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Affiliation(s)
- Christopher R McHenry
- Department of Surgery MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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Wang HC, Wu CW, Huang TY. Hyperthyroidism after radiofrequency ablation for thyroid nodule. Kaohsiung J Med Sci 2024; 40:415-416. [PMID: 38372465 DOI: 10.1002/kjm2.12809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/20/2024] Open
Affiliation(s)
- How-Chen Wang
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Che-Wei Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, International Thyroid Surgery Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Otorhinolaryngology, School of Post-Baccalaureate Medicine and School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tzu-Yen Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, International Thyroid Surgery Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Otorhinolaryngology, School of Post-Baccalaureate Medicine and School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Frey S, Caillard C, Mahot P, Pattier S, Volteau C, Knipping G, Lande G, Drui D, Mirallié E. Mortality After Total Thyroidectomy for Amiodarone-Induced Thyrotoxicosis According to Left Ventricular Ejection Fraction. Otolaryngol Head Neck Surg 2023; 169:1542-1549. [PMID: 37317630 DOI: 10.1002/ohn.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/28/2023] [Accepted: 05/13/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To report cardiac outcomes after total thyroidectomy for amiodarone-induced thyrotoxicosis according to the baseline left ventricular ejection fraction in a tertiary referral center. STUDY DESIGN Retrospective, monocentric. SETTING The tertiary health care system. METHODS Patients who underwent total thyroidectomy for amiodarone-induced thyrotoxicosis between 2010 and 2020 with age >18 and available preoperative left ventricular ejection fraction were included in this study. Patients were dichotomized into: group 1 with left ventricular ejection fraction ≥40% (mildly reduced/normal ejection fraction), and group 2 with left ventricular ejection fraction <40% (reduced ejection fraction). RESULTS There were 34 patients in group 1 and 17 to group 2. The latter were younger (median 58.4 [Q1-Q3 48.0-64.9] vs. 69.8 years in group 1 [59.8-78.3], p = .0035) and they presented more cardiomyopathy (58.8 vs. 26.5%, p = .030). Overall, the median time until surgery referral was 3.1 [1.9-7.1] months and 47.1% underwent surgery after restoration of euthyroidism. Surgical complications accounted for 7.8%. In group 2, the median left ventricular ejection fraction was significantly improved after surgery (22.5 [20.0-25.0] vs. 29.0% [25.3-45.5], p = .0078). Five-year cardiac mortality was significantly higher in group 2 (p < .0001): 47.0% died of cardiac causes versus 2.9% in group 1. A baseline left ventricular ejection fraction <40% and a longer time until surgery referral were significantly associated with cardiac mortality (multivariable Cox regression analysis, p = .015 and .020, respectively). CONCLUSION These results reinforce the idea that surgery, if chosen, should be performed quickly in patients with left ventricular ejection fraction <40%.
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Affiliation(s)
- Samuel Frey
- Nantes Université, CHU Nantes, Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Nantes, France
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Cécile Caillard
- Nantes Université, CHU Nantes, Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Nantes, France
| | - Pascale Mahot
- Nantes Université, CHU Nantes, Service d'Endocrinologie, Diabétologie et Nutrition, l'institut du thorax, Nantes, France
| | - Sabine Pattier
- Nantes Université, CHU Nantes, Service de cardiologie, Hôpital Nord Laennec, Nantes, France
| | - Christelle Volteau
- Nantes Université, CHU Nantes, DRCI, Département Promotion, Nantes, Cedex, France
| | - Garance Knipping
- Nantes Université, CHU Nantes, Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Nantes, France
| | - Gilles Lande
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
- Nantes Université, CHU Nantes, Service de cardiologie, Hôpital Nord Laennec, Nantes, France
| | - Delphine Drui
- Nantes Université, CHU Nantes, Service d'Endocrinologie, Diabétologie et Nutrition, l'institut du thorax, Nantes, France
| | - Eric Mirallié
- Nantes Université, CHU Nantes, Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, Nantes, France
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Hazkani I, Stein E, Edwards E, Maddalozzo J, Johnston D, Samis J, Josefson J, Rastatter J. Abnormal TSH Prior to Surgery in Children with Graves' Disease Predicts Abnormal TSH Following Thyroidectomy. Laryngoscope 2023; 133:2402-2406. [PMID: 36370147 DOI: 10.1002/lary.30485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/20/2022] [Accepted: 10/30/2022] [Indexed: 08/11/2023]
Abstract
OBJECTIVE To identify variables that are associated with poor compliance to thyroid hormone replacement therapy in children after total thyroidectomy. METHOD A retrospective cohort study of children who underwent total thyroidectomy by high-volume pediatric otolaryngologists between 1/2014 and 9/2021. Postoperative poor compliance was characterized by at least three separate measurements of high TSH levels not associated with radioactive iodine treatment. RESULTS There were 100 patients, ages 3-20 years old who met inclusion criteria; 44 patients underwent thyroidectomy for cancer diagnosis, and 56 for Graves' disease. The mean follow-up time was 36.5 months (range 3.0-95.6 months). Overall, 42 patients (42%) were found to have at least three measurements of high TSH during follow-up, and 29 patients (29%) were diagnosed with clinical hypothyroidism. Sex, race, income, insurance type, and benign versus malignant etiology for thyroidectomy were not associated with adherence to therapy. Multivariate regression analysis identified patients with Graves' disease and hyperthyroidism at the time of surgery and Hispanic ethnicity to be associated with postoperative clinical hypothyroidism (OR 9.38, 95% CI 2.16-49.2, p = 0.004 and OR 6.15, 95% CI 1.21-36.0, p = 0.033, respectively). CONCLUSIONS Preoperative hyperthyroidism in patients with Graves' disease and Hispanic ethnicity were predictors of postoperative TSH abnormalities. Preoperative counseling for patients and their families on the implications of total thyroidectomy and the need for life-long medications postoperatively is necessary. Efforts should be made to evaluate and improve adherence to therapy pre-and postoperatively in patients with Graves' disease. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2402-2406, 2023.
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Affiliation(s)
- Inbal Hazkani
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Eli Stein
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Evan Edwards
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - John Maddalozzo
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Douglas Johnston
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jill Samis
- Division of Pediatric Endocrinology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jami Josefson
- Division of Pediatric Endocrinology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jeffrey Rastatter
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Guo XL, Yin WY. A preoperative parathyroid scan is important for the total removal of the transplanted parathyroid tissue in recurrent secondary hyperthyroidism: A case report and literature review. Medicine (Baltimore) 2022; 101:e32453. [PMID: 36595874 PMCID: PMC9794238 DOI: 10.1097/md.0000000000032453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
RATIONALE Secondary hyperparathyroidism was one of mineral and bone disorders owing to chronic kidney disease. Patients who suffer from secondary hyperparathyroidism would receive medical treatment or parathyroidectomy with or without autotransplantation (AT). However, some patients receiving parathyroidectomy with AT have recurrent hyperparathyroidism, which impacts their lives. Patients with recurrent hyperparathyroidism may present persistent hypercalcemia and hyperphosphatemia, which would cause cardiovascular disease, like atherosclerosis. PATIENT CONCERNS A 63-year-old female of Asian descent with chronic kidney disease who suffered from recurrent hyperparathyroidism for twice. The patient underwent parathyroidectomy with AT in the left thigh when secondary hyperparathyroidism happened. After 3 months, recurrent hyperparathyroidism happened. DIAGNOSIS The patient was diagnosed with recurrent hyperparathyroidism due to chronic kidney disease with hyperparathyroidism status post parathyroidectomy with AT in the left thigh. Our patient also suffered from mineral and bone disorder. INTERVENTION Two parathyroid adenoma in the left thigh were found. However, one of them was too small to found in the operation. Therefore, autograftectomy of the large one was performed. However, hyperparathyroidism happened again. This time, the autograftectomy was performed under dual phase Tc-99m MIBI (99m Tc-methoxy isobutyl isonitrile) parathyroid scintigraphy and it succeeded. OUTCOMES After secondary autograftectomy, the value of intact parathyroid hormone was surveyed immediately and dropped by two-third followed by gradual reduction in the following weeks. The calcemia and phosphatemia were back to normal gradually. LESSONS In our case, importance of scintigraphy in the parathyroidectomy was confirmed.
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Affiliation(s)
- Xin-Ling Guo
- School of Medicine, Tzu Chi University, Hualien City, Taiwan
| | - Wen-Yao Yin
- School of Medicine, Tzu Chi University, Hualien City, Taiwan
- Department of General Surgery, Buddhist Tzu Chi Medical Foundation Dalin Tzu Chi Hospital, Chia Yi, Taiwan
- *Correspondence: Wen-Yao Yin, Department of General Surgery, Buddhist Tzu Chi Medical Foundation Dalin Tzu Chi Hospital, Chia Yi, Taiwan (e-mail: )
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Hazkani I, Stein E, Samis J, Josefson J, Maddalozzo J, Johnston D, Huang A, Rastatter J. The effect of hyperthyroidism at thyroidectomy on complication rates in children with Graves' disease. Int J Pediatr Otorhinolaryngol 2022; 163:111360. [PMID: 36274323 DOI: 10.1016/j.ijporl.2022.111360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Graves' disease (GD) is the most common cause of childhood hyperthyroidism. Surgery is often chosen as a treatment modality given the high relapse rates and side effects of antithyroid drugs and has shown to be safe and efficacious. The goal of our study was to evaluate whether hyperthyroidism at time of thyroidectomy is associated with higher intra and postoperative complication rates. METHODS A retrospective cohort study of children who underwent thyroidectomy for GD by high-volume pediatric otolaryngologists between 2014 and 2021. RESULTS 64 patients met inclusion criteria. Patients with hyperthyroidism (defined as free T4≥1.63 ng/dL) were more likely to be treated with beta-blocker preoperatively compared to the euthyroid group (20/24 patients (83%) vs 23/40 patients (58%) respectively, p = 0.035). Twenty (83%) patients with hyperthyroidism and 39 euthyroid patients (98%) were treated with methimazole prior to surgery. Intraoperative tachycardia was noted in 5% of euthyroid patients and 20.8% of patients with hyperthyroidism. The mean peak heart rate intra-operatively and the number of patients with heart rate ≥120bmp were significantly higher for patients with hyperthyroidism (96.5 ± 16.2 vs 87.6 ± 22.1bpm, p = 0.02). Two patients required administration of esmolol during surgery for heart rate control, both with hyperthyroidism. Intra-operative peak systolic blood pressure, operative time, estimated blood loss, persistent hypocalcemia, length of admission and recurrent laryngeal nerve paralysis rates were similar among groups. CONCLUSIONS Hyperthyroidism at surgery is associated with increased heart rate intraoperatively, with no increased risk for other complications. While optimizing thyroid hormone levels before surgery should be pursued in all children, our data suggest that hyperthyroidism should not delay the surgery.
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Affiliation(s)
- Inbal Hazkani
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Eli Stein
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jill Samis
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Division of Pediatric Endocrinology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jami Josefson
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Division of Pediatric Endocrinology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - John Maddalozzo
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Douglas Johnston
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Andrea Huang
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Division of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jeffrey Rastatter
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Ultrasound Intervention Professional Committee of Interventional Physician Branch of Chinese Medical Doctor Association, the Ablation Professional Committee of Interventional Physician Branch of Chinese Medical Doctor Association, Technical Expert Group of Thyroid Tumor Ablation Treatment of Chinese Medical Doctor Association, Technical Expert Group of Tumor Ablation of Chinese Medical Doctor Association, Tumor Ablation Expert Committee of the Chinese Society of Clinical Oncology (CSCO), Tumor Ablation Professional Committee of the Chinese Anti-Cancer Association. [Expert consensus and operation specifications for thermal ablation in the treatment of primary hyperthyroidism]. Zhonghua Nei Ke Za Zhi 2022; 61:507-16. [PMID: 35488600 DOI: 10.3760/cma.j.cn112138-20211208-00869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In recent years, no major advances have been developed in the standard treatment of primary hyperthyroidism, which mainly includes medication, radiotherapy and bilateral subtotal/total thyroidectomy. These three therapies have specific advantages and disadvantages, even traditional surgery is not appropriate for some patients due to invasive trauma, complications and neck scars. As great progresses of thermal ablation technology have been made, many domestic hospitals are carrying out this technique for hyperthyroidism. In order to improve the efficacy and safety, critical issues related to thermal ablation in patients with hyperthyroidism, including indications, contraindications, perioperative preparations, anesthesia and procedure etc, were discussed. The Chinese Medical Doctor Association, Ultrasound Intervention Professional Committee of Interventional Physician Branch of Chinese Medical Doctor Association, Professional Committee of Interventionist Branch of Chinese Medical Doctor Association, The Expert Committee of the Chinese Society of Clinical Oncology (CSCO) and the Professional Committee of the Chinese Anti-Cancer Association organized related experts and formulated this consensus based on the latest research progress.
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Wei B, Xu D. [Problems and prospects for thermal ablation in the treatment of primary hyperthyroidism]. Zhonghua Nei Ke Za Zhi 2022; 61:451-454. [PMID: 35488590 DOI: 10.3760/cma.j.cn112138-20220329-00221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- B Wei
- Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou 310022, China
| | - D Xu
- Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou 310022, China Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou 310022, China
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Yang J, Zheng Y, Li C, Liu Y, Zhou Q, Gao J, Meng X, Zhang K, Wang W, Shao C, Tang YD. The Impact of Subclinical Hyperthyroidism on Cardiovascular Prognosis in Patients Undergoing Percutaneous Coronary Intervention. J Clin Endocrinol Metab 2022; 107:986-997. [PMID: 34850030 DOI: 10.1210/clinem/dgab855] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Indexed: 01/15/2023]
Abstract
CONTEXT Limited studies have focused on the impact of subclinical hyperthyroidism (SHyper) on poor prognosis in patients with known coronary artery disease (CAD). OBJECTIVE We implemented the present study to explore the association between SHyper and adverse cardiovascular events in CAD patients who underwent drug-eluting stent implantation. METHODS We consecutively recruited 8283 CAD patients undergoing percutaneous coronary intervention (PCI). All subjects were divided into 2 groups according to their thyroid function: group 1 (euthyroidism group, n = 7942) and group 2 (SHyper group, n = 341). After 1:4 propensity score (PS) matching, 1603 patients (332 SHyper group and 1271 euthyroidism group) were selected. The primary endpoint was major adverse cardiovascular events (MACEs), a composite of cardiac mortality, nonfatal myocardial infarction (MI), and target vessel revascularization (TVR). RESULTS Kaplan-Meier (K-M) survival analyses suggested that there was no significant difference in the primary endpoint and secondary endpoints (MACE: 11.4% vs 8.8%, log-rank P = .124; cardiac death: 1.2% vs 0.9%, log-rank P = .540; nonfatal MI: 5.7% vs 4%, log-rank P = .177; and TVR: 6% vs 4.7%, log-rank P = .303) in the PS-matched population. Cox regression analysis indicated that SHyper was not an independent risk factor for MACEs (HR 1.33, 95% CI 0.92-1.92, P = .127). CONCLUSION SHyper is not independently associated with adverse cardiovascular events in CAD patients undergoing PCI. More studies should be implemented in the future to assess the long-term predictive value of SHyper with thyrotropin levels <0.1 mIU/L for CAD patients undergoing PCI.
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Affiliation(s)
- Jie Yang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yitian Zheng
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chen Li
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yupeng Liu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qing Zhou
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Gao
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China
| | - Xiangbin Meng
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China
| | - Kuo Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenyao Wang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chunli Shao
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China
| | - Yi-Da Tang
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China
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Abstract
Background The relationship between good early control of thyroid hormone levels after thyroidectomy for Graves’ disease (GD) and subsequent risks of mortality and morbidities is not well known. The aim of this study was to examine the association between thyroid hormone levels within a short interval after surgery and long-term mortality and morbidity risks from a population-based database. Methods Patients with GD who underwent complete/total thyroidectomy between 2006 and 2018 were selected from the Hong Kong Hospital Authority clinical management system. All patients were classified into three groups (euthyroidism, hypothyroidism, and hyperthyroidism) according to their thyroid hormone levels at 6, 12, and 24 months after surgery. Cox proportional hazards models were performed to compare the risks of all-cause mortality, cardiovascular disease (CVD), Graves’ ophthalmopathy, and cancer. Results Over a median follow-up of 68 months with 5709 person-years, 949 patients were included for analysis (euthyroidism, n = 540; hypothyroidism, n = 282; and hyperthyroidism, n = 127). The hypothyroidism group had an increased risk of CVD (HR = 4.20, 95 per cent c.i. 2.37 to 7.44, P < 0.001) and the hyperthyroidism group had an increased risk of cancer (HR = 2.14, 95 per cent c.i. 1.55 to 2.97, P < 0.001) compared with the euthyroidism group. Compared with patients obtaining euthyroidism both at 6 months and 12 months, the risk of cancer increased in patients who achieved euthyroidism at 6 months but had an abnormal thyroid status at 12 months (HR = 2.33, 95 per cent c.i. 1.51 to 3.61, P < 0.001) and in those who had abnormal thyroid status at 6 months but achieved euthyroidism at 12 months (HR = 2.52, 95 per cent c.i. 1.60 to 3.97, P < 0.001). Conclusions This study showed a higher risk of CVD in postsurgical hypothyroidism and a higher risk of cancer in hyperthyroidism compared with achieving euthyroidism early after thyroidectomy. Patients who were euthyroid at 6 months and 12 months had better outcomes than those achieving euthyroidism only at 6 months or 12 months. Attaining biochemical euthyroidism early after thyroidectomy should become a priority.
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Affiliation(s)
- Xiaodong Liu
- Department of Surgery, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Carlos K H Wong
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
- Laboratory of Data Discovery for Health, Hong Kong Science Park, New Territories, Hong Kong SAR, People's Republic of China
| | - Wendy W L Chan
- Department of Clinical Oncology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Eric H M Tang
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Yu Cho Woo
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Shirley Y W Liu
- Division of Endocrine Surgery, Department of Surgery, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Cindy L K Lam
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Brian H H Lang
- Correspondence to: Brian H. H. Lang, Division of Endocrine Surgery, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 102 Pokfulam Road, Hong Kong SAR, People's Republic of China (e-mail: )
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Kaneto H, Kamei S, Tatsumi F, Shimoda M, Kimura T, Obata A, Anno T, Nakanishi S, Kaku K, Mune T. Syndrome of inappropriate secretion of thyroid-stimulating hormone in a subject with galactorrhea and menstrual disorder and undergoing infertility treatment: Case report. Medicine (Baltimore) 2021; 100:e28414. [PMID: 34967378 PMCID: PMC8718172 DOI: 10.1097/md.0000000000028414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/06/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Syndrome of inappropriate secretion of thyroid-stimulating hormone (SITSH) is a rare cause of hyperthyroidism. Thyroid-stimulating hormone (TSH) levels are usually normal or high, and triiodothyronine (FT3) and free thyroxine (FT4) levels are usually high in subjects with SITSH. PATIENT CONCERN A 37-year-old woman had experienced galactorrhea and menstrual disorder for a couple of years before. She had undergone infertility treatment in 1 year before, hyperthyroidism was detected and she was referred to our institution. DIAGNOSIS She was suspected of having SITSH and was hospitalized at our institution for further examination. The data on admission were as follows: FT3, 4.62 pg/mL; FT4, 1.86 ng/dL; TSH, 2.55 μIU/mL. Although both FT3 and FT4 levels were high, TSH levels were not suppressed, which is compatible with SITSH. In addition, in brain contrast-enhanced magnetic resonance imaging, nodular lesions were observed in the pituitary gland with a diameter of approximately 10 mm. In the thyrotropin-releasing hormone load test, TSH did not increase at all, which was also compatible with TSH-secreting pituitary adenoma. In the octreotide load test, the TSH levels were suppressed. Based on these findings, we diagnosed this subject as SITSH. INTERVENTIONS Hardy surgery was performed after the final diagnosis. In TSH staining of the resected pituitary adenoma, many TSH-producing cells were observed. These findings further confirmed the diagnosis of pituitary adenoma producing TSH. OUTCOMES Approximately 2 months after the operation, TSH, FT3, and FT4 levels were normalized. Approximately 3 months after the operation, she became pregnant without any difficulty. LESSONS We should consider the possibility of SITSH in subjects with galactorrhea, menstrual disorders, or infertility. In addition, we should recognize that it is very important to repeatedly examine thyroid function in subjects with galactorrhea, menstrual disorder, or infertility.
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Affiliation(s)
- Hideaki Kaneto
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Japan
| | - Shinji Kamei
- Department of Diabetic Medicine, Kurashiki Central Hospital, Japan
| | - Fuminori Tatsumi
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Japan
| | - Masashi Shimoda
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Japan
| | - Tomohiko Kimura
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Japan
| | - Atsushi Obata
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Japan
| | - Takatoshi Anno
- Department of General Internal Medicine 1, Kawasaki Medical School, Japan
| | - Shuhei Nakanishi
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Japan
| | - Kohei Kaku
- Kawasaki Medical School General Medical Center, Japan
| | - Tomoatsu Mune
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Japan
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Abstract
Background: The American Thyroid Association (ATA) published the 2015 Management Guidelines for patients with thyroid nodules and differentiated thyroid cancer, recommending a shift to less aggressive diagnostic, surgical, and postoperative treatment strategies. At the same time and perhaps related to the new guidelines, there has been a shift to outpatient thyroid surgery. The aim of the current study was to assess physician adherence to these recommendations by identifying and quantifying temporal trends in the rates and indications for thyroid procedures in the inpatient and outpatient settings. Methods: Using the IBM® MarketScan® Commercial database, we identified employer-insured patients in the United States who underwent outpatient and inpatient thyroid surgery from 2007 to 2018. Thyroid surgery was classified as total thyroidectomy (TT), thyroid lobectomy (TL), or a completion thyroidectomy. The surgical indication diagnosis was also determined and classified as either benign or malignant thyroid disease. We compared outpatient and inpatient trends in surgery between benign and malignant thyroid disease both before and after the release of the 2015 ATA guidelines. Results: A total of 220,088 patients who underwent thyroid surgery were included in the analysis. Approximately 80% of TLs were performed in the outpatient setting versus 70% of TTs. Longitudinal analysis showed a statistically significant changepoint for TT proportion occurring in November 2015. The proportion of TT as compared with TL decreased from 80% in September 2015 to 39% by December 2018. For thyroid cancer, there is an increasing trend in performing TL over TT, increasing from 17% in 2015 to 28% by the end of 2018. Conclusions: There was a significant changepoint occurring in November 2015 in the operative and management trends for benign and malignant thyroid disease.
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Affiliation(s)
- Asmae Toumi
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Surgical Oncology, Harvard Medical School, Boston, Massachusetts, USA
| | - Catherine DiGennaro
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Surgical Oncology, Harvard Medical School, Boston, Massachusetts, USA
| | - Vahab Vahdat
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Surgical Oncology, Harvard Medical School, Boston, Massachusetts, USA
| | - Mohammad S. Jalali
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Surgical Oncology, Harvard Medical School, Boston, Massachusetts, USA
| | - G. Scott Gazelle
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Surgical Oncology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jagpreet Chhatwal
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Surgical Oncology, Harvard Medical School, Boston, Massachusetts, USA
| | - Rachel R. Kelz
- Department of Surgery, Center for Surgery and Health Economics, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carrie C. Lubitz
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Surgical Oncology, Harvard Medical School, Boston, Massachusetts, USA
- Address correspondence to: Carrie C. Lubitz, MD, MPH, Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA 02114, USA
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13
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Piccin O, D'Alessio P, Cioccoloni E, Burgio L, Poggi C, Altieri P, Vicennati V, Repaci A, Pagotto U, Cavicchi O. Pre-operative imaging workup for surgical intervention in primary hyperparathyroidism: A tertiary referral center experience. Am J Otolaryngol 2021; 42:102819. [PMID: 33157312 DOI: 10.1016/j.amjoto.2020.102819] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Preoperative imaging in patients with primary hyperparathyroidism provides important localization information, allowing the surgeon to perform a focused surgery. However there are no evidence-based guidelines suggesting which preoperative imaging should be used, resulting in a risk of excessive prescription of exams and waste of economic resources. The main purpose of this study was to describe our experience on the performance of various imaging techniques for the preoperative localization of abnormal parathyroid gland/s, with a focus on the sensitivity and specificity of each technique. Secondly, we carried out an analysis of the cost utility of each technique in order to determine the most clinical and cost-effective combination of localization studies. MATERIALS AND METHODS Records of 336 patients who underwent parathyroidectomy were retrospectively examined comparing imaging and intraoperative/histopathologic findings to evaluate the accuracy in parathyroid detection of each imaging technique. Costs were determined by regional health system reimbursement. RESULTS We found that the sensitivity of color Doppler US was significantly higher than SPECT (p 0,023), while the sensitivity of 4D-CT was significantly better than US (p 0,029) and SPECT (p 0,0002). CONCLUSIONS In experienced hands color Doppler US is a highly sensitive technique especially in patients with no thyroid diseases. In patients with concomitant thyroid pathology, the combination of US and 4D-CT represents a reliable localization technique.
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Affiliation(s)
- Ottavio Piccin
- Department of Otolaryngology Head and Neck Surgery, IRCSS-Azienda Ospedaliero Universitaria di Bologna, Policlinico Sant'Orsola, via Massarenti 9, 40138 Bologna, Italy.
| | - Pasquale D'Alessio
- Department of Otolaryngology Head and Neck Surgery, IRCSS-Azienda Ospedaliero Universitaria di Bologna, Policlinico Sant'Orsola, via Massarenti 9, 40138 Bologna, Italy
| | - Eleonora Cioccoloni
- Department of Otolaryngology Head and Neck Surgery, IRCSS-Azienda Ospedaliero Universitaria di Bologna, Policlinico Sant'Orsola, via Massarenti 9, 40138 Bologna, Italy
| | - Luca Burgio
- Department of Otolaryngology Head and Neck Surgery, IRCSS-Azienda Ospedaliero Universitaria di Bologna, Policlinico Sant'Orsola, via Massarenti 9, 40138 Bologna, Italy
| | - Cristina Poggi
- Department of Radiology, IRCSS-Azienda Ospedaliero Universitaria di Bologna, Policlinico Sant'Orsola, via Massarenti 9, 40138 Bologna, Italy
| | - Paola Altieri
- Division of Endocrinology, IRCSS-Azienda Ospedaliero Universitaria di Bologna, Policlinico Sant'Orsola, via Massarenti 9, 40138 Bologna, Italy
| | - Valentina Vicennati
- Division of Endocrinology, IRCSS-Azienda Ospedaliero Universitaria di Bologna, Policlinico Sant'Orsola, via Massarenti 9, 40138 Bologna, Italy
| | - Andrea Repaci
- Division of Endocrinology, IRCSS-Azienda Ospedaliero Universitaria di Bologna, Policlinico Sant'Orsola, via Massarenti 9, 40138 Bologna, Italy
| | - Uberto Pagotto
- Division of Endocrinology, IRCSS-Azienda Ospedaliero Universitaria di Bologna, Policlinico Sant'Orsola, via Massarenti 9, 40138 Bologna, Italy
| | - Ottavio Cavicchi
- Department of Otolaryngology Head and Neck Surgery, IRCSS-Azienda Ospedaliero Universitaria di Bologna, Policlinico Sant'Orsola, via Massarenti 9, 40138 Bologna, Italy
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14
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Abuqbeitah M, Demir M, Yeyin N, Sager S, Gray D. Thyroid uptake test with portable device (COTI) after 131I tracer administration: proof of concept. Radiat Environ Biophys 2020; 59:553-558. [PMID: 32449015 DOI: 10.1007/s00411-020-00849-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/13/2020] [Indexed: 06/11/2023]
Abstract
COTI (collar therapy indicator) has been recently introduced for the detection of gamma rays with emphasis on thyroid investigations. The aim of this study was to test the feasibility of a prototype version of COTI including activity detectors with low sensitivity in performing thyroid uptake measurements for a large group of patients. Consequently, thyroid uptake tests were carried out for a total of 89 patients (22 males and 67 females; age: 44 ± 13 years) with thyroid cancer (n = 74), hyperthyroidism (n = 16) at 2 and 24 h after administration of 0.44-2 MBq of 131I. Eight individuals among the thyroid cancer patients were monitored up to 96 h after administration. The COTI device was equipped with two CsI (Tl) detectors, known as LoHi type, sensitive to activity ranges from 0.02 to 30 MBq of 131I. The uptake values from COTI were compared with those measured with a standard probe. It was found that the mean uptake of thyroid activity in thyroid cancer patients was 2.1 ± 1.3% at 2 h when measured with the standard probe, while it was 2.2 ± 1.2% when measured with COTI. In addition, the average uptake at 24 h after administration was 2.5 ± 3.2% and 3.2 ± 3.8% measured with COTI and the standard probe, respectively. A strong correlation was found at 24 h between the results obtained with COTI and the standard probe, while a weaker correlation was seen at 2 h. Overall, there was no significant difference between the results obtained with the standard probe and those obtained with COTI at both 2 and 24 h (Pvalue ≥ 0.05). Besides, 85% of the uptake values measured with COTI were less than those measured with the standard probe at the 24 h after administration. The average uptake value was 0.9 ± 0.8% after 96 h by COTI, and 1.4 ± 1.3% by the standard probe. Pertaining to the hyperthyroidism patients, COTI showed mean uptake values of 20 ± 16% and 23 ± 18% at 2 and 24 h, respectively. In contrast, the standard probe suggested higher mean uptake values of 26 ± 18% and 30 ± 22%, respectively. It is concluded that the prototype of COTI used in the present study has been proved to be a feasible and promising tool in thyroid investigations. It is noted, however, that the next COTI generation should include detectors equipped with collimator and energy discrimination.
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Affiliation(s)
- Mohammad Abuqbeitah
- Cerrahpasa Faculty of Medicine, Department of Nuclear Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Mustafa Demir
- Cerrahpasa Faculty of Medicine, Department of Nuclear Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nami Yeyin
- Cerrahpasa Faculty of Medicine, Department of Nuclear Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sait Sager
- Cerrahpasa Faculty of Medicine, Department of Nuclear Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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15
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Abstract
PURPOSE Redo thyroid surgery is associated with higher risk of hematoma than the initial thyroid surgery. We report a single surgeon's experience of performing redo thyroid surgery without drains. METHODS This retrospective single-institutional study evaluates the safety and efficiency of redo thyroid surgery without drains by comparing three groups of patients: those who underwent primary bilateral thyroidectomy (Group 1), those who underwent completion thyroidectomy (Group 2); and those who underwent thyroidectomy for recurrent thyroid diseases (Group 3). RESULTS The demographic characteristics did not differ among the groups. Substernal extension and hyperthyroidism were more frequent in group 1, whereas the weight of the resected thyroid gland was lower in groups 2 and 3. Hematoma occurred in 5%, 4%, and 4% of patients in Groups 1, 2, and 3, respectively. Postoperative transient hypocalcemia occurred in 19%, 16%, and 21% of patients in Groups 1, 2, and 3 respectively. The postoperative incidence of transient recurrent laryngeal nerve (RLN) paralysis in Groups 1, 2, and 3, was 6%, 7%, and 8%, respectively. The incidence of permanent unilateral RLN paralysis in Groups 2 and 3 was 1%. The postoperative length of stay was 1 day in 92% of the patients from all groups. CONCLUSIONS Avoiding the routine use of drains in redo thyroid surgery is safe and effective, it does not increase overall surgical morbidity, and it reduces the overall length of stay in hospital.
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Affiliation(s)
- Bassam Abboud
- Division of General Surgery, Faculty of Medicine, Geitaoui Hospital, Lebanese University, Achrafieh, Beirut, Lebanon.
| | - Alaa El-Kheir
- Division of General Surgery, Faculty of Medicine, Geitaoui Hospital, Lebanese University, Achrafieh, Beirut, Lebanon
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16
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Oramas A, Boston S, Wavreille V. The outcome for feline non-hypersecretory thyroid carcinoma after thyroidectomy. Can Vet J 2020; 61:719-723. [PMID: 32655154 PMCID: PMC7296877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A 14-year-old neutered male cat was presented because of a left ventral cervical mass. Based on imaging, the mass was suspected to have a thyroid origin. There was no evidence of gross metastatic disease or hyperthyroidism. Left thyroidectomy alone was the treatment for this patient and a thyroid carcinoma was diagnosed on histopathology. At last follow-up, 831 days after surgery, there was suspicion of metastasis to the lungs and the cat had developed a right thyroid mass and hyperthyroidism. Key clinical message: This case report identifies a non-hypersecretory thyroid carcinoma. This is a rare diagnosis. The outcome with surgery alone was comparable to that reported for treatment with iodine131.
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Affiliation(s)
- Alberto Oramas
- University of Florida Ringgold standard institution - ECC, 2015 SW 16th Ave, Gainesville, Florida 32610, USA (Oramas); VCA Canada, 404 Veterinary Emergency & Referral - Surgical Oncology, 510 Harry Walker Parkway South, Newmarket, Ontario L3Y 0B3 (Boston); The Ohio State University, College of Veterinary Medicine - Department of Veterinary Clinical Sciences, Columbus, Ohio, USA (Wavreille)
| | - Sarah Boston
- University of Florida Ringgold standard institution - ECC, 2015 SW 16th Ave, Gainesville, Florida 32610, USA (Oramas); VCA Canada, 404 Veterinary Emergency & Referral - Surgical Oncology, 510 Harry Walker Parkway South, Newmarket, Ontario L3Y 0B3 (Boston); The Ohio State University, College of Veterinary Medicine - Department of Veterinary Clinical Sciences, Columbus, Ohio, USA (Wavreille)
| | - Vincent Wavreille
- University of Florida Ringgold standard institution - ECC, 2015 SW 16th Ave, Gainesville, Florida 32610, USA (Oramas); VCA Canada, 404 Veterinary Emergency & Referral - Surgical Oncology, 510 Harry Walker Parkway South, Newmarket, Ontario L3Y 0B3 (Boston); The Ohio State University, College of Veterinary Medicine - Department of Veterinary Clinical Sciences, Columbus, Ohio, USA (Wavreille)
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17
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Hsieh LB, Yen TWF, Dream S, Patel D, Evans DB, Wang TS. Perioperative Management and Outcomes of Hyperthyroid Patients Unable to Tolerate Antithyroid Drugs. World J Surg 2020; 44:3770-3777. [PMID: 32572525 DOI: 10.1007/s00268-020-05654-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prior to thyroidectomy for hyperthyroidism, it is recommended that patients are managed with antithyroid drugs (ATDs) and rendered euthyroid to decrease the risk of thyroid storm. However, not all patients tolerate ATD and the risk of thyroid storm during thyroidectomy in these patients is unclear. Therefore, the aim of this study was to compare the management and outcomes of hyperthyroid patients that were on ATDs prior to surgery to those who were not. STUDY DESIGN A prospectively maintained, single-institution database was queried for all hyperthyroid patients who were initially treated with ATDs and underwent thyroidectomy from January 1, 2012, to June 18, 2018. Patients were divided into two groups: (1) those on ATDs at surgery (ATD group) and (2) those who could not tolerate and stopped ATDs prior to surgery (no-ATD group). Demographic and clinical data were collected. Primary outcomes were readmissions/emergency department visits and postoperative complications within 30 days of thyroidectomy. RESULTS Of the 248 patients, 231 were in the ATD group and 17 (7%) were in the no-ATD group. There were no mortalities or thyroid storm events in either group. There was no difference in Clavien-Dindo Grade 2 or 3 complications between the two groups. There were no ED visits or 30-day readmissions in the no-ATD group compared to 17 (7%) events in the ATD group (p = 1.0). CONCLUSION While it is preferable to render patients euthyroid prior to thyroidectomy for hyperthyroidism, results of this study suggest that when patients cannot tolerate ATDs, it is possible to perform thyroidectomy without increased risk of thyroid storm or intra- and postoperative complications.
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Affiliation(s)
- Lily B Hsieh
- Section of Endocrine Surgery, Division of Surgical Oncology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, USA
| | - Tina W F Yen
- Section of Endocrine Surgery, Division of Surgical Oncology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, USA
| | - Sophie Dream
- Section of Endocrine Surgery, Division of Surgical Oncology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, USA
| | - Dhaval Patel
- Section of Endocrine Surgery, Division of Surgical Oncology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, USA
| | - Douglas B Evans
- Section of Endocrine Surgery, Division of Surgical Oncology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, USA
| | - Tracy S Wang
- Section of Endocrine Surgery, Division of Surgical Oncology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, USA.
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18
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Lombardi CP, D'Amore A, Grani G, Ramundo V, Boscherini M, Gordini L, Marzi F, Tedesco S, Bocale R. Endocrine surgery during COVID-19 pandemic: do we need an update of indications in Italy? Endocrine 2020; 68:485-488. [PMID: 32500518 PMCID: PMC7270156 DOI: 10.1007/s12020-020-02357-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/15/2020] [Indexed: 12/12/2022]
Abstract
The ongoing spread of the coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) poses a significant threat to global health. As the coronavirus outbreak began spreading, hospitals were forced to relocate resources to treat the growing number of COVID-19 patients. As a consequence, doctors across the country canceled tens of thousands of nonurgent surgeries. However, recognizing that the COVID-19 situation may be highly variable and fluid in different communities across the country, elective surgery could be still allowed in some centers for patients included in the high-priority class. The majority of endocrine disorders requiring surgical treatment in patients identifiable as first-priority class, or needing hospitalization within 30 days, are generally represented by malignant thyroid tumors, hyperthyroidism, hyperparathyroidism, and some adrenal disorders. The need for urgent intervention is evaluated on a case-by-case basis according to the severity of the symptoms, the likelihood of progression, and global clinical judgment. On the basis of the above indications, during the last 4 weeks, we performed 18 planned surgical treatments in patients with thyroid cancer (total thyroidectomies, plus lymph node dissection if needed) or multinodular toxic goiter. In no case, postoperative ventilatory support was needed, and the average hospital stay was 3 days. The negative COVID-19 status for all the treated patients was appropriately evaluated beforehand. Nobody knows how long the current COVID-19 pandemic will be lasting. Certainly, we will be requested in the next future to incrementally offer surgical services for endocrine disorders that have been deferred for the COVID-19 pandemic.
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Affiliation(s)
- Celestino Pio Lombardi
- Division of Endocrine Surgery, "Agostino Gemelli" School of Medicine, University Foundation Polyclinic, Catholic University of the Sacred Heart, Rome, Italy
| | - Annamaria D'Amore
- Division of Endocrine Surgery, "Agostino Gemelli" School of Medicine, University Foundation Polyclinic, Catholic University of the Sacred Heart, Rome, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Valeria Ramundo
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Mauro Boscherini
- Division of Endocrine Surgery, "Agostino Gemelli" School of Medicine, University Foundation Polyclinic, Catholic University of the Sacred Heart, Rome, Italy
| | - Luca Gordini
- Division of Endocrine Surgery, "Agostino Gemelli" School of Medicine, University Foundation Polyclinic, Catholic University of the Sacred Heart, Rome, Italy
| | - Federica Marzi
- Division of Endocrine Surgery, "Agostino Gemelli" School of Medicine, University Foundation Polyclinic, Catholic University of the Sacred Heart, Rome, Italy
| | - Silvia Tedesco
- Division of Endocrine Surgery, "Agostino Gemelli" School of Medicine, University Foundation Polyclinic, Catholic University of the Sacred Heart, Rome, Italy
| | - Raffaella Bocale
- Division of Endocrine Surgery, "Agostino Gemelli" School of Medicine, University Foundation Polyclinic, Catholic University of the Sacred Heart, Rome, Italy.
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19
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Hindié E, Ain KB, Zerdoud S, Avram AM. Association of Radioactive Iodine Treatment of Hyperthyroidism With Cancer Mortality: An Unjustified Warning? J Clin Endocrinol Metab 2020; 105:5687008. [PMID: 31875905 DOI: 10.1210/clinem/dgz305] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/21/2019] [Indexed: 02/13/2023]
Affiliation(s)
- Elif Hindié
- Department of Nuclear Medicine, Bordeaux University Hospitals, Hôpital Haut-Lévêque, Pessac, France
| | - Kenneth B Ain
- Department of Internal Medicine, Thyroid Oncology Program, University of Kentucky, Lexington, Kentucky, US
| | - Slimane Zerdoud
- Department of Nuclear Medicine, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Anca M Avram
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, University of Michigan, Ann Arbor, Michigan, US
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20
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Aksoy SÖ, Sevinç Aİ, Durak MG. Hyperthyroidism with thyroid cancer: more common than expected? Ann Ital Chir 2020; 91:16-22. [PMID: 32180570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Hyperthyroidism is a group of diseases with many different etiologies and clinical manifestations. The most common causes include toxic multi-nodular goiter, Graves' disease and toxic adenoma. The prevalence of thyroid cancer developing in patients with hyperthyroidism has gradually increased in recent years. The aim of this study is to detect the incidental thyroid cancer rates in patients who have undergone a surgical operation due to hyperthyroidism, and to specify the patient groups in whom surgical treatment should come into the foreground. METHODS A total of 591 patients, who had surgical excision of the thyroid due to hyperthyroidism between January 2007 and June 2017, were retrospectively analyzed. RESULTS Of all the patients included in the study, 377 (63.7%) had multi-nodular goiter, 132 (22.3%) had Graves' disease, 55 (9.4%) had nodular Graves' disease, and 27 (4.6%) had toxic adenoma. Thyroid cancer was determined in 131 out of 591 patients (22.6%) who were operated. The most common histologic type was thyroid micropapillary carcinoma (65/131; 49.6%). The accompanying pathologies to thyroid cancer were as follows: Toxic multi-nodular goiter (89/131; 67.9%), nodular Graves' disease (24/131; 18.3%), Graves' disease (13/131; 9.9%) and toxic adenoma (5/131; 2.8%). DISCUSSION Prevalence of cancer on a background of hyperthyroidism has gradually increased in recent years. It is not realistic to determine thyroid cancer prevalence only based on autopsy examinations. This rate significantly increases in the presence of nodule in clinical studies. Most of the carcinomas are microcarcinomas that do not have lymphovascular invasion and have very low lymph node metastasis. Thus, their treatment is still under debate. KEY WORDS Hyperthyroidism Micropapillary Cancer, Thyroid cancer.
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21
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Abstract
Whether or not Graves' hyperthyroidism can be really cured, depends on the definition of "cure." If eradication of thyroid hormone excess suffices for the label "cure," then all patients can be cured because total thyroidectomy or high doses of ¹³¹I will abolish hyperthyroidism albeit at the expense of creating another disease (hypothyroidism) requiring lifelong medication with levothyroxine. I would not call this a "cure," which I would like to define as a state with stable thyroid stimulating hormone (TSH), free thyroxine, and triiodothyronine serum concentrations in the normal range in the absence of any thyroid medication. Surgery and radioiodine are unlikely to result in so-defined cures, as their preferable aim as stated in guidelines is to cause permanent hypothyroidism. Discontinuation of antithyroid drugs is followed by 50% recurrences within 4 years; before starting therapy the risk of recurrences can be estimated with the Graves' Recurrent Events After Therapy (GREAT) score. At 20-year follow-up about 62% had developed recurrent hyperthyroidism, 8% had subclinical hypothyroidism, and 3% overt hypothyroidism related to TSH receptor blocking antibodies and thyroid peroxidase antibodies. Only 27% was in remission, and might be considered cured. If the definition of "cure" would also include the disappearance of thyroid antibodies in serum, the proportion of cured patients would become even lower.
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Affiliation(s)
- Wilmar M Wiersinga
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Törring O, Watt T, Sjölin G, Byström K, Abraham-Nordling M, Calissendorff J, Cramon PK, Filipsson Nyström H, Hallengren B, Holmberg M, Khamisi S, Lantz M, Wallin G. Impaired Quality of Life After Radioiodine Therapy Compared to Antithyroid Drugs or Surgical Treatment for Graves' Hyperthyroidism: A Long-Term Follow-Up with the Thyroid-Related Patient-Reported Outcome Questionnaire and 36-Item Short Form Health Status Survey. Thyroid 2019; 29:322-331. [PMID: 30667296 DOI: 10.1089/thy.2018.0315] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Hyperthyroidism is known to have a significant impact on quality of life (QoL), at least in the short term. The purpose of the present study was to assess QoL in patients 6-10 years after treatment for Graves' disease (GD) with radioiodine (RAI) compared to those treated with thyroidectomy or antithyroid drugs (ATD) as assessed with both thyroid-specific Thyroid-Related Patient-Reported Outcome (ThyPRO) questionnaire and general (36-item Short Form Health Status) QoL survey. METHODS The study evaluated 1186 GD patients in a sub-cohort from an incidence study 2003-2005 who had been treated according to routine clinical practice at seven participating centers. Patients were included if they had returned the ThyPRO (n = 975) and/or the 36-item Short Form Health Status survey questionnaire (n = 964) and informed consent at follow-up. Scores from ThyPRO were compared to scores from a general population sample (n = 712) using multiple linear regression adjusting for age and sex as well as multiple testing. Treatment-related QoL outcome for ATD, RAI, and surgery were compared, including adjustment for the number of treatments received, sex, age, and comorbidity. RESULTS Regardless of treatment modality, patients with GD had worse thyroid-related QoL 6-10 years after diagnosis compared to the general population. Patients treated with RAI had worse thyroid-related and general QoL than patients treated with ATD or thyroidectomy on the majority of QoL scales. Sensitivity analyses supported the relative negative comparative effects of RAI treatment on QoL in patients with hyperthyroidism. CONCLUSIONS GD is associated with a lower QoL many years after treatment compared to the general population. In a previous small randomized controlled trial, no difference was found in patient satisfaction years after ATD, RAI, or surgery. Now, it is reported that in a large non-randomized cohort, patients who received RAI had adverse scores on ThyPRO and 36-item Short Form Health Status survey. These findings in a Swedish population are limited by comparison to normative data from Denmark, older age, and possibly a more prolonged course in those patients who received RAI, and a lack of information regarding thyroid status at the time of evaluation. The way RAI may adversely affect QoL is unknown, but since the results may be important for future considerations regarding treatment options for GD, they need to be substantiated in further studies.
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Affiliation(s)
- Ove Törring
- 1 Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- 2 Division of Endocrinology, Department of Internal Medicine, Södersjukhuset, Stockholm, Sweden
| | - Torquil Watt
- 3 Department of Medical Endocrinology Rigshospitalet, Copenhagen, Denmark
- 4 Internal Medicine Herlev Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gabriel Sjölin
- 5 Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Kristina Byström
- 6 Department of Medicine, University Hospital and Örebro University, Örebro, Sweden
| | - Mirna Abraham-Nordling
- 7 Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jan Calissendorff
- 7 Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- 8 Department of Endocrinology, Metabolism, and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - Per Karkov Cramon
- 3 Department of Medical Endocrinology Rigshospitalet, Copenhagen, Denmark
- 4 Internal Medicine Herlev Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Helena Filipsson Nyström
- 9 Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
- 10 Department of Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Bengt Hallengren
- 11 Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- 12 Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Mats Holmberg
- 9 Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
- 13 ANOVA, Karolinska University Hospital, Stockholm, Sweden
| | - Selwan Khamisi
- 14 Department of Endocrinology, Uppsala University Hospital, Uppsala, Sweden
- 15 Institution of Internal Medicine, Uppsala University, Uppsala, Sweden
| | - Mikael Lantz
- 11 Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
- 12 Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Göran Wallin
- 5 Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- 7 Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Boutzios G, Tsourouflis G, Garoufalia Z, Alexandraki K, Kouraklis G. Long-term sequelae of the less than total thyroidectomy procedures for benign thyroid nodular disease. Endocrine 2019; 63:247-251. [PMID: 30302663 DOI: 10.1007/s12020-018-1778-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/01/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Nodular goiter is the most common disorder of the thyroid gland. Less than total thyroidectomy procedures are considered the gold standard in the surgical management of nodular thyroid disease despite its propensity for recurrence. The aim of the study was to assess long-term sequelae of the less than total thyroidectomy procedures. MATERIAL AND METHODS In this single-center retrospective study, records of 154 patients that underwent less than total thyroidectomy, for nodular disease and/or hyperthyroidism between 1998 and 2013, were reviewed. Patients with malignant findings in the histology report and a follow-up of less than 5 years were excluded. RESULTS The mean age of the recorded patients was 65.1 ± 12.91 years of which 132 were females. Subtotal thyroidectomy was performed in 45.5% of the study population, 22.1% underwent partial thyroidectomy, while the remaining 32.5% underwent lobectomy. Long-term thyroxine supplementation was administered in 138 patients (89.6%). Recurrence of clinically important nodules (>1 cm) was observed in 68.2% of patients but only 11% of the population underwent completion thyroidectomy. In the univariate analysis, the duration of follow-up (p = 0.00005, C.I.: 0.903-0.965) as well as the type of operation (p = 0.035, C.I.: 1.031-2.348) appeared to have a significant correlation with nodular recurrence. The multivariate analysis identified the duration of follow-up (p = 0.0005, C.I.: 0.908-0.973) as the only significant predictive factor of nodular recurrence. CONCLUSION This is the first study with such a long duration of post-operative follow-up. The high rate of nodular recurrence in less than total thyroidectomy procedures along with the lifelong need for thyroxine supplementation suggest that a more conservative surgical approach is needed. When surgery is recommended, we suggest total thyroidectomy as the treatment of choice to avoid the recurrence of disease, the high cost associated with frequent follow-ups by means of sonography as well as thyroxine replacement therapy.
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Affiliation(s)
- Georgios Boutzios
- Department of Pathophysiology, Laiko University Hospital, Medical School, University of Athens, Athens, Greece.
| | - Gerasimos Tsourouflis
- Second Department of Propaedeutic Surgery, Laiko University Hospital, Medical School, University of Athens, Athens, Greece
| | - Zoe Garoufalia
- Second Department of Propaedeutic Surgery, Laiko University Hospital, Medical School, University of Athens, Athens, Greece
| | - Krystallenia Alexandraki
- Department of Pathophysiology, Laiko University Hospital, Medical School, University of Athens, Athens, Greece
| | - Grigorios Kouraklis
- Second Department of Propaedeutic Surgery, Laiko University Hospital, Medical School, University of Athens, Athens, Greece
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Greenberg DJ, Luciano G, Frank JL. Transient Recurrent Laryngeal Nerve Palsy Post-Total Thyroidectomy. Am Surg 2019; 85:e36-e38. [PMID: 30760368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Tsai SL, Lin CC, Lin CY, Keng-Wei C, Chien CY. Comatose patient with hypothermia, dyspnea, and general edema in the emergency department: a case report. J Int Med Res 2018; 46:4338-4342. [PMID: 30111206 PMCID: PMC6166344 DOI: 10.1177/0300060518791074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 07/05/2018] [Indexed: 11/17/2022] Open
Abstract
Patients presenting to the emergency department with hypothermia are rare and often require prompt diagnosis and management. Myxedema coma, which may cause severe hypothermia, is a true endocrine emergency requiring early and appropriate treatment. We report on a 47-year-old woman with a history of hyperthyroidism who underwent thyroidectomy 5 years previously, with no regular medication or examinations. She presented to the emergency department with a 1-month history of progressive dyspnea associated with general weakness. She also showed hypothermia, decreased mental status, and general edema. Echocardiography revealed increased pericardial effusion without tamponade. Laboratory examination suggested myxedema coma and hypothyroidism. She received thyroxine, glucocorticoid supplement, and intensive supportive care, after which she gradually improved and was discharged. This case suggests that myxedema coma should be considered in patients with hypothyroidism or a history of thyroidectomy who present with change in consciousness, hypothermia, or other symptoms related to critical or slow presentation in multiple organs. Moreover, long-standing hypothyroidism or precipitating acute events such as sepsis, cerebrovascular accidents, gastrointestinal bleeding, cold exposure, trauma, and some medications may also cause myxedema coma. Myxedema coma is associated with a high mortality, and patients suspected to be suffering from this condition should be treated without delay.
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Affiliation(s)
- Shang-Li Tsai
- Department of Emergency Medicine, Chang Gung Memorial Hospital,
Linkou, Taiwan
| | - Chi-Chun Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital,
Linkou, Taiwan
- Department of Emergency Medicine, Ton-Yen General Hospital,
Taiwan
| | - Cheng-Yu Lin
- Department of Emergency Medicine, Ton-Yen General Hospital,
Taiwan
| | - Chang Keng-Wei
- Department of Emergency Medicine, Ton-Yen General Hospital,
Taiwan
| | - Cheng-Yu Chien
- Department of Emergency Medicine, Chang Gung Memorial Hospital,
Linkou, Taiwan
- Department of Emergency Medicine, Ton-Yen General Hospital,
Taiwan
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Ryödi E, Metso S, Huhtala H, Välimäki M, Auvinen A, Jaatinen P. Cardiovascular Morbidity and Mortality After Treatment of Hyperthyroidism with Either Radioactive Iodine or Thyroidectomy. Thyroid 2018; 28:1111-1120. [PMID: 29882483 DOI: 10.1089/thy.2017.0461] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Hyperthyroid patients remain at an increased risk of cardiovascular diseases (CVDs) after restoring euthyroidism. The impact of the different treatment modalities of hyperthyroidism on future CVD risk remains unclear. The aims of this study were to assess cardiovascular morbidity and mortality in hyperthyroidism before and after treatment, and to compare the effects of two different treatment modalities: radioactive iodine (RAI) and thyroid surgery. METHODS A comparative cohort study was conducted among 6148 hyperthyroid patients treated with either RAI or thyroidectomy and 18,432 age- and sex-matched controls. First, hospitalizations due to CVDs prior to the treatment were analyzed. Second, the hazard ratios (HR) for any new hospitalization and mortality due to CVDs after treatment were estimated among all the hyperthyroid patients compared to the age- and sex-matched controls and also in the RAI-treated patients compared to the thyroidectomy-treated patients. The results were adjusted for prevalent CVDs at the time of treatment. RESULTS Before treatment for hyperthyroidism, hospitalizations due to all CVDs were more common in the hyperthyroid patients compared to the controls (odds ratio = 1.61 [confidence interval (CI) 1.49-1.73]). During the post-treatment follow-up, hospitalizations due to CVDs remained more frequent among the patients (HR = 1.15 [CI 1.09-1.21]), but there was no difference in CVD mortality (HR = 0.93 [CI 0.84-1.03]). Compared to the patients treated with thyroidectomy, the RAI-treated patients had a higher risk of hospitalization due to all CVDs (HR = 1.17), atrial fibrillation (HR = 1.28), as well as a higher CVD mortality rate (HR = 2.56). Yet, treatment with RAI resulting in hypothyroidism was not associated with increased CVD morbidity compared to thyroidectomy. CONCLUSIONS Hyperthyroidism increases the risk of CVD-related hospitalization, and the risk is sustained for up to two decades after treatment with RAI or surgery. Hyperthyroid patients treated with RAI remain at a higher CVD risk compared to patients treated with thyroidectomy. Hypothyroidism during follow-up, however, predicts better cardiovascular outcomes.
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Affiliation(s)
- Essi Ryödi
- 1 Heart Center Co., Tampere University Hospital , Tampere, Finland
- 2 Department of Internal Medicine, Tampere University Hospital , Tampere, Finland
| | - Saara Metso
- 2 Department of Internal Medicine, Tampere University Hospital , Tampere, Finland
- 3 Faculty of Medicine and Life Sciences, Tampere University Hospital , Tampere, Finland
| | - Heini Huhtala
- 4 Faculty of Social Sciences, Tampere University Hospital , Tampere, Finland
| | - Matti Välimäki
- 5 Division of Endocrinology, Department of Medicine, Helsinki University Central Hospital , Helsinki, Finland
| | - Anssi Auvinen
- 4 Faculty of Social Sciences, Tampere University Hospital , Tampere, Finland
| | - Pia Jaatinen
- 2 Department of Internal Medicine, Tampere University Hospital , Tampere, Finland
- 3 Faculty of Medicine and Life Sciences, Tampere University Hospital , Tampere, Finland
- 6 Division of Internal Medicine, Seinäjoki Central Hospital , Seinäjoki, Finland
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Abstract
Hyperthyroidism in children is a rare heterogeneous syndrome characterized by excessive thyroid hormone production. Its manifestations differ according to disease severity. For all forms of hyperthyroidism, treatment aims to restore a euthyroid state, enabling the child to demonstrate appropriate metabolism, growth, and neurocognitive development. Graves' disease is the most frequent cause of hyperthyroidism in children. Treatment modalities include antithyroid drugs, with the advantage that prolonged treatment for several years can be followed by freedom from medical intervention in about 40-50% of cases. It may also be treated with radioactive iodine or, less frequently, thyroidectomy, these more radical treatments both necessitating subsequent lifelong levothyroxine treatment. Particular care is required in the management of pregnant women with Graves' disease. Fetal and neonatal forms of hyperthyroidism are transient and rare, but nevertheless serious. Here, we provide an overview of the best approach to hyperthyroidism diagnosis and management, from fetal development to adolescence.
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Affiliation(s)
- Juliane Léger
- Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes de la Croissance et du développement, F-75019, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, F-75019, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), Unité 1141, DHU PROTECT, F-75019, Paris, France.
| | - Jean Claude Carel
- Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes de la Croissance et du développement, F-75019, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, F-75019, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), Unité 1141, DHU PROTECT, F-75019, Paris, France
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28
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Brown S, Bhutiani N, Quillo AR. Alternative Strategies to Maximize Follow-Up after Parathyroidectomy. Am Surg 2018; 84:e158-e159. [PMID: 30454316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Stephen Brown
- Department of Radiology, University of Louisville, Louisville, Kentucky, USA
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Abstract
Aims and Background The aim of this study was to analyze the frequency of coexisting hyperthyroidism and thyroid malignancy in endemic goiter areas and review the current literature on the subject. Methods During the period January 1984 to June 1998, 1853 patients were examined for hyperthyroidism at the Spedali Civili Hospital of Brescia, Italy; 512 (27.6%) subjects underwent surgery. Of these patients 108 (21%) had Graves’ disease, 251 (49%) multinodular toxic goiter (MTG) and 153 (30%) uninodular toxic goiter (UTG). Results Malignancy was found in 24 (4.7%) patients: 19 females and 5 males with a mean age of 52.2 years (range, 21-76 years). The frequency of cancer in Graves’ disease was 6.4%, 5 females and 2 males; in MTG 3.9%, 2 females and 8 males, and in UTG 4.4%, 7 females and 1 male. Conclusions Our data confirm previous reports on the frequency of thyroid cancer in hyperthyroidism. This association is more relevant than previously suspected. The frequent coexistence of hyperthyroidism and neoplasia, demonstrated by our study and the most recent literature, underlines the importance of studying and excluding the possibility of neoplastic degeneration by means of a systematic approach.
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Affiliation(s)
- R Vaiana
- Second Division of General Surgery, Spedali Civili, Brescia, Italy
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30
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Mathonnet M, Cuerq A, Tresallet C, Thalabard JC, Fery-Lemonnier E, Russ G, Leenhardt L, Bigorgne C, Tuppin P, Millat B, Fagot-Campagna A. What is the care pathway of patients who undergo thyroid surgery in France and its potential pitfalls? A national cohort. BMJ Open 2017; 7:e013589. [PMID: 28389487 PMCID: PMC5558818 DOI: 10.1136/bmjopen-2016-013589] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT The rate of thyroid cancer is increasing in France, as well as concerns about overdiagnosis and treatment. OBJECTIVES To examine the care pathway of patients who undergo thyroid surgery in France and detect potential pitfalls. DESIGN A large observational study based on medical reimbursements, 2009-2011. SETTING Data from the Sniiram (National Health Insurance Information System). PATIENTS Patients with thyroid surgery in 2010, classified into 4 groups: thyroid cancer, benign nodule, goitre or multiple nodules, other (hyperthyroidism, head-neck cancer). MAIN OUTCOME MEASURES Medical investigations during, prior and after thyroidectomy. RESULTS A total of 35 367 patients underwent surgery (mean age 51 years, 80% women): 17% had a reported diagnosis of thyroid cancer, 20% benign nodule, 38% goitre or multiple nodules and 25% another diagnosis. The ratio of thyroidectomies with cancer over thyroidectomies with benign nodule was 0.8 and varied across regions. In the year preceding surgery, 82% of patients had an investigation by thyroid ultrasonography, 21% thyroid scintigraphy, 34% fine-needle aspiration cytology, 40% serum calcitonin assay and 54% serum calcium assay. In the following year, all patients with total thyroidectomy and 44% of patients with partial thyroidectomy and a diagnosis of benign nodule were taking thyroid hormone therapy. 100 patients had been reoperated for a compressive haematoma and 63 died during the first month, half of whom had been operated for cancer. Mean rates of recurrent laryngeal nerve injury and hypocalcaemia (requiring blood tests plus treatments within 4-12 months) were estimated at 1.5% and 3.4%, respectively, and were higher in the cancer group (2.3% and 5.7%). CONCLUSIONS This almost nationwide study demonstrates the suboptimal management of patients prior to thyroidectomy in France. It suggests overdiagnosis and potential harms to patients, and calls for a review of the relevance of thyroidectomy, particularly with regard to microcancers.
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Affiliation(s)
| | - Anne Cuerq
- Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France
| | - Christophe Tresallet
- Department of General, Visceral and Endocrine Surgery, Pitié-Salpêtrière Hospital, Paris, France
| | | | | | - Gilles Russ
- Department of Thyroid Diseases and Endocrine Tumors, Pitié Salpêtrière Hospital, University Paris VI, Institut E3M, Paris, France
| | - Laurence Leenhardt
- Department of Thyroid Diseases and Endocrine Tumors, Pitié Salpêtrière Hospital, University Paris VI, Institut E3M, Paris, France
| | - Claude Bigorgne
- Department of Pathology, La Pitié Salpétrière Hospital, Paris, France
| | - Philippe Tuppin
- Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France
| | | | - Anne Fagot-Campagna
- Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France
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Bel Lassen P, Kyrilli A, Lytrivi M, Ruiz Patino M, Corvilain B. Total thyroidectomy: a clue to understanding the metabolic changes induced by subclinical hyperthyroidism? Clin Endocrinol (Oxf) 2017; 86:270-277. [PMID: 27651121 DOI: 10.1111/cen.13237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/08/2016] [Accepted: 09/15/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The effects of endogenous subclinical hyperthyroidism (eSCH) on heart and bone have been well documented. There are only limited data available regarding the impact of eSCH on weight regulation and lipid metabolism. Our aim was to evaluate the changes in body weight and metabolic parameters after total thyroidectomy in patients with pre-operative eSCH compared with pre-operative patients with euthyroid (EUT). DESIGN A retrospective study of 505 patients who underwent total thyroidectomy for benign multinodular goitre in an academic hospital in Brussels (Belgium) was performed. PATIENT'S MEASUREMENTS Two hundred and 25 patients were included (eSCH group: n = 74; EUT group: n = 151). The mean follow-up time was 26·1 ± 0·8 months and was similar in both groups. RESULTS Absolute BMI gain was significantly greater in the eSCH group than in the EUT group (1·11 ± 0·17 vs 0·33 ± 0·13 kg/m2 ; P = 0·003). A significant increase in LDL cholesterol was observed in the eSCH group (16·1 ± 3·8 mg/dl; P < 0·001) but not in the EUT group (0·0 ± 3·0 mg/dl; P = 0·88). In a multivariate model, pre-operative TSH levels were the main factor significantly associated with increases in BMI or LDL cholesterol. Post-operative median TSH levels and L-thyroxine substitution were similar in both groups. CONCLUSION After total thyroidectomy, increases in weight and serum cholesterol were observed in the eSCH group. Given that post-operative TSH levels were similar in the two groups, these observations are probably due to the correction of eSCH, suggesting a direct effect of eSCH on body weight regulation and lipid metabolism.
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Affiliation(s)
- Pierre Bel Lassen
- Department of Endocrinology, Université Libre de Bruxelles, Brussels, Belgium
| | - Aglaia Kyrilli
- Department of Endocrinology, Université Libre de Bruxelles, Brussels, Belgium
| | - Maria Lytrivi
- Department of Endocrinology, Université Libre de Bruxelles, Brussels, Belgium
| | - Maria Ruiz Patino
- Department of Thoracic Surgery - Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Bernard Corvilain
- Department of Endocrinology, Université Libre de Bruxelles, Brussels, Belgium
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Tanna N, Joshi AS, Glade RS, Zalkind D, Sadeghi N. Da Vinci Robot–Assisted Endocrine Surgery: Novel Applications in Otolaryngology. Otolaryngol Head Neck Surg 2016; 135:633-5. [PMID: 17011430 DOI: 10.1016/j.otohns.2006.07.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Accepted: 07/03/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Neil Tanna
- George Washington University, Washington, DC, USA
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Abstract
OBJECTIVE Postoperative hypocalcemia is frequent after total thyroidectomy. The role of pre-operative vitamin D levels in the pathogenesis of this condition has not been studied under the most current guidelines for evaluation of the role of vitamin D in calcium homeostasis. We hypothesized that patients who are vitamin D deficient (VDD) pre-operatively are more likely to suffer from postoperative hypocalcemia, thereby requiring prolonged hospitalization. METHODS A retrospective chart review of patients undergoing total thyroidectomy at the University of New Mexico Hospital between 2005 and 2014 was performed. Patients who underwent intentional parathyroidectomy were excluded. The study included 30 patients who had a 25-hydroxyvitamin D levels obtained within 12 months before surgery. RESULTS Twelve patients who were VDD (25-hydroxyvitamin D ≤20 ng/mL) were compared to 18 patients who did not have VDD (non-VDD; 25-hydroxyvitamin D >20 ng/mL). The mean nadir postoperative ionized calcium concentration was lower in the VDD group (0.99 ± 0.10 vs. 1.06 ± 0.06 mmol/L, P = .04) (reference range = 1.15-1.27 mmol/L), as was the postoperative concentration of phosphorus (3.48 ± 0.60 vs. 4.17 ± 0.84 mg/dL, P = .03). VDD patients had a longer length of stay (4.3 ± 4.4 vs. 1.7 ± 1.5 days, P = .03). Three patients in the VDD group required intravenous calcium for treatment of symptomatic hypocalcemia, but none of the non-VDD patients required this intervention (P = .054). CONCLUSION Pre-operative vitamin D deficiency is associated with an increased risk of postoperative hypocalcemia and a prolonged length of stay in patients undergoing total thyroidectomy. Vitamin D replacement before thyroidectomy may improve postsurgical outcomes in VDD patients. ABBREVIATIONS BMI = body mass index non-VDD = non-vitamin D deficient PTH = parathyroid hormone VDD = vitamin D deficient.
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Ryödi E, Metso S, Jaatinen P, Huhtala H, Saaristo R, Välimäki M, Auvinen A. Cancer Incidence and Mortality in Patients Treated Either With RAI or Thyroidectomy for Hyperthyroidism. J Clin Endocrinol Metab 2015; 100:3710-7. [PMID: 26262435 DOI: 10.1210/jc.2015-1874] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Some previous studies have suggested increased cancer risk in hyperthyroid patients treated with radioactive iodine (RAI). It is unclear whether the excess cancer risk is attributable to hyperthyroidism, its treatment, or the shared risk factors of the two diseases. OBJECTIVE The objective was to assess cancer morbidity and mortality in hyperthyroid patients treated with either RAI or surgery. PATIENTS We identified 4334 patients treated surgically for hyperthyroidism in Finland during 1986-2007 from the Hospital Discharge Registry and 1814 patients treated with RAI for hyperthyroidism at Tampere University Hospital. For each patient, three age- and gender-matched controls were chosen. Information on cancer diagnoses was obtained from the Cancer Registry. The follow-up began 3 months after the treatment and ended at cancer diagnosis, death, emigration, or the common closing date (December 31, 2009). RESULTS The overall cancer incidence was not increased among the hyperthyroid patients compared to their controls (rate ratio [RR], 1.05; 95% confidence interval [CI], 0.96-1.15). However, the risk of cancers of the respiratory tract (RR, 1.46; 95% CI, 1.05-2.02) and the stomach (RR, 1.64; 95% CI, 1.01-2.68) was increased among the patients. The overall cancer mortality did not differ between the patients and the controls (RR, 1.08; 95% CI, 0.94-1.25). The type of treatment did not affect the overall risk of cancer (hazard ratio for RAI vs thyroidectomy, 1.03; 95% CI, 0.86-1.23) or cancer mortality (hazard ratio, 1.04; 95% CI, 0.91-1.21). CONCLUSIONS In this cohort of Finnish patients with hyperthyroidism treated with thyroidectomy or RAI, the overall risk of cancer was not increased, although an increased risk of gastric and respiratory tract cancers was seen in hyperthyroid patients. Based on this large-scale, long-term follow-up study, the increased cancer risk in hyperthyroid patients is attributable to hyperthyroidism and shared risk factors, not the treatment modality.
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Affiliation(s)
- Essi Ryödi
- Heart Center Co. (R.E.), Tampere University Hospital, 33521 Tampere, Finland; School of Medicine (R.E., M.S., J.P.), University of Tampere, 33521 Tampere, Finland; Department of Internal Medicine (M.S., J.P.), Tampere University Hospital, 33521 Tampere, Finland; Department of Internal Medicine (J.P.), Seinäjoki Central Hospital, 60220 Seinäjoki, Finland; School of Health Sciences (H.H., A.A.) and Department of Surgery (S.R.), Tampere University Hospital, 33521 Tampere, Finland; and Division of Endocrinology (V.M.), Department of Medicine, Helsinki University Central Hospital, 00100 Helsinki, Finland
| | - Saara Metso
- Heart Center Co. (R.E.), Tampere University Hospital, 33521 Tampere, Finland; School of Medicine (R.E., M.S., J.P.), University of Tampere, 33521 Tampere, Finland; Department of Internal Medicine (M.S., J.P.), Tampere University Hospital, 33521 Tampere, Finland; Department of Internal Medicine (J.P.), Seinäjoki Central Hospital, 60220 Seinäjoki, Finland; School of Health Sciences (H.H., A.A.) and Department of Surgery (S.R.), Tampere University Hospital, 33521 Tampere, Finland; and Division of Endocrinology (V.M.), Department of Medicine, Helsinki University Central Hospital, 00100 Helsinki, Finland
| | - Pia Jaatinen
- Heart Center Co. (R.E.), Tampere University Hospital, 33521 Tampere, Finland; School of Medicine (R.E., M.S., J.P.), University of Tampere, 33521 Tampere, Finland; Department of Internal Medicine (M.S., J.P.), Tampere University Hospital, 33521 Tampere, Finland; Department of Internal Medicine (J.P.), Seinäjoki Central Hospital, 60220 Seinäjoki, Finland; School of Health Sciences (H.H., A.A.) and Department of Surgery (S.R.), Tampere University Hospital, 33521 Tampere, Finland; and Division of Endocrinology (V.M.), Department of Medicine, Helsinki University Central Hospital, 00100 Helsinki, Finland
| | - Heini Huhtala
- Heart Center Co. (R.E.), Tampere University Hospital, 33521 Tampere, Finland; School of Medicine (R.E., M.S., J.P.), University of Tampere, 33521 Tampere, Finland; Department of Internal Medicine (M.S., J.P.), Tampere University Hospital, 33521 Tampere, Finland; Department of Internal Medicine (J.P.), Seinäjoki Central Hospital, 60220 Seinäjoki, Finland; School of Health Sciences (H.H., A.A.) and Department of Surgery (S.R.), Tampere University Hospital, 33521 Tampere, Finland; and Division of Endocrinology (V.M.), Department of Medicine, Helsinki University Central Hospital, 00100 Helsinki, Finland
| | - Rauni Saaristo
- Heart Center Co. (R.E.), Tampere University Hospital, 33521 Tampere, Finland; School of Medicine (R.E., M.S., J.P.), University of Tampere, 33521 Tampere, Finland; Department of Internal Medicine (M.S., J.P.), Tampere University Hospital, 33521 Tampere, Finland; Department of Internal Medicine (J.P.), Seinäjoki Central Hospital, 60220 Seinäjoki, Finland; School of Health Sciences (H.H., A.A.) and Department of Surgery (S.R.), Tampere University Hospital, 33521 Tampere, Finland; and Division of Endocrinology (V.M.), Department of Medicine, Helsinki University Central Hospital, 00100 Helsinki, Finland
| | - Matti Välimäki
- Heart Center Co. (R.E.), Tampere University Hospital, 33521 Tampere, Finland; School of Medicine (R.E., M.S., J.P.), University of Tampere, 33521 Tampere, Finland; Department of Internal Medicine (M.S., J.P.), Tampere University Hospital, 33521 Tampere, Finland; Department of Internal Medicine (J.P.), Seinäjoki Central Hospital, 60220 Seinäjoki, Finland; School of Health Sciences (H.H., A.A.) and Department of Surgery (S.R.), Tampere University Hospital, 33521 Tampere, Finland; and Division of Endocrinology (V.M.), Department of Medicine, Helsinki University Central Hospital, 00100 Helsinki, Finland
| | - Anssi Auvinen
- Heart Center Co. (R.E.), Tampere University Hospital, 33521 Tampere, Finland; School of Medicine (R.E., M.S., J.P.), University of Tampere, 33521 Tampere, Finland; Department of Internal Medicine (M.S., J.P.), Tampere University Hospital, 33521 Tampere, Finland; Department of Internal Medicine (J.P.), Seinäjoki Central Hospital, 60220 Seinäjoki, Finland; School of Health Sciences (H.H., A.A.) and Department of Surgery (S.R.), Tampere University Hospital, 33521 Tampere, Finland; and Division of Endocrinology (V.M.), Department of Medicine, Helsinki University Central Hospital, 00100 Helsinki, Finland
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Abstract
BACKGROUND Vascular malformations and hemangiomas of the thyroid gland are rare disorders. The first case of a patient with recurrent high-flow arterio-venous malformation of the right thyroid gland involving the right endolarynx is presented. PATIENT FINDINGS In June 2013, a 42-year-old female patient presented to the surgical department with recurrent hoarseness and a soft, vibrating mass on the right side of her neck. In 1993, she underwent right subtotal hemithyroidectomy with embolization on the day before surgery for a high-flow arterio-venous malformation of the thyroid gland. Diagnostic work-up in 2013 demonstrated a complex recurrent high-flow arterio-venous malformation on the right side of her neck involving the endolarynx. Full function of the right vocal fold could not be ascertained. The lesion was embolized again and excised the following day. Intraoperative gross bleeding and scar tissue prevented visualization and monitoring of the recurrent laryngeal nerve. Gross bleeding was also noted on hemithyroidectomy after embolization in 1993. No therapy was needed for the endolaryngeal part of the lesion. Histology showed large arterio-venous malformations with thyroid tissue. She remains well without signs of recurrence 18 month later but with a definitive voice handicap. SUMMARY This is the first report of a recurrent high-flow arterio-venous malformation originally developing from the right thyroid gland involving the right endolarynx. Counseling, diagnostic, and therapeutic work-up of the patient was possible only with an interdisciplinary team. The endolaryngeal part of the hemangioma dried out after embolization and completion hemithyroidectomy. Her hoarseness has greatly improved but a definitive voice handicap remains. CONCLUSION High-flow arterio-venous malformations of the thyroid gland are a rare disease, and recurrent lesions have not been reported. Interdisciplinary management of these patients is mandatory due to the complex nature of the underlying pathology. Recurrence might develop after long free intervals.
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Affiliation(s)
- D H Borchert
- 1 Department of Surgery, Saarland University Hospitals , Homburg, Germany
| | - A Massmann
- 2 Department of Diagnostic and Interventional Radiology, Saarland University Hospitals , Homburg, Germany
| | - Y J Kim
- 3 Institute of Pathology, Saarland University Hospitals , Homburg, Germany
| | - C A Bader
- 4 Department of Otolaryngology, Saarland University Hospitals , Homburg, Germany
| | - G Wolf
- 4 Department of Otolaryngology, Saarland University Hospitals , Homburg, Germany
| | - R Eisele
- 1 Department of Surgery, Saarland University Hospitals , Homburg, Germany
| | - P Minko
- 2 Department of Diagnostic and Interventional Radiology, Saarland University Hospitals , Homburg, Germany
| | - A Bücker
- 2 Department of Diagnostic and Interventional Radiology, Saarland University Hospitals , Homburg, Germany
| | - M Glanemann
- 1 Department of Surgery, Saarland University Hospitals , Homburg, Germany
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Watt T, Cramon P, Hegedüs L, Bjorner JB, Bonnema SJ, Rasmussen ÅK, Feldt-Rasmussen U, Groenvold M. The thyroid-related quality of life measure ThyPRO has good responsiveness and ability to detect relevant treatment effects. J Clin Endocrinol Metab 2014; 99:3708-17. [PMID: 25004246 DOI: 10.1210/jc.2014-1322] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE Patient-reported outcomes have become important endpoints in comparative effectiveness research and in patient-centered health care. Valid patient-reported outcome measures detect and respond to clinically relevant changes. The purpose of this study was to evaluate responsiveness of the thyroid-related quality of life (QoL) instrument ThyPRO in patients undergoing relevant clinical treatments for benign thyroid diseases and to compare it with responsiveness of the generic SF-36 Health Survey. METHODS A sample of 435 patients undergoing treatment completed the ThyPRO and SF-36 Health Survey (Version 2) at baseline and 6 months after treatment initiation. Responsiveness was evaluated in three thyroid patient groups: patients with hyperthyroidism (n = 66) and hypothyroidism (n = 84) rendered euthyroid after medical therapy, and patients with a clinically detectable nontoxic goiter treated with surgery or radioactive iodine and remaining euthyroid (n = 62). Changes in QoL were evaluated in terms of effect size and compared to the changes predicted by clinical experts. The responsiveness of equivalent scales from ThyPRO and SF-36 Health Survey were compared with the relative validity index. RESULTS The ThyPRO demonstrated good responsiveness across the whole range of QoL aspects in patients with hyper- and hypothyroidism. Responsiveness to treatment of nontoxic goiter was also demonstrated for physical and mental symptoms and overall QoL, but not for impact on social life or cosmetic complaints, in contrast to clinicians' predictions. For all comparable scales except one, the ThyPRO was more responsive to treatment than the SF-36 Health Survey. CONCLUSIONS The ThyPRO was responsive to treatment across the range of benign thyroid diseases. We suggest implementing this measurement instrument as a patient-reported outcome in clinical studies and in clinical management.
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Affiliation(s)
- Torquil Watt
- Department of Endocrinology (T.W., P.C., Å.K.R., U.F.-R.), Copenhagen University Hospital Rigshospitalet, DK-2100 Copenhagen, Denmark; Department of Endocrinology and Metabolism (L.H., S.J.B.), Odense University Hospital, DK-5000 Odense, Denmark; QualityMetric (J.B.B.), Lincoln, Rhode Island 02865; Department of Public Health (M.G., J.B.B.), University of Copenhagen, DK-1353 Copenhagen, Denmark; National Research Institute for the Working Environment (J.B.B.), DK-2200 Copenhagen, Denmark; and Department of Palliative Medicine (M.G.), Bispebjerg Hospital, DK-2400 Copenhagen, Denmark
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Ohrling H, Törring O, Yin L, Iliadou AN, Tullgren O, Abraham-Nordling M, Wallin G, Hall P, Lönn S. Decreased birth weight, length, and head circumference in children born by women years after treatment for hyperthyroidism. J Clin Endocrinol Metab 2014; 99:3217-23. [PMID: 24878049 DOI: 10.1210/jc.2014-1168] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT Whether hyperthyroidism influences the birth characteristics of children born several years after treatment is unknown. OBJECTIVE The objective of the study was to compare birth characteristics in singleton newborns delivered by women previously treated for Graves' disease (GD), toxic nodular goiter (TNG), or nontoxic goiter (NTG). DESIGN This was a nested case-control design within a national cohort registry study from 1950 through 2006. SETTING The study was conducted at a university and a hospital center in collaboration. PATIENTS The birth characteristics of newborns (n = 3421) delivered in a cohort of 43 633 women treated for GD or toxic nodular goiter by radioiodine or surgery (exposed group) at least 1 year prior to pregnancy were compared with newborns (n = 2914) of 45 655 mothers, previously operated for NTG (unexposed group). MAIN OUTCOME The primary outcome was birth weight, length, and head circumference. The secondary outcome was malformations, gestational age, and type of hyperthyroidism. RESULTS The birth weight of exposed children was 3431 ± 607 g (mean ± SD) compared with the unexposed, 3520 ± 641 g (P < .001). The cumulative odds ratio (OR) for lower birth weight was 1.29 [95% confidence interval (CI) 1.16-1.43]. The average birth length for the exposed children was 50.0 ± 2.7 cm compared with the unexposed of 50.4 cm ± 2.6 cm (P < .01) [cumulative OR 1.25 (95% CI 1.13-1.37)]. The head circumference was 34.5 ± 1.9 cm among exposed and 34.7 ± 1.8 cm, respectively (P < .001), with an OR of 1.24 (95% CI 1.13-1.35). No differences in birth characteristics were observed between children born after maternal GD or toxic nodular goiter. CONCLUSIONS Previous GD or TNG may influence the birth characteristics several years after radioiodine or surgical treatment.
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Affiliation(s)
- Hans Ohrling
- Division of Endocrinology (H.O., O.Tö.), Department of Internal Medicine, Södersjukhuset, 11883, Stockholm, Sweden; Institution of Clinical Research and Education (O.Tö.), Department of Medical Epidemiology and Biostatistics (L.Y., A.N.I., P.H., S.L.), and Institution of Molecular Medicine and Surgery (M.A.-N., G.W.), Karolinska Institutet, 17177, Stockholm, Sweden; Department of Oncology (O.Tu.), Karolinska University Hospital, 171 76 Solna, Sweden; and Department of Research and Development (S.L.), Region Halland, 301 80 Halmstad, Sweden
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Târcoveanu E. Prof. Dr. M.R. Diaconescu at the age of 75. Chirurgia (Bucur) 2014; 109:568-569. [PMID: 25233538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Ryödi E, Salmi J, Jaatinen P, Huhtala H, Saaristo R, Välimäki M, Auvinen A, Metso S. Cardiovascular morbidity and mortality in surgically treated hyperthyroidism - a nation-wide cohort study with a long-term follow-up. Clin Endocrinol (Oxf) 2014; 80:743-50. [PMID: 24304446 DOI: 10.1111/cen.12359] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 07/03/2013] [Accepted: 10/27/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Previous studies suggest that patients with hyperthyroidism remain at an increased risk of cardiovascular morbidity even after restoring euthyroidism. The mechanisms of the increased risk and its dependency on the different treatment modalities of hyperthyroidism remain unclear. The aim of this long-term follow-up study was to compare the rate of hospitalizations for cardiovascular causes and the mortality in hyperthyroid patients treated surgically with an age- and gender-matched reference population. PATIENTS AND MEASUREMENTS A population-based cohort study was conducted among 4334 hyperthyroid patients (median age 46 years) treated with thyroidectomy in 1986-2007 in Finland and among 12,991 reference subjects. Firstly, the hospitalizations due to cardiovascular diseases (CVD) were analysed until thyroidectomy. Secondly, the hazard ratios for any new hospitalization due to CVDs after the thyroidectomy were calculated in Cox regression analysis adjusted with the prevalent CVDs at the time of thyroidectomy. RESULTS The risk of hospitalization due to all CVDs started to increase already 5 years before the thyroidectomy, and by the time of the operation, it was 50% higher in the hyperthyroid patients compared to the controls (P < 0·001). After the thyroidectomy, the hospitalizations due to all CVDs (HR 1·15), hypertension (HR 1·23), heart failure (HR 1·17) and valvular diseases or cardiomyopathies (HR 1·55) remained more frequent among the patients than among the controls for 20 years after thyroidectomy. The increased morbidity was not clearly related to the aetiology of hyperthyroidism. Despite the increased CVD morbidity among the patients, there was no difference in cardiovascular mortality. CONCLUSIONS The present study shows that hyperthyroidism increases the risk of hospitalization due to CVDs and the risk is sustained up to two decades after effective surgical treatment. However, there was no excess CVD mortality in the middle-aged patient cohort studied.
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Affiliation(s)
- Essi Ryödi
- Heart Center Co., Tampere University Hospital, Tampere, Finland; School of Medicine, University of Tampere, Tampere, Finland
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Cirillo L, Casella C, D'Adda F, Cappelli C, Salerni B. Ultrasound and color-flow Doppler evaluation for the diagnosis of subclinical hyperthyroidism. MINERVA ENDOCRINOL 2014; 39:53-58. [PMID: 24513604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM Clinical significance, population screening and management of subclinical hyperthyroidism (SHyper) are still debated. Although the diagnosis of subclinical hyperthyroidism is, by definition, purely a biochemical one a conventional gray-scale sonography and, more recently, color-flow Doppler sonography (CFDS) have proven to be useful in obtaining information about thyroid morphology and function in thyroid disease, such as SHyper. The objective of this study was to evaluate, using CFDS, the presence and significance of changes in intrathyroidal blood flow and velocity in patients affected by SHyper and, to evalutate the potential diagnostic role of CFDS in mild thyroid disease in absence of a significant alteration in the serum level of circulating thyroid hormones. METHODS In this study, patients with SHyper (the case group) and euthyroid patients (the control group) were enrolled. All patients from the two groups who were affected by multinodular goiter as preoperative diagnosis, underwent total thyroidectomy. In both groups preoperative examination included a conventional grey-scale sonography, followed by CFDS. Quantitative flow evaluation was performed measuring the maximal peak systolic velocity (PSV) at the level of intrathyroid arteries and inferior thyroid artery. RESULTS Patients with SHyper showed an increased thyroid vascularization both intranodular and peripheral and the mean PSV values were higher in case patients than in control subjects. CONCLUSION We have shown that significant changes in thyroid vascularity and blood flow velocity are already present in patients with SHyper. CFDS is a suitable technique to identify SHyper.
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Affiliation(s)
- L Cirillo
- Department of Molecular and Translational Medicine, 1st Division of General SurgeryUniversity of Brescia, Spedali Civili, Brescia, Italy -
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Deng D, Luo L, Chen M, Xu M, Wang Y. Acromegaly and diabetes mellitus associated with hyperthyroidism. Neuro Endocrinol Lett 2014; 35:171-174. [PMID: 24977962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Accepted: 03/02/2014] [Indexed: 06/03/2023]
Abstract
A 66-year-old woman with acromegaly and diabetes mellitus as well as primary hyperthyroidism is described. Serum GH Levels were inappprpriately high.MRI revealed an enlarged sella turcica with intrasellar mass. Her HbAlc was 12.2% and fasting blood glucose 8.89 mmol/l. Thyroid hormone levels in serum and thyroidal radioiodine uptake values were elevated, while TSH measurements in serum were low. Anti TPO antibodies were negative, TSH receptor antibodies were normal. Thyrotoxicosis as the first presenting illness in acromegaly was particulary uncommon. An ultrasound thyroid scan showed a multinodular goiter. Histology of the pituitary lesion showed a typical eosinophilic adenoma which only secreted GH when tested with specific immunostain. Post-operatively, the patient's clinical conditions improved, however, secondary hypoadrenalism appeared.
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Ojanguren Arranz A, Baena Fustegueras JA, Ros López S, Santamaría Gómez M, Ojanguren Arranz I, Olsina Kissle JJ. Best approach for posterior mediastinal goiter removal: transcervical incision and lateral thoracotomy. Arch Bronconeumol 2013; 50:255-7. [PMID: 24239133 DOI: 10.1016/j.arbres.2013.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 09/13/2013] [Accepted: 09/16/2013] [Indexed: 11/30/2022]
Abstract
Surgical removal of intrathoracic goiter can be performed by a cervical approach in the majority of patients. Review of literature shows that experienced surgeons need to perform an extracervical approach in 2-3% of cases. In spite of surgical management of substernal goiter is well defined, there is little available information about surgical approach of intrathoracic goiters extending beyond the aortic arch into the posterior mediastinum. We report two cases and propose combination of cervical incision and muscle-sparing lateral thoracotomy for posterior mediastinal goiter removal. In such cases, we do not favour sternotomy as posterior mediastinum is inaccessible due to the presence of heart and great vessels anterior to the thyroidal mass that would lead to perform a perilous blind dissection. Based in our experience, transcervical and thoracotomy approach is indicated for a complete and safe posterior mediastinal goiter removal.
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Affiliation(s)
- Amaya Ojanguren Arranz
- Departamento de Cirugía General, Unidad de Cirugía Torácica, Hospital Universitari Arnau de Vilanova, Lleida, España.
| | | | - Susana Ros López
- Departamento de Cirugía General, Hospital Universitari Arnau de Vilanova, Lleida, España
| | - Maite Santamaría Gómez
- Departamento de Cirugía General, Hospital Universitari Arnau de Vilanova, Lleida, España
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Meng ZW, Zhang YJ, Li W, Shi T, Wu SG, Tan J. Relapse of hyperthyroidism after hemithyroidectomy in concurrent medullary thyroid cancer and Graves' disease. BRATISL MED J 2013; 114:544-6. [PMID: 24020714 DOI: 10.4149/bll_2013_114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We present a rare case of concurrent medullary thyroid cancer (MTC) and relapse of Graves' disease (GD). A 26-year-old Chinese female suffered from GD for 1 year. Physical examination demonstrated mildly diffuse goiter with a palpable 1.0 cm nodule in the right thyroid lobe and exophthalmos. Before hemithyroidectomy, calcitonin was elevated and thyroglobulin was normal. After surgery, histopathological findings proved coexistence of MTC and GD. 16 months later, GD relapsed and radioactive iodine 131 therapy was given. Meanwhile, postoperative monitoring showed well controlled calcitonin and carcinoembryonic antigen. Our lesson demonstrates although concomitant of MTC and GD is very rare, yet after hemithyroidectomy for the single nodular MTC lesion, remnant thyroid lobe could be the source of GD relapse very soon. More importantly, the relapse of GD and the following radioiodine therapy and radiation exposure could have been prevented if a better therapy plan of total thyroidectomy was adopted in the first place, instead of hemithyroidectomy (Tab. 1, Fig. 2, Ref. 11).
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STURNIOLO G, GAGLIANO E, TONANTE A, TARANTO F, VERMIGLIO F, STURNIOLO G. Toxic multinodular goitre. Personal case histories and literature review. G Chir 2013; 34:257-259. [PMID: 24629810 PMCID: PMC3926478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The authors reviewed their own case histories of surgical thyreopathy over the last 20 years in order to establish how many multinodular goitre (MNG) patients developed hyperthyroidism during the follow-up period. In agreement with the findings reported in literature, the authors observed that 220 out of 1117 patients with MNG developed hyperthyroidism caused by the appearance of hyperfunctioning nodules after 6-18 years from the initial diagnosis of MNG.
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Affiliation(s)
- Gia. STURNIOLO
- Endocrinology Section, Clinical Experimental Department of Medicine and Pharmacology, “G. Martino” University Hospital of Messina, Messina, Italy
| | - E. GAGLIANO
- General and Gastrointestinal Surgical Unit, “G. Martino” University Hospital of Messina, Messina, Italy (Head: Prof. Giovanni Sturniolo)
| | - A. TONANTE
- General and Gastrointestinal Surgical Unit, “G. Martino” University Hospital of Messina, Messina, Italy (Head: Prof. Giovanni Sturniolo)
| | - F. TARANTO
- General and Gastrointestinal Surgical Unit, “G. Martino” University Hospital of Messina, Messina, Italy (Head: Prof. Giovanni Sturniolo)
| | - F. VERMIGLIO
- Endocrinology Section, Clinical Experimental Department of Medicine and Pharmacology, “G. Martino” University Hospital of Messina, Messina, Italy
| | - Gio. STURNIOLO
- General and Gastrointestinal Surgical Unit, “G. Martino” University Hospital of Messina, Messina, Italy (Head: Prof. Giovanni Sturniolo)
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Affiliation(s)
- Gilbert H Daniels
- Department of Medicine, Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
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Pandev R, Kouzi A, Cherkezov G, Damyanov D. Selective or radical surgical strategy in functional autonomy of the thyroid in endemic areas. Khirurgiia (Mosk) 2013:12-14. [PMID: 24151744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The purpose of the research is to compare two surgical methods in the treatment of functional autonomy of the thyroid regarding postsurgical complications and functional results. METHODS 212 patients were examined--divided into two groups. Group 1 (n = 148)--in which selective thyroid resection have been done and Group 2 (n = 64)--in which radical resection have been undertaken. RESULTS For both groups the following postoperative complications have been determined: In 4 (1.8%) patients transitory recurrent palsy is determined and in 1 (0.5%) patient-permanent recurrent palsy. The frequency of the transitory hypoparathyroidism is 7.5% (n = 16) and that of the permanent hypoparathyroidism is 0%. 148 patients from the two groups were followed up with respect to the functional results obtained at the eight postsurgical week and from 1 to 7 years after the operation. In the selective group (eight postsurgical week) 3 from the patients were with hyperthyroidism and 4 with hypothyroidism. From 1 to 7 years after the operation the following functional results have been determinated: in 7 patients relapse of the hyperthyroidism, in 8 patients new hypothyroidism and in 3 patients- morphological recurrence In radically operated patients the frequency of the postsurgical hypothyroidism during the 8 postsurgical week was 50% (n = 26). For the period from 1 to 7 years after the operation the following functional results were observed: 1 patient with relapse of hypothyroidism, 11 patients with new hypothyroidism. Not one morphological recurrence was observed. CONCLUSIONS The residual and recurrent hyperthyroidism are related to the insufficient extent of resection. A functionally confirmed surgical strategy has been imposed in the endemic areas striving to remove all nodular structures at the same preserving the normal thyroid tissue.
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Affiliation(s)
- R Pandev
- Clinic of Surgery, Hospital "Queen Giovanna - ISUL"- Medical University, Sofia, Bulgaria.
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Osadchiĭ AM, Kurnikova EA, Marinin VA, Lebedev DS, Karuzin SV, Kozhevnikov AA, Chinchuk IK, Ushkats AK, Fedotov IN. [A temporary electrocardiostimulation in patients with planned surgical intervention]. Vestn Khir Im I I Grek 2013; 172:103-105. [PMID: 24340985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Abstract
Smoking is the most important risk factor for the occurrence/progression of Graves' ophthalmopathy (GO), as well as for its lower/slower response to immunosuppression. Accordingly, refrain from smoking should be urged, both as primary prevention (removal of risk factors in Graves' patients without GO), secondary prevention (early detection and treatment of asymptomatic/very mild GO) and tertiary prevention (reduction of complications/disability of overt GO). A 6-month course of 200 μg/day sodium selenite can prevent progression of mild GO to more severe GO and is, therefore, a form of secondary prevention and, probably, primary prevention. Correction of thyroid dysfunction and stable maintenance of euthyroidism are important preventive measures. The optimal treatment for hyperthyroidism in patients with GO is uncertain, because evidence demonstrating the superiority of antithyroid drugs over thyroid ablation (radioiodine, thyroidectomy, or both) is lacking. If radioiodine is used, low-dose steroid prophylaxis is recommended, particularly in smokers, to prevent radioiodine-associated GO progression.
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Affiliation(s)
- Luigi Bartalena
- Department of Clinical and Experimental Medicine, University of Insubria, Endocrine Unit, Ospedale di Circolo, viale Borri, 57, 21100 Varese, Italy.
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Abstract
The etiology of Graves' orbitopathy (GO) remains enigmatic. Optimal therapeutic choices for the hyperthyroidism associated with Graves' disease (GD) in the presence of GO remain controversial. Whether antithyroid drugs (ATDs), radioiodine (RAI), or thyroidectomy should be favored in such patients remains debated. Pre-therapy variables such as ethnicity, sex, age, thyroid function, level of TSH-receptor antibodies and smoking behavior influence response to therapy. Among the most important management goals are restoring euthyroidism and abstaining from smoking. On average, ATDs and thyroidectomy - independent of extent - do not influence the natural course of GO. RAI can cause de novo development or progression of GO, which is largely preventable with oral steroid prophylaxis. In patients with mild GO, the thyroid treatment is largely independent of GO. Moderate to severe GO should be treated promptly. Deciding whether, in the latter, GD is better treated with ATDs, RAI, or surgery, is based more on expert opinion than on evidence. It is clear that in the individual patient a number of factors, not addressed in any trial, influence the final choice of therapy for GD, including concern of developing or negatively affecting pre-existing GO. Evidently, there is room for improving therapy of GO. Progress using novel drugs such as rituximab, which might potentially influence positively both GD and GO, are impatiently awaited.
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