1
|
Kapoor A, Panda NK, Sharma V, Bakshi J, Bhadada S. Serum PTH at 4 h after total thyroidectomy as a predictor of hypocalcemia: a prospective time frame analysis in search of evidence. Eur Arch Otorhinolaryngol 2023:10.1007/s00405-023-07950-w. [PMID: 37147508 DOI: 10.1007/s00405-023-07950-w] [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: 11/22/2022] [Accepted: 03/28/2023] [Indexed: 05/07/2023]
Abstract
INTRODUCTION There has not been a universal agreement about the timings and the threshold level of PTH that can accurately predict the risk of hypocalcemia. Our study aimed to investigate the changes in the serum PTH levels at various time intervals and correlate it with the development of subsequent hypocalcemia. MATERIALS AND METHODS All patients had a pre-operative serum PTH done and were again assessed intra-operatively, at 4 h, 24 h, 72 h, and 1 month after the thyroid surgery. Absolute serum PTH value at various time points, absolute change in serum PTH values compared to pre-operative level, and relative change (percentage change) in serum PTH values compared with pre-operative levels were used to predict post-operative Hypocalcemia. RESULTS 49 patients were included in the study. The sensitivity and negative predictive value was 100% for serum PTH at 4 h. There was a statistically significant difference between the groups that required calcium supplementation versus the group that did not require it. The maximum relative reduction in serum PTH value with respect to the pre-operative level occurred at 4 h in the calcium supplement required group which was 82.5%. Use of combination of 4 h serum PTH and relative change at 4 h yielded the best results. CONCLUSION A combination of absolute serum PTH level at 4 h and the relative decline in serum PTH at 4 h has the highest diagnostic accuracy. The use of this combined parameter helps to reliably predict patients who would require supplementation.
Collapse
Affiliation(s)
- Archit Kapoor
- Department of Otolaryngology & Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Naresh K Panda
- Department of Otolaryngology & Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Vikas Sharma
- Department of Otolaryngology & Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Jaimanti Bakshi
- Department of Otolaryngology & Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sanjay Bhadada
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
2
|
Chirayath SR, Menon UV, Nair V, Kumar H, Praveen VP, Bhavani N, Abraham N. Factors Determining Risk Categories in Differentiated Thyroid Carcinoma: Study of an Indian Cohort. Indian J Endocrinol Metab 2022; 26:269-274. [PMID: 36248037 PMCID: PMC9555377 DOI: 10.4103/ijem.ijem_245_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 01/03/2022] [Accepted: 01/21/2022] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Differentiated thyroid carcinoma/cancer (DTC) burden in developing countries could be different from that of the developed nations. AIMS AND OBJECTIVES To describe the clinicopathological characteristics in a cohort of DTC patients in a south Indian state of Kerala and to compare with the data from other centres. MATERIALS AND METHODS A retrospective analysis of the data collected on DTC patients, from January 2010 to August 2018, attending thyroid cancer clinic at a tertiary care centre. RESULTS mong the 944 patients (male 262; female 682; mean age 43.8 years; standard deviation, SD 13.8), types of tumour were as follows: classical papillary thyroid carcinoma (cPTC) 48.3%, follicular variants of PTC (FVPTC) 28.8%, follicular and hurthle cell carcinoma (FTC&HCC) 10.1%. Mean size of the tumour was 2.7 cm (SD 1.8) papillary thyroid micro carcinomas (PTMC) were seen in 113 patients (12%), which were detected incidentally. Metastases were present at diagnosis in 40.2% cases, most common site being cervical lymph nodes. Distant metastases were seen in 113 patients (14.5%) and commonest site was bone. The American Thyroid Association (ATA) risk stratification was possible only in 684 subjects and showed 31.3% low risk, 41.8% intermediate risk and 26.9% at high-risk category. Lymph node metastasis and distant metastasis were the commonest determining factors for intermediate and high-risk category, respectively. High-risk category was significantly higher in patients >55 years, tumour size >4 cm, FTC/HCC tumour type and extranodal extension (ENE) of lymph node metastasis. Radio active iodine ablation was given to 85.2% subjects. CONCLUSION In our DTC population, FVPTC formed the second most common type and PTMC were all incidentalomas. Metastasis at diagnosis was higher suggesting delayed presentation. Old age, FTC/HCC, large size of the tumour, ENE were significantly higher in high-risk patients. Rest of the features of these cohort was comparable with the United States cohort of DTC patients.
Collapse
Affiliation(s)
| | - Usha V. Menon
- Department of Endocrinology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Vasantha Nair
- Department of Endocrinology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Harish Kumar
- Department of Endocrinology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - VP Praveen
- Department of Endocrinology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Nisha Bhavani
- Department of Endocrinology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Nithya Abraham
- Department of Endocrinology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| |
Collapse
|
3
|
Panato C, Vaccarella S, Dal Maso L, Basu P, Franceschi S, Serraino D, Wang K, Lei F, Chen Q, Huang B, Mathew A. Thyroid Cancer Incidence in India Between 2006 and 2014 and Impact of Overdiagnosis. J Clin Endocrinol Metab 2020; 105:dgaa192. [PMID: 32297630 PMCID: PMC7947989 DOI: 10.1210/clinem/dgaa192] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/14/2020] [Indexed: 12/19/2022]
Abstract
CONTEXT/OBJECTIVE Increases of thyroid cancer (TC) incidence emerged in the past several decades in several countries. This study aimed to estimate time trends of TC incidence in India and the proportion of TC cases potentially attributable to overdiagnosis by sex, age, and area. DESIGN TC cases aged 0 to 74 years reported to Indian cancer registries during 2006 through 2014 were included. Age-standardized incidence rates (ASR) and TC overdiagnosis were estimated by sex, period, age, and area. RESULTS Between 2006 to 2008 and 2012 to 2014, the ASRs for TC in India increased from 2.5 to 3.5/100,000 women (+37%) and from 1.0 to 1.3/100,000 men (+27%). However, up to a 10-fold difference was found among regions in both sexes. Highest ASRs emerged in Thiruvananthapuram (14.6/100,000 women and 4.1/100,000 men in 2012-2014), with 93% increase in women and 64% in men compared with 2006 to 2008. No evidence of overdiagnosis was found in Indian men. Conversely, overdiagnosis accounted for 51% of TC in Indian women: 74% in those aged < 35 years, 50% at ages 35 to 54 years, and 30% at ages 55 to 64 years. In particular, 80% of TC overdiagnosis in women emerged in Thiruvananthapuram, whereas none or limited evidence of overdiagnosis emerged in Kamrup, Dibrugarh, Bhopal, or Sikkim. CONCLUSIONS Relatively high and increasing TC ASRs emerged in Indian regions where better access to health care was reported. In India, as elsewhere, new strategies are needed to discourage opportunistic screening practice, particularly in young women, and to avoid unnecessary and expensive treatments. Present results may serve as a warning also for other transitioning countries.
Collapse
Affiliation(s)
- Chiara Panato
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | | | - Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Partha Basu
- International Agency for Research on Cancer, Lyon, France
| | - Silvia Franceschi
- Scientific Directorate, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Kevin Wang
- Department of Internal Medicine, Division of Medical Oncology, University of Kentucky, Lexington, KY, USA
| | - Feitong Lei
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Quan Chen
- Biostatistics and Bioinformatics Shared Facility, Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Bin Huang
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, USA
- Biostatistics and Bioinformatics Shared Facility, Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Aju Mathew
- Department of Internal Medicine, Division of Medical Oncology, University of Kentucky, Lexington, KY, USA
- MOSC Medical College Kolenchery, Kerala, India
| |
Collapse
|
4
|
Ko HY, Lu IC, Chang PY, Wang LF, Wu CW, Yu WHV, Hwang TZ, Wang CC, Huang TY, Chiang FY. U-shaped strap muscle flap for difficult thyroid surgery. Gland Surg 2020; 9:372-379. [PMID: 32420261 DOI: 10.21037/gs.2020.02.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Open thyroidectomy via conventional midline approach can be challenging in complex thyroid surgeries. This study proposes a U-shaped strap muscle flap (USMF) technique that provides adequately wide exposure of the surgical field. Methods Strap muscles were cut close to the clavicle and along the anterior margin of both sternocleidomastoid muscles followed by total thyroidectomy in 20 patients as USMF group, and surgical outcomes were compared with 40 patients who had received total thyroidectomy via midline approach. Results No patient had postoperative hematoma, vocal cord paralysis, permanent hypocalcaemia, wound infection or flap necrosis. At 2 months post-surgery, objective voice analysis and subjective assessment of voice and swallowing showed no significant difference between groups. Conclusions USMF provides superb surgical field exposure, and the voice and swallowing functions after USMF are comparable to those obtained by midline approach. The USMF approach is a feasible option for selective difficult thyroid surgery.
Collapse
Affiliation(s)
- How-Yun Ko
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - I-Cheng Lu
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pi-Ying Chang
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ling-Feng Wang
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Che-Wei Wu
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wing-Hei Viola Yu
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tzer Zen Hwang
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.,Department of Otolaryngology, E-Da Hospital, Kaohsiung, Taiwan
| | | | - Tzu-Yen Huang
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Feng-Yu Chiang
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.,Department of Otolaryngology, E-Da Hospital, Kaohsiung, Taiwan
| |
Collapse
|