Outcomes of Preoperative Medical Therapy for Thyroidectomy in Autoimmune Thyroid Disease.

INTRODUCTION: Thyroidectomy provides definitive treatment for autoimmune thyroid disease (AITD) often resulting in improved quality of life. Historically, patients with AITD undergoing thyroidectomy have increased rates of postoperative hypoparathyroidism and recurrent laryngeal nerve palsy. We investigated the outcomes of preoperative medications in patients with AITD undergoing thyroidectomy. METHODS: We performed a retrospective analysis of patients who underwent thyroidectomy for AITD at a single institution from 2015 to 2021. Surgical outcomes and perioperative laboratory values were analyzed by type of AITD and type of preoperative medical treatment: none, saturated solution of potassium iodide (SSKI), corticosteroids, or both SSKI and corticosteroids. RESULTS: A total of 123 patients underwent thyroidectomy for AITD and were included in analysis: 50 received no preoperative medications, 40 received SSKI, 20 received corticosteroids, and 13 received both. Seventy-six patients had Graves' disease and 47 had Hashimoto's thyroiditis. There were no significant differences in blood loss, operative time, wound complications, hematoma, or recurrent laryngeal nerve injury for patients treated with preoperative corticosteroids compared to those who were not. Patients who received corticosteroids and patients with Graves' disease more commonly had at least one instance of hypocalcemia postoperatively (P < 0.01, P = 0.01), although only on postoperative day 1 was mean calcium < 8.5 mg/dL. There was no difference in rate of transient or permanent hypoparathyroidism. CONCLUSIONS: Patients who received corticosteroids preoperatively had no increased risk of complications. They did have mildly lower calcium levels in the early postoperative period, although no difference in hypoparathyroidism. Further exploration is warranted to investigate the impact of preoperative corticosteroids on operative difficulty, quality of life, and autoantibody clearance.

Enhancing Surgical Teaching Effectiveness: A Needs Assessment Study Using a Modified Delphi Process.

INTRODUCTION: As methods of measuring surgical resident competency become more defined, how can faculty know that they are effectively guiding residents toward increasing entrustment? The goal of this study was to use a systematic process to identify effective teaching behaviors, understand discrepancies between learner and teacher perception of behaviors, and provide an insight into areas for improvement in surgical teaching. MATERIALS AND METHODS: A modified Delphi process was used to create a list of critical teaching behaviors for surgical resident education in four domains: Operating Room, Clinic, Inpatient Rounds, and Didactics. Round One surveyed residents and faculty to identify critical teaching behaviors. In Rounds Two and Three, stakeholders narrowed the list to five behaviors in each domain. A needs assessment survey was created and used to identify (1) areas for improvement in residency education and (2) differences in perception of teaching behavior use between faculty and residents. RESULTS: Eighty one faculty and 56 residents in the Department of Surgery completed the survey. All teaching behaviors in the Operating Room, Clinic, and Rounds domains had a significant difference in response distribution between residents and faculty. Except in Didactics, residents perceived that teaching behaviors were performed less often by attending surgeons than was reported by the faculty members. CONCLUSIONS: A modified Delphi process is an effective way to create a needs assessment survey relating to how surgical education is delivered. Future steps will involve directed interventions aimed at improving the use of certain surgical teaching behaviors in our department.

Evaluating Discrimination of ACS-NSQIP Surgical Risk Calculator in Thyroidectomy Patients.

BACKGROUND: The ACS-NSQIP surgical risk calculator (SRC) often guides preoperative counseling, but the rarity of complications in certain populations causes class imbalance, complicating risk prediction. We aimed to compare the performance of the ACS-NSQIP SRC to other classical machine learning algorithms trained on NSQIP data, and to demonstrate challenges and strategies in predicting such rare events. METHODS: Data from the NSQIP thyroidectomy module ys 2016 - 2018 were used to train logistic regression, Ridge regression and Random Forest classifiers for predicting 2 different composite outcomes of surgical risk (systemic and thyroidectomy-specific). We implemented techniques to address imbalanced class sizes and reported the area under the receiver operating characteristic (AUC) for each classifier including the ACS-NSQIP SRC, along with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) at a 5% - 15% predicted risk threshold. RESULTS: Of 18,078 included patients, 405 (2.24%) patients suffered systemic complications and 1670 (9.24%) thyroidectomy-specific complications. Logistic regression performed best for predicting systemic complication risk (AUC 0.723 [0.658 - 0.778]); Random Forest with RUSBoost performed best for predicting thyroidectomy-specific complication risk (0.702; 0.674 - 0.726). The addition of optimizations for class imbalance improved performance for all classifiers. CONCLUSIONS: Complications are rare after thyroidectomy even when considered as composite outcomes, and class imbalance poses a challenge in surgical risk prediction. Using the SRC as a classifier where intervention occurs above a certain validated threshold, rather than citing the numeric estimates of complication risk, should be considered in low-risk patients.

Assessing American Thyroid Association Guidelines for Total Thyroidectomy in Graves' Disease.

BACKGROUND: The American Thyroid Association (ATA) issued specific preoperative preparatory guidelines for patients undergoing thyroidectomy for treatment of Graves' disease. Our goal is to determine if compliance with these guidelines is associated with better outcomes. METHODS: A retrospective review of a prospectively maintained database identified 228 patients with Graves' disease who underwent total thyroidectomy between August 2007 and May 2015. Patients treated in compliance with ATA guidelines were compared with those not in full compliance with the current preparatory guidelines. RESULTS: At the time of surgery, 52% of all patients followed ATA guidelines. Patients who were prepped per ATA guidelines had fewer episodes of intraoperative tachycardia (0.3 versus 4.5, P = 0.04) but had no difference in peak systolic blood pressure or in number of episodes of systolic blood pressure > 180 mmHg. ATA prepped and nonprepped patients had similar mean operating room time and length of stay. ATA prepped and nonprepped patients had similar complication rates, including transient hypocalcemia (30.4% versus 25.5%, P = 0.45), prolonged hypoparathyroidism (0.98% versus 4.3%, P = 0.15), hoarse voice (10.8% versus 7.5%, P = 0.42), permanent recurrent laryngeal nerve paralysis (2.9% versus 2.1%, P = 0.71), and hematoma (2.9% versus 0%, P = 0.09). CONCLUSIONS: Our data suggest that compliance with ATA guidelines for thyroidectomy preparation is not essential for a successful surgical outcome. Although preparation per the guidelines decreased the frequency of intraoperative tachycardia, it did not impact intraoperative hypertension, operating room time, or postoperative complications.

Surgical Trainees' Sense of Responsibility for Patient Outcomes: A Multi-institutional Appraisal.

BACKGROUND: Surgeon educators express concern about trainees' sense of patient ownership. We aimed to compare resident and faculty perceptions on residents' sense of personal responsibility for patient outcomes and to correlate patient ownership with resident and residency characteristics. METHODS: An anonymous electronic questionnaire surveyed 373 residents and 390 faculty at seven academic surgery residencies across the United States. We modified an established psychological ownership scale to measure patient ownership among surgical trainees. RESULTS: Respondents included 123 residents and 136 faculty (response rate 33% and 35%, respectively). Overall, 78.0% of faculty agreed that residents took personal responsibility for patient outcomes, but only 26.4% thought residents felt a similar or higher degree of patient ownership compared with themselves. Faculty underestimated the proportion of residents that routinely checked on their patients when off-duty (36.8 versus 92.6%, P < 0.001). Higher means on the patient ownership scale correlated with female sex (5.9 versus. 5.5 for males, P = 0.009), advanced post graduate year level (5.3, 5.5, 5.7, 5.8, 6.1, for post graduate year 1-5, respectively, P = 0.02), and the sense that patient outcomes affected the resident respondent's mood (5.8 versus 4.8 for those whose mood was not affected, P < 0.001). In addition, trainees who perceived better resident camaraderie (P = 0.004), faculty mentorship (P < 0.001), and that their program provided appropriate autonomy (P = 0.03) felt greater responsibility for patient outcomes. CONCLUSIONS: Most faculty agree that residents assume personal responsibility for patient outcomes, but many still underestimate residents' sense of patient ownership. Certain modifiable aspects of residency culture including camaraderie, mentorship, and autonomy are associated with patient ownership among trainees.

Encapsulated follicular variant of papillary thyroid cancer: are these tumors really benign?

BACKGROUND: Recent studies suggest that the encapsulated form of follicular variant of papillary thyroid cancer (eFVPTC) behaves more similarly to benign lesions and can be treated with thyroid lobectomy alone instead of total thyroidectomy. To distinguish aggressive cancers from more benign lesions more clearly, the objective of this study was to determine if the eFVPTC behaves less aggressively than the nonencapsulated variant (neFVPTC). METHODS: A prospectively collected endocrine surgery database in our institution was reviewed for all patients with FVPTC on surgical pathology from 1999 to 2012. Samples were rereviewed to determine if the tumor was eFVPTC or neFVPTC, which were correlated with patient outcomes. RESULTS: Of the 68 patients, 59 (87%) had eFVPTC and 9 (13%) had neFVPTC. The mean age was 48 y and 63% were female. Fifty-four of 64 patients (84%) who had a total thyroidectomy received radioactive iodine. The eFVPTC group had lower rates of cervical LN involvement (5% versus 22%, P = 0.2504). The median follow-up time was 3 y (0-13 y) and only two patients had recurrence, one with eFVPTC and one with neFVPTC. None of the patients had distant metastasis or died of their disease. CONCLUSIONS: eFVPTCs appear to have a lower rate of cervical lymph node metastases compared with neFVPTCs, but recurrent disease may be seen in both subtypes. These findings suggest eFVPTC can be managed more conservatively.

GAUGING THE EXTENT OF THYROIDECTOMY FOR INDETERMINATE THYROID NODULES: AN ONCOLOGIC PERSPECTIVE.

OBJECTIVE: Increasing emphasis is being placed on appropriateness of care and avoidance of over- and under-treatment. Indeterminate thyroid nodules (ITNs) present a particular risk for this problem because cancer found via diagnostic lobectomy (DL) often requires a completion thyroidectomy (CT). However, initial total thyroidectomy (TT) for benign ITN results in lifelong thyroid hormone replacement. We sought to measure the accuracy and factors associated with the extent of initial thyroidectomy for ITN. METHODS: We queried a single institution thyroid surgery database for all adult patients undergoing an initial operation for ITN. Multivariate logistic regression identified factors associated with either oncologic under- or overtreatment at initial operation. RESULTS: There were 639 patients with ITN. The median age was 52 (range, 18 to 93) years, 78.4% were female, and final pathology revealed a cancer >1 cm in 24.7%. The most common cytology was follicular neoplasm (45.1%) followed by Hürthle cell neoplasm (20.2%). CT or initial oncologic undertreatment was required in 58 patients (9.3%). Excluding those with goiters, 19.0% were treated with TT for benign final pathology. Multivariate analysis failed to identify any factor that independently predicted the need for CT. Female gender was associated with TT in benign disease (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.0 to 4.5; P = .05). Age >45 years predicted correct initial use of DL (OR, 2.6; 95% CI, 1.2 to 5.7; P = .02). Suspicious for papillary thyroid carcinoma (OR, 5.7; 95% CI, 2.1 to 15.3; P<.01) and frozen section (OR, 9.7; 95% CI, 2.5 to 38.6; P<.01) were associated with oncologically appropriate initial TT. The highest frequency of CT occurred in patients with follicular lesion of undetermined significance (11.6%). TT for benign final pathology occurred most frequently in patients with a Hürthle cell neoplasm (24.8%). CONCLUSION: In patients with ITN, nearly 30% received an inappropriate extent of initial thyroidectomy from an oncologic standpoint. Tools to pre-operatively identify both benign and malignant disease can assist in the complex decision making to gauge the proper extent of initial surgery for ITN. ABBREVIATIONS: ATA = American Thyroid Association AUS = atypia of undetermined significance CI = confidence interval CT = completion thyroidectomy FLUS = follicular lesion of undetermined significance ITN = indeterminate thyroid nodule OR = odds ratio PTC = papillary thyroid carcinoma TT = total thyroidectomy.

Clinical and socioeconomic factors influence treatment decisions in Graves' disease.

BACKGROUND: Definitive treatment of Graves' disease includes radioactive iodine (RAI) and thyroidectomy, but utilization varies. We hypothesize that, in addition to clinical reasons, there are socioeconomic factors that influence whether a patient undergoes thyroidectomy or RAI. METHODS: Patients treated for Graves' disease between August 2007 and September 2013 at our university hospital were included. A comparative analysis of clinical and socioeconomic factors was completed. RESULTS: Of 427 patients, 300 (70 %) underwent RAI, whereas 127 (30 %) underwent surgery. Multiple factors were associated with surgery: younger age (mean 36 vs. 41 years, p < 0.01), female gender (33 vs. 19 % males, p = 0.01), black race (56 vs. 28 % nonblack, p < 0.01), Medicaid or uninsured (43 vs. 27 % private insurance or Medicare, p < 0.01), ophthalmopathy (38 vs. 26 %, p < 0.01), goiter (35 vs. 23 %, p < 0.01), and lowest quartile of median household income (38 vs. 27 % upper three quartiles, p = 0.03). Thyroidectomy increased annually, with 52 % undergoing surgery during the final year (p < 0.01). Adjusting for confounding, younger age (odds ratio [OR] 1.04; 95 % confidence interval [CI] 1.02, 1.05), female gender (OR 2.06; 95 % CI 1.06, 4.01), ophthalmopathy (OR 2.35; 95 % CI 1.40, 3.96), and later year of treatment (OR 1.66; 95 % CI 1.41, 1.95) remained significantly associated with surgery. CONCLUSIONS: Surgery has now become the primary treatment modality of choice for Graves' disease at our institution. Clinical factors are the main drivers behind treatment choice, but patients with lower SES are more likely to have clinical features best treated with surgery, underlying the importance of improving access to quality surgical care for all patients.

CaPTHUS scoring model in primary hyperparathyroidism: can it eliminate the need for ioPTH testing?

BACKGROUND: The CaPTHUS model was reported to have a positive predictive value of 100 % to correctly predict single-gland disease in patients with primary hyperparathyroidism, thus obviating the need for intraoperative parathyroid hormone (ioPTH) testing. We sought to apply the CaPTHUS scoring model in our patient population and assess its utility in predicting long-term biochemical cure. METHODS: We retrospective reviewed all parathyroidectomies for primary hyperparathyroidism performed at our university hospital from 2003 to 2012. We routinely perform ioPTH testing. Biochemical cure was defined as a normal calcium level at 6 months. RESULTS: A total of 1,421 patients met the inclusion criteria: 78 % of patients had a single adenoma at the time of surgery, 98 % had a normal serum calcium at 1 week postoperatively, and 96 % had a normal serum calcium level 6 months postoperatively. Using the CaPTHUS scoring model, 307 patients (22.5 %) had a score of ≥ 3, with a positive predictive value of 91 % for single adenoma. A CaPTHUS score of ≥ 3 had a positive predictive value of 98 % for biochemical cure at 1 week as well as at 6 months. CONCLUSIONS: In our population, where ioPTH testing is used routinely to guide use of bilateral exploration, patients with a preoperative CaPTHUS score of ≥ 3 had good long-term biochemical cure rates. However, the model only predicted adenoma in 91 % of cases. If minimally invasive parathyroidectomy without ioPTH testing had been done for these patients, the cure rate would have dropped from 98 % to an unacceptable 89 %. Even in these patients with high CaPTHUS scores, multigland disease is present in almost 10 %, and ioPTH testing is necessary.

Substernal goiter: when is a sternotomy required?

BACKGROUND: Sternotomy for substernal goiters (SSG) is associated with greater morbidity than a cervical approach to thyroidectomy. We sought to identify predictors for sternotomy as a surgical approach for the removal of SSG and analyzed the preoperative and postoperative characteristics of patients with SSG compared with those with large goiters contained entirely within the neck or a cervical goiter. METHODS: A retrospective review of a surgical database was performed. We included patients with large (>100 g) thyroids or SSG, regardless of size. Between 1995 and 2013, 220 patients met these criteria. Comparisons were made between patients who had an SSG and patients who had a cervical goiter with particular focus on those who required sternotomy. RESULTS: Of the 220 patients, 127 patients (58%) had SSG, of whom 7 (5.5%) required sternotomy. All patients who underwent sternotomy underwent preoperative computed tomography scanning and were more likely to have preoperative symptoms of chest pressure and voice complaints and have extension of the thyroid gland below the aortic arch. Sternotomy took an average of 2 hours longer than a cervical incision, was associated with significantly more blood loss (600 versus 190 mL, P = 0.04), and a longer length of stay (3.1 versus 1.8 d, P = 0.03) than cervical thyroidectomy. CONCLUSIONS: Sternotomy for SSG is rare. All patients necessitating sternotomy had extension below the aortic arch and were more likely to present complaining of chest pressure and voice issues.

Surgical site infection after thyroidectomy: a rare but significant complication.

BACKGROUND: Surgical site infections (SSIs) after thyroidectomy are rare but can have significant consequences. Thyroidectomy is a clean case, and the patterns for use of prophylactic antibiotics vary. We hypothesized that patient and operative characteristics may predict a higher risk of SSI, and that SSI are associated with other complications leading to increased resource utilization. METHODS: Data from the American College of Surgeons National Surgical Quality Improvement Program dataset for patients who underwent thyroidectomy through cervical incisions from 2005-2011 were included. Bivariate analysis using t-tests and chi-square tests were performed, and variables with P<0.2 were considered for inclusion in a multivariate logistic regression model. RESULTS: A total of 49,326 patients underwent thyroidectomy from 2005-2011 and 179 (0.36%) had an SSI. On multivariate analysis, the strongest predictors of SSI were operative time (P<0.001) and wound classification clean-contaminated (odds ratio 6.1; 95% confidence interval, 3.6, 10.3). Preoperative factors associated with SSI on multivariate analysis had lower magnitudes of influence on SSI risk but included obesity, alcohol use, and nonindependent functional status. Patients with SSI were more likely to have a wound dehiscence, renal insufficiency, bleeding requiring transfusion, and return to the operating room on a multivariate model of outcomes. CONCLUSIONS: Although rare, SSI after thyroidectomy are associated with other postoperative complications. We have identified preoperative and intraoperative factors that are associated with SSI, and this may help identify high-risk patients who may benefit from selective use of antibiotics.

Health-Related Quality of Life in Patients with Low-Risk Differentiated Thyroid Cancer: A Systematic Review Examining the Extent of Thyroidectomy.

Background: Total thyroidectomy (TT) and hemithyroidectomy (HT) are acceptable surgical options for the treatment of low-risk differentiated thyroid cancer (DTC). While previous data suggest similar disease-free and disease-specific survival regardless of initial surgical treatment, the effect of the extent of surgery on health-related quality of life (HRQOL) is less clear. This systematic review aimed to examine HRQOL in low-risk DTC survivors after TT compared with HT. Methods: A search of PubMed, CINAHL, Cochrane, PsycINFO, and Scopus databases was conducted to identify studies published between January 1, 2011, and December 31, 2022, that assessed HRQOL predominantly in patients with low-risk DTC who underwent open thyroid surgery. Covidence™ software was used to apply the inclusion criteria, and a validated instrument was used to assess study quality. Results: Sixteen of the 1402 identified studies were included: 5 prospective and 11 retrospective cohort studies. The majority of included studies were of good quality (n = 14) and were from Asia and the Middle East (n = 11). Overall, six studies concluded that HT led to a better HRQOL than TT, two concluded that HT only resulted in better HRQOL compared with TT with central neck dissection (CND), and two concluded HT resulted in better short-term HRQOL that dissipated by 6 months postoperatively. The HRQOL domains found across all studies to be most consistently improved after HT included physical health, psychological/emotional, and social function. Factors found to be associated with HRQOL in more than one study included age, stage, and marital status. Conclusion: Differences in HRQOL after HT and TT tended to favor HT particularly when measured <6 months after surgery or when compared with TT with CND. Additional prospective and ideally randomized data are needed to fully determine the impact of the extent of surgery on HRQOL in patients with low-risk thyroid cancer.

Comparison of laparoscopic versus open adrenalectomy: results from American College of Surgeons-National Surgery Quality Improvement Project.

BACKGROUND: Although the existing literature suggests that laparoscopic adrenalectomy may be associated with less postoperative morbidity than open adrenalectomy, a comparison of the two approaches has not been published using American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data. The objective of our analysis was to compare the 30-d outcomes after laparoscopic versus open adrenalectomy using this data source. METHODS: The ACS-NSQIP Participant User Files for 2005-2010 were used for this retrospective analysis, which included all patients with (1) a primary Current Procedural Terminology code for open or laparoscopic adrenalectomy and (2) a postoperative International Classification of Diseases, Ninth Revision (ICD-9) code for adrenal gland pathology. Primary outcomes were 30-d postoperative mortality, overall complication rate, and length of postoperative hospitalization. The association between surgical approach and primary outcomes were determined after adjusting for a comprehensive array of patient- and procedure-related factors. RESULTS: A total of 3100 patients were included for analysis (644 undergoing open versus 2456 undergoing laparoscopic adrenalectomy). Patients undergoing a laparoscopic procedure had significantly lower postoperative morbidity and shorter length of stay than patients undergoing an open procedure after adjustment for patient- and procedure-related factors. Similar findings were demonstrated for all indications, including malignancy. CONCLUSIONS: To our knowledge, the present study represents the largest comparison to date of laparoscopic versus open adrenalectomy. Our findings suggest that the laparoscopic approach is associated with sizeable reductions in postoperative morbidity and length of postoperative hospitalization.

Identifying Intraoperative Behaviors Associated With Surgical Resident Teachability.

OBJECTIVE: The resident-attending dyad influences the intraoperative training of surgery residents. To better understand the role of trainees within the dyad, we hypothesized there is a measurable concept of "teachability," a combination of the trainee's observed skills and behaviors with their performance. This study aims to define teachability and identify discrete intraoperative behaviors that contribute to this concept. We posit that residents who are active learners as demonstrated by asking questions, proposing next steps, and initiating purposeful actions have higher teachability. DESIGN, SETTING, PARTICIPANTS: Previously recorded videos from 26 laparoscopic inguinal hernia repairs performed by two PGY-5 general surgery residents at a Midwest tertiary care center were qualitatively reviewed for intraoperative behaviors. A summative content analysis identified behaviors associated with increased teachability and improved operative performance assessment scores. RESULTS: Average frequencies of intraoperative behaviors for resident 1 and 2 (R1 and R2) were not significantly different, although R2 asked more medical knowledge and technical questions. While the rate of attending feedback was similar for both residents (x=3.82 vs 3.40, p=0.646), R1 consistently incorporated feedback (x=2.27 vs 0.40, p=0.001) whereas R2 needed frequent prompting (x=2.45 vs 1.55, p=0.239). R1 scored higher in all but one operative performance assessment category, including overall performance (x=4.17 vs 2.93, p=0.007), but R2 had a larger magnitude of overall improvement (+1 vs +2). CONCLUSIONS: Teachability is a dynamic component of the resident-attending dyad. While intraoperative active learning behaviors do not appear to be associated with teachability, asking questions may increase the magnitude of improvement in performance. Most importantly, the ability to incorporate intraoperative feedback in real time seems to be a critical aspect of teachability and warrants further research.

What Does Honors Mean? National Analysis of Medical School Clinical Clerkship Grading.

OBJECTIVE: Medical Student Performance Evaluation (MSPE) letters provide critical comparative information about clerkship performance, and are a crucial part of the surgical residency application. The elimination of USMLE Step 1 numeric reporting increases the importance of transparency, standardization, and accessibility of comparative information reported on the MSPE. The objective of our study was to measure the variability in clerkship grade reporting on the MSPE from US medical schools, particularly focusing on the highest (honors) grades. DESIGN, SETTING, AND PARTICIPANTS: We identified representative MSPE letters from US medical schools and recorded the percentage of honors for 5 core clerkships. We grouped medical schools according to medical school rankings, geographic region, and number of grading categories RESULTS: Of 122 medical schools, 106 schools (87%) reported their grading scheme and percent honors. The most commonly used grading scheme was a 4-tier system (51/122; 42%). The percentage of honors was highly variable (from 1-91%) and did not vary by region. However, schools in the top 20 research ranking were less likely to report grade comparisons (30% vs. 10%), and more likely to award more students honors in 4 of the 5 clerkships. Schools in the top 20 primary care ranking were more likely to award more honors in the medicine clerkship. CONCLUSIONS: There is significant variability in the number of grading tiers used and the percentage of students awarded honors across US medical schools. Factors that correlated to higher grades included schools with higher rankings, and higher ranked schools were less likely to report comparative information at all.

Surgery Acting Internship Individual Learning Plans: Fostering Mentorship in the COVID-19 Era.

OBJECTIVE: Mentorship facilitates successful matching for surgical specialties. A formal mentorship plan may counteract restricted mentorship opportunities due to the COVID-19 pandemic. DESIGN: We surveyed medical students applying to surgery specialties who participated in our formalized mentorship program (MF) and those of a prior cohort who were informally mentored (MI). Epistemic Network Analysis was used to model qualitative responses. SETTING: University of Wisconsin School of Medicine and Public Health. PARTICIPANTS: Fourth-year medical students who matched into ACGME-accredited surgical specialties. RESULTS: MF students (n = 12) met with their mentors more frequently than MI students (n = 13; p = 0.03). Both groups received career guidance, letters of recommendation and application preparation. However, the MI cohort reported greater psychological and emotional support whereas the MF cohort reported more assistance with skills development. CONCLUSIONS: A formalized mentorship program fostered successful mentoring relationships despite limitations from the COVID-19 pandemic.

What is the experience of our patients with transient hypoparathyroidism after total thyroidectomy?

BACKGROUND: We sought to better understand the experience of patients with transient hypoparathyroidism using patient interviews and quality of life surveys. METHODS: This is a prospective analysis of 62 patients after total thyroidectomy at a high-volume institution. Semistructured patient interviews and quality of life surveys were conducted preoperatively and postoperatively at 2 weeks, 6 weeks, 6 months, and 1 year and compared based on postoperative parathyroid hormone levels. RESULTS: Postoperative parathyroid hormone levels were <10 pg/mL in 32% of patients (n = 20), 10 to 20 pg/mL in 19% (n = 12), and >20 pg/mL in 48% (n = 30). Hypocalcemic symptoms at 2 weeks were reported in 28 of 55 patients (51%), but patients felt "well prepared" and reported it "wasn't a big deal." If symptoms persisted at 6 weeks, they became more bothersome. At 6 months and 1 year, patients reported calcium supplementation prevented most symptoms and did not interfere with daily activities. Quality of life as measured by the European Organization for Research and Treatment of Cancer and the 12-Item Short Form Survey demonstrated a slight improvement at 1 year postoperatively regardless of parathyroid hormone level. CONCLUSION: Early postoperative transient hypoparathyroidism is common but when appropriately managed did not have a substantial negative impact on the overall quality of life.

Evaluation of Thyroid Nodules.

This is a brief overview of the initial workup of patients with thyroid nodules. Most nodules are incidentally discovered, benign, and do not require surgery, but the clinician's job is to determine which nodules are concerning and what the appropriate workup should be. Ultrasound examination is the best imaging modality to evaluation thyroid nodules and, when biopsy is indicated, fine needle aspiration is the proper technique to sample thyroid nodules.

Dr Google: The readability and accuracy of patient education websites for Graves' disease treatment.

BACKGROUND: National guidelines emphasize the importance of incorporating patient preferences into the recommendations for the treatment of Graves' disease. Many patients use the Internet to obtain health information, and search results can affect their treatment decisions. This study compares the readability and accuracy of patient-oriented online resources for the treatment of Graves' disease by website affiliation and treatment modality. METHODS: A systematic Internet search was used to identify the top websites discussing the treatment of Graves' disease. Readability was measured using 5 standardized tests. Accuracy was assessed by a blinded, expert panel, which scored the accuracy of sites on a scale of 1 to 5. Mean readability and accuracy scores were compared among website affiliations and treatment modalities. RESULTS: We identified 13 unique websites, including 2 academic, 2 government, 5 nonprofit, and 4 private sites. There was a difference in both readability (mean 13.2, range 9.1-15.7, P = .003) and accuracy (mean 4.04, range 2.75-4.50, P = .019) based on website affiliation. Government sites (mean readability 11.1) were easier to read than academic (14.3, P < .01), nonprofit (13.9, P < .01), and private sites (13.5, P < .05). Academic sites (mean accuracy 4.50) were more accurate than private sites (3.56, P < .05). CONCLUSION: Online patient resources for the treatment of Graves' disease are written at an inappropriately high reading level. Academic sites contain both the most accurate and the most difficult to read information. Private sites represented the majority of our top results but contained the least accurate information.