJ and TT knife groups, respectively. Conclusion: New triangular knife reduces procedure time and technical difficulty with POEM. POEM is an efficacious treatment for achalasia and can be safely executed in an endoscopy unit. PMID:29451180

40 CFR Table Tt-1 to Subpart Tt - Default DOC and Decay Rate Values for Industrial Waste Landfills

Code of Federal Regulations, 2012 CFR

2012-07-01

... Industrial Waste Landfills TT Table TT-1 to Subpart TT Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) MANDATORY GREENHOUSE GAS REPORTING Industrial Waste Landfills Pt. 98, Subpt. TT, Table TT Table TT-1 to Subpart TT—Default DOC and Decay Rate Values for Industrial...

The role of hypothyroidism in the etiology and progression of dilated cardiomyopathy in Doberman Pinschers.

PubMed

Beier, P; Reese, S; Holler, P J; Simak, J; Tater, G; Wess, G

2015-01-01

Hypothyroidism and dilated cardiomyopathy (DCM) are both common diseases in Doberman Pinschers. A possible influence of hypothyroidism on the etiology and progression of DCM is controversial. Evaluation of the role of hypothyroidism in etiology and progression of DCM. A total of 175 Doberman Pinschers. In this longitudinal prospective study, echocardiography and 24-hour ambulatory ECG recordings were performed in all dogs as screening tests for DCM. Total thyroxine (TT4 ) and thyroid ultrasonography served as initial screening tests for hypothyroidism and low TT4 values were followed up by a thyroid stimulating hormone (TSH) test or free total thyroxine (fT4 )/cTSH measurements. Additionally, a follow-up study of dogs affected by both DCM and hypothyroidism under optimal treatment for hypothyroidism was conducted. A total of 107 dogs were healthy, 45 dogs had DCM, 11 hypothyroidism, and 12 dogs had both DCM and hypothyroidism. TT4 values as well as the thyroid volumes were equivalent in the healthy dogs and in those with DCM. Neither ventricular premature complexes nor echocardiographic parameters differed between healthy and hypothyroid dogs. Dogs with DCM had a 2.26-fold (CI0.95 = 1.1-4.8) higher risk of also being affected by hypothyroidism. Despite optimal thyroid treatment of dogs with hypothyroidism and DCM, there was a progression of the heart disease. This study did not confirm a role of hypothyroidism in the etiology or progression of DCM. Treatment of hypothyroidism did not improve the clinical outcome. Copyright © 2014 by the American College of Veterinary Internal Medicine.

Effect of task familiarisation on distribution of energy during a 2000 m cycling time trial.

PubMed

Corbett, J; Barwood, M J; Parkhouse, K

2009-10-01

To investigate the effect of task familiarisation on the spontaneous pattern of energy expenditure during a series of 2000 m cycling time trials (TTs). Nine trained males completed three 2000 m TTs on a Velotron cycling ergometer. To examine pacing strategy, the data were assigned to 250 m "bins," with the pattern of aerobic and anaerobic energy expenditure calculated from total work accomplished and gas-exchange data. There were no significant differences between trials in performance times (191.4 (SD 4.3), 189.4 (4.6), 190.1 (5.6) s), total aerobic (58.3 (2.7), 58.4 (3.1), 58.0 (3.4) kJ) and total anaerobic energy expenditure (16.4 (3.3), 17.3 (2.8), 16.5 (3.1) kJ). Pacing strategy in the second and third TT differed from the first TT in that a lower power output was adopted during the first 500 m, enabling a higher power output during the final 750 m of the TT. This adjustment in the pattern of energy expenditure was mediated by an alteration in the pattern of anaerobic energy expenditure, which paralleled changes in total energy expenditure. Furthermore, participants retained an anaerobic energy "reserve" enabling an end-spurt during the second and third trials. Small modifications to the pacing strategy are made following a single bout of exercise, primarily by altering the rate of anaerobic energy expenditure. This may have served to prevent critical metabolic disturbances. The alteration in pacing strategy following the first exercise bout is compatible with a complex intelligent regulatory system.

MenAfriVac as an Antitetanus Vaccine

PubMed Central

Borrow, Ray; Tang, Yuxiao; Yakubu, Ahmadu; Kulkarni, Prasad S.; LaForce, F. Marc

2015-01-01

Background. The group A meningococcal conjugate vaccine, PsA-TT, uses tetanus toxoid (TT) as a carrier protein (PsA-TT). TT as a carrier protein in other conjugate vaccines is known to be immunogenic and generates a robust anti-TT response. Methods. Clinical studies in Africa assessed whether PsA-TT generated tetanus serologic responses when tested in African populations (toddlers to adults). Second, the high acceptance of PsA-TT mass immunization campaigns in the 1- to 29-year age group meant that a sizeable fraction of women of reproductive age received PsA-TT. Incidence data for neonatal tetanus were reviewed for countries with and without PsA-TT campaigns to check whether this had any impact on the incidence. Results. PsA-TT generated robust tetanus serologic responses in 1- to 29-year-olds, similar to those expected after a booster dose of TT. Neonatal cases of tetanus fell by 25% in countries that completed PsA-TT campaigns in 1- to 29-year-olds. Conclusions. Although these data are not yet definitive, they are consistent with the hypothesis that improved community immunity to tetanus as a result of the PsA-TT campaigns may be having an impact on the incidence of neonatal tetanus in sub-Saharan Africa. Clinical Trials Registration. ISRCTN17662153 (PsA-TT 001); ISRTCN78147026 (PsA-TT 002); ISRCTN87739946 (PsA-TT 003); ISRCTN46335400 (PsA-TT 003a); ISRCTN82484612 (PsA-TT 004); CTRI/2009/091/000368 (PsA-TT 005); PACTR ATMR2010030001913177 (PsA-TT 006); and PACTR201110000328305 (PsA-TT 007). PMID:26553690

Long-term immunogenicity and safety after a single dose of the quadrivalent meningococcal serogroups A, C, W, and Y tetanus toxoid conjugate vaccine in adolescents and adults: 5-year follow-up of an open, randomized trial.

PubMed

Borja-Tabora, Charissa Fay Corazon; Montalban, Cecilia; Memish, Ziad A; Boutriau, Dominique; Kolhe, Devayani; Miller, Jacqueline M; Van der Wielen, Marie

2015-10-06

Long-term protection against meningococcal disease is associated with persistence of post-vaccination antibodies at protective levels. We evaluated the bactericidal antibody persistence and safety of the quadrivalent meningococcal serogroups A, C, W and Y tetanus-toxoid conjugate vaccine (MenACWY-TT) and the meningococcal polysaccharide serogroups A, C, W, and Y vaccine (MenACWY-PS) up to 5 years post-vaccination. This phase IIb, open, randomized, controlled study conducted in the Philippines and Saudi Arabia consisted of a vaccination phase and a long-term persistence phase. Healthy adolescents and adults aged 11-55 years were randomized (3:1) to receive a single dose of MenACWY-TT (ACWY-TT group) or MenACWY-PS (Men-PS group). Primary and persistence results up to 3 years post-vaccination have been previously reported. Antibody responses against meningococcal serogroups A, C, W, and Y were assessed by a serum bactericidal antibody assay using rabbit complement (rSBA, cut-off titers 1:8 and 1:128) at Year 4 and Year 5 post-vaccination. Vaccine-related serious adverse events (SAEs) and cases of meningococcal disease were assessed up to Year 5. Of the 500 vaccinated participants, 404 returned for the Year 5 study visit (Total Cohort Year 5). For the Total Cohort Year 5, 71.6-90.0 and 64.9-86.3 % of MenACWY-TT recipients had rSBA titers ≥1:8 and ≥1:128, respectively, compared to 24.8-74.3 and 21.0-68.6 % of MenACWY-PS recipients. The rSBA geometric mean titers (GMTs) remained above the pre-vaccination levels in both treatment groups. Exploratory analyses suggested that both rSBA GMTs as well as the percentages of participants with rSBA titers above the cut-offs were higher in the ACWY-TT than in the Men-PS group for serogroups A, W and Y, with no apparent difference for MenC. No SAEs related to vaccination or cases of meningococcal disease were reported up to Year 5. These results suggest that a single dose of MenACWY-TT could protect at least 72 % of vaccinated adolescents and adults against meningococcal disease at least 5 years post-vaccination. ClinicalTrials.gov NCT00356369.

Cardiovascular morbidity and mortality after treatment of hyperthyroidism with either radioactive iodine or thyroidectomy.

PubMed

Ryodi, Essi; Metso, Saara; Huhtala, Heini; Välimäki, Matti; Auvinen, Anssi; Jaatinen, Pia

2018-06-08

BACKGROUND Hyperthyroid patients remain at an increased risk of cardiovascular diseases (CVDs) after restoring euthyroidism. The impact of the different treatment modalities of hyperthyroidism on future CVD risk remains unclear. The aim of this paper is to assess cardiovascular morbidity and mortality in hyperthyroidism before and after the treatment, and to compare the effects of two different treatment modalities, radioactive iodine (RAI) and thyroid surgery. METHODS A comparative cohort study was conducted among 6,148 hyperthyroid patients treated either with RAI or thyroidectomy, and 18,432 age- and gender-matched controls. Firstly, hospitalizations due to CVDs prior to the treatment were analyzed. Secondly, the hazard ratios (HR) for any new hospitalization and mortality due to CVDs after the treatment were estimated among all the hyperthyroid patients compared to the age- and gender-matched controls and also in the RAI-treated patients compared to the thyroidectomy-treated patients. The results were adjusted for prevalent CVDs at the time of treatment. RESULTS Before the treatment of hyperthyroidism, hospitalizations due to all CVDs were more common in the hyperthyroid patients compared to the controls (OR 1.61, 95% CI 1.49-1.73). During the post-treatment follow-up, hospitalizations due to CVDs remained more frequent among the patients (HR 1.15, 95% CI 1.09-1.21), but there was no difference in CVD mortality (HR 0.93, 95% CI 0.84-1.03). Compared to the patients treated with thyroidectomy, the RAI-treated patients had a higher risk of hospitalization due to all CVDs (HR 1.17), and atrial fibrillation (HR 1.28), as well as a higher CVD mortality (HR 2.56). Yet, treatment with RAI resulting in hypothyroidism was not associated with increased CVD morbidity compared with thyroidectomy. CONCLUSIONS Hyperthyroidism increases the risk of CVD-related hospitalization, and the risk is sustained for up to two decades after treatment with RAI or surgery. Hyperthyroid patients treated with RAI remain at a higher CVD risk compared to patients treated with thyroidectomy. Hypothyroidism during the follow-up, however, predicts better cardiovascular outcome.

Hypothalamic-Pituitary-Gonadal Axis in Aging Men and Women: Increasing Total Testosterone in Aging Men.

PubMed

Xia, Fangzhen; Wang, Ningjian; Han, Bing; Li, Qin; Chen, Yi; Zhu, Chunfang; Chen, Yingchao; Pu, Xiaoqi; Cang, Zhen; Zhu, Chaoxia; Lu, Meng; Meng, Ying; Guo, Hui; Chen, Chi; Lin, Dongping; Zheng, Junke; Kuang, Lin; Tu, Weiping; Li, Bin; Hu, Lin; Shen, Zhoujun; Lu, Yingli

2017-01-01

Aging is associated with variations in hypothalamic-pituitary-gonadal (HPG) axis hormones. However, it is not clear how aging changes these hormones. This study examined the natural alterations in the HPG axis in aging men and women in China. Data were obtained from our cross-sectional study (SPECT-China) in 16 areas of three provinces in East China between February and June 2014. There were 6,825 subjects selected, including 2,908 men and 3,917 women aged 25-93 years who had no diseases affecting HPG hormones and did not take exogenous supplements. Total testosterone (TT), estradiol (E2), free testosterone, sex hormone-binding globulin (SHBG), follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were measured. In men, the ranges of the 10-90th percentiles for each hormone were as follows: TT, 9.9-23.4 nmol/l; SHBG, 20.6-79.54 nmol/l; E2, 34.84-187 pmol/l. TT values were higher in men aged 25-30 years than in those aged 31-35 years and began to increase progressively at the age of 41-50 years until men reached their eighties. The unadjusted annual age trend (β) was 0.079 nmol/l/year (p < 0.001). A linear regression analysis, after full adjustment for demographic variables, metabolic factors, other hormones, lifestyle and co-morbidities, showed that higher TT levels were still associated with aging (p < 0.05). However, the ratio of TT to LH decreased with age (β = -0.272/year, p < 0.001). E2 and SHBG increased with age (β = 1.774 pmol/l/year and 1.118 nmol/l/year, respectively, p < 0.001). In women, the 10-90th percentile range of E2 was 32.79-565.8 pmol/l. E2 began to decrease at the age of 46-50 years, declined sharply at the age of 51-55 years (β = -5.73 pmol/l/year, p < 0.001) and then stabilized at a low concentration after the age of 55 years. The 10-90th percentile ranges of LH and FSH in men were 2.4-9.2 and 3.4-15.5 IU/l, and in women they were 3-36.6 and 4-89.28 IU/l, respectively. FSH increased by 7.11% per annum in men and by 12.76% per annum in women, but LH increased by only approximately 4.00% per annum in both sexes. The influence of aging on the HPG axis is sex dependent. The pattern of age-related TT was different in Chinese Han men when compared with previous studies in Western populations. TT values increased in aging men, so it is not suitable to estimate the life quality of older Chinese men just based on TT. © 2016 S. Karger AG, Basel.

Human Factor Investigation of Waste Processing System During the HI-SEAS 4 Month Mars Analog Mission in Support of NASA's Logistic Reduction and Repurposing Project: Trash to Gas

NASA Technical Reports Server (NTRS)

Caraccio, Anne; Hintze, Paul; Miles, John D.

2014-01-01

NASAs Logistics Reduction and Repurposing (LRR) project is a collaborative effort in which NASA is tasked with reducing total logistical mass through reduction, reuse and recycling of various wastes and components of long duration space missions and habitats. Trash to Gas (TtG) is a sub task to LRR with efforts focused on development of a technology that converts wastes generated during long duration space missions into high-value products such as methane, water for life support, raw material production feedstocks, and other energy sources. The reuse of discarded materials is a critical component to reducing overall mission mass. The 120 day Hawaii Space Exploration and Analog Simulation provides a unique opportunity to answer questions regarding crew interface and system analysis for designing and developing future flight-like versions of a TtG system. This paper will discuss the human factors that would affect the design of a TtG or other waste processing systems. An overview of the habitat, utility usage, and waste storage and generation is given. Crew time spent preparing trash for TtG processing was recorded. Gas concentrations were measured near the waste storage locations and at other locations in the habitat. In parallel with the analog mission, experimental processing of waste materials in a TtG reactor was performed in order to evaluate performance with realistic waste materials.

Omitting duodenal biopsy in children with suspected celiac disease and extra-intestinal symptoms.

PubMed

Bozzola, Mauro; Meazza, Cristina; Gertosio, Chiara; Pagani, Sara; Larizza, Daniela; Calcaterra, Valeria; Luinetti, Ombretta; Farello, Giovanni; Tinelli, Carmine; Iughetti, Lorenzo

2017-07-15

The aim of our study is to evaluate if in children with highly positive serology and HLA-DQ2/DQ8 (triple test, TT) and only extra-intestinal symptoms, it is possible to omit performing an intestinal biopsy for celiac disease (CD) diagnosis, as suggested by the new European Society for Pediatric Gastroenterology, Hepatology and Nutrition ESPGHAN guidelines. In this retrospective study a total of 105 patients, suspected of having CD because of extra-intestinal symptoms and showing serum tissue transglutaminase antibody (anti-tTG) and anti-endomysial antibody (EMA) measurements and HLA genotyping, were considered for the final analysis (33 boys and 72 girls; age range 1.5-17.6 years). Histological findings confirmed diagnosis of CD in 97 (92.4%) patients. Forty-one patients (39%) showed anti-tTG >10 times normal values, positive EMA and positive HLA-DQ2/DQ8 (positive TT). All of them had a diagnosis of CD, therefore there were no false positive cases. Sixty-four patients were negative for the TT. In eight cases, CD was ruled out and these were considered true negative cases. In the remaining 56 negative TT patients, intestinal biopsy confirmed CD diagnosis and they were considered false negatives. Based on these results, specificity for the TT was 100% and sensitivity was 42.3%. On the basis of the present study, diagnosis of CD can be reliably performed without a duodenal biopsy in children with only extra-intestinal symptoms.

Effect of unsaponifiable matter extracted from Pistacia khinjuk fruit oil on the oxidative stability of olive oil.

PubMed

Tavakoli, Javad; Estakhr, Parviz; Jelyani, Aniseh Zarei

2017-08-01

The present study was carried out to investigate the improvement of oxidative stability of refined olive oil using various concentrations of unsaponifiable matters extracted from Pistacia khinjuk fruit oil (UFO). For further elucidation of UFO antioxidative power, tertbutylhydroquinone (TBHQ) was used in an olive oil sample, too. Oxidative stability of olive oil samples without and with different levels of UFO (50, 100, 250, 500, 750 and 1000 ppm) and TBHQ (100 ppm) were studied via evaluation of conjugated diene value, carbonyl value, oil/oxidative stability index, acid value and total tocopherol (TT) contents through 8 h thermal process at 170 °C. Results obtained by oxidative stability assays revealed that the highest antioxidative activity of olive oil was obtained by 100 ppm of UFO, followed using 100, 250, 500, 750, and 1000 ppm of UFO and 100 ppm TBHQ, respectively. Evaluation of the relationship between oxidative stability indexes and TT changes indicated a strong correlation (R 2  = 0.9718) between mean relative resistance to oxidation and relative resistance to TT reduction during thermal process. By promotion of relative resistance to TT reduction, olive oil samples' relative resistance to oxidation was enhanced exponentially; implying importance of TT in promotion of oxidative stability of edible oils. The results obtained in this study showed that UFO has higher antioxidative activity compared to TBHQ; thus UFO can be considered as a natural antioxidant with ideal antioxidative activity.

Human Factor Investigation of Waste Processing System During the HI-SEAS 4-month Mars Analog Mission in Support of NASA's Logistic Reduction and Repurposing Project: Trash to Gas

NASA Technical Reports Server (NTRS)

Caraccio, Anne; Hintze, Paul E.; Miles, John D.

2014-01-01

NASA's Logistics Reduction and Repurposing (LRR) project is a collaborative effort in which NASA is tasked with reducing total logistical mass through reduction, reuse and recycling of various wastes and components of long duration space missions and habitats. Trash to Gas (TtG) is a sub task to LRR with efforts focused on development of a technology that converts wastes generated during long duration space missions into high-value products such as methane, water for life support, raw material production feedstocks, and other energy sources. The reuse of discarded materials is a critical component to reducing overall mission mass. The 120 day Hawaii Space Exploration and Analog Simulation provides a unique opportunity to answer questions regarding crew interface and system analysis for designing and developing future flight-like versions of a TtG system. This paper will discuss the human factors that would affect the design of a TtG or other waste processing systems. An overview of the habitat, utility usage, and waste storage and generation is given. Crew time spent preparing trash for TtG processing was recorded. Gas concentrations were measured near the waste storage locations and at other locations in the habitat. In parallel with the analog mission, experimental processing of waste materials in a TtG reactor was performed in order to evaluate performance with realistic waste materials.

TT-1, an analog of melittin, triggers apoptosis in human thyroid cancer TT cells via regulating caspase, Bcl-2 and Bax

PubMed Central

Wan, Lanlan; Zhang, Daqi; Zhang, Jinnan; Ren, Liqun

2018-01-01

Melittin is a 26 amino acid residue antimicrobial peptide with known antitumor activity. In the present study, a novel peptide TT-1, derived from melittin and contained only 11 amino acids, was designed, and its antitumor effect was investigated. The present study is aimed to elucidate the effects and relative mechanisms of TT-1 on a human thyroid cancer cell line (TT) in vitro and in vivo. Cell viability assays, Annexin V/propidium iodide assays, western blotting and quantitative reverse transcription polymerase chain reaction were performed. Furthermore, a tumor-xenograft model was established to investigate the apoptotic mechanisms of TT-1 on TT cells. The results obtained indicated that TT-1 was able to suppress the proliferation of TT cells and exhibited low cytotoxicity to normal thyroid cells in vitro. The apoptotic rates of TT cells were also increased following TT-1 treatment. Additionally, TT-1 stimulated caspase-3, caspase-9 and Bax, and inhibited B-cell lymphoma 2 mRNA and protein expression. Finally, it was also demonstrated that TT-1 is able to markedly suppress tumor growth in a TT-bearing nude mouse model. In summary, TT-1 may inhibit the proliferation of TT cells by inducing apoptosis in vitro and in vivo, indicating that TT-1 may be a potential candidate for the treatment of thyroid cancer. PMID:29387245

Effectiveness of preventative and other surgical measures on hypocalcemia following bilateral thyroid surgery: a systematic review and meta-analysis.

PubMed

Antakia, Ramez; Edafe, Ovie; Uttley, Lesley; Balasubramanian, Saba P

2015-01-01

A variety of measures have been proposed to reduce the incidence of post-thyroidectomy hypocalcemia. The aim of this study was to perform a systematic review and meta-analysis of preventive and other surgical measures on post-thyroidectomy hypocalcemia as reported in the literature. Comprehensive searches of the PubMed, EMBASE, and Cochrane databases were performed, and the quality of included papers was assessed using the Cochrane risk of bias tool or a modified Newcastle-Ottawa Scale (NOS). The results of all included studies were summarized, and meta-analyses were performed where appropriate. Thirty-nine randomized controlled trials (RCTs) and 37 observational studies were included. Measures studied included hemostatic techniques, extent of thyroidectomy and central neck dissection, surgical approach, calcium/vitamin D/thiazide diuretic supplements, parathyroid gland autotransplantation (PGAT) and intraoperative parathyroid gland (PG) identification, truncal ligation of inferior thyroid artery (ITA), preoperative magnesium infusion, and use of magnification loupes and Surgicel. Measures associated with significantly lower rates of transient hypocalcemia in meta-analysis were postoperative calcium and vitamin D supplementation compared to either calcium supplements alone (odds ratio (OR) 0.66; p=0.04) or no supplements (OR 0.34; p=0.007), and bilateral subtotal thyroidectomy (BST) compared to Hartley Dunhill (HD) procedure (OR 0.35; p=0.01). Meta-analyses did not demonstrate any measure to be significantly associated with a reduction in permanent hypocalcemia. This review identified postoperative calcium and vitamin D supplementation and bilateral subtotal thyroidectomy (over HD) as being effective in prevention of transient hypocalcemia. However, the majority of RCTs were of low quality, primarily due to a lack of blinding. The wide variability in study design, definitions of hypocalcemia, and methods of assessment prevented meaningful summation of results for permanent hypocalcemia.

Patient attitudes toward transaxillary robot-assisted thyroidectomy.

PubMed

Linos, Dimitrios; Kiriakopoulos, Andreas; Petralias, Athanassios

2013-08-01

The transaxillary robot-assisted technique constitutes an acceptable treatment option for patients requiring thyroidectomy. However, patients' attitudes toward this new technique have not yet been analyzed. A sample of 596 randomly selected patients who underwent thyroidectomy between January 2000 and March 2010 was assessed. We evaluated patients' attitudes toward transaxillary robot-assisted thyroidectomy, taking into account the validated Patient Scar Assessment Questionnaire, the SF-36 Health Survey Questionnaire, and 11 sociodemographic and surgical patient characteristics. Only 11.6 % of the patients would prefer to have been treated with the transaxillary method. Most patients had concerns that it would be a more painful procedure (39.2 %), and they expressed satisfaction with the existing esthetic outcome (29.1 %); other concerns were that the robotic approach would be of longer duration (25.4 %) and at higher cost (15.5 %). Nevertheless, the worse the appearance of the neck scar the more preferable is the new method (p = 0.025), a result that holds true irrespective of patients' physical health, the invasive procedure attained (conventional or minimal), and the presence of postoperative complications, among other characteristics. Patients diagnosed with a benign or uncertain neoplasm (p = 0.022) and younger patients (p = 0.003) held a more positive view of the new method. Patients who have undergone conventional thyroidectomy via the usual neck incision do not express a preference for the transaxillary method. The reasons given include various perceived disadvantages of the robotic procedure (increased pain, longer operative times, and higher cost). Younger patients, patients with poor appearance of their neck scar, and patients with benign thyroid pathology seem to hold a more positive attitude toward the robotic approach.

Trans-areola single-site endoscopic thyroidectomy: pilot study of 35 cases.

PubMed

Youben, Fan; Bo, Wu; Chunlin, Zhong; Jie, Kang; Bomin, Guo; Fan, Yang; Xianzhao, Deng; Qi, Zheng

2012-04-01

Endoscopic thyroidectomy via thoracic/breast approach is an acceptable and successful technique in Asia. This technique has the advantage of better cosmesis compared with open or even video-assisted thyroidectomy. Unfortunately, because of the need for three separate ports, conventional endoscopic thyroidectomy usually involves significantly more tissue dissection, and thus more injury to patients, limiting the popularity of this technique. We herein present 35 cases of trans-areola single-site endoscopic thyroidectomy (TASSET), which was first performed in 2009. Thirty-five patients who underwent TASSET for thyroid nodules from September 2009 to March 2011 were evaluated. The surgical outcomes of the surgery were retrospectively analyzed, including conversion, operative time, estimated blood loss, complications, length of stay, and patient satisfaction. Thirty-one of the 35 patients (88.5%) underwent successful TASSET, with subtotal lobectomy being the most common procedure. Median operative time for the surgery was 153.65 min (range 100-190 min). Estimated blood loss ranged from 20 to 40 mL. Length of postoperative stay ranged from 2 to 4 days (average 2.5 days). Visual analog scale scores were 0 to 4 without administration of analgesics. The complication rate was low (8.6%) and included one case of transient recurrent laryngeal nerve (RLN) palsy, one case of subcutaneous seroma, and one case of tracheal injury. All patients were satisfied with the cosmetic outcome after mean follow-up of 8 months. TASSET is feasible and safe, with great cosmetic benefits and less injury than other procedures. It may become an alternative procedure for treatment of patients with benign thyroid tumors, especially those with strong desire for cervical cosmesis.

Dietary calcium induced cytological and biochemical changes in thyroid.

PubMed

Chandra, Amar K; Goswami, Haimanti; Sengupta, Pallav

2012-09-01

Certain epidemiological studies revealed correlation between hard water consumption (with high calcium) and thyroid size of the population, though the possible alterations in thyroid physiology upon calcium exposure are still inconclusive. Adult male Wistar strain rats were subjected to calcium treatment at the doses of 0.5g%, 1.0g% and 1.5g% calcium chloride (CaCl(2)) for 60 days. The parameters studied were - thyroid gland weight, histopathology, histomorphometry; thyroid peroxidase (TPO), 5'-deiodinase I (DI), sodium-potassium adenosine triphosphatase (Na(+)-K(+)-ATPase) activities; serum total and free thyroxine (tT4, fT4), total and free triiodothyronine (tT3, fT3), thyroid stimulating hormone (TSH) levels. Enlargement of thyroid with hypertrophic and hyperplastic changes, retarded TPO and 5'-DI but enhanced Na(+)-K(+)-ATPase activities, augmented serum total and free T4 and TSH but decreased total and free T3 levels and low T3/T4 ratio (T3:T4) were observed in the treated groups. All these findings indicate development of goitrogenesis upon exposure to excessive dietary calcium. Copyright © 2012 Elsevier B.V. All rights reserved.

Cost analysis of intraoperative frozen section examinations in thyroid surgery in a Canadian tertiary center.

PubMed

Lai, Philip; Segall, Lorne; de Korompay, Nevin; Witterick, Ian; Freeman, Jeremy

2009-10-01

To perform a cost analysis of the routine intraoperative frozen section (FS) examinations in the management of patients undergoing thyroid surgery for unilateral thyroid nodules with benign or indeterminate cytology on preoperative fine-needle aspiration biopsies (FNABs). A retrospective chart review of 190 consecutive patients with unilateral thyroid nodules undergoing thyroid surgery was undertaken between March 2006 and March 2008. The results of FNAB, FS, and final histology were obtained from the pathology report. A cost analysis was performed to compare the cost of routine FS examinations to determine malignancy with the cost of performing a second surgical procedure. Of the 169 patients evaluated, there were 53 cases of malignant nodules. Malignancy was diagnosed by FS in 16 of these 53 cases, resulting in a total thyroidectomy and thereby avoiding the need for a completion thyroidectomy. The sensitivity and specificity of FS examination were 30.2% and 100.0%, respectively. The routine use of intraoperative FS examination in cases of benign or indeterminate nodules afforded a total cost savings of $3719.27, or a cost savings of $22.01 per patient. FS examination was useful in guiding our intraoperative management for patients with unilateral thyroid nodules with benign or indeterminate preoperative FNAB. The routine use of FS was cost-effective in our Canadian health care system, even without considering the intangible costs, such as patients' anxiety, emotional stress, and the loss of productivity owing to a second surgical procedure.

Dynamic Risk Stratification in Stage I Papillary Thyroid Cancer Patients Younger Than 45 Years of Age.

PubMed

Sung, Tae-Yon; Cho, Jae Won; Lee, Yu-Mi; Lee, Yi Ho; Kwon, Hyemi; Jeon, Min Ji; Kim, Won Gu; Choi, Young Jun; Song, Dong Eun; Chung, Ki-Wook; Yoon, Jong Ho; Hong, Suck Joon

2017-11-01

This study validated the dynamic risk stratification (DRS) system with regard to its association with structural recurrence and risk factors associated with non-excellent responses in patients <45 years with stage I classical papillary thyroid cancer (PTC). This historical cohort study included 598 patients with stage I classical PTC <45 years of age treated with total thyroidectomy followed by radioactive iodine remnant ablation (n = 440), total thyroidectomy without radioactive iodine remnant ablation (n = 23), and thyroid lobectomy alone (n = 135). The median follow-up period was 123 months. Structural recurrence occurred in 4.2% (n = 18/432) of the patients with an excellent response, 17.1% (18/105) of patients with an indeterminate response, 44.7% (17/38) of patients with a biochemically incomplete response, and 82.6% (19/23) of patients with a structurally incomplete response (p < 0.001) during the follow-up. The disease-free survival curves of each response showed significant differences (p < 0.001). Extensive extrathyroidal extension and extranodal extension were the independent risk factors associated with non-excellent response (p < 0.05). DRS may reduce unnecessary additional treatments by reclassifying initial risk estimates of structural recurrence. Furthermore, applying the risk factors associated with non-excellent response to initial therapy may be a more useful and viable surrogate of the risk for structural recurrence in stage I PTC patients <45 years of age.

A newly identified variation at the entry of the recurrent laryngeal nerve into the larynx.

PubMed

Shao, Tanglei; Yang, Weiping; Zhang, Tao; Wang, Yang; Jin, Xiaotai; Li, Qinyu; Kuang, Jie; Qiu, Weihua; Chu, Peiguo G; Yen, Yun

2010-12-01

We aimed to highlight a new anatomical variation of the recurrent laryngeal nerve (RLN), and to emphasize its implications for thyroid surgery. A prospective study was carried out in a group of 3,078 consecutive thyroidectomies from 1998 to 2008. Total, near-total, subtotal, and partial thyroidectomy were performed for various thyroid diseases. The RLN was routinely identified and exposed in its entire course until the entry into the larynx. The postoperative complications of patients with different variations were compared. 4,241 RLNs were successfully identified in all patients unilaterally or bilaterally. In addition to extralaryngeal branching and nonrecurrent laryngeal nerves, an unreported variation was identified in 44 RLNs (1.04%) at their entries into the larynx. The variation happened at the trunk or the branches of the RLN entering the larynx far from the posterior of cricothyroid joint, and the entry was higher than the superior cornu of the thyroid cartilage and the arch of the cricoid. The median distance from the entry to the posterior of cricothyroid joint was more than 5 mm. As the trunk or the branches had to travel along the lateral edge of the upper 1/3 of the thyroid before entering the larynx, the incidence of RLN palsy was higher than that in extralaryngeal branching variations (p < .05). This newly discovered variation of the RLN is more vulnerable to injury and should be brought to the attention of surgeons.

Encapsulated FVPTC: Are These Tumors Really Benign?

PubMed Central

Aburjania, Z; Jang, S; Montemayor-Garcia, C; Lloyd, RV; Schneider, DF; Sippel, RS; Chen, H; Elfenbein, DM

2017-01-01

OBJECTIVE Recent studies suggest that the encapsulated form of follicular variant papillary thyroid cancer (eFVPTC) behave more similarly to benign lesions and can be treated with thyroid lobectomy alone instead of total thyroidectomy. To distinguish aggressive cancers from more benign lesions more clearly, the objective of this study was to determine if the eFVPTC behaves less aggressively than the non-encapsulated variant (neFVPTC). METHODS A prospectively collected endocrine surgery database in our institution was reviewed for all patients with FVPTC on surgical pathology from 1999 to 2012. Samples were re-reviewed to determine if the tumor was eFVPTC or neFVPTC, which were correlated with patient outcomes. RESULTS Of the 68 patients, 59 (87%) had eFVPTC and 9 (13%) had neFVPTC. The mean age was 48 years and 63% were female. Fifty-four out of 64 patients (84%) who had a total thyroidectomy received radioactive iodine. The eFVPTC group had lower rates of cervical LN involvement (5% vs 22%, p=0.2504). The median follow-up time was 3 years (0–13y) and only 2 patients had recurrence, one with eFVPTC and one with neFVPTC. None of the patients had distant metastasis or died of their disease. CONCLUSION eFVPTCs appear to have a lower rate of cervical lymph node metastases compared to neFVPTCs, but recurrent disease may be seen in both subtypes. These findings suggest eFVPTC can be managed more conservatively. PMID:28807198

Robotic versus Open Thyroidectomy for Differentiated Thyroid Cancer: An Evidence-Based Review.

PubMed

Liu, Shirley Yuk Wah; Ng, Enders Kwok Wai

2016-01-01

While open thyroidectomy (OT) is advocated as the gold standard treatment for differentiated thyroid cancer, the contemporary use of robotic thyroidectomy (RT) is often controversial. Although RT combines the unique benefits of the surgical robot and remote access thyroidectomy, its applicability on cancer patients is challenged by the questionable oncological benefits and safety. This review aims to analyze the current literature evidence in comparing RT to OT on thyroid cancers for their perioperative and oncological outcomes. To date, no randomized controlled trial is available in comparing RT to OT. All published studies are nonrandomized or retrospective comparisons. Current data suggests that RT compares less favorably than OT for longer operative time, higher cost, and possibly inferior oncological control with lower number of central lymph nodes retrieved. In terms of morbidity, quality of life outcomes, and short-term recurrence rates, RT and OT are comparable. While conventional OT continues to be appropriate for most thyroid cancers, RT should better be continued by expert surgeons on selected patients who have low-risk thyroid cancers and have high expectations on cosmetic outcomes. Future research should embark on prospective randomized studies for unbiased comparisons. Long-term follow-up studies are also needed to evaluate outcomes on recurrence and survival.

Pharmacokinetics of total thyroxine after repeated oral administration of levothyroxine solution and its clinical efficacy in hypothyroid dogs.

PubMed

van Dijl, I C; Le Traon, G; van de Meulengraaf, B D A M; Burgaud, S; Horspool, L J I; Kooistra, H S

2014-01-01

Oral levothyroxine (l-T4 ) supplementation is commonly used to treat hypothyroid dogs. Investigate the plasma profile and pharmacokinetics of total thyroxine (tT4 ) after PO administration of a l-T4 solution and its clinical efficacy in hypothyroid dogs. Ten dogs with naturally occurring hypothyroidism. After hypothyroidism diagnosis and supplementation with l-T4 solution PO q24h at 20 μg/kg BW for minimum 4 weeks, the plasma profile and pharmacokinetics of tT4 were determined over 34 hours and the clinical condition of the dogs was evaluated. Before dosing for pharmacokinetic evaluation, mean tT4 concentration was 23 ± 9 nmol/L. l-T4 was absorbed rapidly (tmax , 5 hours), reaching a mean maximal tT4 concentration of 56 ± 11 nmol/L. The apparent terminal half-life was 11.8 hours. Clinical signs of hypothyroidism improved or resolved in all dogs after 4 weeks of treatment. The dosage of 20 μg/kg PO q24h was judged appropriate in 5 dogs, and 4 dogs required slight increases (9-16%). Twice daily treatment, with a 30% increase in dosage, was necessary for 1 dog. The pharmacokinetics of l-T4 in hypothyroid dogs was similar to that reported in healthy euthyroid dogs. Clinical and hormonal responses to l-T4 solution were rapid in all dogs. The starting dosage of 20 μg/kg PO q24h was suitable for maintenance supplementation in 50% of the dogs, minor dosage modification was required in 4 other dogs, and treatment q12h was required in 1 dog. Copyright © 2014 by the American College of Veterinary Internal Medicine.

Association of APOA5 -1131T>C polymorphism and serum lipid levels in patients with type 2 diabetes.

PubMed

Celap, Ivana; Simundic, Ana-Maria; Nikolac, Nora; Kackov, Sanja; Katalinic, Darko

2013-10-01

Significant abnormalities in lipid metabolism are frequently present in patients with type 2 diabetes mellitus (T2DM). Hypertriglyceridemia, a highly proatherogenic state, is associated with increased risk of coronary artery disease. Genetic polymorphism APOA5 -1131T>C has been recognized as a significant contributor to hypertriglyceridemia in both healthy and diabetic populations. The aim of the study was to investigate the association of APOA5 -1131T>C polymorphism with the serum levels of triglycerides, total cholesterol, high-density lipoprotein (HDL) cholesterol, and low-density lipoprotein (LDL) cholesterol in patients with T2DM. In total, 234 DNA samples from patients with T2DM were genotyped using the PCR-RFLP method. Serum lipid levels were measured using standard laboratory methods. Obtained APOA5 -1131T>C genotype frequencies were 89% (T/T) and 11% (T/C+C/C). There was no significant association between APOA5 -1131T>C genotypes and triglyceride levels (1.90 mM [1.32-2.74] vs. 1.78 mM [1.54-3.05] for T/T vs. T/C+C/C genotype; p=0.553), HDL cholesterol levels (1.30 mM [1.10-1.40] vs. 1.30 mM [1.05-1.40] for T/T vs. T/C+C/C; p=0.534), and LDL cholesterol levels (3.1 mM [2.3-3.8] vs. 3.0 mM [2.2-3.5] for T/T vs. T/C+C/C; p=0.313). Our results suggest that hypertriglyceridemia in patients with T2DM is not likely to be associated with the APOA5 -1131T>C polymorphism.

The Severity of Coronary Arterial Stenosis in Patients With Acute ST-Elevated Myocardial Infarction: A Thrombolytic Therapy Study

PubMed Central

Kilic, Salih; Kocabas, Umut; Can, Levent Hurkan; Yavuzgil, Oguz; Zoghi, Mehdi

2018-01-01

Background It is widely believed that ST-elevated myocardial infarction (STEMI) generally occurs at the site of mild to moderate coronary stenosis. The aim of this study was to determine the degree of stenosis of infarct-related artery (IRA) in STEMI patients who underwent coronary angiography (CAG) after successful reperfusion with thrombolytic therapy (TT). Methods A total of 463 consecutive patients between January 2008 and December 2013 with acute STEMI treated with TT were evaluated retrospectively. The patients in whom reperfusion failed (n = 120), death occurred before CAG (n = 12), IRA cannot be determined (n = 10), and CAG was not performed in index hospitalization (n = 54) were excluded from the study. To determine the severity of stenosis of IRA, two experienced cardiologists who were unaware of each other used quantitative CAG analysis. Significant stenosis was defined as a ≥ 50% stenosis in the coronary artery lumen. A total of 267 patients who were successfully reperfused with TT and in whom CAG was performed during hospitalization with median 8 (1 - 17) days after myocardial infarction were included in the study. Results The mean age of patients was 55.7 ± 10.8 years (85.5% male). Most of the patients had a significant stenosis in IRA ( ≥ 50%, n = 236, group 1) after successful TT; whereas only 11.6% had stenosis < 50% (n = 31, group 2). In addition, majority of the patients had ≥ 70.4% (n = 188, 70.4%) stenosis in IRA. Average of stenosis in IRA was 74±16%. Conclusions In contrast to the general opinion, we detected that majority of STEMI patients had a significant stenosis in IRA. PMID:29479380

Thyroid Disruption in Zebrafish Larvae by Short-Term Exposure to Bisphenol AF

PubMed Central

Tang, Tianle; Yang, Yang; Chen, Yawen; Tang, Wenhao; Wang, Fuqiang; Diao, Xiaoping

2015-01-01

Bisphenol AF (BPAF) is extensively used as a raw material in industry, resulting in its widespread distribution in the aqueous environment. However, the effect of BPAF on the hypothalamic-pituitary-thyroidal (HPT) axis remains unknown. For elucidating the disruptive effects of BPAF on thyroid function and expression of the representative genes along the HPT axis in zebrafish (Danio rerio) embryos, whole-body total 3,3′,5-triiodothyronine (TT3), total 3,5,3′,5′-tetraiodothyronine (TT4), free 3,3′,5-triiodothyronine (FT3) and free 3,5,3′,5′-tetraiodothyronine (FT4) levels were examined following 168 h post-fertilization exposure to different BPAF concentrations (0, 5, 50 and 500 μg/L). The results showed that whole-body TT3, TT4, FT3 and FT4 contents decreased significantly with the BPAF treatment, indicating an endocrine disruption of thyroid. The expression of thyroid-stimulating hormone-β and thyroglobulin genes increased after exposing to 50 μg/L BPAF in seven-day-old larvae. The expressions of thyronine deiodinases type 1, type 2 and transthyretin mRNAs were also significantly up-regulated, which were possibly associated with a deterioration of thyroid function. However, slc5a5 gene transcription was significantly down-regulated at 50 μg/L and 500 μg/L BPAF exposure. Furthermore, trα and trβ genes were down-regulated transcriptionally after BPAF exposure. It demonstrates that BPAF exposure triggered thyroid endocrine toxicity by altering the whole-body contents of thyroid hormones and changing the transcription of the genes involved in the HPT axis in zebrafish larvae. PMID:26501309

Sex Hormones and Sleep in Men and Women From the General Population: A Cross-Sectional Observational Study.

PubMed

Kische, Hanna; Ewert, Ralf; Fietze, Ingo; Gross, Stefan; Wallaschofski, Henri; Völzke, Henry; Dörr, Marcus; Nauck, Matthias; Obst, Anne; Stubbe, Beate; Penzel, Thomas; Haring, Robin

2016-11-01

Associations between sex hormones and sleep habits originate mainly from small and selected patient-based samples. We examined data from a population-based sample with various sleep characteristics and the major part of sex hormones measured by mass spectrometry. We used data from 204 men and 213 women of the cross-sectional Study of Health in Pomerania-TREND. Associations of total T (TT) and free T, androstenedione (ASD), estrone, estradiol (E2), dehydroepiandrosterone-sulphate, SHBG, and E2 to TT ratio with sleep measures (including total sleep time, sleep efficiency, wake after sleep onset, apnea-hypopnea index [AHI], Insomnia Severity Index, Epworth Sleepiness Scale, and Pittsburgh Sleep Quality Index) were assessed by sex-specific multivariable regression models. In men, age-adjusted associations of TT (odds ratio 0.62; 95% confidence interval (CI) 0.46-0.83), free T, and SHBG with AHI were rendered nonsignificant after multivariable adjustment. In multivariable analyses, ASD was associated with Epworth Sleepiness Scale (β-coefficient per SD increase in ASD: -0.71; 95% CI: -1.18 to -0.25). In women, multivariable analyses showed positive associations of dehydroepiandrosterone-sulphate with wake after sleep onset (β-coefficient: .16; 95% CI 0.03-0.28) and of E2 and E2 to TT ratio with Epworth Sleepiness Scale. Additionally, free T and SHBG were associated with AHI in multivariable models among premenopausal women. The present cross-sectional, population-based study observed sex-specific associations of androgens, E2, and SHBG with sleep apnea and daytime sleepiness. However, multivariable-adjusted analyses confirmed the impact of body composition and health-related lifestyle on the association between sex hormones and sleep.

Effects of buprenorphine in the adrenal, thyroid, and cytokine intra-operative responses in a rat model (Rattus norvegicus): a preliminary study

PubMed Central

Félix, Nuno M; Leal, Rodolfo O; Goy-Thollot, I; Walton, Ronald S; Gil, Solange A; Mateus, Luísa M; Matos, Ana S; Niza, Maria M R E

2017-01-01

Objective(s): Buprenorphine is a common analgesic in experimental research, due to effectiveness and having few side-effects, including a limited influence in the immune and endocrine systems. However, how buprenorphine affects cytokine levels and the adrenal and thyroid response during general anesthesia and surgery is incompletely understood. This study aimed to assess whether buprenorphine modulated significantly those responses in rats submitted to general anesthesia, mechanical ventilation, and surgical insertion of intravascular catheters. Materials and Methods: Animals were anesthetized with isoflurane, mechanically ventilated, and surgically instrumented for carotid artery and the femoral vein catheter placement. The test group (n=16), received buprenorphine subcutaneously before surgery, whereas the control group (n=16) received normal saline. Blood sampling to determine plasma levels of adrenocorticotropic hormone (ACTH), corticosterone (CS), total thyroxine (TT4), total triiodothyronine (TT3), thyroid-stimulating hormone (TSH), TNF-α, IL6, IL10, TNF-α, IL6, and IL10 mRNA was performed at 10 min after completion of all surgical procedures and at 90, 150, 240, and 300 min thereafter, with the animals still anesthetized and with mechanical ventilation. Results: Buprenorphine-treated animals had higher levels of ACTH, CS, and TT4 at several time points (P<0.05) and TSH and TT3 at all-time points (P<0.05). They also had increased IL10, TNF-α, and IL10 mRNA levels. Conclusion: In this model, buprenorphine significantly modulated the intra-operative cytokine and endocrine response to anesthesia, mechanical ventilation, and surgical placement of intravascular catheters. The mechanism and significance of these findings remain undetermined. Researchers should be aware of these effects when considering the use of buprenorphine for analgesic purposes. PMID:28804607

Operative outcomes of robot-assisted transaxillary thyroid surgery for benign thyroid disease: early experience in 50 patients.

PubMed

Axente, Dan Damian; Silaghi, Horatiu; Silaghi, Cristina Alina; Major, Zsigmond Zoltán; Micu, Carmen Maria; Constantea, Nicolae Augustin

2013-08-01

The main benefits of robot-assisted transaxillary thyroid surgery are to overcome the technical limitations of other endoscopic procedures for this surgical pathology and to avoid any cervical skin incision. This article describes the first experience of a Romanian team with the endoscopic robot-assisted thyroid surgery. We used the da Vinci SI intuitive surgical system to carry out 50 thyroid operations: 33 unilateral total lobectomies with isthmectomy (TL), 8 unilateral total lobectomies, with contralateral subtotal lobectomy, and 9 total thyroidectomies. Preoperatively, the patients were diagnosed with nodular goiter in 42 cases, nodular autoimmune thyroiditis in 3 cases, Basedow disease in 2 cases, toxic thyroid adenoma in 2 cases, and diffuse goiter in 1 case. We analyzed the clinical characteristics, size and location of the nodules, surgery duration, postoperative complications, pain medication, histopathological findings and postoperative cosmetic results. All surgical procedures were carried out without major incidents. One case required conversion to open approach. The mean length of surgery was 159 ± 38.2 min and the average console time was 68 ± 39.9 min; postoperatively, we recorded one case of transient brachial plexus neurapraxia, one transient vocal cord paresis, one transient hypocalcemia, and four postoperative wound complications. The final histopathological examination revealed two cases of well-differentiated carcinoma. This paper reports the largest series to date in Southeast Europe about robot-assisted transaxillary thyroidectomy. On a group of selected Caucasian patients, postoperative results were similar to open cervicotomy in terms of postoperative complications. The major cosmetic advantage is the absence of scar in the anterior cervical region.

Predictive factors for intraoperative excessive bleeding in Graves' disease.

PubMed

Yamanouchi, Kosho; Minami, Shigeki; Hayashida, Naomi; Sakimura, Chika; Kuroki, Tamotsu; Eguchi, Susumu

2015-01-01

In Graves' disease, because a thyroid tends to have extreme vascularity, the amount of intraoperative blood loss (AIOBL) becomes significant in some cases. We sought to elucidate the predictive factors of the AIOBL. A total of 197 patients underwent thyroidectomy for Graves' disease between 2002 and 2012. We evaluated clinical factors that would be potentially related to AIOBL retrospectively. The median period between disease onset and surgery was 16 months (range: 1-480 months). Conventional surgery was performed in 125 patients, whereas video-assisted surgery was performed in 72 patients. Subtotal and near-total/total thyroidectomies were performed in 137 patients and 60 patients, respectively. The median weight of the thyroid was 45 g (range: 7.3-480.0 g). Univariate analysis revealed that the strongest correlation of AIOBL was noted with the weight of thyroid (p < 0.001). Additionally, AIOBL was correlated positively with the period between disease onset and surgery (p < 0.001) and negatively with preoperative free T4 (p < 0.01). Multivariate analysis showed that only the weight of the thyroid was independently correlated with AIOBL (p < 0.001). Four patients (2.0%) needed blood transfusion, including two requiring autotransfusion, whose thyroids were all weighing in excess of 200 g. The amount of drainage during the initial 6 hours and days until drain removal was correlated positively with AIOBL (p < 0.001, each). Occurrences of postoperative complications, such as recurrent laryngeal nerve palsy or hypoparathyroidism, and postoperative hospital stay were not correlated with AIOBL. A huge goiter presented as a predictive factor for excessive bleeding during surgery for Graves' disease, and preparation for blood transfusion should be considered in cases where thyroids weigh more than 200 g. Copyright © 2014. Published by Elsevier Taiwan.

Sagittal tibiotalar translation and clinical outcomes in mobile and fixed-bearing total ankle replacement.

PubMed

Usuelli, Federico G; Manzi, Luigi; Brusaferri, Giovanni; Neher, Robert E; Guelfi, Matteo; Maccario, Camilla

2017-06-01

Sagittal implant malalignment after total ankle replacement (TAR) has been considered to be a possible cause for premature implant failure. In a prior study, the change over time of the tibiotalar ratio (T-T ratio), which is the ratio between the posterior longitudinal talar length and the full longitudinal talar length, was assessed in 66 TARs where an unconstrained, mobile-bearing implant was implanted. The analysis documented an increase in the T-T ratio between 2 and 6 months post-surgery (on average from 34.6% to 37.2%). We hypothesized that this change might have been related to the presence of a mobile-bearing insert. In order to test our hypothesis, we designed a study to compare the translation of the talus in TARs performed with an unconstrained, mobile-bearing implant (designated the "Mobile ankle") and those performed with a semi-constrained, fixed-bearing implant (designated the "Fixed ankle"). The study included 71 consecutive patients (71 ankles) who underwent TAR with the Mobile ankle and 24 consecutive patients (24 ankles) who received the Fixed ankle from May 2011 to December 2014. Patients were assessed clinically and radiologically preoperatively (T 0 ), at 6 months (T 2 ) and 12 months (T 3 ) post-surgery. There was also a radiological assessment at 2 months post-surgery (T 1 ). The comparison of the T-T ratio between the two implant groups and over time indicated an interaction between time and group, therefore the changes of the T-T ratio over time were affected by the implant type factor (P<0.001). The changes of the postoperative T-T ratio over time were not significant in the Fixed ankle group (35.7±6.7% at T 1 , T 2 , and T 3 ; P=1.0 for each pairwise comparison). In the Mobile ankle group, the T-T ratio at 2 months (34.4±5.5%) was significantly different to the T-T ratio at 6 months (37.0±5.8%; P<0.001; i.e. there was a significant posterior translation of the talus). The AOFAS score increased from preop to 12 months post-surgery in both the Mobile ankle (72.7±12.8 at 12 months; P<0.001) and the Fixed ankle (85.0±9.7 at 12 months; P<0.001). The significant posterior translation of the talus from 2 to 6 months documented only in the Mobile ankle group may have been associated with the presence of the mobile bearing interface. Copyright © 2016 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

[Pseudomalabsorption of levothyroxine: a case report].

PubMed

Pedrosa, William; Santana, Geraldo

2005-04-01

A 49-year-old woman who had been treated with sodium levothyroxine because of hypothyroidism after diagnosis of Hashimoto thyroiditis and total thyroidectomy for multinodular atoxic goiter was evaluated for persistent hypothyroidism despite the use of large doses of levothyroxine (600 microg/day). The patient showed signs and symptoms of hypothyroidism and her laboratory tests were: TSH of 351 microUI/mL, free thyroxine of 0.20 ng/dL, and total triiodothyronine of 27 ng/dL. She was submitted, under medical supervision, to a levothyroxine overload test with no evidence of malabsorption of the thyroid hormone. Diagnosis of factitious disorder and Munchausen syndrome leading to the pseudomalabsorption of levothyroxine was considered.

Is there a negative association between the content of condensed tannins, total phenols, and total tannins of tropical plant extracts and in vitro anthelmintic activity against Haemonchus contortus eggs?

PubMed

Castañeda-Ramírez, G S; Torres-Acosta, J F J; Sandoval-Castro, C A; González-Pech, P G; Parra-Tabla, V P; Mathieu, C

2017-12-01

In vitro studies using plant extracts suggest a relationship between their polyphenol contents and their anthelmintic (AH) activity against Haemonchus contortus. High polyphenol content appears to increase the efficacy of plant extracts against H. contortus as assessed by the larval exsheathment inhibition assay (LEIA) while appearing to reduce the AH efficacy measured using the egg hatch assay (EHA). In addition, some plants lack AH activity. Therefore, the present study investigated the relationship between the contents of condensed tannins (CT), total phenols (TP), and total tannins (TT) in methanol:water extracts (70:30) obtained from ten tropical plant species consumed by small ruminants as well as their AH activity against H. contortus evaluated by LEIA and EHA. Extracts of Acacia collinsii, Lysiloma latisiliquum, Havardia albicans, Senegalia gaumeri, Mimosa bahamensis, Piscidia piscipula, Acacia pennatula, Gymnopodium floribundum, Leucaena leucocephala, and Bunchosia swartziana were examined. Positive correlations were found between the effective concentration 50% (EC 50 ) (EHA) of extracts and their CT (r = 0.6809, P < 0.05, n = 10) and TP (r = 0.9152, P < 0.05, n = 10) content, suggesting that their concentration negatively affected AH activity against eggs. Based on the LEIA, there was no significant association between the EC 50 and the CT, TP, or TT of all extracts evaluated. Thus, if sheep and goats consume a complex feed mixture with high amounts of CT, TP, and TT, it might be difficult to observe an AH effect against H. contortus egg hatching. However, the AH effect upon L 3 establishment might be feasible.

The effects of added sulphur amino acids, threonine and an ideal amino acid ratio on nitrogen metabolism in mature, overweight dogs.

PubMed

Bohaty, Robin E; de Godoy, Maria R C; McLeod, Kyle R; Harmon, David L

2012-02-01

The objectives of this study were to investigate the effects of added essential amino acids in conjunction with a dietary lysine/MJ of 0.72 on nitrogen (N) metabolism in dogs. Treatments were; a control diet, a diet that provided an ideal amino acid profile (IAA), a diet with added total sulphur amino acids (TSAA), and a diet with added TSAA and threonine (TT). Diets were fed to eight overweight, mature, female hounds using a replicated 4 x 4 Latin Square design. Food intake was similar across treatments, however, food N intake was higher (p < 0.001) for TSAA than control, IAA or TT. Nitrogen absorbed was higher (p < 0.01) for TSAA than IAA and control. Urea N excretion was greater for control than TT (p < 0.05). Urine N excretion did not differ between diets. There were no differences in digestibility or N retention of diets. There were no differences in protein turnover, synthesis, or degradation. Blood metabolites were within normal ranges and did not differ due to dietary treatment. Based on the measurements made in this study, there is no benefit for added TSAA, TT or additional EAA in diets for mature dogs formulated to provide a 0.72 g lysine/MJ ME ratio.

Effects of dutasteride on lower urinary tract symptoms and general health in men with benign prostatic hypertroplasia and hypogonadism: a prospective study.

PubMed

Shigehara, Kazuyoshi; Koh, Eitetsu; Sakamoto, Jiro; Yaegashi, Hiroshi; Izumi, Koji; Ueno, Satoru; Kitagawa, Yasuhide; Maeda, Yuji; Kadono, Yoshifumi; Konaka, Hiroyuki; Mizokami, Atsushi; Nakashima, Takao; Namiki, Mikio

2014-03-01

We investigated the effects of the relative increase in testosterone by dutasteride administration in patients with benign prostatic hyperplasia and hypogonadism on urinary symptoms or androgen-responsive general health. Seventy-six patients were enrolled, and were taking 0.5 mg dutasteride daily for 52 weeks. Before and after treatment, all participants underwent blood test, and body mass index, prostate volume (PV), bone mineral density (BMD), post-voiding residual (PVR) volume, and muscle volume were measured. All patients responded to the questionnaires: International prostatic symptom score (IPSS), Overactive Bladder Symptom score (OABSS). Patients were divided into two groups according to the increase rate of total testosterone (TT): group A, ≥20% increase in TT level; group B, <20% increase or decrease. Baseline TT and free testosterone (FT) levels were significantly lower in group A than group B. Both groups showed marked improvement in PV and PVR. Group A showed significant improvement in IPSS and OABSS with a significant increase of FT level, whereas group B showed no significant change. Dutasteride treatment contributed to a significant increase in BMD in group A. Dutasteride treatment significantly improved urinary symptoms and BMD in patients with low baseline serum TT and FT levels.

Cerebral peduncle tumor ablated by novel 3-mm laser tip.

PubMed

Xu, David S; Rosenfeld, Amy; Ponce, Francisco A; Nakaji, Peter; Bhardwaj, Ratan D

2015-01-01

Decisions to use open surgery or radiotherapy in pediatric patients with familial neoplastic syndromes must consider not only the symptomatic benefits of treatment, but also future limitations these treatments may impose. Specifically, open surgical resection of noncurable tumors may preclude or encumber future lesion resections, while radiotherapy has detrimental effects on pediatric cognitive development and increases the risk of future malignancy development. We provide the first report of using a novel 3.0-mm diffusing laser tip with laser-induced thermal therapy (LiTT) to treat a pediatric patient with neurofibromatosis type 1 (NF-1). A 12-year-old boy with NF-1 presented with a progressively enlarging lesion in the right midbrain. A stereotactic biopsy was performed, followed by LiTT with a novel 3.0-mm laser applicator. MRI 1 week after LiTT showed stable gross total ablation of the lesion with reduction in fluid-attenuated inversion recovery signal. The patient remained neurologically intact 6 months after his procedure, and follow-up MRI showed no evidence of recurrence. LiTT is a powerful adjunct to conventional open surgical and radiotherapy modalities in the treatment of patients with familial neoplastic syndromes or incurable lesions. The novel laser applicator tip described expands the treatment scope of this technique. © 2015 S. Karger AG, Basel.

Clinicopathologic assessment of hypogonadism in men with type 2 diabetes mellitus

PubMed Central

Ugwu, Theophilus E.; Ikem, Rosemary T.; Kolawole, Babatope A.; Ezeani, Ignatius U.

2016-01-01

Objective: To determine the prevalence of hypogonadism in men with type 2 diabetes mellitus and evaluate its clinical and pathologic correlates. Subjects and Methods: In a cross-sectional survey of 200 type 2 diabetic males aged 32–69 years, total testosterone (TT), follicle stimulating hormone, luteinizing hormone, waist circumference (WC), glycated hemoglobin, and lipids were measured. Clinical assessment of androgen deficiency was done using the androgen deficiency in aging male (ADAM) questionnaire. Overt hypogonadism was defined as a combination of positive ADAM score and TT < 8 nmol/L while possible hypogonadism was defined as positive ADAM score with TT 8–12 nmol/L. Results: Overt and possible hypogonadism occurred in 29.5% and 23% of the participants, respectively. Majority (76.3%) of the subjects who had overt hypogonadism had the hypogonadotrophic pattern. Hypogonadal subjects were significantly older (P = 0.014) and had higher mean WC (P = 0.009) than eugonadal ones. Erectile dysfunction was the most common symptom, occurring in 79.7% of overtly hypogonadal subjects. There was a significant negative correlation between WC and serum TT (r = −0.41, P = 0.001). Conclusion: There is a high frequency of symptomatic hypogonadism in men with type 2 diabetes and the frequency increases with advancing age and visceral adiposity. PMID:27730078

Near-infrared autofluorescence imaging to detect parathyroid glands in thyroid surgery.

PubMed

Ladurner, R; Al Arabi, N; Guendogar, U; Hallfeldt, Kkj; Stepp, H; Gallwas, Jks

2018-01-01

Objective To identify and save parathyroid glands during thyroidectomy by displaying their autofluorescence. Methods Autofluorescence imaging was carried out during thyroidectomy with and without central lymph node dissection. After visual recognition by the surgeon, the parathyroid glands and the surrounding tissue were exposed to near-infrared light with a wavelength of 690-770 nm using a modified Karl Storz near infrared/indocyanine green endoscopic system. Parathyroid tissue was expected to show near infrared autofluorescence at 820 nm, captured in the blue channel of the camera. Results We investigated 41 parathyroid glands from 20 patients; 37 glands were identified correctly based on near-infrared autofluorescence. Neither lymph nodes nor thyroid revealed substantial autofluorescence and nor did adipose tissue. Conclusions Parathyroid tissue is characterised by showing autofluorescence in the near-infrared spectrum. This effect can be used to identify and preserve parathyroid glands during thyroidectomy.

Effect of recombinant human thyroid stimulating hormone on serum thyroxin and thyroid scintigraphy in euthyroid cats.

PubMed

van Hoek, Ingrid M; Peremans, Kathelijne; Vandermeulen, Eva; Duchateau, Luc; Gommeren, Kris; Daminet, Sylvie

2009-04-01

This study investigated the thyroidal response to administration of recombinant human thyroid stimulating hormone (rhTSH) by means of serum total thyroxine (TT(4)) concentration and pertechnetate uptake by the thyroid gland in six healthy euthyroid spayed female cats. A pertechnetate scan was performed on day 1 to calculate thyroid/salivary gland (T/S) uptake ratio. On day 3, 25 microg rhTSH was injected intravenously. Six hours later the thyroid scan was repeated as on day 1. Blood was drawn for serum TT(4) measurement prior to injection of rhTSH and performance of the pertechnetate scan. Statistically significant differences in mean serum TT(4) concentration, T/S uptake ratio before and 6h after rhTSH administration and T/S uptake ratio between left and right lobes were noted. We can conclude that 25 microg rhTSH increases pertechnetate uptake in the thyroid glands of cats, this should be taken into account when thyroid scintigraphy after rhTSH administration is interpreted.

Coordination preference and magnetic properties of FeII assemblies with a bis-azole bearing 1,2,4-triazole and tetrazole

NASA Astrophysics Data System (ADS)

Naik, Anil D.; Railliet, Antoine P.; Dîrtu, Marinela M.; Garcia, Yann

2012-03-01

With a new bis-azole molecular fragment ( Htt) bearing 1,2,4-triazole and tetrazole, a mononuclear complex [Fe(tt)2(H2O)4]·2H2O ( 1), a trinuclear complex [Fe3(tt)6(H2O)6]·2H2O ( 2) and a 1D coordination polymer [Fe(tt)(Htt)2]BF4·2CH3OH ( 3) were obtained by varying reaction conditions. Htt acts either as an anionic or neutral ligand depending upon the reaction medium and pH. Thermal variation of spin states of 1- 3 were investigated in the range 77-300 K by 57Fe Mössbauer spectroscopy. 1 totally remains in high-spin state over the entire temperature range whereas no spin crossover was evidenced in 2. Nearly 1:1 high-spin and low-spin population ratio is found in 3, which remains constant over the entire temperature range investigated.

Measurement of the tt¯W and tt¯Z production cross sections in pp collisions at √s = 8 TeV with the ATLAS detector

DOE PAGES

Aad, G.; Abbott, B.; Abdallah, J.; ...

2015-11-24

The production cross sections of top-quark pairs in association with massive vector bosons have been measured using data from pp collisions at √s = 8 TeV. The dataset corresponds to an integrated luminosity of 20.3 fb –1 collected by the ATLAS detector in 2012 at the LHC. Final states with two, three or four leptons are considered. A fit to the data considering the tt¯W and tt¯Z processes simultaneously yields a significance of 5.0σ (4.2σ) over the background-only hypothesis for tt¯W (tt¯Z) production. The measured cross sections are σ tt¯W = 369 +100 –91 fband σ tt¯Z =176 +58 –52more » fb. The background-only hypothesis with neither tt¯W nor tt¯Z production is excluded at 7.1σ. As a result, all measurements are consistent with next-to-leading-order calculations for the tt¯W and tt¯Z processes.« less

Postoperative pain after one-visit root-canal treatment on teeth with vital pulps: Comparison of three different obturation technique

PubMed Central

Alonso-Ezpeleta, Luis O.; Gasco-Garcia, Carmen; Castellanos-Cosano, Lizett; Martín-González, Jenifer; López-Frías, Francsico J.

2012-01-01

Objectives. To investigate and compare postoperative pain after one-visit root canal treatment (RCT) on teeth with vital pulps using three different obturation techniques. Study Design. Two hundred and four patients (105 men and 99 women) aged 12 to 77 years were randomly assigned into three treatments groups: cold lateral compaction of gutta-percha (LC), Thermafil technique (TT), and Backfill - Thermafil obturation technique (BT). Postoperative pain was recorded on a visual analogue scale (VAS) of 0 - 10 after 2 and 6 hours, and 1, 2, 3, 4, 5, 6 and 7 days. Data were statistically analyzed using multivariate logistic regression analysis. Results. In the total sample, 87% of patients experienced discomfort or pain in some moment between RCT and the seventh day. The discomfort experienced was weak, light, moderate and intense in 6%, 44%, 20% and 6% of the cases, respectively. Mean pain levels were 0.4 ± 0.4, 0.4 ± 0.3, and 1.4 ± 0.7 in LC, BT, and TT groups, respectively. Patients of TT group experienced a significantly higher mean pain level compared to other two groups (p < 0.0001). In TT group, all patients felt some level of pain at six hours after RCT. Conclusions. Postoperative pain was significantly associated with the obturation technique used during root canal treatment. Patients whose teeth were filled with Thermafil obturators (TT technique) showed significantly higher levels of discomfort than patients whose teeth were filled using any of the other two techniques. Key words:Postoperative pain, root-canal obturation, root-canal treatment, Thermafil. PMID:22322522

EFFECT OF THERAPEUTIC TOUCH ON PAIN RELATED PARAMETERS IN PATIENTS WITH CANCER: A RANDOMIZED CLINICAL TRIAL.

PubMed

Tabatabaee, Amir; Tafreshi, Mansoureh Zagheri; Rassouli, Maryam; Aledavood, Seyed Amir; AlaviMajd, Hamid; Farahmand, Seyed Kazem

2016-06-01

In patients with cancer, pain may influence their life style, and feeling of satisfaction and comfort, leading to fatigue, and cause impairment of their quality of life, personal relationships, sleep and daily activities. The aim of this study was to evaluate the effect of therapeutic touch (TT) on pain related parameters of in patients with cancer. In a randomized clinical trial a total of 90 male patients referring to Specialized Oncology Hospital in Mashhad, were conveniently selected and randomly divided into three intervention, placebo, and control groups. The intervention consisted of TT in 7 sessions for a 4-week period. The data were collected using a demographic questionnaire along with the Brief Pain Inventory, which were then analyzed and compared using Kruskal-Wallis and Mann-Whitney tests. By comparing scores parameters of pain scales (general activity, mood, walking ability, relations with other people and sleep) in the three groups, there was no significant difference at the beginning of the first session. However, a significant difference was observed at the end of TT sessions between the three groups (p= 0.001). Furthermore, the groups were compared two-by-two by using Mann-Whitney test and Bonferroni correction, and the result indicated significant differences between the two intervention and placebo groups as well as between the two intervention and control groups. The results of the study showed that TT had a positive impact on the positive management of pain related parameters in cancer patients. Therefore, TT is suggested to be used by healthcare providers as a complementary method for managing pain and its parameters.

Toothguide Trainer tests with color vision deficiency simulation monitor.

PubMed

Borbély, Judit; Varsányi, Balázs; Fejérdy, Pál; Hermann, Péter; Jakstat, Holger A

2010-01-01

The aim of this study was to evaluate whether simulated severe red and green color vision deficiency (CVD) influenced color matching results and to investigate whether training with Toothguide Trainer (TT) computer program enabled better color matching results. A total of 31 color normal dental students participated in the study. Every participant had to pass the Ishihara Test. Participants with a red/green color vision deficiency were excluded. A lecture on tooth color matching was given, and individual training with TT was performed. To measure the individual tooth color matching results in normal and color deficient display modes, the TT final exam was displayed on a calibrated monitor that served as a hardware-based method of simulating protanopy and deuteranopy. Data from the TT final exams were collected in normal and in severe red and green CVD-simulating monitor display modes. Color difference values for each participant in each display mode were computed (∑ΔE(ab)(*)), and the respective means and standard deviations were calculated. The Student's t-test was used in statistical evaluation. Participants made larger ΔE(ab)(*) errors in severe color vision deficient display modes than in the normal monitor mode. TT tests showed significant (p<0.05) difference in the tooth color matching results of severe green color vision deficiency simulation mode compared to normal vision mode. Students' shade matching results were significantly better after training (p=0.009). Computer-simulated severe color vision deficiency mode resulted in significantly worse color matching quality compared to normal color vision mode. Toothguide Trainer computer program improved color matching results. Copyright © 2010 Elsevier Ltd. All rights reserved.

Testosterone deficiency: a determinant of aortic stiffness in men.

PubMed

Vlachopoulos, Charalambos; Ioakeimidis, Nikolaos; Miner, Martin; Aggelis, Athanassios; Pietri, Panagiota; Terentes-Printzios, Dimitrios; Tsekoura, Dorothea; Stefanadis, Christodoulos

2014-03-01

Low testosterone levels and increased aortic stiffness are predictors of cardiovascular events. The influence of androgen level on the age- and blood pressure-related increase in aortic stiffness is unknown. From January 2007 to June 2011 we enrolled 455 consecutive men with no evidence of cardiovascular disease from a large cohort followed in our Department for arterial function studies. Their total testosterone (TT) levels were measured and carotid-femoral pulse wave velocity (PWVc-f) was measured as an index of aortic stiffness. In multivariable analysis, PWVc-f values were inversely correlated to TT after adjustment for confounders (β = -0.365, P < 0.001). In younger age categories (<50 yrs and 50-59 yrs), patients with testosterone deficiency (TD) had higher blood pressure-adjusted PWVc-f (P < 0.001 and P = 0.005, respectively) compared to subjects with normal TT, indicating an "aging effect" of 10 years, whereas in older age categories such a difference was not observed. Furthermore, in men with a higher mean pressure (102-108 mmHg and >108 mmHg), patients with TD had higher age-adjusted PWVc-f (P < 0.001) compared to subjects with normal TT, indicating a synergistic unfavorable effect of testosterone deficiency and blood pressure on aortic stiffness. TT levels are independently associated with aortic stiffening. The effect of low testosterone concentration on aortic stiffness is more prominent in young men and in subjects with higher blood pressure levels. These findings identify testosterone as a marker of arterial damage with special emphasis on young and hypertensive individuals and support its role as predictor of events. Copyright © 2014. Published by Elsevier Ireland Ltd.

Radioiodine Accumulation in a Giant Ovarian Cystadenofibroma Detected Incidentally by 131-I Whole Body Scans

PubMed Central

Mebarki, Mohammed; Menemani, Abdelghani; Medjahedi, Abdelkader; Boualou, Fouad; Slama, Abdelhak; Ouguirti, Sarah; Kherbouche, Fatima Zahra; Berber, Nécib

2012-01-01

Ovarian cystadenofibroma is a relatively rare tumor; it is usually asymptomatic and is found incidentally. We present the case of a 24-year-old female patient, who had undergone total thyroidectomy for thyroid papillary carcinoma, with an asymptomatic giant cystadenofibroma, incidentally discovered by diagnostic 131I-SPECT/CT WBSs. We summarize the clinical history, imaging data, and histopathological study on a rare case of radioiodine accumulation in cystadenofibroma, and we discuss the mechanism of uptake of radioiodine in this case. PMID:23119215

Use of spiral computed tomography volumetry for determining the operative approach in patients with Graves' disease.

PubMed

Choi, June Young; Lee, Kyu Eun; Koo, Do Hoon; Kim, Kyu Hyung; Kim, Eun young; Bae, Dong Sik; Jung, Sung Eun; Youn, Yeo-Kyu

2014-03-01

The purposes of the present study were to assess (1) the correlation between the weight of the postoperative thyroid specimen and the spiral computed tomography (CT) volumetry results of the thyroid gland in patients with Graves' disease, and (2) the utility of CT volumetry for determining the operative approach. From 2009 to 2010, a total of 56 patients with Graves' disease underwent total or subtotal thyroidectomy. An enhanced spiral CT was taken in all patients prior to the operation. From 2.5 mm-thick slices of the thyroid gland, the surface area was calculated to measure the volume of the thyroid gland. The glandular volume was compared to the weight of the postoperative thyroid specimen. A total of 42 and 14 patients underwent total and subtotal thyroidectomy, respectively. The mean weight of the postoperative thyroid specimen was 43.9 ± 33.4 g, and the mean volume obtained by CT volumetry was 44.2 ± 32.8 mL. A good correlation was observed between the weight of the postoperative thyroid specimen and the volume calculated by CT (r = 0.98, p < 0.001). When 100 mL was set as the higher cut-off value of the thyroid volume for minimally invasive thyroid surgery, the estimated blood loss showed a significant difference between the >100 mL and the ≤100 mL groups (608.3 ± 540.8 vs. 119.7 ± 110.4 mL; p = 0.036). Spiral CT volumetry may be used to measure the thyroid volume reliably in patients with Graves' disease. For cases in which surgery is indicated in patients with Graves' disease, CT volumetry provides useful information from which to determine the operative approach. One hundred milliliter or less of thyroid volume in CT volumetry is recommended to perform minimally invasive thyroid surgery.

Normalization of Testosterone Levels After Testosterone Replacement Therapy Is Associated With Decreased Incidence of Atrial Fibrillation.

PubMed

Sharma, Rishi; Oni, Olurinde A; Gupta, Kamal; Sharma, Mukut; Sharma, Ram; Singh, Vikas; Parashara, Deepak; Kamalakar, Surineni; Dawn, Buddhadeb; Chen, Guoqing; Ambrose, John A; Barua, Rajat S

2017-05-09

Atrial fibrillation (AF) is the most common cardiac dysrhythmia associated with significant morbidity and mortality. Several small studies have reported that low serum total testosterone (TT) levels were associated with a higher incidence of AF. In contrast, it is also reported that anabolic steroid use is associated with an increase in the risk of AF. To date, no study has explored the effect of testosterone normalization on new incidence of AF after testosterone replacement therapy (TRT) in patients with low testosterone. Using data from the Veterans Administrations Corporate Data Warehouse, we identified a national cohort of 76 639 veterans with low TT levels and divided them into 3 groups. Group 1 had TRT resulting in normalization of TT levels (normalized TRT), group 2 had TRT without normalization of TT levels (nonnormalized TRT), and group 3 did not receive TRT (no TRT). Propensity score-weighted stabilized inverse probability of treatment weighting Cox proportional hazard methods were used for analysis of the data from these groups to determine the association between post-TRT levels of TT and the incidence of AF. Group 1 (40 856 patients, median age 66 years) had significantly lower risk of AF than group 2 (23 939 patients, median age 65 years; hazard ratio 0.90, 95% CI 0.81-0.99, P =0.0255) and group 3 (11 853 patients, median age 67 years; hazard ratio 0.79, 95% CI 0.70-0.89, P =0.0001). There was no statistical difference between groups 2 and 3 (hazard ratio 0.89, 95% CI 0.78- 1.0009, P =0.0675) in incidence of AF. These novel results suggest that normalization of TT levels after TRT is associated with a significant decrease in the incidence of AF. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Assessment of thyroid function in dogs with low plasma thyroxine concentration.

PubMed

Diaz Espineira, M M; Mol, J A; Peeters, M E; Pollak, Y W E A; Iversen, L; van Dijk, J E; Rijnberk, A; Kooistra, H S

2007-01-01

Differentiation between hypothyroidism and nonthyroidal illness in dogs poses specific problems, because plasma total thyroxine (TT4) concentrations are often low in nonthyroidal illness, and plasma thyroid stimulating hormone (TSH) concentrations are frequently not high in primary hypothyroidism. The serum concentrations of the common basal biochemical variables (TT4, freeT4 [fT4], and TSH) overlap between dogs with hypothyroidism and dogs with nonthyroidal illness, but, with stimulation tests and quantitative measurement of thyroidal 99mTcO4(-) uptake, differentiation will be possible. In 30 dogs with low plasma TT4 concentration, the final diagnosis was based upon histopathologic examination of thyroid tissue obtained by biopsy. Fourteen dogs had primary hypothyroidism, and 13 dogs had nonthyroidal illness. Two dogs had secondary hypothyroidism, and 1 dog had metastatic thyroid cancer. The diagnostic value was assessed for (1) plasma concentrations of TT4, fT4, and TSH; (2) TSH-stimulation test; (3) plasma TSH concentration after stimulation with TSH-releasing hormone (TRH); (4) occurrence of thyroglobulin antibodies (TgAbs); and (5) thyroidal 99mTcO4(-) uptake. Plasma concentrations of TT4, fT4, TSH, and the hormone pairs TT4/TSH and fT4/TSH overlapped in the 2 groups, whereas, with TgAbs, there was 1 false-negative result. Results of the TSH- and TRH-stimulation tests did not meet earlier established diagnostic criteria, overlapped, or both. With a quantitative measurement of thyroidal 99mTcO4(-) uptake, there was no overlap between dogs with primary hypothyroidism and dogs with nonthyroidal illness. The results of this study confirm earlier observations that, in dogs, accurate biochemical diagnosis of primary hypothyroidism poses specific problems. Previous studies, in which the TSH-stimulation test was used as the "gold standard" for the diagnosis of hypothyroidism may have suffered from misclassification. Quantitative measurement of thyroidal 99mTcO- uptake has the highest discriminatory power with regard to the differentiation between primary hypothyroidism and nonthyroidal illness.

Choline Intake, Plasma Riboflavin, and the Phosphatidylethanolamine N-Methyltransferase G5465A Genotype Predict Plasma Homocysteine in Folate-Deplete Mexican-American Men with the Methylenetetrahydrofolate Reductase 677TT Genotype12

PubMed Central

Caudill, Marie A.; Dellschaft, Neele; Solis, Claudia; Hinkis, Sabrina; Ivanov, Alexandre A.; Nash-Barboza, Susan; Randall, Katharine E.; Jackson, Brandi; Solomita, Gina N.; Vermeylen, Francoise

2009-01-01

We previously showed that provision of the folate recommended dietary allowance and either 300, 550, 1100, or 2200 mg/d choline for 12 wk resulted in diminished folate status and a tripling of plasma total homocysteine (tHcy) in men with the methylenetetrahydrofolate reductase (MTHFR) 677TT genotype. However, the substantial variation in tHcy within the 677TT genotype at wk 12 implied that several factors were interacting with this genotype to affect homocysteine. As an extension of this work, the present study sought to identify the main predictors of wk-12 plasma tHcy, alone and together with the MTHFR C677T genotype (29 TT, 31 CC), using linear regression analysis. A basic model explaining 82.5% of the variation (i.e. adjusted R2 = 0.825) was constructed. However, the effects of the variables within this model were dependent upon the MTHFR C677T genotype (P for interaction ≤ 0.021). Within the 677TT genotype, serum folate (P = 0.005) and plasma riboflavin (P = 0.002) were strong negative predictors (inversely related) explaining 12 and 15%, respectively, of the variation in tHcy, whereas choline intake (P = 0.003) and serum creatinine (P < 0.001) were strong positive predictors, explaining 19 and 25% of the variation. None of these variables, except creatinine (P = 0.021), correlated with tHcy within the 677CC genotype. Of the 8 additional polymorphisms tested, none appeared to influence tHcy. However, when creatinine was not in the model, the phosphatidylethanolamine N-methyltransferase 5465G→A variant predicted lower tHcy (P < 0.001); an effect confined to the MTHFR 677TT genotype. Thus, in folate-deplete men, several factors with roles in 1-carbon metabolism interact with the MTHFR C677T genotype to affect plasma tHcy. PMID:19211833

Multilevel Analysis of Trachomatous Trichiasis and Corneal Opacity in Nigeria: The Role of Environmental and Climatic Risk Factors on the Distribution of Disease.

PubMed

Smith, Jennifer L; Sivasubramaniam, Selvaraj; Rabiu, Mansur M; Kyari, Fatima; Solomon, Anthony W; Gilbert, Clare

2015-01-01

The distribution of trachoma in Nigeria is spatially heterogeneous, with large-scale trends observed across the country and more local variation within areas. Relative contributions of individual and cluster-level risk factors to the geographic distribution of disease remain largely unknown. The primary aim of this analysis is to assess the relationship between climatic factors and trachomatous trichiasis (TT) and/or corneal opacity (CO) due to trachoma in Nigeria, while accounting for the effects of individual risk factors and spatial correlation. In addition, we explore the relative importance of variation in the risk of trichiasis and/or corneal opacity (TT/CO) at different levels. Data from the 2007 National Blindness and Visual Impairment Survey were used for this analysis, which included a nationally representative sample of adults aged 40 years and above. Complete data were available from 304 clusters selected using a multi-stage stratified cluster-random sampling strategy. All participants (13,543 individuals) were interviewed and examined by an ophthalmologist for the presence or absence of TT and CO. In addition to field-collected data, remotely sensed climatic data were extracted for each cluster and used to fit Bayesian hierarchical logistic models to disease outcome. The risk of TT/CO was associated with factors at both the individual and cluster levels, with approximately 14% of the total variation attributed to the cluster level. Beyond established individual risk factors (age, gender and occupation), there was strong evidence that environmental/climatic factors at the cluster-level (lower precipitation, higher land surface temperature, higher mean annual temperature and rural classification) were also associated with a greater risk of TT/CO. This study establishes the importance of large-scale risk factors in the geographical distribution of TT/CO in Nigeria, supporting anecdotal evidence that environmental conditions are associated with increased risk in this context and highlighting their potential use in improving estimates of disease burden at large scales.

The Association Among Hypogonadism, Symptom Burden, and Survival in Male Patients with Advanced Cancer

PubMed Central

Dev, R; Hui, D; Del Fabbro, E; Delgado-Guay, MO; Sobti, N; Dalal, S; Bruera, E

2014-01-01

Background A high frequency of hypogonadism has been reported in male patients with advanced cancer. Objectives To evaluate the association among low testosterone, symptom burden and survival in cancer patients. Methods 119/131 (91%) consecutive male cancer patients had an endocrine evaluation of total/free/bioavailable testosterone (TT, FT, BT, respectively), high-sensitivity C-reactive protein (CRP), vitamin B12, thyroid stimulating hormone, 25-hydroxy vitamin D and cortisol levels when presenting with symptoms of fatigue and/or anorexia-cachexia. Symptoms were evaluated by the Edmonton Symptom Assessment Scale. We examined the correlation with Spearman test and survival with log rank test and Cox-regression analysis. Results The median age was 64; majority were white 85 (71%). Median TT was 209ng/dL (normal ≥200 ng/dL), FT was 4.4 ng/dL (normal ≥9 ng/dL), and BT was 22.0 ng/dL (normal ≥61ng/dL). Low TT, FT, and BT values were all associated with worse fatigue (p≤0.04), poor performance status (p≤0.05), weight loss (p≤0.01), and opioid use (p≤0.005). Low TT and FT were associated with increased anxiety (p≤0.04), decreased feeling of well-being (p≤0.04), and increased dyspnea (p≤0.05); while BT was only associated with anorexia (p=0.05). Decreased TT, FT, and BT values were all significantly associated with elevated CRP, low albumin and hemoglobin. In multivariate analysis, decreased survival was associated with low TT (HR 1.66; p=0.034), declining ECOG performance status (HR 1.55; p=0.004), high CRP (HR 3.28; p<0.001), and decreased albumin (HR 2.52; p<0.001). Conclusion In male cancer patients, low testosterone was associated with systemic inflammation, weight loss, increased symptom burden, and decreased survival. PMID:24577665

Thrombophilic genetic factors PAI-1 4G-4G and MTHFR 677TT as risk factors of alcohol, cryptogenic liver cirrhosis and portal vein thrombosis, in a Caucasian population.

PubMed

D'Amico, Mario; Pasta, Francesca; Pasta, Linda

2015-08-15

The thrombophilic genetic factors (THRGFs), PAI-1 4G-4G, MTHFR 677TT, V Leiden 506Q and Prothrombin 20210A, were studied as risk factors in 865 Caucasian patients with liver cirrhosis, consecutively enrolled from June 2008 to January 2014. A total of 582 HCV, 80 HBV, 94 alcohol, (82 with more than one etiologic factor) and 191 cryptogenic patients with liver cirrhosis had been consecutively enrolled; 243 patients showed portal vein thrombosis (PVT). At least one of the above THRGFs was present in 339/865 patients (39.2%). PAI-1 4G-4G and MTHFR 677TT were the most frequent THRGFs, statistically significant in patients with alcohol, cryptogenic liver cirrhosis, and PVT: respectively 24 and 28, 50 and 73, and 65 and 83 (all chi-square tests>3.84, and p values<0.05). Two logistic regression analysis, using PAI-1 4G-4G and MTHFR 677TT, as dependent variable, confirmed the independent significant relationship of these THRGFs with alcohol, cryptogenic liver cirrhosis and PVT. PAI 1 and MTHFR 677 genotypes, deviated from those expected in populations in Hardy-Weinberg equilibrium (all p values<0.05), in the subgroups of patients with alcohol, cryptogenic liver cirrhosis and presence of PVT. Our study shows the pivotal role of PAI-1 4G-4G and MTHFR 677TT in patients with alcohol, cryptogenic liver cirrhosis, and PVT, in a Caucasian population. In conclusion, thrombo and fibro-genetic mechanisms of PAI-1 4G-4G and MTHFR 677TT, could have a role in the development of liver cirrhosis, mainly in patients without HCV and HBV, and PVT. Copyright © 2015 Elsevier B.V. All rights reserved.

MTHFR gene C677T and A1298C polymorphisms and homocysteine levels in primary open angle and primary closed angle glaucoma

PubMed Central

Micheal, Shazia; Qamar, Raheel; Akhtar, Farah; Khan, Muhammad Imran; Khan, Wajid Ali

2009-01-01

Purpose To investigate the methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C genotypes and plasma concentrations of total homocysteine (tHcy) in Pakistani patients with primary open angle glaucoma (POAG) and primary closed angle glaucoma (PCAG). Methods This was a prospective case-control study. A total of 295 patients (173 POAG, 122 PCAG) and 143 age- and sex-matched controls were subdivided into two ethnic groups, Punjabis (Punjab province, central Pakistan) and Pathans (North-West Frontier Province, northern Pakistan). Genotypes of the MTHFR C677T and A1298C polymorphisms were detected by polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP). An enzyme-linked immunosorbent assay was used to determine the total serum homocysteine (tHcy) levels. Associations were determined by logistic regression analysis. Results Frequency distributions of genotypes and combined genotypes as well as homocysteine levels were obtained. The overall distribution of the C677T genotype was found to be significantly associated with PCAG (CC 69%, CT 21%, TT 10%; p=0.001, χ2=12.6), but not with POAG (CC 71%, CT 28%, TT 1%; p=0.98, χ2=0.02) as compared to the controls (CC 71%, CT 29%, TT 1%). The Pathan cohorts revealed no association with the disease; however, the Punjabis demonstrated a significant association with PCAG (CC 75%, CT 11%, TT 13%; p<0.001, χ2=17.2). PCAG in the Punjabi subjects was also significantly associated with the A1298C polymorphism (AA 43%, AC 54%, CC 3%; p<0.001, χ2=33.9) as compared to the controls. Combined genotype data showed no association with POAG; however, a significant association with all combined genotypes was observed in the overall PCAG subjects (p<0.05, χ2=20.1). This difference was particularly apparent in the TTAA and TTAC combinations that were completely absent in the control groups (p<0.05. χ2=49.6). Mean serum tHcy levels were found to be significantly increased in the POAG (15.2±1.28 µmol/l, p<0.001) and PCAG (20.8±4.8 µmol/l) groups as compared to the controls (10.0±0.97 µmol/l). The tHcy levels in the TT and AC genotype were significantly elevated in the PCAG group (67±12.39 µmol/l, p<0.001; 23±5.94 µmol/l, p=0.027) as compared to the controls. Conclusion The TT and AC genotypes of MTHFR C677T and A1298C polymorphisms and the combined genotype TTAC were associated with PCAG in Punjabi subjects of Pakistani origin and correlated with the high serum tHcy levels seen in these patients. PMID:19936026

Low Sex Hormone-Binding Globulin Levels Associate with Prediabetes in Chinese Men Independent of Total Testosterone

PubMed Central

Han, Bing; Li, Qin; Chen, Yi; Zhu, Chunfang; Chen, Yingchao; Xia, Fangzhen; Cang, Zhen; Lu, Meng; Chen, Chi; Lin, Dongping; Lu, Yingli

2016-01-01

Objective The association ns between prediabetes and androgens have been rarely reported, especially in Chinese men. We aimed to investigate whether androgens were associated with the prevalence of prediabetes diagnosed with new American Diabetes Association criteria in Chinese men and then to assess which androgen value was the most relevant factor. Methods A total of 2654 men (52.6±13.4 years old) were selected. Serum total testosterone (TT), sex hormone-binding globulin (SHBG) and free testosterone (FT) were measured. Covariance analysis of different androgen values were performed in age subgroups. Multinomial logistic regression was used for the association of TT, SHBG and FT with prediabetes and diabetes, as well as prediabetes in age subgroups. Results According to ADA new criteria, normoglycemia, prediabetes, and diabetes were diagnosed in 1405, 907 and 342 men, respectively. In covariance analysis, SHBG of prediabetes were found lower than that of normoglycemia but higher than that of diabetes (P <0.05). In multinomial logistic regression, serum TT and SHBG were inversely associated with prediabetes and diabetes. While, after full adjustment for age, residence area, economic status, waist circumference, metabolic factors, other two androgen values and HOMA-IR, only the associations of SHBG with prevalence of prediabetes and diabetes persisted statistically significant, especially in the elderly with prediabetes (all P for trend <0.05). Conclusions Serum androgen was inversely associated with prediabetes and diabetes in Chinese men. Low serum SHBG was the most relevant factor for prediabetes and diabetes. Whether it is an independent predictor for incident prediabetes in Chinese men needs further explorations. PMID:27583401

Carotid artery intima-media thickness and erectile dysfunction in patients with metabolic syndrome.

PubMed

Unal, Mustafa; Aksoy, Duygu Yazgan; Aydın, Yusuf; Tanriover, Mine Durusu; Berker, Dilek; Karakaya, Jale; Guler, Serdar

2014-05-29

Metabolic syndrome (MS) has become a pandemic in Turkey, as is the case globally. Increase in carotid artery intima-media thickness (CIMT) and erectile dysfunction (ED) may be evident before the clinical signs of cardiovascular disease appear. We aimed to investigate the prevalence of increased CIMT and ED as markers of atherosclerotic disease in patients with MS. Thirty-two patients with MS and 29 healthy controls were included. Anthropometric and biochemical parameters, along with total testosterone (TT), high sensitive C-reactive protein (hs-CRP), were recorded. Carotid artery intima-media thickness was measured. Erectile dysfunction was assessed with International Index of Erectile Function. Patients with MS had higher BMI, fasting plasma glucose, post-prandial plasma glucose, insulin, HOMA-IR, total cholesterol, triglycerides, hs-CRP, and CIMT, whereas TT levels were lower (p<0.0001). The prevalence and severity of erectile dysfunction were higher in patients with MS (p<0.0001). Erectile dysfunction scores correlated inversely with CIMT. MS patients with ED were older and had higher CIMT compared to those without ED. Increase in age and HOMA and decrease in TT increased the risk of ED. When KIMT exceeding the 95th percentile of healthy controls was accepted as a risk factor for CVD, presence of ED was the only determinant for this increase. Erectile dysfunction was more prevalent and severe in patients with MS and correlated with subclinical endothelial dysfunction. Total testosterone deficiency was prominent among MS patients. Presence of ED points to an increased risk of cardiovascular disease when MS is present.