Factors affecting the rates of incidental parathyroidectomy during thyroidectomy.

BACKGROUND: The most important factors affecting the development of postoperative hypocalcaemia (PH) include intraoperative trauma to the parathyroid glands, incidental parathyroidectomy (IP), and the surgeon's experience. In this study, we aimed to determine the incidence of IP, evaluate its effect on postoperative calcium levels and investigate the effect of surgeon experience and volume on IP incidence and postoperative calcium levels. METHODS: This retrospective study included 645 patients who underwent thyroid surgery at the Department of General Surgery, Kütahya Health Sciences University between September 2016 and March 2020. All patients underwent surgery at a single clinic by general surgeons experienced in thyroid surgery and their residents (3-5 years). RESULTS: Normal parathyroid glands were reported in 58 (8.9%) of 645 patients. In 5 (8.6%) of 58 patients the parathyroid gland was detected in the intrathyroidal region. PH developed in ten patients (17.2%) with incidental removal of the parathyroid glands. A statistically significant difference was found between the number of incidentally removed parathyroid glands and the development of hypocalcaemia (p<0.05). Normal parathyroid glands were reported in the pathology of 37 (7.9%) patients operated on by general surgeons and 22 (12.6%) patients operated on by their residents. PH developed in 39 (8.2%) patients operated on by general surgeons and in 8 (4.5%) patients operated on by their residents. CONCLUSIONS: We found that the complication rate during the resident training process was the same as that of experienced general surgeons. A thyroidectomy can be safely performed by senior residents during residential training.

High serum levels of IGF-I and IGFBP3 may increase comorbidity risk for asthmatic patients.

OBJECTIVE: Asthma is known as a chronic inflammatory lung disease which has also systemic features. Insulin-like growth factor I (IGF-I) plays a role for asthma pathogenesis. Controversially, IGF-binding protein 3 (IGFBP3) blocks asthma development. That is why IGF-I and IGFBP3 are targeted for future therapeutic treatments of asthma. We aimed to investigate serum level of IGF-I and IGFBP3 in patients with asthma. This study was performed in 27 asthma and 23 healthy individuals. Serum levels of IGF-I and IGFBP3 were measured by human ELISA assay kits. Serum levels of IGF-I and IGFBP3 were significanlty higher in the asthma group than the control group. Significant negative correlation was found between IGF-I and asthma control test (ACT) puan, O2 saturation, Forced Expiratory Volume in 1 second/ Forced Vital Capacity (FEV1/FVC), Forced Expiratory Flow 25 second/75 second (FEF2575) (%). Significant positive correlation was found between IGFBP3 and IGF-I, systolic blood pressure. Significant negative correlation was found between IGF-I and FEV1 (ml). RESULTS: Our results indicate that the serum levels of IGF-I and IGFBP3 are significanlty elevated in the asthma group. We assume that current treatment strategies are not really good enough for asthma. We suppose further strategies which are seeking to balance IGF-I and IGFBP3 should be developed for more effective and curative treatment of asthma (Tab. 2, Fig. 2, Ref. 22).