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Dong M, Song JL, Hu LL, Hong CC, Nie XY, Wang Z, Liao SC, Yao F. Analysis of preoperative influential factors and construction of a predictive nomogram of difficult thyroidectomy. BMC Surg 2023; 23:91. [PMID: 37069574 PMCID: PMC10111741 DOI: 10.1186/s12893-023-01990-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/04/2023] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVE To explore the preoperative influential factors of difficult thyroidectomy and establish a preoperative nomogram for predicting the difficulty of thyroidectomy. METHODS A total of 753 patients who underwent total thyroidectomy with central lymph node dissection between January 2018 and December 2021 were retrospectively enrolled in this study and randomly divided into training and validation groups at a ratio of 8:2. In both subgroups, the patients were divided into difficult thyroidectomy and nondifficult thyroidectomy groups based on the operation time. Patient age, sex, body mass index (BMI), thyroid ultrasound, thyroid function, preoperative fine needle aspiration (FNA), postoperative complications and other data were collected. Logistic regression analysis was performed to identify the predictors of difficult thyroidectomy, and a nomogram predicting surgical difficulty was created. RESULTS Multivariate logistic regression analysis demonstrated that male sex (OR = 2.138, 95% CI 1.055-4.336, p = 0.035), age (OR = 0.954, 95% CI 0.932-0.976, p < 0.001), BMI (OR = 1.233, 95% CI 1.106-1.375, p < 0.001), thyroid volume (OR = 1.177, 95% CI 1.104-1.254, p < 0.001) and TPO-Ab (OR = 1.001, 95% CI 1.001-1.002, p = 0.001) were independent risk factors for difficult thyroidectomy. The nomogram model incorporating the above predictors performed well in both the training and validation sets. A higher postoperative complication rate was found in the difficult thyroidectomy group than in the nondifficult thyroidectomy group. CONCLUSION This study identified independent risk factors for difficult thyroidectomy and created a predictive nomogram for difficult thyroidectomy. This nomogram may help to objectively and individually predict surgical difficulty before surgery and provide optimal treatment.
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Affiliation(s)
- Meng Dong
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Jun-Long Song
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Lin-Lin Hu
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Chen-Chen Hong
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Xin-Yue Nie
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Zhong Wang
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
| | - Shi-Chong Liao
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
| | - Feng Yao
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
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Tao T, Gang Y, Ji S, Xiao-Li C, Wei-Nan L, Qiang L, Jian-Jiao Z, Yong-Fu X, Jing-Dong L. Giant cervical goiter in Hashimoto's thyroiditis: A case report. J Int Med Res 2022; 50:3000605221096379. [PMID: 35538703 PMCID: PMC9102141 DOI: 10.1177/03000605221096379] [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] [Indexed: 12/03/2022] Open
Abstract
A giant cervical goiter, defined as a thyroid mass larger than 8 cm in diameter, is usually a nodular or adenomatous goiter. A giant cervical goiter can also be caused by hyperthyroidism (i.e., Hashimoto’s thyroiditis). The surgical indications for patients with Hashimoto’s disease include suspected malignant tumors, persistent symptoms related to the disease, or persistent enlargement of the goiter. We herein describe a woman who developed symptoms of compression from a thyroid tumor, the volume of which was almost the largest reported in the relevant literature to date. The bilateral lobes of the giant thyroid tumor were removed by total en bloc excision. We protected the bilateral recurrent laryngeal nerve and preserved the bilateral upper and lower parathyroid glands in situ. The excised left lobe tumor was 16 × 9 × 5.5 cm, whereas the right lobe tumor was 12 × 8 × 4 cm. The pathological diagnosis was Hashimoto’s thyroiditis. Although surgical excision is difficult, it is still the main treatment modality for giant goiters in patients with Hashimoto’s thyroiditis and can help to reduce the occurrence of complications.
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Affiliation(s)
- Tang Tao
- The First Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province 637000, China.,Institute of Hepato-Biliary-Pancreatic-Intestinal Disease, North Sichuan Medical College, Nanchong, Sichuan Province 637000, China
| | - Yang Gang
- The First Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province 637000, China.,Institute of Hepato-Biliary-Pancreatic-Intestinal Disease, North Sichuan Medical College, Nanchong, Sichuan Province 637000, China
| | - Sun Ji
- The First Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province 637000, China.,Institute of Hepato-Biliary-Pancreatic-Intestinal Disease, North Sichuan Medical College, Nanchong, Sichuan Province 637000, China
| | - Chen Xiao-Li
- Department of Pathology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province 637000, China
| | - Li Wei-Nan
- The First Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province 637000, China.,Institute of Hepato-Biliary-Pancreatic-Intestinal Disease, North Sichuan Medical College, Nanchong, Sichuan Province 637000, China
| | - Li Qiang
- The First Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province 637000, China.,Institute of Hepato-Biliary-Pancreatic-Intestinal Disease, North Sichuan Medical College, Nanchong, Sichuan Province 637000, China
| | - Zhu Jian-Jiao
- The First Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province 637000, China.,Institute of Hepato-Biliary-Pancreatic-Intestinal Disease, North Sichuan Medical College, Nanchong, Sichuan Province 637000, China
| | - Xiong Yong-Fu
- The First Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province 637000, China.,Institute of Hepato-Biliary-Pancreatic-Intestinal Disease, North Sichuan Medical College, Nanchong, Sichuan Province 637000, China
| | - Li Jing-Dong
- The First Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province 637000, China.,Institute of Hepato-Biliary-Pancreatic-Intestinal Disease, North Sichuan Medical College, Nanchong, Sichuan Province 637000, China
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Ramkumar S, Sivanandham S. The Combined Utility of HBME-1 and Galectin-3 Immunohistochemistry and BRAF V600E Mutations in the Diagnosis of Papillary Thyroid Carcinoma. Cureus 2021; 13:e20339. [PMID: 34934597 PMCID: PMC8668044 DOI: 10.7759/cureus.20339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 12/03/2022] Open
Abstract
Newer diagnostic modalities have revolutionized the pathologist’s approach to diagnosing thyroid malignancies. Molecular characterization of these malignancies has helped circumvent common morphologic diagnostic difficulties by integrating their genotypic, phenotypic, and immunohistochemical features. BRAF V600E mutation has been characterized as highly specific for thyroid carcinoma, especially papillary thyroid carcinoma (PTC); human bone marrow endothelial marker-1 (HBME-1) and galectin-3 are also such markers that are highly specific for PTC. We propose to study HBME-1 and galectin-3 expression and BRAF V600E mutation in thyroid neoplasms and do a comparative analysis to determine whether there is a correlation between BRAF V600E expression and that of HBME-1 and galectin-3. We further propose to analyze the individual and combined diagnosed utility of the above-mentioned ancillary diagnostic techniques.
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Huang L, Wang X, Huang X, Gui H, Li Y, Chen Q, Liu D, Liu L. Diagnostic significance of CK19, galectin-3, CD56, TPO and Ki67 expression and BRAF mutation in papillary thyroid carcinoma. Oncol Lett 2018. [PMID: 29541194 PMCID: PMC5835856 DOI: 10.3892/ol.2018.7873] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The aim of the present study was to examine the rate of BRAF mutation and the expression profiles of CK19, galectin-3, CD56, thyroid peroxidase (TPO) and Ki67 in papillary thyroid carcinoma (PTC) and papillary thyroid micro-carcinoma (PTMC). A total of 246 cases of thyroid disease were collected, including PTC, PTMC, nodular goiter (NG) and Hashimoto thyroiditis (HT). The results revealed that CK19 expression was 116/120 in PTC, 61/64 in PTMC, 2/34 in NG and 1/28 in HT. Galectin-3 positive expression was 115/120 in PTC, 60/64 in PTMC, 6/34 in NG and 4/28 in HT. TPO positive expression was 8/120 in PTC, 1/64 in PTMC, 30/34 in NG and 25/28 in HT. CD56-positive expression was 12/120 in PTC, 3/64 in PTMC, 33/34 in NG and 26/28 in HT. Ki67 labeling index was 2.52±0.46% in PTC (120 cases), 2.62±0.52% in PTMC (64 cases), 2.55±0.44% in NG (34 cases) and 2.58±0.48% in HT (28 cases). BRAF mutation rate was 93/120 in PTC, 47/64 in PTMC, 3/34 in NG and 2/28 in HT. These results suggested that expression patterns of CK19, galectin-3, CD56 and TPO and BRAF mutation exhibit diagnosis value in thyroid disease. However, Ki67-positive rate exhibits no notable diagnosis value in thyroid disease.
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Affiliation(s)
- Lihua Huang
- Department of Pathology, Wuhan Puai Hospital, Wuhan, Hubei 430030, P.R. China
| | - Xuming Wang
- Department of Histopathology, Jiangda Pathology Institute, Jianghan University, Wuhan, Hubei 430056, P.R. China.,Department of Pathology and Pathophysiology, School of Medicine, Jianghan University, Wuhan, Hubei 430056, P.R. China
| | - Xuan Huang
- Department of Histopathology, Jiangda Pathology Institute, Jianghan University, Wuhan, Hubei 430056, P.R. China.,Department of Pathology and Pathophysiology, School of Medicine, Jianghan University, Wuhan, Hubei 430056, P.R. China
| | - Huawei Gui
- Department of Pathology, Wuhan Puai Hospital, Wuhan, Hubei 430030, P.R. China
| | - Yan Li
- Department of Histopathology, Jiangda Pathology Institute, Jianghan University, Wuhan, Hubei 430056, P.R. China.,Department of Pathology and Pathophysiology, School of Medicine, Jianghan University, Wuhan, Hubei 430056, P.R. China
| | - Qiongxia Chen
- Department of Histopathology, Jiangda Pathology Institute, Jianghan University, Wuhan, Hubei 430056, P.R. China.,Department of Pathology and Pathophysiology, School of Medicine, Jianghan University, Wuhan, Hubei 430056, P.R. China
| | - Dongling Liu
- Department of Pathology, Wuhan Puai Hospital, Wuhan, Hubei 430030, P.R. China
| | - Lijiang Liu
- Department of Histopathology, Jiangda Pathology Institute, Jianghan University, Wuhan, Hubei 430056, P.R. China.,Department of Pathology and Pathophysiology, School of Medicine, Jianghan University, Wuhan, Hubei 430056, P.R. China
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Bayhan Z, Zeren S, Ucar BI, Ozbay I, Sonmez Y, Mestan M, Balaban O, Bayhan NA, Ekici MF. Emergency thyroidectomy: Due to acute respiratory failure. Int J Surg Case Rep 2014; 5:1251-3. [PMID: 25437688 PMCID: PMC4276272 DOI: 10.1016/j.ijscr.2014.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 11/03/2014] [Accepted: 11/03/2014] [Indexed: 11/22/2022] Open
Abstract
CT scan has a great value for retrosternally extended giant goiter cases. If the general status of the patient prevents CT scan, bedside ultrasound can be used instead. Nasal awake intubiation is an appropriate choice for the patients with destructed trachea. Emergency thyroidectomy is a common option for the treatment of giant goiter causing airway obstruction.
INTRODUCTION Giant cervical and mediastinal goiter may lead to acute respiratory failure caused by laryngotracheal compression and airway obstruction. Here, we present a case admitted to the emergency service with a giant goiter along with respiratory failure and poor general health status, which required urgent surgical intervention. PRESENTATION OF CASE A 71-year-old female admitted to the emergency room with shortness of breath and poor general health status resulting from a giant cervical swelling progressively increased during the last 7 years and constituted severe respiratory failure which has become severe in the last one month. A giant nodular goiter of the left thyroid lobe extending retrosternally, causing tracheal compression, limiting the neck movements was detected with clinical examination and bedside ultrasound. Emergency thyroidectomy was planned. Fiberoptic-assisted awake nasal intubation was performed in the operating room. Emergency total thyroidectomy was performed for the life-threatening respiratory failure. Postoperative period was uneventful. She was transferred from intensive care unit to the ward on postoperative day 3 and was discharged from the hospital on the postoperative 7th day. Benign multinodular hyperplasia was reported on the histopathological report. Patient was included in routine follow-up. DISCUSSION In the present case tracheal destruction due to compression of the giant goiter was found in agreement with previous reports. Emergency thyroidectomy was performed after awake intubation since it is a common surgical option for the treatment of giant goiter causing severe airway obstruction. CONCLUSION Respiratory failure due to giant nodular goiter is a life-threatening situation and should be treated immediately by performing awake endotracheal intubation following emergency total thyroidectomy.
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Affiliation(s)
- Zulfu Bayhan
- Department of General Surgery, Faculty of Medicine, Dumlupinar University, 43020 Kutahya, Turkey.
| | - Sezgin Zeren
- Department of General Surgery, Faculty of Medicine, Dumlupinar University, 43020 Kutahya, Turkey.
| | - Bercis Imge Ucar
- Department of General Surgery, Faculty of Medicine, Dumlupinar University, 43020 Kutahya, Turkey.
| | - Isa Ozbay
- Department of Otolaryngology, Faculty of Medicine, Dumlupinar University, 43020 Kutahya, Turkey.
| | - Yalcin Sonmez
- Department of General Surgery, Dumlupinar University Evliya Celebi Education and Research Hospital, 43020 Kutahya, Turkey.
| | - Metin Mestan
- Department of General Surgery, Dumlupinar University Evliya Celebi Education and Research Hospital, 43020 Kutahya, Turkey.
| | - Onur Balaban
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Dumlupinar University, 43020 Kutahya, Turkey.
| | - Nilufer Araz Bayhan
- Department of Anesthesiology and Reanimation, Dumlupinar University Evliya Celebi Education and Research Hospital, 43020 Kutahya, Turkey.
| | - Mehmet Fatih Ekici
- Department of General Surgery, Dumlupinar University Evliya Celebi Education and Research Hospital, 43020 Kutahya, Turkey.
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Walker TM, Fortson JK, Patel VG. Experience with Total Thyroidectomy for Massive Multinodular Goiter. Am Surg 2013. [DOI: 10.1177/000313481307900831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - James K. Fortson
- Department of Surgery Morehouse School of Medicine Atlanta, Georgia
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