Feasibility and impact of a one-stop thyroid clinic in a low- and middle-income country.

BACKGROUND: The study was done to evaluate the feasibility, safety and outcomes of a one-stop thyroid clinic (OSTC) in a low- and middle-income country (LMIC) setting. METHODS: This was a prospective non-randomised case control study consisting of patients with thyroid nodules evaluated and managed at a tertiary referral centre in an LMIC between February 2019 and January 2020. Patients were divided into two groups based on the kind of preoperative evaluation protocol: OSTC group (n = 118) - OSTC protocol, and control group (CG, n = 108) - routine protocol. RESULTS: Baseline clinical characteristics of the two groups including median age (p = 0.13) and gender distribution (p = 0.76) were comparable. The majority of patients in both groups belonged to a low-income group (46.6% vs 47.3%; p = 0.91), followed by a middle-income group (35.6% vs 30.5%; p = 0.41). The median number of outpatient department visits (1 vs 3 days; p = < 0.001), waiting time for neck ultrasonography (1 vs 3 days; p = < 0.0001), fine needle aspiration cytology (1 vs 2 days; p = < 0.0001), and out of pocket expenditure (INR 3 965 vs 6 624; p = < 0.001) was significantly less in the OSTC group compared to the CG. Patients in the OSTC group reported better satisfaction levels (p = < 0.0001). Accuracy of diagnosis did not differ between the two groups (p = 0.14). CONCLUSION: OSTC practice is feasible, provides comparative clinical outcomes and seems cost effective in an LMIC. This protocol can be adopted as a routine practice in any health system.

What is the impact of thyroidectomy on autoimmune features associated with Hashimoto's thyroiditis?-Institutional experience.

BACKGROUND: Hashimoto's thyroiditis (HT) is one of the commonest endocrine disorders, globally. Often, HT presents a protean range of associated autoimmune features (AAI) such as vitiligo, rheumatoid arthritis, pernicious anemia, skin allergy/atopy, thrombocytopenia, Addison's disease, type 1 diabetes, celiac disease, eosinophilia, etc., The usual treatment of HT is symptomatic with no curative option. In this context, we report our experience on the impact of surgical thyroidectomy on remission of AAI in HT. AIMS: To report our experience on the impact of surgical thyroidectomy on remission of AAI in patients with HT. MATERIAL AND METHODS: This is a retrospective study conducted in the Endocrine Surgery department of a tertiary care hospital. A total of 61 patients with HT and various AAI combinations were included in this study. All the clinicoinvestigative and operative data were systematically analyzed. The most frequent indication for surgery was nodular goiter followed by associated malignancy, persistent goiter, and painful thyroiditis. Others were cosmetic/pressure symptoms and not AAI per se. The mean follow-up after surgery was 55.6 ± 11.8 months. RESULTS: The gender ratio was 5.8:1 in favor of women and the mean age was 41.5 ± 5.4 years. The mean preoperative and postoperative serum anti-thyroperoxidase antibody (Anti-TPO Ab) levels were 339 ± 98.2 and 58.75 ± 25 IU/L at the last follow-up visit. A total of 60% AAI manifestations had resolution or significant alleviation. The major improvements in AAI were skin allergy, eosinophilia, rheumatoid arthritis, vitiligo, thrombocytopenia, celiac disease symptomatic episodes; but, type 1 diabetes and Addison's disease showed static response. CONCLUSIONS: Surgical total thyroidectomy and anti-TPO Ab-related autoimmunity appear to play a beneficial role and definitive role in the remission of AAI in HT.

Role of postoperative intact serum PTH as an early predictor of severe post-thyroidectomy hypocalcemia: a prospective study.

BACKGROUND: Post thyroidectomy hypocalcemia is a major sequel of thyroidectomy and continues to trouble the endocrinologists and the endocrine surgeons as there is no ideal predictive marker of hypocalcemia which has the potential to develop into a life-threatening complication. The role of early serum intact parathormone (iPTH) to predict post thyroidectomy hypocalcemia is becoming useful but the literature is still unclear regarding the optimal time of testing and the optimal cut-off value of serum iPTH. PATIENTS AND METHODS: This is a prospective cohort study of 111 patients who underwent total thyroidectomy in a tertiary care endocrine surgery referral unit. Serum iPTH was measured after 20 min and 4 h of surgery. Receiver-Operator characteristic Curve (ROC) was used to find out of the best cut-off value of S. iPTH 20 min and 4 h after surgery in predicting hypocalcemia. RESULTS: Hypocalcemia was noted in 60 (54%) out of 111 subjects who underwent total thyroidectomy. The best cut-off values of Serum iPTH to predict hypocalcemia was found to be 4.28 pmol/l at 20 min post total thyroidectomy with a sensitivity and specificity of 81.7% and 51%, respectively. In addition, patients with malignancy or central lymph nodal dissection were significantly over-represented in the hypocalcemia group with serum iPTH above the threshold level of 4.28 pmol/l. Below the cut off level, parenteral calcium supplementation was required in 23% (17/74) subjects while the rate was only 5.4% (2/37) patients when serum iPTH was above the cut-off level. CONCLUSIONS: The decline of serum iPTH below a specific level after surgery has predictive value together with other factors strictly related to patient, the thyroid disease itself and surgery. The risk of development of hypocalcemia and consequent need for calcium supplementation should be evaluated by clinical assessment along with serum PTH measurement.