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Yamashita H, Sato S, Shindo H, Mori Y, Yoshimoto K, Tachibana S, Fukuda T, Takahashi H. A prospective cross-sectional study on hypocalcemia after total thyroidectomy in patients with Graves' disease: insights on secondary hyperparathyroidism. Surg Today 2024; 54:1058-1066. [PMID: 38635056 DOI: 10.1007/s00595-024-02848-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/21/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE To investigate the parathyroid function and calcium (Ca) levels in the secondary hyperparathyroidism (SHPT) state in patients with Graves' disease. METHODS We examined 31 consecutive patients with Graves' disease without chronic kidney disease, who were treated with total thyroidectomy. The patients were divided into a normal parathyroid hormone (PTH) group (NPTH group; n = 19) with a PTH level ≤ 65 pg/mL, and a secondary hyperparathyroidism group (SHPT group; n = 12), with a PTH level > 65 pg/mL. The PTH and Ca-related parameters were examined and the risk factors for postoperative hypocalcemia were analyzed. RESULTS The preoperative Ca level was significantly lower (2.24 ± 0.06 vs. 2.31 ± 0.07 mmol/L, p < 0.05) in the SHPT group than in the NPTH group. The reduction in PTH, 1,25-dihydroxyvitamin D (1,25(OH)2D), and Ca levels from the preoperative day to the next morning was significantly greater in the SHPT group than in the NPTH group (p < 0.05). When intraoperative factors were included, the decrease in the PTH level alone was significant. SHPT was a significant factor in determining the extent of PTH reduction. CONCLUSIONS Hyperfunctioning parathyroid glands in the SHPT state were more susceptible to postoperative PTH reduction, which, combined with low preoperative Ca levels, increased the risk of postoperative hypocalcemia in patients with Graves' disease.
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Affiliation(s)
- Hiroyuki Yamashita
- Department of Surgery, Yamashita Thyroid Hospital, 1-8 Simo-Gofukumachi, Hakata-ku, Fukuoka City, 812-0034, Japan.
| | - Shinya Sato
- Department of Surgery, Yamashita Thyroid Hospital, 1-8 Simo-Gofukumachi, Hakata-ku, Fukuoka City, 812-0034, Japan
| | - Hisakazu Shindo
- Department of Surgery, Yamashita Thyroid Hospital, 1-8 Simo-Gofukumachi, Hakata-ku, Fukuoka City, 812-0034, Japan
| | - Yusuke Mori
- Department of Surgery, Yamashita Thyroid Hospital, 1-8 Simo-Gofukumachi, Hakata-ku, Fukuoka City, 812-0034, Japan
| | - Kouichi Yoshimoto
- Department of Surgery, Yamashita Thyroid Hospital, 1-8 Simo-Gofukumachi, Hakata-ku, Fukuoka City, 812-0034, Japan
| | - Seigo Tachibana
- Department of Endocrinology, Yamashita Thyroid Hospital, Fukuoka City, Japan
| | - Takashi Fukuda
- Department of Endocrinology, Yamashita Thyroid Hospital, Fukuoka City, Japan
| | - Hiroshi Takahashi
- Department of Surgery, Yamashita Thyroid Hospital, 1-8 Simo-Gofukumachi, Hakata-ku, Fukuoka City, 812-0034, Japan
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Zhang D, Qiu Y, Yang J, Hong Z, Li J, Chen S, Wu SS. Ultrasound-guided percutaneous radiofrequency ablation versus surgery for solitary T1N0M0 papillary thyroid carcinoma in the danger triangle. Eur Radiol 2024:10.1007/s00330-024-10910-5. [PMID: 38980413 DOI: 10.1007/s00330-024-10910-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 04/24/2024] [Accepted: 05/13/2024] [Indexed: 07/10/2024]
Abstract
OBJECTIVES To compare the safety and efficiency of ultrasound-guided percutaneous radiofrequency ablation (RFA) and surgical resection (SR) for thyroid papillary carcinoma (PTC) in the danger triangle area. METHODS The clinical data of 298 patients who underwent either percutaneous RFA or SR for PTC in the thyroid danger triangle at our hospital between January 2018 and April 2020 were retrospectively analyzed. Propensity score matching is employed to regulate for confounding factors. All patients undergoing ablation were treated using a strategy that combined sufficient paratracheal fluid isolation with a low-power, short electrode. Disease progression was analyzed in patients with T1N0M0 PTC (T1a and T1b) employed in Kaplan‒Meier curves. Treatment parameters and the rates of local recurrence, distant metastasis, and complications are recorded and compared. RESULTS Of 182 eligible patients who were included, 91 were in the RFA (age 44.84 ± 13.19; 71 females; 77 T1a) and 91 were in the SR (age 47.36 ± 11.05; 68 females; 69 T1a). The average treatment time, length of hospital stays, blood loss volume, and scar length are substantially less in the RFA than in the SR. Major complications as well as postoperative permanent recurrent laryngeal nerve injury and postoperative transient parathyroid dysfunction occurred only in the SR, with a substantial distinction between the two groups (p < 0.05). There is no substantial distinction in the disease progression between RFA and SR treatment of T1N0M0 PTC. CONCLUSION RFA is as effective as surgery for PTC in the danger triangle area in the short term, with faster recovery and fewer complications. CLINICAL RELEVANCE STATEMENT Radiofrequency ablation has a clinical efficacy comparable to surgery in the treatment of papillary thyroid carcinoma in the danger triangle area in the short term with the advantages of faster recovery and fewer complications when compared with surgery. KEY POINTS Use of radiofrequency ablation (RFA) in the thyroid danger triangle is still controversial. RFA and surgery groups showed no difference in disease progressions, and no major complications occurred with RFA. Radiofrequency ablation offers a new option for papillary thyroid carcinoma patients in the danger triangle.
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Affiliation(s)
- Danling Zhang
- Department of Ultrasonography, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
- Department of Ultrasonography, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yuhan Qiu
- Department of Ultrasonography, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Jianchuan Yang
- Department of Ultrasonography, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Zhiliang Hong
- Department of Ultrasonography, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Jianwei Li
- Department of Ultrasonography, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Sheng Chen
- Department of Ultrasonography, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.
| | - Song-Song Wu
- Department of Ultrasonography, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.
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Hashem M, Lim CB, Balasubramanian SP. Postoperative parathyroid hormone (PTH) is equivalent to perioperative PTH drop in predicting postsurgical hypoparathyroidism. Ann R Coll Surg Engl 2024; 106:547-552. [PMID: 38478048 PMCID: PMC11214856 DOI: 10.1308/rcsann.2024.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 07/02/2024] Open
Abstract
INTRODUCTION Postoperative surgical hypoparathyroidism (PoSH) following thyroid surgery is an established complication. Several predictive factors have been identified including perioperative parathyroid hormone (PTH) levels. The aim of the study is to compare the drop in perioperative PTH to postoperative day 1 PTH in predicting hypocalcaemia and hypoparathyroidism. METHODS Records of consecutive patients who had either total or completion thyroidectomy with or without central neck dissection in a 3-year period in a single thyroid surgery unit were accessed to retrieve data on demographics, pathology, surgery, perioperative biochemistry and management. RESULTS Of 295 included patients, there were 227 (76.9%) females. Forty-five (15.3%) had completion thyroidectomy, and the rest had total thyroidectomy. Seventy-eight (26.4%) had concomitant central neck dissection. Sixty-four (21.7%) had hypocalcaemia on the day after surgery. Hypoparathyroidism persisted in 10.5% of patients at 6 months. Both day 1 PTH and a drop in PTH predicted day 1 hypocalcaemia (p < 0.001) and 6-month hypoparathyroidism (p < 0.001). The area under the receiver operating characteristic (ROC) curves for day 1 PTH and drop in PTH for the prediction of day 1 hypocalcaemia (0.729 vs 0.726, respectively) and for 6-month hypoparathyroidism (0.964 vs 0.958, respectively) were similar, albeit slightly better for day 1 PTH. CONCLUSIONS Day 1 PTH is equivalent to (if not better than) drop in PTH in predicting short- and long-term PoSH. Preoperative PTH measurements may not be needed in the detection and/or management of PoSH after thyroid surgery.
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Affiliation(s)
- M Hashem
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - CB Lim
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
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Wang B, Zhu Y, Zhou S, Lu C, Zhang A, Tian J, Li W, Ren S, Dong Y, Liu L. The effect of carbon nanoparticles vs. immune colloidal gold technique test strips on parathyroid protection in total thyroidectomy: A randomized clinical trial study. Head Neck 2024; 46:1727-1736. [PMID: 38429055 DOI: 10.1002/hed.27685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/09/2024] [Accepted: 02/04/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND The long-term effect of intraoperative usage of carbon nanoparticles (CN) and parathyroid hormone (PTH) test strip using immune colloidal gold technique (ICGT) is unclear. This study aims to compare the effect of intraoperative usage of CN and ICGT test strips on PG function. METHODS This randomized clinical study involved adult patients who underwent total thyroidectomy. They were randomly allocated into three groups (control, CN, and ICGT group). Clinical data were analyzed. RESULTS Each group involved 98 patients. Serum calcium and PTH concentrations at 24 h postoperatively (PTH24h) were higher in CN group. The parathyroid function recovered quicker in CN group. Use of CN increased in situ PG preservation and PTH24h. Mediation analysis indicated that 23.05% of the total effect of CN on PTH24h was attributed to PGRIS. CONCLUSION CN holds promise to improve in situ PG preservation and protect PG vasculature, thereby reducing the incidence of early hypoparathyroidism. The value of ICGT test strips for PG protection is dubious.
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Affiliation(s)
- Bochun Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yiyuan Zhu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shiguo Zhou
- Statistics Room, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Cheng Lu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Aobo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jun Tian
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wanxin Li
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shuling Ren
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yanbo Dong
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Liangfa Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Lee JS, Lee JS, Yun HJ, Kim SM, Chang H, Lee YS, Yang J, Lee HS, Chang HS. No Change in Complications Following Thyroidectomy Despite Increase in Thyroid Cancer Surgeries: A Meta-Regression Analysis. Yonsei Med J 2024; 65:348-355. [PMID: 38804029 PMCID: PMC11130591 DOI: 10.3349/ymj.2023.0266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/05/2023] [Accepted: 01/09/2024] [Indexed: 05/29/2024] Open
Abstract
PURPOSE The increase in thyroid cancer incidence has inevitably led to an increase in thyroid cancer surgeries. This meta-regression analysis aimed to determine if the rate of post-thyroidectomy complications changes by year. MATERIALS AND METHODS PubMed and Embase databases were used to perform a systematic literature search of studies published from January 1, 2005, using the keywords "thyroidectomy" and "complication." A meta-regression was performed for post-thyroidectomy hypocalcemia and bleeding. RESULTS This meta-analysis included 25 studies involving 927751 individuals. Through the years of publications in this study, there was no significant difference in the proportion of post-thyroidectomy hypocalcemia and bleeding (p=0.9978, 0.6393). CONCLUSION Although the number of thyroid surgeries has recently increased, the incidence of post-thyroidectomy hypocalcemia and bleeding did not significantly increase.
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Affiliation(s)
- Jun Sung Lee
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Seok Lee
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeok Jun Yun
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Korea
| | - Seok-Mo Kim
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Korea
| | - Hojin Chang
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Sang Lee
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Korea.
| | - Juyeon Yang
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Hang-Seok Chang
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Korea
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Frye CC, Sullivan J, Sanka SA, Smith ER, Goetz B, Brunt LM, Gillanders W, Brown TC, Olson JA, Hall B, Pandian TK. Cost-Effectiveness of Parathyroid Cryopreservation and Autotransplantation. JAMA Surg 2024; 159:634-641. [PMID: 38506884 PMCID: PMC10955396 DOI: 10.1001/jamasurg.2024.0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/24/2023] [Indexed: 03/21/2024]
Abstract
Importance Delayed autotransplantation of cryopreserved parathyroid tissue (DACP) is the only surgical treatment for permanent postoperative hypoparathyroidism. Studies suggest that only a small minority of cryopreserved samples are ultimately autotransplanted with highly variable outcomes. For these reasons, many have questioned the economic utility of the process, although, to the authors' knowledge, this has never been formally studied. Objective To report the clinical outcomes of parathyroid cryopreservation and DACP at a large academic institution and to determine the cost-effectiveness of this treatment. Design, Setting, and Participants An institutional review board-approved, retrospective review of patients at a single institution who underwent DACP over a 17-year period was conducted with a median follow-up of 48.2 months. A forward-looking cost-utility analysis was then performed to determine the economic utility of cryopreservation/DACP vs usual care (monitoring and supplementation). Patients who had parathyroid tissue in cryopreserved storage between August 2005 to September 2022 at a single-center, academic, quaternary care center were identified. Exposure Parathyroid cryopreservation and DACP. Main Outcomes and Measures Graft functionality, clinical outcomes, and cost utility using a willingness-to-pay threshold of $100 000 per quality-adjusted life-year (QALY). Results A total of 591 patients underwent cryopreservation. Of these, 10 patients (1.7%; mean [SD] age, 45.6 [17.9] years; 6 male [60%]) underwent DACP. A minority of autografts (2 [20%]) were subsequently fully functional, one-half (5 [50%]) were partially functional, and 3 (30%) were not functional. The cost-utility model estimated that at a large academic center over 10 years, the additional cost of 591 patients undergoing cryopreservation and 10 patients undergoing autotransplantation would be $618 791.64 (2022 dollars) and would add 8.75 QALYs, resulting in a cost per marginal QALY of $70 719.04, which is less than the common willingness-to-pay threshold of $100 000/QALY. Conclusions and Relevance The reimplantation rate of cryopreserved tissue was low (<2%), but when implanted, autografts were at least partially functional 70% of the time. In the first-ever, to the authors' knowledge, formal cost analysis for this treatment, results of the current model suggest that cryopreservation and autotransplantation were cost-effective compared with the usual care for hypoparathyroidism at a large, academic institution. It is recommended that each surgical center consider whether the economic and logistical commitments necessary for cryopreservation are worthwhile for their individual needs.
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Affiliation(s)
- C. Corbin Frye
- Department of Surgery, Section of Surgical Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Janessa Sullivan
- Department of Surgery, Section of Surgical Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Sai Anusha Sanka
- Department of Surgery, Section of Surgical Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Eileen R. Smith
- Department of Surgery, Section of Surgical Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Brian Goetz
- Siteman Cancer Center, Washington University School of Medicine, Barnes Jewish Hospital, St Louis, Missouri
| | - L. Michael Brunt
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St Louis, Missouri
| | - William Gillanders
- Department of Surgery, Section of Surgical Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Taylor C. Brown
- Department of Surgery, Section of Surgical Oncology, Washington University School of Medicine, St Louis, Missouri
| | - John A. Olson
- Department of Surgery, Section of Surgical Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Bruce Hall
- Department of Surgery, Section of Surgical Oncology, Washington University School of Medicine, St Louis, Missouri
- BJC HealthCare, St Louis, Missouri
| | - T. K. Pandian
- Department of Surgery, Section of Surgical Oncology, Washington University School of Medicine, St Louis, Missouri
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Yamashita H, Mori Y, Sato S, Shindo H, Yoshimoto K, Tachibana S, Fukuda T, Takahashi H. Significant role of 1,25-dihydroxyvitamin D on serum calcium levels after total thyroidectomy: a prospective cohort study. Front Endocrinol (Lausanne) 2024; 15:1360464. [PMID: 38803480 PMCID: PMC11128608 DOI: 10.3389/fendo.2024.1360464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Although active vitamin D (VD) has been used both preoperatively and postoperatively to prevent hypocalcemia risk in patients undergoing total thyroidectomy, the role of 1,25-dihydroxyvitamin D (1,25(OH)2D) has not been examined. This study comprehensively investigated the effects of 1,25(OH)2D on calcium (Ca) concentrations after total thyroidectomy. Methods Serum Ca, parathyroid hormone (PTH), and 1,25(OH)2D levels were measured in 82 patients with thyroid disease before and after surgery. Results Serum Ca, PTH, and 1,25(OH)2D levels decreased significantly on the morning of the first postoperative day. Notably, the decrease in 1,25(OH)2D concentration was significantly lower than that of PTH concentration (10.5 ± 33.4% vs. 52.1 ± 30.1%, p<0.0001), with 28% of patients showing increases in 1,25(OH)2D. The only factor predicting a postoperative 1,25(OH)2D decrease was a high preoperative 1,25(OH)2D concentration. Postoperative 1,25(OH)2D concentrations, as well as the magnitude and rate of decrease from preoperative levels, showed strong positive correlations with preoperative 1,25(OH)2D concentrations (p<0.0001 for all three variables) but not with PTH concentrations. These findings suggest that 1,25(OH)2D concentrations after thyroidectomy were more strongly dependent on preoperative concentrations than on the effect of PTH decrease and were relatively preserved, possibly preventing sudden severe postoperative hypocalcemia. A high 1,25(OH)2D level was the most important preoperative factor for hypocalcemia (<2 mmol/L; p<0.05) on the first postoperative day; however, only PTH decrease was statistically significant (p<0.001) when intraoperative factors were added. In the PTH >10 pg/mL group, the decrease in 1,25(OH)2D levels was significantly associated with postoperative hypocalcemia (p<0.05). Similarly, in the PTH levels >15 pg/mL group, a decrease in 1,25(OH)2D concentration was a significant factor, and the amount of PTH decrease was no longer significant. Conclusion 1,25(OH)2D plays an important role in preventing sudden, severe hypocalcemia due to decreased PTH levels after total thyroidectomy, whereas high preoperative 1,25(OH)2D levels are a significant risk factor for postoperative hypocalcemia. Optimizing preoperative protocols to adjust Ca, PTH, and 1,25(OH)2D levels to improve the management of patients undergoing total thyroidectomy and to prevent extreme intraoperative PTH decreases may reduce the risk of hypocalcemia.
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Affiliation(s)
| | - Yusuke Mori
- Department of Surgery, Yamashita Thyroid Hospital, Fukuoka, Japan
| | - Shinya Sato
- Department of Surgery, Yamashita Thyroid Hospital, Fukuoka, Japan
| | - Hisakazu Shindo
- Department of Surgery, Yamashita Thyroid Hospital, Fukuoka, Japan
| | | | - Seigo Tachibana
- Department of Endocrinology, Yamashita Thyroid Hospital, Fukuoka, Japan
| | - Takashi Fukuda
- Department of Endocrinology, Yamashita Thyroid Hospital, Fukuoka, Japan
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Zhang FG, Ow TJ, Lin J, Smith RV, Schiff BA, DeBiase CA, McAuliffe JC, Bloomgarden N, Mehta V. Complications related to thyroidectomy among patients with hyperthyroidism: Exploring the potential for ambulatory surgery. Head Neck 2024; 46:1094-1102. [PMID: 38270487 DOI: 10.1002/hed.27658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Total thyroidectomy for hyperthyroidism is typically followed by overnight admission to monitor for complications including thyrotoxicosis. Outpatient thyroid surgery is increasingly common, but its safety in patients with hyperthyroidism has not been well studied. METHODS This retrospective study reviewed 183 patients with hyperthyroidism who underwent total thyroidectomy from 2015 to 2022 at one urban, academic center. The main outcomes were rates of thyroid storm, surgical complications, and 30-day ED visits and readmissions. RESULTS Among 183 patients with hyperthyroidism (mean age, 45 ± 14.5 years; 82.5% female), there were no cases of thyroid storm and complications included recurrent laryngeal nerve (RLN) palsy (7.0%), symptomatic hypocalcemia (4.4%), and hematoma (1.6%). ED visits were present in 1.1% and no patients were readmitted. CONCLUSION Total thyroidectomy was not associated with thyroid storm and <6% of patients required inpatient management. Ambulatory total thyroidectomy for hyperthyroidism warrants further consideration through identification of predictive factors for postoperative complications.
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Affiliation(s)
- Faye G Zhang
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Thomas J Ow
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Juan Lin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Richard V Smith
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Bradley A Schiff
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Carolyn A DeBiase
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - John C McAuliffe
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Noah Bloomgarden
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Vikas Mehta
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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Alhakami M, Lajdam GB, Ghaddaf AA, Alayoubi S, Alhelali S, Alshareef M, Alharbi J. Preoperative Vitamin D and Calcium Administration in Patients Undergoing Thyroidectomy: A Systematic Review and Meta-analysis of Randomized Controlled Trials. OTO Open 2024; 8:e116. [PMID: 38371915 PMCID: PMC10870329 DOI: 10.1002/oto2.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/27/2023] [Accepted: 01/21/2024] [Indexed: 02/20/2024] Open
Abstract
Objective This systematic review and meta-analysis aimed to assess whether preoperative administration of calcium and vitamin D prevents postoperative hypocalcemia. Data Sources A computerized search in Medline, Embase, and CENTRAL databases was performed. Review Methods Trials comparing preoperative calcium and vitamin D administration with either placebo or nothing were eligible for inclusion. The primary outcomes were the occurrence of laboratory hypocalcemia, mean postoperative calcium level, and symptomatic hypocalcemia. The secondary outcomes were the development of permanent hypoparathyroidism and length of hospitalization. Continuous outcomes were represented as standardized mean difference (SMD), and dichotomous outcomes were represented as risk ratio (RR). Results Nine trials that enrolled 1079 patients were found eligible. Postoperative laboratory hypocalcemia occurred less in patients who received preoperative calcium and vitamin D, but it was not statistically significant (RR = 0.77, 95% CI: 0.60-1.00; P = .05). Mean postoperative calcium level was significantly higher in the intervention group (SMD = 0.10, 95% CI: 0.07-0.12; P < .00001). The number of patients with symptomatic hypocalcemia was significantly lower in the intervention group (RR = 0.54, 95% CI: 0.38-0.76; P = .0005). There was no significant difference between the 2 groups in cases of permanent hypoparathyroidism and length of hospitalization. Conclusion Administration of calcium and vitamin D preoperatively achieves lower rates of postthyroidectomy symptomatic hypocalcemia in comparison with no intervention.
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Affiliation(s)
- Mohammed Alhakami
- College of MedicineKing Saud bin Abdulaziz University for Health SciencesJeddahSaudi Arabia
- King Abdullah International Medical Research CenterJeddahSaudi Arabia
| | - Ghassan B. Lajdam
- College of MedicineKing Saud bin Abdulaziz University for Health SciencesJeddahSaudi Arabia
- King Abdullah International Medical Research CenterJeddahSaudi Arabia
| | - Abdullah A. Ghaddaf
- College of MedicineKing Saud bin Abdulaziz University for Health SciencesJeddahSaudi Arabia
- King Abdullah International Medical Research CenterJeddahSaudi Arabia
| | - Sarah Alayoubi
- Department of Otolaryngology‐Head & Neck Surgery, King Saud bin Abdulaziz University for Health SciencesKing Abdulaziz Medical CityJeddahSaudi Arabia
| | - Shaden Alhelali
- Collage of MedicineIbn Sina National Collage for Medical StudiesJeddahSaudi Arabia
| | - Mohammad Alshareef
- Department of Otolaryngology‐Head & Neck Surgery, King Saud bin Abdulaziz University for Health SciencesKing Abdulaziz Medical CityJeddahSaudi Arabia
| | - Jabir Alharbi
- Head & Neck and Skull Base Health CenterKing Abdullah Medical CityMakkahSaudi Arabia
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Soelling SJ, Mahvi DA, Liu JB, Sheu NO, Doherty G, Nehs MA, Cho NL. Impact of Obesity on Risk of Hypocalcemia After Total Thyroidectomy: Targeted National Surgical Quality Improvement Program Analysis of 16,277 Patients. J Surg Res 2023; 291:250-259. [PMID: 37478649 DOI: 10.1016/j.jss.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/20/2023] [Accepted: 06/13/2023] [Indexed: 07/23/2023]
Abstract
INTRODUCTION Hypocalcemia following total thyroidectomy (TT) is common due to postoperative parathyroid dysfunction and vitamin D deficiency. Given the association between obesity and vitamin D deficiency, we sought to correlate body mass index (BMI) with hypocalcemia after TT. METHODS Patients undergoing TT between 2016 and 2020 were identified from the American College of Surgeons National Surgical Quality Improvement Program thyroidectomy-targeted database. Univariable and multivariable regressions, stratified by BMI category (normal, overweight, obese), identified factors associated with hypocalcemia prior to discharge, within 30 d, and severe hypocalcemic events (emergent evaluation, intravenous calcium supplementation, or readmission). RESULTS Sixteen thousand two hundred seventy seven TT were performed with available BMI data. Three thousand five hundred thirty one (21.7%) patients had normal BMI, 4823 (29.6%) were overweight, and 7772 (47.7%) were obese. Patients with BMI ≥ 25 had decreased risk of hypocalcemia before discharge (9.8% versus 13%, odds ratio [OR] 0.73, P < 0.001), 30 d (8.1% versus 10.4%, OR 0.76, P < 0.001), and severe hypocalcemic events (5.5% versus 6.4%, OR 0.84, P = 0.029) compared to normal BMI patients. On multivariable analysis for normal BMI patients, age < 45 y was a risk factor for hypocalcemia before discharge, 30 d, and severe hypocalcemic events (P < 0.05 for all). Additional risk factors in this group for 30-d hypocalcemia included parathyroid autotransplant and central neck dissection (P < 0.05) and recurrent laryngeal nerve injury for severe hypocalcemic events (P = 0.01). CONCLUSIONS Younger patients with BMI < 25 are at an increased risk for hypocalcemia and severe hypocalcemic events after TT. These patients may benefit from preoperative counseling and increased calcium/vitamin D supplementation to reduce prolonged hospitalization and mitigate morbidity.
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Affiliation(s)
- Stefanie J Soelling
- Division of Surgical Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - David A Mahvi
- Division of Surgical Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jason B Liu
- Division of Surgical Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nora O Sheu
- Division of Surgical Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Gerard Doherty
- Division of Surgical Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Matthew A Nehs
- Division of Surgical Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nancy L Cho
- Division of Surgical Oncology, Brigham and Women's Hospital, Boston, Massachusetts.
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Liu W, Zhang D, Jiang H, Peng J, Xu F, Shu H, Su Z, Yi T, Lv Y. Prediction model of cervical lymph node metastasis based on clinicopathological characteristics of papillary thyroid carcinoma: a dual-center retrospective study. Front Endocrinol (Lausanne) 2023; 14:1233929. [PMID: 37766691 PMCID: PMC10519787 DOI: 10.3389/fendo.2023.1233929] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
Background The overall prevalence of papillary thyroid carcinoma (PTC) patients is expanding along with an ongoing increase in thyroid cancer incidence. Patients with PTC who have lymph node metastases have a poor prognosis and a high death rate. There is an urgent need for indicators that can predict lymph node metastasis (LNM) before surgery as current imaging techniques, such as ultrasonography, do not have sufficient sensitivity to detect LNM. To predict independent risk factors for Central lymph node metastasis (CLNM) or Lateral lymph node metastasis (LLNM), we therefore developed two nomograms based on CLNM and LLNM, separately. Methods In two centers, the Second Affiliated Hospital of Nanchang University and Yichun People's Hospital, we retrospectively analyzed clinicopathological characteristics of PTC patients. We utilized multivariate analysis to screen for variables that might be suspiciously related to CLNM or LLNM. Furthermore, we developed nomograms to graphically depict the independent risk valuables connected to lymph node metastasis in PTC patients. Result Ultimately, 6068 PTC patients in all were included in the research. Six factors, including age<45, male, mETE, TSH>1.418, tumor size>4cm, and location (multicentric and lobe), were observed to be related to CLNM. Age<45, male, mETE (minimal extrathyroidal extension), multifocality, TSH≥2.910, CLNM positive, and tumor size>4cm were regarded as related risk factors for LLNM. The two nomograms developed subsequently proved to have good predictive power with 0.706 and 0.818 and demonstrated good clinical guidance functionality with clinical decision curves and impact curves. Conclusion Based on the successful establishment of this dual-institution-based visual nomogram model, we found that some clinical features are highly correlated with cervical lymph node metastasis, including CLNM and LLNM, which will better help clinicians make individualized clinical decisions for more effectively rationalizing managing PTC patients.
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Affiliation(s)
- Wenji Liu
- Department of Thyroid Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Second Clinical Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Die Zhang
- Department of Thyroid Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Medical Department, The First Clinical Medicine College, Nanchang University, Nanchang, Jiangxi, China
| | - Hui Jiang
- Department of Thyroid Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Second Clinical Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Jie Peng
- Department of Thyroid Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Second Clinical Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Fei Xu
- Department of Thyroid Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Second Clinical Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Hongxin Shu
- Department of Thyroid Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Second Clinical Medical College, Nanchang University, Nanchang, Jiangxi, China
| | - Zijian Su
- Department of Thyroid Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Medical Department, The First Clinical Medicine College, Nanchang University, Nanchang, Jiangxi, China
| | - Tao Yi
- Department of Otolaryngology, Yichun People’s Hospital, Yichun, Jiangxi, China
| | - Yunxia Lv
- Department of Thyroid Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Moreno-Llorente P, Pascua-Solé M, García-Barrasa A, Muñoz-de-Nova JL. Indocyanine green (ICG) angiography-guided thyroidectomy: description of surgical technique. Front Surg 2023; 10:1217764. [PMID: 37529659 PMCID: PMC10388241 DOI: 10.3389/fsurg.2023.1217764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/28/2023] [Indexed: 08/03/2023] Open
Abstract
Background Postoperative hypoparathyroidism is the most common complication after total thyroidectomy and, when becomes permanent, lead to a myriad of clinical symptoms, long-term need of calcium and vitamin D supplementation and negative impact on the patient's health-related quality of life. Any surgical innovation that could reduce complications and improve outcomes of patients undergoing total thyroidectomy deserves to be considered. Angiography-Guided Thyroidectomy has been proposed as a modification of the standard technique of thyroidectomy aimed to identifying the vascular pattern of the parathyroid glands to maximize efforts for preserving functioning glands at the time of operation. Our aim is to provide a technical description of this procedure based on the use of indocyanine green (ICG) angiography to standardize this technique. Methods The surgical steps that are followed during a total thyroidectomy are modified due to previous visualization of the feeding vessels of the parathyroid glands according to fluorescence of the vascular mapping obtained by ICG angiography prior to thyroidectomy. The first step is to perform an ICG angiography to assess anatomical features of the feeding vasculature of the parathyroid glands, which allows precise surgical dissection for preservation of the glands. Once the viability of the parathyroids has been evaluated angiographically, thyroidectomy is performed in a second step. Conclusions ICG angiography-guided thyroidectomy may be effective to preserve the largest number of better perfused parathyroid glands, which would contribute to reduce the risk of postoperative and permanent hypoparathyroidism. It can be successfully and safely implemented in thyroid surgery and standardization of the technique is necessary to homogenize this procedure in the future, allowing a better comparation of the results to be published.
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Affiliation(s)
- Pablo Moreno-Llorente
- Unit of Endocrine Surgery, Department of Surgery, Hospital Universitari de Bellvitge, Universitat de Barcelona (UB), Barcelona, Spain
| | - Mireia Pascua-Solé
- Unit of Endocrine Surgery, Department of Surgery, Hospital Universitari de Bellvitge, Universitat de Barcelona (UB), Barcelona, Spain
| | - Arantxa García-Barrasa
- Unit of Endocrine Surgery, Department of Surgery, Hospital Universitari de Bellvitge, Universitat de Barcelona (UB), Barcelona, Spain
| | - José Luis Muñoz-de-Nova
- Department of General and Digestive Surgery, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
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Liang JJ, Irizarry R, Victor LS, Hoepner LA, Chernichenko N. Postoperative Complications After Total Thyroidectomy for Patients With Graves' Disease. Otolaryngol Head Neck Surg 2023; 168:754-760. [PMID: 35763358 DOI: 10.1177/01945998221108050] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/01/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To identify the rates and types of postoperative complications in patients with and without Graves' disease undergoing total thyroidectomy using the National Surgical Quality Improvement Program (NSQIP) database. STUDY DESIGN Retrospective cohort study. SETTING All hospitals participating in NSQIP from 2007 to 2017. METHODS Thyroidectomy data were abstracted from the NSQIP database from 2007 to 2017 using related Current Procedural Terminology codes. Exclusion criteria included diagnosis of malignancy and partial thyroidectomy. Patients with a diagnosis of Graves' disease were compared against the control group, which consisted of other nononcologic diagnoses. Statistical analysis including matched pair analysis was performed. RESULTS Unmatched data demonstrated that patients with Graves' disease who underwent total thyroidectomy (n = 5495) had a higher rate of readmission (odds ratio [OR], 1.41; 95% CI, 1.16-1.73) and rate of reoperation (OR, 2.29; 95% CI, 1.88-2.79) in comparison to control patients (n = 24,213). They also had a higher rate of postoperative complication (OR, 1.54; 95% CI, 1.23-1.93) especially for wound-related outcomes (OR, 1.88; 95% CI, 1.32-2.69), readmission for postoperative hypocalcemia (OR, 2.12; 95% CI, 1.54-2.92), and reoperation for hematoma or hemorrhage (OR, 1.88; 95% CI, 1.32-2.69). A matched-pair analysis of the data also demonstrated similar significant results. CONCLUSION Patients with Graves' disease undergoing total thyroidectomy are at higher risk of complications in comparison to those who do not have Graves' disease, likely due to sequelae of the disease. However, overall rates were low, suggesting that the procedure remains relatively low risk and should continue to be offered to select patients who meet criteria for surgery.
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Affiliation(s)
- Jennifer J Liang
- Department of Otolaryngology, SUNY Downstate School of Medicine, Brooklyn, New York, USA
| | - Rachel Irizarry
- Department of Otolaryngology, SUNY Downstate School of Medicine, Brooklyn, New York, USA
| | | | - Lori A Hoepner
- SUNY Downstate School of Public Health, Brooklyn, New York, USA
| | - Natalya Chernichenko
- Department of Otolaryngology, SUNY Downstate School of Medicine, Brooklyn, New York, USA
- New York Presbyterian Brooklyn Methodist Hospital, New York, USA
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Zheng L, Dou JP, Han ZY, Liu FY, Yu J, Cheng ZG, Yu XL, Wang H, Cong ZB, Wang SR, Yu MA, Xu ZF, Che Y, Nan B, Liu C, Hao Y, Wang X, Liu Y, Zhou Y, Liang P. Microwave Ablation for Papillary Thyroid Microcarcinoma with and without US-detected Capsule Invasion: A Multicenter Prospective Cohort Study. Radiology 2023; 307:e220661. [PMID: 36880949 DOI: 10.1148/radiol.220661] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Background Microwave ablation (MWA) has achieved favorable results in the treatment of papillary thyroid microcarcinoma (PTMC) confined in glandular parenchyma. However, studies on the outcome of MWA for PTMC with US-detected capsular invasion remain unclarified in the literature. Purpose To compare the feasibility, effectiveness, and safety of MWA in the treatment of PTMC with and without US-detected capsular invasion. Materials and Methods Participants from 12 hospitals with a PTMC maximal diameter of 1 cm or less without US- or CT-detected lymph node metastasis (LNM) who planned to undergo MWA were enrolled in this prospective study between December 2019 and April 2021. All tumors were evaluated with preoperative US and were divided into those with and those without capsular invasion. The participants were observed until July 1, 2022. The primary end points, including technical success and disease progression, and the secondary end points, including treatment parameters, complications, and tumor shrinkage during follow-up, were compared between the two groups, and multivariable regression was performed. Results After exclusion, 461 participants (mean age, 43 years ± 11 [SD]; 337 women) were included: 83 with and 378 without capsular invasion. After one participant with capsular invasion aborted MWA because of technical failure, 82 participants with and 378 participants without capsular invasion (mean tumor volume, 0.1 mL ± 0.1 vs 0.1 mL ± 0.1; P = .07) were analyzed with a mean follow-up period of 20 months ± 4 (range, 12-25 months) and 21 months ± 4 (range, 11-26 months), respectively. In those with and those without capsular invasion, comparable technical success rates were achieved (99% [82 of 83] vs 100% [378 of 378], P = .18), with one and 11 complications, respectively (1% [one of 82] vs 3% [11 of 378], P = .38). There was no evidence of differences in disease progression (2% [one of 82] vs 1% [four of 378]; P = .82) or tumor shrinkage (mean, 97% ± 8 [SD] vs 96% ± 13; P = .58). Conclusion Microwave ablation was feasible in the treatment of papillary thyroid microcarcinoma with US-detected capsular invasion and showed comparable short-term efficacy with or without the presence of capsular invasion. © RSNA, 2023 Clinical trial registration no. NCT04197960 Supplemental material is available for this article.
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Affiliation(s)
- Lin Zheng
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Jian-Ping Dou
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Zhi-Yu Han
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Fang-Yi Liu
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Jie Yu
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Zhi-Gang Cheng
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Xiao-Ling Yu
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Hui Wang
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Zhi-Bin Cong
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Shu-Rong Wang
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Ming-An Yu
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Zhi-Feng Xu
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Ying Che
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Bai Nan
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Cun Liu
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Ying Hao
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Xue Wang
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Ying Liu
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Ying Zhou
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
| | - Ping Liang
- From the Department of Interventional Ultrasound, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (L.Z., J.P.D., Z.Y.H., F.Y.L., J.Y., Z.G.C., X.L.Y., P.L.); Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China (H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C., X.W.); Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W., Y.L.); Department of Interventional Ultrasound Medicine, China-Japan Friendship Hospital, Beijing, China (M.A.Y.); First Department of Surgery, Hebei Hospital of Traditional Chinese Medicine, Shijiazhuang, China (Z.F.X., Y.Z.); First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Surgery, Beijing Jishuitan Hospital, Beijing, China (B.N.); Department of Ultrasound, Central Hospital Affiliated to Shandong First Medical University, Jinan, China (C.L.); and Department of Ultrasound, Mudanjiang Tumor Hospital, Mudanjiang, China (Y.H.)
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15
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Pasieka JL, Wentworth K, Yeo CT, Cremers S, Dempster D, Fukumoto S, Goswami R, Houillier P, Levine MA, Pasternak JD, Perrier ND, Sitges-Serra A, Shoback DM. Etiology and Pathophysiology of Hypoparathyroidism: A Narrative Review. J Bone Miner Res 2022; 37:2586-2601. [PMID: 36153665 PMCID: PMC10364481 DOI: 10.1002/jbmr.4714] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 08/29/2022] [Accepted: 09/22/2022] [Indexed: 01/19/2023]
Abstract
The approach utilized a systematic review of the medical literature executed with specifically designed criteria that focused on the etiologies and pathogenesis of hypoparathyroidism. Enhanced attention by endocrine surgeons to new knowledge about parathyroid gland viability are reviewed along with the role of intraoperative parathyroid hormone (ioPTH) monitoring during and after neck surgery. Nonsurgical etiologies account for a significant proportion of cases of hypoparathyroidism (~25%), and among them, genetic etiologies are key. Given the pervasive nature of PTH deficiency across multiple organ systems, a detailed review of the skeletal, renal, neuromuscular, and ocular complications is provided. The burden of illness on affected patients and their caregivers contributes to reduced quality of life and social costs for this chronic endocrinopathy. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Janice L Pasieka
- Clinical Professor of Surgery and Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kelly Wentworth
- Assistant Adjunct Professor of Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Caitlin T Yeo
- Clinical Lecturer of Surgery and Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Serge Cremers
- Associate Professor of Pathology and Cell Biology and Medicine, Vagelos College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - David Dempster
- Professor of Clinical Pathology and Cell Biology, Vagelos College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Seiji Fukumoto
- Specially Appointed Professor, Fujii Memorial Institute of Medical Sciences, Institute of Advanced Medical Sciences, Tokushima University, Tokushima, Japan
| | - Ravinder Goswami
- Professor, Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Pascal Houillier
- Département de Physiologie, Professor of Physiology, Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Michael A Levine
- Professor Emeritus of Pediatrics and Medicine, University of Pennsylvania, Director, Center for Bone Health, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jesse D Pasternak
- Endocrine Surgery Section Head, Division of General Surgery, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Nancy D Perrier
- Professor of Surgery, University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Section of Surgical Endocrinology, Houston, TX, USA
| | - Antonio Sitges-Serra
- Emeritus Professor, Universitat Autònoma de Barcelona, Endocrine Surgery, Hospital del Mar, Barcelona, Spain
| | - Dolores M Shoback
- Professor of Medicine, University of California, San Francisco, Endocrine Research Unit, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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16
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Mahvi DA, Witt RG, Lyu HG, Gawande AA, Nehs MA, Doherty GM, Cho NL. Increased BMI is Associated With Lower Risk of Hypocalcemia in Total Thyroidectomy Patients. J Surg Res 2022; 279:240-246. [DOI: 10.1016/j.jss.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 05/01/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022]
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17
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Li D, Tian M, Zhang Y, Yu Y, Cheng W, Li Y, Wang J, Wei S, Wang X, Yang X, Zhao J, Yun X, Zhang W, Song J, Zhang H, Zheng X, Gao M. Preoperative supplementation of calcitriol and calcium relieves symptom and extent of hypocalcemia in patients undergoing total thyroidectomy and bilateral central compartment neck dissection: A prospective, randomized, open-label, parallel-controlled clinical study. Front Oncol 2022; 12:967451. [PMID: 36091150 PMCID: PMC9461476 DOI: 10.3389/fonc.2022.967451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background Hypocalcemia is the most common complication that challenges surgeons performing total thyroidectomy. Conventional postoperative calcium and calcitriol supplement has been reportedly effective; however, a time lag has been reported before taking effect. Therefore, the role of preoperative strategy is yet to be determined. Study design In this prospective, randomized, open-label, parallel-controlled phase II clinical study (registration number: ChiCTR2200059815), a short-term preoperative administration of calcitriol and calcium was proposed in 210 patients undergoing total thyroidectomy and bilateral central compartment neck dissection. Patients were recruited and randomized (1:1:1) into three groups: (A) combined (preoperative calcitriol and calcium), (B) calcium only (preoperative calcium only), and (C) control (no preoperative intervention). Finally, a total of 172 patients were qualified for final analysis. Results Our data showed that 16 of 63 patients (25.4%) in the combined group had symptomatic hypocalcemia, whereas more patients from the control group (25 of 57 patients, 43.9%, P = 0.033) had symptomatic hypocalcemia. Further, the postoperative calcium level in the combined group is higher than in the control group (2.15 ± 0.15 vs. 2.09 ± 0.15 mmol/L, P = 0.031). Moreover, patients from the combined group showed lower calcium rates of <2.00 mmol/L (12.7% vs. 28.1%, P = 0.036). Remarkably, compared with the control group, patients with transient hypoparathyroidism in the combined group showed fewer rates for both symptomatic and biochemical hypocalcemia (28.6% vs. 61.1% for symptomatic hypocalcemia; 47.6% vs. 75% for biochemical hypocalcemia). Patients without transient hypoparathyroidism in all three groups showed no significant difference in rates for either symptomatic or biochemical hypocalcemia, indicating that this preoperative strategy is only effective for patients with transient hypoparathyroidism. We did not observe such beneficial effects in patients from the calcium group. Conclusions Preoperative administration of calcitriol and calcium could reduce symptomatic and biochemical hypocalcemia, especially for those with transient hypoparathyroidism. Moreover, this maneuver could be recommended as a clinical routine in patients undergoing total thyroidectomy and bilateral central compartment neck dissection. Clinical Trial Registration http://www.chictr.org.cn/edit.aspx?pid=164316&htm=4, identifier ChiCTR2200059815.
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Affiliation(s)
- Dapeng Li
- Department of Thyroid and Neck Oncology, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Mengran Tian
- Department of Thyroid and Neck Oncology, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Yan Zhang
- Department of Thyroid and Neck Oncology, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Yang Yu
- Department of Thyroid and Neck Oncology, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Wenyuan Cheng
- Department of Thyroid and Neck Oncology, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Yigong Li
- Department of Thyroid and Neck Oncology, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Junyi Wang
- Department of Thyroid and Neck Oncology, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Songfeng Wei
- Department of Thyroid and Neck Oncology, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Xin Wang
- Department of Thyroid and Neck Oncology, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Xiaoyong Yang
- Department of Thyroid and Neck Oncology, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Jingzhu Zhao
- Department of Thyroid and Neck Oncology, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Xinwei Yun
- Department of Thyroid and Neck Oncology, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Wei Zhang
- Department of Thyroid and Neck Oncology, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Jiayin Song
- Department of Clinical Laboratory, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Huan Zhang
- Cancer Prevention Center, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Xiangqian Zheng
- Department of Thyroid and Neck Oncology, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- *Correspondence: Ming Gao, ; Xiangqian Zheng,
| | - Ming Gao
- Tianjin Union Medical Center, Tianjin, China
- *Correspondence: Ming Gao, ; Xiangqian Zheng,
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18
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Swift WM, Iorio CB, Hamdi OA, Mallawaarachchi I, Wages NA, Shonka DC. Change in parathyroid hormone levels from baseline predicts hypocalcemia following total or completion thyroidectomy. Head Neck 2022; 44:1588-1595. [PMID: 35396878 DOI: 10.1002/hed.27057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/25/2022] [Accepted: 03/29/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND This study aims to identify the strongest predictor of postoperative hypocalcemia following thyroid surgery. METHODS Study of patients who underwent total/completion thyroidectomy. No patients received postoperative calcium supplementation. Demographic and perioperative data were collected including preoperative baseline parathyroid hormone (PTH) levels, PTH levels at 30 min and 6 h post-excision, and 18 h post-excision calcium levels. RESULTS Of 124 patients studied, 20.2% developed temporary hypocalcemia (Ca <8.5 mg/dL at 18 h post-excision). In multivariate analyses, absolute PTH levels at 30 min and 6 h post-excision as well as change in PTH from baseline at 30 min and 6 h post-excision were statistically significantly associated with postoperative hypocalcemia. Per 10 units decrease in PTH from baseline at 30 min post-excision, the risk of developing temporary hypocalcemia increases by 17%. CONCLUSION Absolute PTH levels and change in PTH from baseline at 30 min and 6 h post-excision predict hypocalcemia after total or completion thyroidectomy.
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Affiliation(s)
- William M Swift
- Department of Otolaryngology - Head & Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Caitlin B Iorio
- Department of Otolaryngology - Head & Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Osama A Hamdi
- Department of Otolaryngology - Head & Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Indika Mallawaarachchi
- Department of Public Health Sciences, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Nolan A Wages
- Department of Public Health Sciences, University of Virginia Health System, Charlottesville, Virginia, USA
| | - David C Shonka
- Department of Otolaryngology - Head & Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
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19
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Microwave ablation vs. surgery for papillary thyroid carcinoma with minimal sonographic extrathyroid extension: a multicentre prospective study. Eur Radiol 2022; 33:233-243. [PMID: 35771248 DOI: 10.1007/s00330-022-08962-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 04/24/2022] [Accepted: 06/11/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Minimal extrathyroid extension (mETE) was removed from the TNM staging system. This study was designed prospectively to compare the safety and efficacy of microwave ablation (MWA) versus surgery for treating T1N0M0 papillary thyroid carcinomas (PTC) with sonographically detected mETE. METHODS From December 2019 to April 2021, 198 patients with T1N0M0 mETE-PTCs evaluated by preoperative ultrasound from 10 hospitals were included. Ninety-two patients elected MWA, and 106 patients elected surgery for treatment. MWA was performed using extensive ablation with hydrodissection. Surgery consisted of lobectomy with ipsilateral central lymph node dissection (CLD), lobe and isthmus excision with ipsilateral CLD and total thyroidectomy with ipsilateral CLD. The rates of technical success, cost, oncologic outcomes, complications and quality of life of the two groups were assessed. RESULTS The follow-up times for the MWA and surgery groups were 12.7 ± 4.1 and 12.6 ± 5.0 months, respectively. The technical success rate was 100% for both groups. Oncological outcomes of the two groups were similar during the follow-up (all p > 0.05). The MWA group had a shorter operation time, less blood loss and lower costs (all p < 0.001). Three complications (3.3%) were reported in the MWA group and 4 (3.8%) in the surgery group (p = 0.846). The surgery group had higher scores for scar problems and anxiety (p < 0.001 and p = 0.003, respectively). CONCLUSIONS Microwave ablation was comparable in the short term to surgery in terms of treatment safety and efficacy in selected patients with T1N0M0 mETE-PTC detected by ultrasound. KEY POINTS • Microwave ablation is comparable to surgery in the safety and short-term efficacy for PTCs with sonographically detected mETE. • Thermal ablation is technically feasible for mETE-PTC treatment. • Patients with mETE-PTC have similar quality of life in the two groups, except for worse scar problems and anxiety in the surgery group.
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20
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Qian B, Zhang X, Bing K, Hu L, Qu X, Huang T, Shi W, Zhang S. Real-time intraoperative near-infrared autofluorescence imaging to locate the parathyroid glands: A preliminary report. Biosci Trends 2022; 16:301-306. [PMID: 35768258 DOI: 10.5582/bst.2022.01256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Identification and localization of parathyroid glands (PGs) remains a challenge for surgeons. The aim of this study was to evaluate the efficiency of intraoperative near-infrared autofluorescence (NIRAF) imaging to detect PGs in thyroid and parathyroid diseases. Seventy-six patients undergoing surgery for thyroid or parathyroid diseases between July 9, 2020 and August 20, 2021 were retrospectively analyzed. Intraoperative carbon nanoparticle (CN) negative imaging and handheld NIRAF imaging were successively performed for each patient. Of 206 PGs that needed to be identified for surgery, 162 were identified by NIRAF imaging, with a theoretical rate of identification of 78.64%. This was higher than the rate of identification with CN negative imaging, which was 75.73%. The number of PGs identified by NIRAF imaging and CN negative imaging did not differ significantly in either total thyroidectomy or thyroid lobectomy. In addition, the autofluorescence (AF) intensity of secondary parathyroid adenoma was weaker than that of normal PGs. NIRAF imaging is potentially a more efficient tool for identification of PGs than CN negative imaging, with a shorter learning curve and lower risk. It may not be well-suited to secondary hyperthyroidism or adenoma, but it was more efficient at identifying excised specimens than visual identification by a surgeon.
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Affiliation(s)
- Bei Qian
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ximeng Zhang
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Kaijian Bing
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Longqing Hu
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xincai Qu
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Tao Huang
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wei Shi
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shoupeng Zhang
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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21
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Zhou J, Ju H, Ma H, Diao Q. Clinical Efficacy of Modified Small Incision Thyroidectomy and Analysis of Influencing Factors of Postoperative Hypocalcemia. Front Surg 2022; 9:905920. [PMID: 35722535 PMCID: PMC9198629 DOI: 10.3389/fsurg.2022.905920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/15/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Analyze the clinical effect of modified small incision thyroidectomy and evaluate the influencing factors of hypocalcemia (EH) in patients after operation. Methods A total of 220 patients with thyroid cancer in our hospital from October 2019 to October 2021 were selected. The patients were randomly divided into a control group and an observation group, with 110 patients in each group. The control group were treated with traditional thyroidectomy, while the observation group were treated with modified small incision surgery. The perioperative indicators of the two groups were compared. The thyroid hormone indexes of the two groups were meansured before operation and 7 days after operation, and the incidence of complications was compared between the two groups. Serum calcium was detected 7 days after operation in both groups. According to the level of blood calcium, patients were divided into EH group and normal group. The data of two groups were compared, and the related factors affecting the occurrence of EH after operation were analyzed. Results The operation time, incision length and intraoperative bleeding volume of patients in the observation group were significantly lower than those of patients in the control group (p < 0.05). There was no significant difference in drainage time and postoperative drainage volume between the two groups (p > 0.05). The postoperative PTH level of patients in the observation group was significantly higher than that in the control group (p < 0.05), but there was no significant difference in FT3, FT4 and TSH levels (p > 0.05). The incidence of postoperative complications in the observation group (11.82%) was significantly lower than that in the control group (34.55%). Logistic regression analysis showed that bilateral lymph node dissection, parathyroidectomy and decreased PTH were the independent risk factors for EH in our patient after operation (p < 0.05). Conclusion The modified small incision operation can effectively reduce the occurrence of surgical trauma and related complications. Bilateral lymph node dissection, parathyroidectomy and PTH decrease are the risk factors for postoperative EH in patients with thyroid cancer. Taking corresponding measures to improve the metabolic function of patients during perioperative period will help to reduce the incidence of postoperative EH in patients with thyroid cancer.
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Affiliation(s)
- Jian Zhou
- Second Department of General Surgery, Qingdao Hospital of Traditional Chinese Medicine (Qingdao Haici Hospital), Qingdao, China
| | - Hongqing Ju
- Operating Room of Qingdao Traditional Chinese Medicine Hospital (Qingdao Haici Hospital), Qingdao, China
| | - Hongyan Ma
- Operating Room of Qingdao Traditional Chinese Medicine Hospital (Qingdao Haici Hospital), Qingdao, China
| | - Qixian Diao
- Second Department of General Surgery, Qingdao Hospital of Traditional Chinese Medicine (Qingdao Haici Hospital), Qingdao, China
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22
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He Q, Dong H, Gong M, Guo Y, Xia Q, Gong J, Lu F. New Therapeutic Horizon of Graves' Hyperthyroidism: Treatment Regimens Based on Immunology and Ingredients From Traditional Chinese Medicine. Front Pharmacol 2022; 13:862831. [PMID: 35462920 PMCID: PMC9020194 DOI: 10.3389/fphar.2022.862831] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/09/2022] [Indexed: 12/21/2022] Open
Abstract
Graves’ disease is an autoimmune disease characterized by goiter and hyperthyroidism, and 25% patients develop GO. Traditional treatment options, such as antithyroid drugs, radioiodine or thyroidectomy, have remained largely unchanged over the past 70 years. For many patients, there is a high rate of recurrence after antithyroid drugs and lifelong hypothyroidism after ablation and thyroidectomy. The symptoms and quality of life of some patients have not been effectively improved. The clinical demand for new therapeutic regimens, coupled with a deeper understanding of the pathophysiology and immunobiology of Graves’ disease, has led to the emergence of several new therapeutic ideas, including biologics, small molecule peptides, immunomodulators and teprotumumab, a specific antibody targeting IGF-1R. Besides, the elements of TCM have attracted more and more interests in modern medicine, because some effective components have been successfully used in the treatment of autoimmune diseases. Based on the pathophysiology and efficacy of clinical management and treatment in Graves’ hyperthyroidism, here we review the new strategies under investigation and summarize the effective components of traditional Chinese medicine used for Graves’ hyperthyroidism, and explore their mechanisms. These therapies have opened a new window for the treatment of Graves’ disease, but the exact mechanism and the research direction still need to be further explored.
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Affiliation(s)
- Qiongyao He
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Grade 2017 of Integrated Traditional Chinese and Western Clinical Medicine, Second Clinical School, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui Dong
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Minmin Gong
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yujin Guo
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qingsong Xia
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Gong
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Fuer Lu
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
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23
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Fackelmayer OJ, Wu JX, Yeh MW. Endocrine Surgery: Management of Postoperative Complications Following Endocrine Surgery of the Neck. Surg Clin North Am 2021; 101:767-784. [PMID: 34537142 DOI: 10.1016/j.suc.2021.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cervical endocrine operations include parathyroidectomy, thyroid lobectomy, thyroidectomy, central neck dissection, and lateral neck dissection. The vital structures at risk include the recurrent laryngeal nerves to the intrinsic muscles of the larynx, additional cranial nerves, parathyroid glands essential for calcium homeostasis, aerodigestive structures, and great vessels. Here, the authors discuss complications of endocrine neck surgery, including cervical hematoma and other fluid collections, hypocalcemia from hypoparathyroidism, and nerve injuries, along with their prevention, mitigation, and management. Significant and permanent morbidity can result, but fortunately the overall rate of complications remains low, especially when surgery is performed by high-volume surgeons.
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Affiliation(s)
- Oliver J Fackelmayer
- Section of Endocrine Surgery, UCLA David Geffen School of Medicine, UCLA Endocrine Center, 100 Medical Plaza Driveway, Suite 310, Los Angeles, CA 90095, USA
| | - James X Wu
- Section of Endocrine Surgery, UCLA David Geffen School of Medicine, UCLA Endocrine Center, 100 Medical Plaza Driveway, Suite 310, Los Angeles, CA 90095, USA
| | - Michael W Yeh
- Section of Endocrine Surgery, UCLA David Geffen School of Medicine, UCLA Endocrine Center, 100 Medical Plaza Driveway, Suite 310, Los Angeles, CA 90095, USA.
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24
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Zhang LZ, Xu JJ, Ge XY, Wang KJ, Tan Z, Jin TF, Zhang WC, Li QL, Luo DC, Ge MH. Pathological analysis and surgical modalities selection of cT1N0M0 solitary papillary thyroid carcinoma in the isthmus. Gland Surg 2021; 10:2445-2454. [PMID: 34527556 DOI: 10.21037/gs-21-357] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/05/2021] [Indexed: 12/17/2022]
Abstract
Background prognosis, identify clinicopathological characteristics, and determine optimal modalities for cT1N0M0 solitary papillary thyroid carcinoma in the isthmus (PTCI). Methods The clinical data of 124 patients with cT1N0M0 solitary PTCI from 3 medical centers were analyzed retrospectively. Of these, 32 participants had undergone total thyroidectomy plus unilateral central neck dissection, 36 had received total thyroidectomy plus bilateral central neck dissection, 24 had less-than-total thyroidectomy plus unilateral central neck dissection, and 32 had less-than-total thyroidectomy plus bilateral central neck dissection. We compared the effects of different surgical modalities and clinicopathological characteristics on the prognosis of cT1N0M0 solitary PTCI. Results There was no significant difference in postoperative recurrence-free survival between participants who received different extents of central region lymph node dissection and thyroidectomies (P>0.05). Temporary hypocalcemia occurred in participants who underwent total thyroidectomy plus bilateral central neck dissection [chi-square (χ2) =7.87, P=0.005]. Tumors with primary lesions ≥0.55 cm were prone to have central lymph node metastasis [95% confidence interval (CI): 0.51 to 0.71, P=0.047]. Multiple logistic analysis suggested that age over 55 years [odds ratio (OR) =11.90, 95% CI: 1.36 to 104.03, P=0.025], tumor size greater than 0.55 cm (OR =4.16, 95% CI: 1.28 to 13.52, P=0.018), and absence of nodular goiter (OR =2.57, 95% CI: 1.05 to 6.32, P=0.04) were risk factors for central lymph node metastasis of patients with cT1N0M0 solitary PTCI. Conclusions Less-than-total thyroidectomy is recommended for patients with cT1N0M0 solitary PTCI. Central lymph node dissection is recommended for patients who are prone to have central occult lymph node metastases with tumor size ≥55 cm, older than 55 years, and without nodular goiter.
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Affiliation(s)
- Li-Zhuo Zhang
- Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China.,Department of Head and Neck Surgery, Center of Otolaryngology-Head and Neck Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China.,Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Jia-Jie Xu
- Department of Head and Neck Surgery, Center of Otolaryngology-Head and Neck Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China.,Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Xin-Yang Ge
- College of Letters and Science, University of California, Los Angeles, Los Angeles, California, USA
| | - Ke-Jing Wang
- Department of Head and Neck Surgery, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
| | - Zhuo Tan
- Department of Head and Neck Surgery, Center of Otolaryngology-Head and Neck Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China.,Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Tie-Feng Jin
- Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China.,Department of Head and Neck Surgery, Center of Otolaryngology-Head and Neck Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China.,Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Wan-Chen Zhang
- Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China.,Department of Head and Neck Surgery, Center of Otolaryngology-Head and Neck Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China.,Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Qing-Lin Li
- Department of Scientific Research, Cancer Hospital, University of Chinese Academy of Sciences, Hangzhou, China
| | - Ding-Cun Luo
- Department of Surgical Oncology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ming-Hua Ge
- Department of Head and Neck Surgery, Center of Otolaryngology-Head and Neck Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China.,Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
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25
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Luddy MK, Vetter R, Shank J, Goldner W, Patel A, Kotwal A, Fingeret A. Patient Reported Outcome Measures of Health-Related Quality of Life and Asthenia after Thyroidectomy. J Surg Res 2021; 264:394-401. [PMID: 33848838 DOI: 10.1016/j.jss.2021.02.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/11/2021] [Accepted: 02/27/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND After thyroidectomy some patients experience a chronic fatigue syndrome called asthenia. The purpose of this study was to determine the post-operative health related quality of life (HRQOL) and risk of asthenia in patients undergoing thyroidectomy. METHODS A single institution prospective observational cohort study of adults undergoing thyroidectomy from September 2016 to July 2019 with four HRQOL surveys: preoperative baseline, 2 wk-, 6 mo- and 12 mo-postoperatively. Patients were surveyed using the Short Form 36 version 2 and Brief Fatigue Inventory. Asthenia was defined as Brief Fatigue Inventory > 60 at 12 mo. HRQOL was compared between patients undergoing thyroid lobectomy (TL) or total thyroidectomy (TT) with benign (-B) or malignant (-Ca) final pathology. RESULTS A total of 182 patients were included: 67 (37%) with TL-B, 32 (17%) with TL-Ca, 40 (22%) with TT-B, and 43 (24%) with TT-Ca. The incidence of asthenia was 42% for TT and 4% for TL. In the TL-B group, 2 patients (3%) developed asthenia, compared with 2 patients (6.25%) in the TL-Ca group, 14 patients (35%) in the TT-B group, and 21 (48.8%) in the TT-Ca group (P = 0.0001). The odds ratio of asthenia for TT compared to TL was 10.4 (95% CI 3.86-28.16) and for patients with malignancy compared to benign disease was 2.05 (95% CI 1.17-3.61). CONCLUSIONS Patients undergoing TT have a higher risk of developing asthenia than those undergoing TL, particularly if the final pathology shows malignancy.
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Affiliation(s)
- Mary Kate Luddy
- College of Medicine, University of Nebraska, Omaha, Nebraska
| | - Rachel Vetter
- College of Medicine, University of Nebraska, Omaha, Nebraska
| | - Jessica Shank
- Department of Surgery, Division of Surgical Oncology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Whitney Goldner
- Department of Medicine, Division of Diabetes, Endocrinology, and Metabolism, University of Nebraska Medical Center, Omaha, Nebraska
| | - Anery Patel
- Department of Medicine, Division of Diabetes, Endocrinology, and Metabolism, University of Nebraska Medical Center, Omaha, Nebraska
| | - Anupam Kotwal
- Department of Medicine, Division of Diabetes, Endocrinology, and Metabolism, University of Nebraska Medical Center, Omaha, Nebraska
| | - Abbey Fingeret
- Department of Surgery, Division of Surgical Oncology, University of Nebraska Medical Center, Omaha, Nebraska.
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26
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Choi EHE, Qeadan F, Alkhalili E, Lovato C, Burge MR. Preoperative vitamin D deficiency is associated with increased risk of postoperative hypocalcemia after total thyroidectomy. J Investig Med 2021; 69:1175-1181. [PMID: 33789986 DOI: 10.1136/jim-2020-001644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 11/04/2022]
Abstract
Prior single-institution studies suggest that preoperative vitamin D deficiency (VDD) is associated with postoperative hypocalcemia and a prolonged length of hospital stay following total thyroidectomy. In this study, we employ a multi-institutional, de-identified electronic health records database to address this issue. We hypothesize that total thyroidectomy patients with preoperative VDD will be at an increased associated risk of postoperative hypocalcemia and hospitalization. Using Cerner Health Facts, we identified 2447 patients who underwent total or subtotal thyroidectomy between 2008 and 2016 and who had a documented 25-hydroxyvitamin D concentration obtained within 12 months of the surgery date using International Classification of Diseases 9/10, Current Procedural Terminology and Healthcare Common Procedure Coding System codes. Data from 984 patients who underwent total thyroidectomy were analyzed. Analysis of variance models estimated the effect of VDD on postoperative numerical variables. Multiple logistic regression estimated the risk of postoperative hypocalcemia and hospital stay, adjusting for any imbalanced demographic variables and operative characteristics. On average, postoperative total calcium concentrations in the VDD group were lower by 0.3 mg/dL compared with that of the non-VDD group (p<0.01). The risk of postoperative hypocalcemia was 2.2 times higher in the VDD group compared with the non-VDD group (p<0.01). Although the length of hospital stay after thyroidectomy was longer in the VDD group compared with the non-VDD group (p=0.03), VDD is not an independent risk factor for prolonged hospitalization following thyroidectomy (p=0.13). VDD is associated with a higher risk of hypocalcemia following total thyroidectomy. Prethyroidectomy operative screening for VDD should be considered.
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Affiliation(s)
- Eun Ho Eunice Choi
- Clinical and Translational Science Center, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Fares Qeadan
- Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - Eyas Alkhalili
- Department of Surgery, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - Christina Lovato
- Department of Internal Medicine and Endocrinology, University of New Mexico Hospital, Albuquerque, New Mexico, USA
| | - Mark R Burge
- Department of Internal Medicine and Endocrinology, University of New Mexico Hospital, Albuquerque, New Mexico, USA
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27
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Bashir AY, Alzubaidi AN, Bashir MA, Obed AH, Zakarneh RK, Ennab HZ, Abu-Hijleh OM, El-Zaheri MM, Bashir AA. The Optimal Parathyroid Hormone Cut-Off Threshold for Early and Safe Management of Hypocalcemia After Total Thyroidectomy. Endocr Pract 2021; 27:925-933. [PMID: 33652107 DOI: 10.1016/j.eprac.2021.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To define optimal intact parathyroid hormone (iPTH) cut-off threshold predictive of hypocalcemia after total thyroidectomy for safe and effective postoperative management. METHODS This prospective single center study was done in 2 phases. In phase I, predictors of symptomatic hypocalcemia were analyzed and the receiver operating characteristic curve was used to define the optimal iPTH cut-off threshold predictive of hypocalcemia. Phase II studied giving prompt prophylactic supplemental calcium and vitamin D to all patients who had iPTH levels below the calculated threshold, while phase I patients were given prompt selective supplementation if they had postoperative hypocalcemia or symptoms. RESULTS Univariate analysis of patients in phase I showed that postoperative iPTH was the only significant variable that can predict symptomatic hypocalcemia. Using receiver operating characteristic curve and Youden index, the confirmed optimal cut-off threshold predictive of hypocalcemia was iPTH 19.95 pg/mL, with area under the curve of 0.903, 100% sensitivity, negative predictive value, and highest Youden index, while iPTH 15 pg/mL and iPTH 10 pg/mL were less optimal. Symptomatic hypocalcemia occurred in 30% of the phase I cohort who received selective supplementation versus 3% of those in the phase II cohort who received prophylactic supplementation. Return to emergency department and need for intravenous calcium were also significantly better in phase II. CONCLUSION iPTH cut-off for post-thyroidectomy hypocalcemia was 19.95 pg/mL. Low-risk patients were discharged with no supplementation while all high-risk patients received prompt calcium and vitamin D supplementation, which led to effective hypocalcemia management and safe 24-hour discharge.
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Affiliation(s)
| | - Ahmad N Alzubaidi
- Department of Surgery, Jordan Hospital, Amman, Jordan; Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - Aiman H Obed
- Department of Surgery, Jordan Hospital, Amman, Jordan
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28
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Hungry Bone Syndrome Secondary to Subtotal Thyroidectomy in A Patient With Thyrotoxicosis. Am J Med Sci 2021; 362:314-320. [PMID: 33582155 DOI: 10.1016/j.amjms.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 12/23/2020] [Accepted: 02/08/2021] [Indexed: 11/23/2022]
Abstract
Patients with thyrotoxicosis are prone to transient hypocalcemia after thyroidectomy, which may be due in part to surgical damage to the parathyroid glands. Hungry bone syndrome (HBS) can also cause hypocalcemia after thyroidectomy. HBS is due to increased osteoblast-mediated bone formation activity and normal or decreased bone resorption activity. As HBS is uncommon in patients after thyroidectomy, we herein present a case of hypocalcemia secondary to HBS after subtotal thyroidectomy for thyrotoxicosis in a 25-year-old woman with a two-month history of tingling extremities and carpopedal spasms after subtotal thyroidectomy for thyrotoxicosis. Diagnostic tests showed hypocalcemia and hyperphosphatemia with elevated parathyroid hormone levels and moderately decreased serum 25-hydroxyvitamin D levels. In addition to thyroid hormone replacement therapy, she was given calcitriol and Caltrate D (600 mg calcium plus 125 IU cholecalciferol). After two months of treatment, she no longer had spasms and her paresthesia improved. Meanwhile, serum electrolytes and parathyroid hormone levels had almost returned to the normal ranges. This is a rare case of HBS presented as a complication of subtotal thyroidectomy in a patient with thyrotoxicosis.
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29
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Fei Y, Qiu Y, Xing Z, Zhao W, Su A, Zhu J. The effects of radioiodine therapy on parathyroid function among patients with papillary thyroid cancer: a retrospective cohort study. Endocrine 2020; 70:426-434. [PMID: 32725445 DOI: 10.1007/s12020-020-02429-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 07/18/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To explore the effects of initial radioiodine therapy on parathyroid function among postoperative papillary thyroid cancer (PTC) patients. METHODS Postoperative PTC patients who were admitted in our department from April 2018 to April 2019 were recruited. Patients were divided into two groups: Group A, who underwent surgery and initial radioiodine therapy in our hospital, and Group B, who did not receive radioiodine therapy after surgery. The levels of serum calcium, magnesium, phosphorus, parathyroid hormone (PTH), and 25 hydroxyvitamin D3 were collected. Data were analyzed by SPSS 25.0. RESULTS A total of 252 patients were included. Between the two groups, no significant difference of PTH in 6th, 9th, and 12th month was found during postoperative follow-up (p = 0.493, p = 0.202, p = 0.814). No significant difference of PTH was found after stratifying Group A according to 131I dosage (p = 0.751 for 6th month after operation, p = 0.130 for 9th month after operation, p = 0.683 for 12th month after operation), interval time between surgery and radioiodine therapy (p = 0.522 for 3rd day after 131I therapy, p = 0.184 for 9th month after operation, p = 0.311 for 12th month after operation), and ratio of parathyroid autotransplantation (p = 0.545 for 3rd day after 131I therapy, p = 0.485 for 6th month after operation, p = 0.201 for 9th month after operation, p = 0.146 for 12th month after operation). CONCLUSIONS Initial radioiodine therapy following PTC surgery had no significant adverse effect on parathyroid function in the short term. However, physicians should inform patients of possible risks of abnormal parathyroid function prior to RAI therapy, and parathyroid function was periodically reviewed after RAI therapy.
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Affiliation(s)
- Yuan Fei
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, NO. 37 Guo Xue Xiang, 610041, Chengdu, Sichuan, PR China
| | - Yuxuan Qiu
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, NO. 37 Guo Xue Xiang, 610041, Chengdu, Sichuan, PR China
| | - Zhichao Xing
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, NO. 37 Guo Xue Xiang, 610041, Chengdu, Sichuan, PR China
| | - Wanjun Zhao
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, NO. 37 Guo Xue Xiang, 610041, Chengdu, Sichuan, PR China
| | - Anping Su
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, NO. 37 Guo Xue Xiang, 610041, Chengdu, Sichuan, PR China.
| | - Jingqiang Zhu
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, NO. 37 Guo Xue Xiang, 610041, Chengdu, Sichuan, PR China.
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