Microwave ablation as an efficient therapy for primary hyperparathyroidism: Efficacy and predictors of treatment success.

BACKGROUND: Microwave ablation (MWA) has great potential for the treatment of primary hyperparathyroidism, but as predictors and therapeutic efficiency have not been fully clarified, further investigations are required. AIM: The purpose of this study was to explore the predictors of MWA efficacy in patients with primary hyperparathyroidism (PHPT) induced by parathyroid adenoma. METHODS: The study included patients with PHPT treated with MWA separated into two groups as response and no response group, according to the efficacy of the treatment. The two groups were compared with respect of possible predictors, such as age, gender, parathyroid adenoma volume, baseline levels of calcium (Ca), phosphorous (P), alkaline phosphate (ALP) and vitamin D, localisation of parathyroid adenoma, and instrumental parameters such as microwave ablation time and power. The statistical significance of possible predictors of MWA efficacy was investigated by using logistic regression analysis. RESULTS: Evaluation was made of 32 patients in respect of analysing predictors of MWA efficacy. In the comparison of the values of the response and no response groups, only baseline Ca level was determined to be a potential predictor of the efficacy of MWA (P < .05). Further logistic regression results showed the baseline Ca level to be insignificant for the construction of a mathematical model to predict the efficacy of MWA (P = .071). The clinical success rate was 87.5%. Compared with pre-MWA, the serum PTH, calcium, phosphorus and ALP levels were significantly improved at 6 months post-MWA (PTH, 99 (86-154) ng/L vs 50 (46-58) ng/L; calcium, 2.94 (2.81-2.98) mmol/L vs 2.38 (2.28-2.50) mmol/L; phosphorus, 0.87 (0.82-1.01) mmol/L vs 1.16 (1.0-1.3) mmol/L; ALP, 82 (73-98) U/L vs 69 (54-84) U/L, respectively; all, P < .01. CONCLUSIONS: Although no predictor of treatment success could be determined, MWA might be an effective treatment in patients with PHPT.

Microwave ablation of autonomously functioning thyroid nodules: a comparative study with radioactive iodine therapy on the functional treatment success.

INTRODUCTION: The objective of this study was to compare the efficiency of microwave ablation (MWA) and radioactive iodine (RAI) in the treatment of toxic adenoma (TA), and to investigate the functional treatment success of the used modalities for its remission. MATERIAL AND METHODS: Treatment outcomes- thyroid hormone levels and nodule characteristics- of 30 patients (23:7 F:M; 52.77 ± 11.13 years) treated by MWA were compared with the those of 35 patients (24:11 F:M; 61.43 ± 12.60 years) treated by RAI. The baseline characteristics of TAs, which are gender and pre volume, were analogous and did not show any statistical significance (p > 0.05). Thyroid hormone levels of patients treated with two different methods were measured after 9 months, and the obtained results were compared. RESULTS: Although there was no statistically significant difference in the nodule volume (p > 0.05), there was a greater volume reduction rate (VRR%) in the group treated with MWA rather than RAI (p < 0.05) at the end of the follow-up. In the MWA group, there was a higher increase in FT3 than in the RAI group (p < 0.05). Furthermore, no statistically significant difference in TSH (p = 0.124) and FT4 (p = 0.144) levels of the patients as treatment outcomes was observed. The therapeutic success was accomplished in 18/30 (60%) of the MWA group and in 24/35 (68.6%) of the RAI group. CONCLUSIONS: Therapeutic success of MWA and RAI did not show any statistically significant difference (p = 0.471). However, the development of hypothyroidism in 7 of 35 patients treated with RAI was observed. On the other hand, no case of post-treatment hypothyroidism was observed in patients treated with MWA. In this regard, MWA could be a great alternative to RAI due to its advantages in terms of non-exposure to radiation and lower risk of post-treatment hypothyroidism.

Endoscopic parathyroidectomy via unilateral axillobreast approach.

Endoscopic parathyroid and thyroid surgery is becoming increasingly common. In this study, we present the results of patients who underwent Endo- scopic parathyroid via unilateral axillo-breast approach (EP via UABA). Three patients underwent EP via UABA. Patients were discharged on the next day after surgery, while at one month follow up all of them reported no further symptoms. Operation performed via two axiller and one areolar trochar. As different from open surgery, the strap muscles don't pulled laterally and not entered into the thyroid lobe from the midline. In this technique, the strap muscles are separated from the middle part of the strap muscles and the thyroid gland is reached from the middle of the strap muscles. In this way, N. laryngeal recurrence and parathyroid gland that usually located in the posterior aspect of the thyroid gland can be revealed clearly by reducing the risk of complications. EP via UABA can be performed safe effective procedure via good cosmetic results.

Microwave ablation of symptomatic benign thyroid nodules: Short- and long-term effects on thyroid function tests, thyroglobulin and thyroid autoantibodies.

OBJECTIVE: Microwave ablation therapy has been attracting great attention due to its advantages such as low complication rate, good cosmetic results and effective nodule shrinking. Although the effect of thermal ablation therapy on the nodule volume reduction rate has been shown several studies, a limited number of papers have been reported for the effects of microwave ablation (MWA) on thyroid function tests. The aim of this study was to investigate the short- and long-term effects of MWA therapy on thyroid function tests (TFTs), thyroglobulin (Tg) and thyroid autoantibodies in euthyroid patients. DESIGN, PATIENTS AND MEASUREMENTS: Demographic data of the patients, TFTs, Tg, thyroid autoantibodies and thyroid volume of the nodules were recorded before the procedure and follow-up. Any differences in serum thyroid hormone levels were investigated in pre-, post- and 6-month follow-up periods before and after MWA. RESULTS: The difference between all thyroid hormone levels at pre MWA and 24 h after MWA was statistically significant (p < .001). FT3 (4.62) pmol/L and FT4 (10.81) pmol/L median levels increased significantly (p < .001), while thyrotropin (TSH) levels decreased at 24 h after MWA (p < .001). Thyroid antibodies levels were not statistically different at 6-month (p > .05), whereas Tg levels decreased (p < .001) compared to pre MWA. CONCLUSIONS: While no significant effect was observed at 6 month, the effect of MWA on thyroid function tests was prominent at 24 h.

Indocyanine green fluorescence angiography-guided transoral endoscopic thyroidectomy and parathyroidectomy: First clinical report.

BACKGROUND: Indocyanine green fluorescence (ICG) angiography has been used for many purposes including as part of a focused parathyroidectomy technique. Concomitant fluorescence of thyroid tissue may cause challenges defining parathyroid tissue during surgery, since ICG is not a selective fluorescent agent. On the other hand, cosmesis is still a big problem for patients due to the visible neck scars produced by the standard surgical technique. In this study, we described a novel technique to solve both these handicaps. MATERIALS AND METHODS: Seven patients who underwent ICG fluorescence angiography-guided transoral endoscopic thyroidectomy and parathyroidectomy vestibular approach between February 2018 and July 2019 were included. Serum parathyroid hormone (PTH) levels were measured intraoperatively and on postoperative day 1. Fluorescent images were confirmed with intraoperative quick-PTH levels. RESULTS: All operations were done successfully without conversion to open surgery. Intense and isolated parathyroid fluorescent images were achieved in all operations. All patients had a 50 % decrease between the baseline and final quick-PTH levels and the final quick-PTH levels were in the normal range in all. One of 7 patients had epistaxis due to nasotracheal intubation. One of 7 patients had seroma on post-operative day 5. None of patients had mental nerve injury, permanent hypocalcemia and temporary or permanent recurrent laryngeal nerve injury. CONCLUSION: ICG-guided transoral endoscopic thyroid and parathyroid surgery can be used in select patients to increase operative success in focused parathyroidectomy with excellent cosmetic outcome also noted.

Microwave Ablation of Benign Thyroid Nodules: Effects on Systemic Inflammatory Response.

OBJECTIVE:  To explore the alterations of neutrophil-to-lymphocyte ratio (NLR) as a systemic inflammatory marker after microwave ablation for benign thyroid nodules.   Study Design: A descriptive study. PLACE AND DURATION OF STUDY: Department of Radiology, Antalya Training and Research Hospital, from December 2018 to June 2019. METHODOLOGY: Demographic data of the patients, ultrasonographic features of the nodules, thyroid function tests of the patients, leukocyte, neutrophil, lymphocyte values, and thyroid nodule volumes of the patients before and after the procedure were recorded. NLR and volume reduction ratio (VRR %) of 35 patients with thyroid nodules were compared before and after microwave ablation therapy of the thyroid nodules. RESULTS: The nodule volume decreased from 23.89 ±15.44 cc to 11.57 ±8.65 cc at two months and to 7.79 ±5.74 cc at six months. The VRR% increased from 38.65 ±16.82 to 63.16 ±14.19 at three months and to 68.29 ±11.80 at six months. The mean value of NLR decreased from 2.28 ±0.86 to 1.78 ±0.54. ROC curve analysis suggested that the optimum pre-NLR cut-off point for 50% VRR success was 2.50 with the specifity and sensitivity of 0.67 and 0.50. CONCLUSION: After ultrasound-guided microwave ablation of benign thyroid module, VRR percentage increased significantly, while the inflammatory marker NLR value decreased. Key Words: Biomarker, Inflammation, Microwaves, Neutrophil-to-lymphocyte ratio, Thyroid nodule.

A subset of patients with acquired partial lipodystrophy developing severe metabolic abnormalities.

Purpose/Aim of the study: Acquired partial lipodystrophy (APL) is a rare disease characterized by selective loss of adipose tissue. In this study, we aimed to present a subset of patients with APL, who developed severe metabolic abnormalities, from our national lipodystrophy registry. MATERIALS AND METHODS: Severe metabolic abnormalities were defined as: poorly controlled diabetes (HbA1c above 7% despite treatment with insulin more than 1 unit/kg/day combined with oral antidiabetics), severe hypertriglyceridemia (triglycerides above 500 mg/dL despite treatment with lipid-lowering drugs), episodes of acute pancreatitis, or severe hepatic involvement (biopsy-proven non-alcoholic steatohepatitis (NASH)). RESULTS: Among 140 patients with all forms of lipodystrophy (28 with APL), we identified 6 APL patients with severe metabolic abnormalities. The geometric mean for age was 37 years (range: 27-50 years; 4 females and 2 males). Five patients had poorly controlled diabetes despite treatment with high-dose insulin combined with oral antidiabetics. Severe hypertriglyceridemia developed in five patients, of those three experienced episodes of acute pancreatitis. Although all six patients had hepatic steatosis at various levels on imaging studies, NASH was proven in two patients on liver biopsy. Our data suggested that APL patients with severe metabolic abnormalities had a more advanced fat loss and longer disease duration. CONCLUSIONS: We suggest that these patients represent a potential subgroup of APL who may benefit from metreleptin or investigational therapies as standard treatment strategies fail to achieve a good metabolic control.

Clinical presentations, metabolic abnormalities and end-organ complications in patients with familial partial lipodystrophy.

OBJECTIVE: Familial partial lipodystrophy (FPLD) is a rare genetic disorder characterized by partial lack of subcutaneous fat. METHODS: This multicenter prospective observational study included data from 56 subjects with FPLD (18 independent Turkish families). Thirty healthy controls were enrolled for comparison. RESULTS: Pathogenic variants of the LMNA gene were determined in nine families. Of those, typical exon 8 codon 482 pathogenic variants were identified in four families. Analysis of the LMNA gene also revealed exon 1 codon 47, exon 5 codon 306, exon 6 codon 349, exon 9 codon 528, and exon 11 codon 582 pathogenic variants. Analysis of the PPARG gene revealed exon 3 p.Y151C pathogenic variant in two families and exon 7 p.H477L pathogenic variant in one family. A non-pathogenic exon 5 p.R215Q variant of the LMNB2 gene was detected in another family. Five other families harbored no mutation in any of the genes sequenced. MRI studies showed slightly different fat distribution patterns among subjects with different point mutations, though it was strikingly different in subjects with LMNA p.R349W pathogenic variant. Subjects with pathogenic variants of the PPARG gene were associated with less prominent fat loss and relatively higher levels of leptin compared to those with pathogenic variants in the LMNA gene. Various metabolic abnormalities associated with insulin resistance were detected in all subjects. End-organ complications were observed. CONCLUSION: We have identified various pathogenic variants scattered throughout the LMNA and PPARG genes in Turkish patients with FPLD. Phenotypic heterogeneity is remarkable in patients with LMNA pathogenic variants related to the site of missense mutations. FPLD, caused by pathogenic variants either in LMNA or PPARG is associated with metabolic abnormalities associated with insulin resistance that lead to increased morbidity.