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1.
J Laryngol Otol ; 135(3): 264-268, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33632350

RESUMO

OBJECTIVES: This study aimed to report the pre- and post-operative laryngeal endoscopic findings in patients referred by non-otolaryngologists who are undergoing thyroid and/or parathyroid surgery, and to determine the number and nature of referrals before and after the release of the clinical practice guideline for improving voice outcomes after thyroid surgery. METHODS: This retrospective cohort study, conducted at a tertiary care academic hospital, comprised adult patients referred by the endocrine surgery service for laryngoscopy from 2007 to 2018 (n = 166). Data regarding patient demographics, reason for referral and endoscopic findings were recorded. RESULTS: The number of referrals increased significantly after the release of the practice guideline. The most common indication for referral pre- and post-operatively was voice change. The most common finding during laryngoscopy was normal examination findings (pre-operatively) and unilateral vocal fold immobility (post-operatively). CONCLUSION: Peri-operative thyroid and/or parathyroid patients have laryngoscopic findings other than vocal fold immobility. Laryngoscopy to detect structural and functional pathology is warranted.


Assuntos
Laringoscopia/estatística & dados numéricos , Otolaringologia/estatística & dados numéricos , Glândulas Paratireoides/cirurgia , Encaminhamento e Consulta/estatística & dados numéricos , Glândula Tireoide/cirurgia , Adulto , Feminino , Humanos , Laringoscopia/normas , Laringe/patologia , Laringe/cirurgia , Masculino , Pessoa de Meia-Idade , Otolaringologia/normas , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Guias de Prática Clínica como Assunto , Período Pré-Operatório , Encaminhamento e Consulta/normas , Estudos Retrospectivos , Paralisia das Pregas Vocais/diagnóstico , Paralisia das Pregas Vocais/etiologia , Prega Vocal/patologia , Prega Vocal/cirurgia , Voz , Distúrbios da Voz/diagnóstico , Distúrbios da Voz/etiologia
2.
Rev Col Bras Cir ; 48: e20202557, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33503138

RESUMO

The thyroidectomy is the most frequently executed procedure in head and neck surgery. Since its first description by Kocher, the transverse cervical incision has been the main access to the thyroid site, as it provides broad exposure of the central neck compartment. Despite the meticulous suture of the incision, the development of a scar with variable dimensions is unavoidable and, hence, some patients might not agree to the approach, due to this consequence. The transoral endoscopic thyroidectomy vestibular access (TOETVA) gains importance as an alternative to the traditional surgery, since it avoids the formation of visible scars. The objective of this study is to develop a systematic review on the currently available literature to evaluate possible complications related to the TOETVA. The systematic review was based on the databases of Medline, Cochrane library, Embase and Scielo/Lilacs, resulting in the selection of six studies, which were compared in regard of the type of study duration of the study and identified complications. Our study showed that TOETVA is related to complications similar to the ones identified in the conventional approach, such as hematoma, seroma, recurrent laryngeal nerve injury, hypoparathyroidism, surgical site infection. The TOETVA was associated to a higher risk of thermic injury of the skin and mentual nerve paresthesia. Moreover, it was possible to conclude that TOETVA is a safe procedure for well selected patients, with favorable conditions and concerned about the aesthetic outcome. The risk of complications of the procedure should always be explained to those patients.


Assuntos
Hipoparatireoidismo/cirurgia , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Hematoma , Humanos , Complicações Pós-Operatórias , Tireoidectomia/efeitos adversos
3.
Laryngoscope ; 131(3): E1029-E1034, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33319385

RESUMO

OBJECTIVES/HYPOTHESIS: Nodal involvement is frequent in patients with differentiated thyroid cancers (DTCs), but its prognostic relevance is not univocal. Some characteristics of nodal metastases can increase the risk of recurrence. We attempted to quantify the impact on survival of nodal factors included in the American Thyroid Association (ATA) risk stratification system in N1b patients with DTC. STUDY DESIGN: Retrospective study. METHODS: A retrospective analysis of patients affected by DTC who underwent therapeutic lateral neck dissection (ND) was performed. The impact on the prognosis of the number of positive lymph nodes (LNs), dimension of nodal metastasis, and microscopic and macroscopic extranodal extension (miENE and maENE, respectively) was investigated. RESULTS: The study included 347 N1b patients who underwent 401 therapeutic lateral NDs. Mean number of positive LNs was nine, mean nodal ratio was 0.27, and mean diameter of metastasis was 15.5 mm. ENE was detected in 25.9% of patients (22.5% miENE and 3.5% maENE). In univariate analysis, the presence of maENE had an impact on disease specific survival (DSS) (P = .023); increasing number of positive LNs affected DSS and locoregional control (LRC) (P = .009 and =.006, respectively); increasing metastatic node dimension was a risk factors for overall survival, DSS, and metastases free survival (MFS) (P = .05, =.013 and =.016). In multivariate analysis, number of positive LNs and LN dimension were independent risk factors for LRC and MFS, respectively (HR 1.1, P = .028; HR 1.1, P = .026). CONCLUSIONS: In our analysis on a cohort of N1b patients, the number of positive LNs and LN dimension were confirmed as independent risk factors for locoregional and distant recurrence, respectively. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E1029-E1034, 2021.


Assuntos
Metástase Linfática/patologia , Esvaziamento Cervical/estatística & dados numéricos , Recidiva Local de Neoplasia/epidemiologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Linfonodos/patologia , Linfonodos/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/prevenção & controle , Prognóstico , Estudos Retrospectivos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Glândula Tireoide/patologia , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/mortalidade , Neoplasias da Glândula Tireoide/patologia , Adulto Jovem
4.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370973

RESUMO

We report two cases of anaplastic thyroid cancer (ATC) which had a very good response to a treatment with lenvatinib at 14 mg. A 73-year-old man with ATC stage IVB was operated on, undergoing a near-total thyroidectomy, and the pathological remnant tissue showed a quick and partial response to treatment with the drug. The patient had a single metastasis in the brain after 9 months, but then died due to bronchopneumonia after undergoing a neurosurgical intervention for the complete removal of the lesion. A 74-year-old woman with ATC stage IV was operated on, undergoing a near-total thyroidectomy after a neoadjuvant treatment with the drug, that was continued after surgical treatment. She had a partial remission of the local disease and of distant metastasis, which lasted for 14 months. She then died 4 months later due to cancer progression. Lenvatinib at 14 mg appears to be effective, fast and well tolerated.


Assuntos
Compostos de Fenilureia/administração & dosagem , Inibidores de Proteínas Quinases/administração & dosagem , Quinolinas/administração & dosagem , Carcinoma Anaplásico da Tireoide/terapia , Neoplasias da Glândula Tireoide/terapia , Tireoidectomia , Idoso , Quimioterapia Adjuvante/métodos , Relação Dose-Resposta a Droga , Humanos , Masculino , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Carcinoma Anaplásico da Tireoide/diagnóstico , Carcinoma Anaplásico da Tireoide/patologia , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/patologia , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/patologia , Resultado do Tratamento
5.
Rev Med Suisse ; 16(709): 1849-1852, 2020 Oct 07.
Artigo em Francês | MEDLINE | ID: mdl-33026726

RESUMO

For safe procedures, the surgeon performing thyroid gland surgeries must know precisely the anatomical relationships of the inferior laryngeal nerve with other cervical structures, in particular the inferior laryngeal artery and its branches. Classic descriptions of these relationships are based almost exclusively on the observation of Caucasian populations. However, this study shows that there are important differences between Caucasian and Sub-Saharian ethnic group, differences that any surgeon having the opportunity to operate in Africa should know to limit the risk of iatrogenic nerve damage and its morbid consequences.


Assuntos
Grupo com Ancestrais do Continente Africano , Artérias/cirurgia , Grupos Étnicos , Nervo Laríngeo Recorrente/cirurgia , Glândula Tireoide/cirurgia , África/etnologia , Grupo com Ancestrais do Continente Europeu , Humanos , Laringe/irrigação sanguínea , Laringe/cirurgia
7.
J Med Life ; 13(3): 426-430, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33072219

RESUMO

Several studies deal with learning causes stipulating nodular formations in the thyroid tissue, including those occurring against the ground of metabolic disorders of thyroid hormones. Our study's objective was to determine the peculiarities of thyroid homeostasis disorders in patients suffering from benign nodular thyroid pathology with relapses of the disease and its relapse-free course. For this purpose, 96 female patients suffering from nodular thyroid pathology and 20 without thyroid pathology were examined. In the course of the study, the following were found in patients with benign focal thyroid pathology: disorders of the peripheral conversion of the thyroid hormones, compensatory activation of the hypothalamic-pituitary system evident in increased levels of the thyroid-stimulating hormone, ТSH/fT3 and ТSH/fT4 ratios, increasing titers of the anti-thyroid antibodies which can be hazardous for the risk of development of nodules or reflects the process of thyroid tissue damage; high level of thyroglobulin caused by an increased probability of relapse and rate of nodule growth, an increase of the thyroid gland volume associated with activation of the hypothalamic-pituitary system, increased antibodies titer and thyroid gland damage. Thus, changes of the examined indices in the blood can be used as prognostic markers concerning the relapse of nodule formation in the thyroid tissue.


Assuntos
Doenças da Glândula Tireoide/fisiopatologia , Glândula Tireoide/patologia , Glândula Tireoide/fisiopatologia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva , Doenças da Glândula Tireoide/sangue , Doenças da Glândula Tireoide/patologia , Doenças da Glândula Tireoide/cirurgia , Glândula Tireoide/cirurgia , Tireotropina/sangue , Tiroxina/sangue
8.
Rev. ORL (Salamanca) ; 11(3): 243-252, jul.-sept. 2020. tab, graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-197893

RESUMO

La atención al paciente con patología de las glándulas tiroides y paratiroides es multidisciplinar. La formación y actualización de los conocimientos sobre el diagnóstico y tratamiento de las patologías de tiroides y paratiroides es una necesidad en todas las especialidades implicadas. Página web del curso 'Bases de Tiroidología y Paratiroidología en cirugía de tiroides y paratiroides': http://tiroides.org.es/


Attention to patients with pathology of thyroid and parathyroid glands is multidisciplinary. The training and updating of knowledge on the diagnosis and treatment of thyroid and parathyroid pathologies is a necessity in all the specialties involved. Web page of the course 'Bases of Thyroidology and Parathyroidology in thyroid and parathyroid surgery': http://tiroides.org.es/


Assuntos
Humanos , Doenças da Glândula Tireoide/cirurgia , Glândula Tireoide/cirurgia , Equipe de Assistência ao Paciente , Internato e Residência , Educação Médica Continuada , Segurança do Paciente , Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias de Cabeça e Pescoço/cirurgia
9.
Int. j. morphol ; 38(4): 1128-1135, Aug. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1124905

RESUMO

El estudio de las venas tiroideas no ha recibido una investigación tan exhaustiva como lo tuvieron las arterias tiroideas y los nervios laríngeos en relación a la cirugía tiroidea.De los tres pedículos venosos de la glándula tiroides, el medio, de lejos es el menos estudiado. La vena tiroidea media es inconstante y es el primer elemento vascular de la glándula tiroides que debe ser seccionado antes de luxar el lóbulo hacia medial para evaluar sus relaciones posteriores. Su lesión puede provocar sangrado intraoperatorio dificultando secundariamente la identificación del nervio laríngeo inferior y las glándulas paratiroides, próximas a la misma. Se realizó un estudio descriptivo de corte transversal evaluando la pesencia, número, simetría y asociación de la vena tiroidea media con variables tales como edad y sexo del paciente, así como la hiperfuncionalidad de la glándula tiroides y la presencia del tubérculo de Zuckerkandl en 100 tiroidectomías totales llevadas a cabo en el Instituto Nacional del Cáncer y en el Servicio de Otorrinolaringología del Hospital Central del Instituto de Previsión Social del Paraguay. La prevalencia global de vena tiroidea media fue del 74 %. En el lóbulo derecho, la vena se presentó en el 60 %, mientras que en el lóbulo izquierdo en el 53 %. En el 38 % se encontró la vena en ambos lóbulos. En 4 pacientes se localizaron venas tiroideas medias dobles, en una de ellas fue bilateral. El mayor porcentaje de las venas tiroideas medias se originó en el tercio medio del lóbulo, el 72 % en el lado derecho y el 70% en el izquierdo. No se encontró asociación entre la presencia de la vena tiroidea media y la edad, sexo, estado de hiperfunción glandular, así como tampoco con la presencia del tubérculo de Zuckerkandl.


The study of the thyroid veins has not received an investigation as extensive as the thyroid arteries and laryngeal nerves did in relation to thyroid surgery. Of the three veins pedicles of the gland the middle is far the least studied. This vein is inconstant and is the first vascular element of the gland that must be sectioned before the medial lobe is dislocated to evaluate ist posterior relationships. His injury can cause intraoperative bleeding, making it difficult to identify the inferior laryngeal nerve and the parathyroid glands, proximal to it. A descriptive crossseccional study was carried aot evaluating the presence, number, symmetricity and association of the middle thyroid vein with variables such as age and sex of the patient, as well as the hyperfunctionality of the gland and the presence of the Zuckerkandl tubercle in 100 total thyroidectomies undergoing at the National Cancer Institute and the ENT Service of the Social Security Institute´s Central Hospital. The overall prevalence of the middle thyroid vein was 74%. In the right lobe the vein appeared in 60% while in the left lobe in 53 %. Double middle thyroid vein was found in 4 patients, in one of them it was bilateral. The highest percentage of the middle thyroid veins originated in the middle third of the lobe, 72 % on the right and 70% on the left side. No association was found between the presence of the vain and age and sex, the state of glandular hyperfunstion, as well as the presence of Zuckerkandl tubercle.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Glândula Tireoide/irrigação sanguínea , Veias/anatomia & histologia , Veias/cirurgia , Glândula Tireoide/cirurgia , Tireoidectomia , Prevalência , Estudos Transversais
10.
BMC Infect Dis ; 20(1): 440, 2020 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-32571242

RESUMO

BACKGROUND: Infection with the Cryptococcus neoformans yeast fungus is largely restricted to patients with HIV, sarcoidosis or immunosuppressive therapies. In sarcoidosis, there is intense local immune response in granuloma lesions, coupled with a paradoxical systemic anergy. An analysis of cryptococcal infection in sarcoidosis may therefore shed light on whether opportunistic pathogens preferentially engage immune-privileged tissues. CASE PRESENTATION: A 54-year-old man was admitted to our hospital after 2 months with palpitations and activity-related presyncope. A chest X-ray was normal, electrocardiography showed type-II atrioventricular-block, and there was a tentative diagnosis of myocarditis. Computed tomography reported minor hilar lymph glands and multiple nodular lesions in the lungs. Magnetic resonance imaging showed oedema and nodular structures in the heart, and fibrosis and granulomas were found in endomyocardial biopsies. The diagnosis was revised to cardiac sarcoidosis, and prednisone was initiated. In parallel, positron-emission tomography had revealed a marked uptake in the right thyroid lobe, a thyroid lobectomy was then performed, and the pathology showed a BRAF-positive papillary thyroid carcinoma. Four days postoperatively the patient developed symptoms suggestive of meningoencephalitis. Cerebrospinal fluid and blood cultures yielded growth of C. neoformans. Fungal staining of the thyroid specimen revealed cryptococcal elements in the carcinoma and in granulomas close to the tumour. Notably, there was no evidence of cryptococci in the heart sarcoid sections or in the normal thyroid parenchyma. The patient was successfully treated with antifungal agents and at the 2-year follow-up there was no evidence of thyroid cancer relapse. CONCLUSION: This sarcoidosis patient had a remarkable clinic with evidence of cryptococcal infection only in body compartments commonly regarded to be immune-privileged. The findings suggest that an opportunistic and environmentally abundant pathogen, when infecting an immunocompromised host, primarily engages immunodeficient locations such as the brain, a tumour microenvironment and some forms of granuloma.


Assuntos
Criptococose/imunologia , Sarcoidose/etiologia , Antifúngicos/uso terapêutico , Cardiomiopatias/etiologia , Líquido Cefalorraquidiano/microbiologia , Criptococose/tratamento farmacológico , Cryptococcus neoformans/patogenicidade , Humanos , Hospedeiro Imunocomprometido , Imagem por Ressonância Magnética , Masculino , Meningoencefalite/microbiologia , Pessoa de Meia-Idade , Miocárdio/patologia , Sarcoidose/microbiologia , Câncer Papilífero da Tireoide/patologia , Câncer Papilífero da Tireoide/cirurgia , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/microbiologia , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
11.
J Surg Res ; 255: 42-49, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32540579

RESUMO

BACKGROUND: Recurrent laryngeal nerve (RLN) injury is a well-known, potentially serious complication of thyroid surgery. We investigated factors associated with RLN injury during thyroid surgery using a multi-institutional data set. MATERIALS AND METHODS: Patients who underwent either lobectomy or total thyroidectomy were abstracted from the American College of Surgeons National Surgical Quality Improvement Program thyroidectomy-specific database (2016-2017). Baseline and operative factors associated with RLN injury ≤30 d of surgery were analyzed using bivariate and multivariate methods. Secondary complications of interest included unplanned reintubation and hypocalcemia. RESULTS: RLN injury occurred in 6.0% (n = 677) of the 11,370 patients included in the study. The RLN injury rate varied significantly based on the primary indication for surgery, from 4.3% in patients undergoing surgery for a single nodule to 9.0% in patients undergoing surgery for differentiated cancer (P < 0.01). RLN injury occurred more often in thyroidectomies than lobectomies (6.9% versus 4.3%, P < 0.01) and in surgeries without intraoperative nerve monitoring (6.5% versus 5.6%, P = 0.01). After multivariate adjustment, RLN injury was independently associated with age ≥65 y [odds ratio (OR) 1.6, 95% confidence interval (CI) 1.3-2.0], total thyroidectomy (OR = 1.4, 95% CI 1.1-1.6), and diagnosis of thyroid malignancy (OR = 2.1, 95% CI = 1.6-2.7) (all P < 0.001) but not intraoperative RLN monitoring (OR = 0.9, 95% CI = 0.7-1.0, P = 0.06). CONCLUSIONS: In this large multi-institutional study, RLN injury ≤30 d of surgery occurred in nearly 6% of thyroid surgeries. This comprehensive analysis of RLN injury can be used to guide informed consent discussions and aid surgeons in identifying candidates who may be at higher risk for injury.


Assuntos
Complicações Pós-Operatórias/epidemiologia , Traumatismos do Nervo Laríngeo Recorrente/epidemiologia , Tireoidectomia/efeitos adversos , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Traumatismos do Nervo Laríngeo Recorrente/etiologia , Traumatismos do Nervo Laríngeo Recorrente/prevenção & controle , Fatores de Risco , Glândula Tireoide/inervação , Glândula Tireoide/cirurgia , Tireoidectomia/métodos
12.
Medicine (Baltimore) ; 99(22): e20392, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481427

RESUMO

RATIONALE: Thyroglossal duct cyst (TGDC), the most common midline neck mass, has several histological diagnoses other than cyst in the literature. We present the first case of thyroglossal duct lipoma. PATIENT CONCERNS: A 63-year-old woman presented with a painless soft midline neck mass for more than 3 years, which enlarged in size and caused a lump sensation during swallowing. DIAGNOSES: Sonography revealed a 3.5 × 3.0 × 3.0-cm homogenous isoechoic oval lesion without an acoustic shadow beyond the thyroid glands. An ultrasound-guided biopsy revealed abundant sheets of fat cells with infiltration of some lymphocytes and histiocytes. Computed tomography revealed a 3.5 × 3.0 × 3.0-cm well-circumscribed ovoid mass with Hounsfield unit (HU) between -50 and -100 and a thyroglossal duct remnant. All these findings supported the diagnosis of thyroglossal duct lipoma. INTERVENTIONS: The patient underwent Sistrunk operation for excision of the neck tumor, and pathological examination revealed an adipose tumor surrounded by benign thyroid tissue, confirming the diagnosis of thyroglossal duct lipoma. OUTCOMES: Neither postoperative complication nor recurrence was noted at the 18-month follow-up. LESSONS: This is the first case of thyroglossal duct lipoma in the literature. Our study extends the disease spectrum of thyroglossal duct mass and suggests that clinicians should consider thyroglossal duct lipoma in the differential diagnosis of a midline neck mass.


Assuntos
Lipoma/diagnóstico , Cisto Tireoglosso/diagnóstico , Neoplasias da Glândula Tireoide/diagnóstico , Feminino , Humanos , Lipoma/patologia , Lipoma/cirurgia , Pessoa de Meia-Idade , Cisto Tireoglosso/patologia , Cisto Tireoglosso/cirurgia , Glândula Tireoide/patologia , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia
13.
Ann R Coll Surg Engl ; 102(8): e192-e195, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32436720

RESUMO

We describe the case of an 89-year old Caucasian woman admitted with confusion and severe clinical manifestations of acute hypercalcaemia. There was no history suggestive of any malignancy and initial management included correction of the hypercalcaemia with intravenous fluid therapy. Sestamibi parathyroid scintigraphy and neck ultrasonography demonstrated a 4cm left-sided thyroid lesion and a nearly 2cm right-sided thyroid lesion. The patient underwent a total thyroidectomy and parathyroidectomy. Histology confirmed a concomitant parathyroid adenoma, parathyroid carcinoma and follicular thyroid carcinoma. To our knowledge, this is the first reported case in the literature.


Assuntos
Adenocarcinoma Folicular , Neoplasias das Paratireoides , Neoplasias da Glândula Tireoide , Idoso de 80 Anos ou mais , Feminino , Humanos , Hipercalcemia/etiologia , Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/patologia , Glândulas Paratireoides/cirurgia , Paratireoidectomia , Cintilografia , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/patologia , Glândula Tireoide/cirurgia , Tireoidectomia
14.
J Laryngol Otol ; 134(5): 381-386, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32468965

RESUMO

Mr President, Mr President Elect, Fellows and Members, Ladies and Gentleman, it is a pleasure to address the Section of Laryngology this morning and deliver the 94th Semon Lecture. I would like to thank the Semon Committee for their kind invitation. My lecture will discuss Sir Felix Semon (the man himself), highlight the history of head and neck surgery, and then discuss the requirements of a modern-day thyroid surgeon. I have no conflict of interest and nothing to declare.


Assuntos
Otolaringologia/história , Doenças da Glândula Tireoide/história , Glândula Tireoide/cirurgia , História do Século XVII , História do Século XVIII , História do Século XIX , História do Século XX , História Medieval , Humanos , Londres , Doenças da Glândula Tireoide/epidemiologia , Doenças da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/história , Tireoidectomia/estatística & dados numéricos , Reino Unido/epidemiologia
15.
Arch Endocrinol Metab ; 64(4): 427-435, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32267347

RESUMO

Objective The most vital complications of thyroidectomy are recurrent nerve damage and hypocalcaemia. We aimed to compare the tissue perfusion scores (PS) of IG fluorescence angiography (IGFA) and visual examination by the surgeon after total thyroidectomy. Subjects and methods Forty-three patients were accepted into the study. Localisation of the parathyroid gland (PG) was determined by the naked eye and scored in terms of tissue perfusion. The averages of fluorescent light intensities for each IGFA were calculated, the perfusions were scored and compared with the PS given by the surgeon. Biochemical parameters were noted. Results 37.2% of patients had autotransplanted PGs, according to their visual scores. The means of IGFA-PS for PGs scored as 0, 1 or 2 on visual inspection were 48.58 ± 4.49 [30-70], 89.65 ± 8.93 [36-144] and 158.76 ± 8.93 [70-253], respectively, which correlated with the visual PSs in a statistically significant manner (P < 0.0001). The predictive cut-off value for IGFA-PS was determined to be 70, given a visual PS of 0 (95% CI [0.72-0.85]), and this was interpreted to be a candidate cut-off point for the autotransplantation of PGs. Conclusion IGFA scoring may be considered as an operative predictor, providing objective criteria to evaluate the tissue and blood perfusion of PGs after thyroidectomy. IGFA scoring may be considered to have value in minimising postoperative permanent hypoparathyroidism in patients.


Assuntos
Glândulas Paratireoides , Glândula Tireoide/cirurgia , Angiofluoresceinografia , Humanos , Hipoparatireoidismo , Verde de Indocianina , Complicações Pós-Operatórias , Tireoidectomia
16.
J Surg Res ; 253: 69-78, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32335393

RESUMO

BACKGROUND: This study aimed to explore the new factors that can predict central lymph node metastasis (CLNM) of papillary thyroid carcinoma (PTC) independently from ultrasound characteristics, elastic parameters, and endocrine indicators. METHODS: A total of 391 patients with PTC undergoing thyroidectomy and prophylactic central lymph node dissection from January 2017 to June 2019 were collected to determine the independent predictors of CLNM by single-factor and multivariate logistic regression analysis. RESULTS: Multivariate logistic regression analysis showed 9 independent predictors of CLNM, age, male, tumors in the middle or lower poles (without tumors in the isthmus), tumors in the isthmus, multiple tumors, and maximum tumor diameter measured by ultrasound, microcalcification, visible surrounding blood flow signal, and the maximum value of elastic modulus (Emax).We used the aforementioned factors to establish a scoring prediction model: predictive score Y(P) = 1/[1 + exp (1.444 + 0.084 ∗ age - 0.834 ∗ men - 0.73 ∗ multifocality - 2.718 ∗ tumors in the isthmus - 0.954 ∗ tumors in the middle or lower poles - 0.086 ∗ tumor maximum diameter - 1.070 ∗ microcalcification - 0.892 ∗ visible surrounding blood flow signal - 0.021 ∗ Emax)]. The area under the curve of the receiver operating characteristic was 0.827. It was found that 0.524 was the highest index of Youden, and the best cutoff value for predicting CLNM. When Y(P)≥0.524, the risk of CLNM in patients with PTC is predicted to be high. Predictive accuracy was 78.5% and 72.4% in the internal validation group and 78.6% in the external validation group. CONCLUSIONS: These data indicate that the scoring prediction model could provide a scientific and quantitative way to predict CLNM in patients with PTC.


Assuntos
Metástase Linfática/diagnóstico , Câncer Papilífero da Tireoide/secundário , Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Ultrassonografia Doppler em Cores/estatística & dados numéricos , Adolescente , Adulto , Idoso , Biópsia por Agulha Fina , Elasticidade , Feminino , Humanos , Excisão de Linfonodo/estatística & dados numéricos , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática/patologia , Metástase Linfática/terapia , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Valor Preditivo dos Testes , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos , Câncer Papilífero da Tireoide/diagnóstico por imagem , Câncer Papilífero da Tireoide/cirurgia , Glândula Tireoide/patologia , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/estatística & dados numéricos , Adulto Jovem
17.
J Surg Res ; 253: 63-68, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32320898

RESUMO

BACKGROUND: Crowdfunding has become a unique response to the challenge of health care expenses, yet it has been rarely studied by the medical community. We looked to describe the scope of crowdfunding in thyroid surgery and analyze the factors that contribute toward a successful campaign. METHODS: In November 2018, active campaigns were retrieved from a popular crowdfunding Web site using search terms thyroidectomy and thyroid surgery and filtered to include only campaigns that originated in the United States. RESULTS: About 1052 thyroid surgery-related campaigns were analyzed. About 836 (79.5%) involved female patients and 43 (4.1%) pediatric patients. About 792 campaigns (75.3%) referred to thyroid cancer as a primary condition, 163 (15.5%) benign thyroid disease, and 97 (9.2%) other conditions. The average amount raised per campaign was $2514.54 (range, $0-$53,160). About 338 (32.1%) campaigns were self-posted, 317 (30.1%) posted by family, and 397 (37.7%) posted by friends. Median campaign duration was 20 mo, with a median number of 16 donors, 17 hearts, and 136 social media shares. Campaigns related to thyroid cancer raised more funds ($2729.97) than benign ($1669.84) or other ($2175.03) conditions (P < 0.001). Campaigns submitted by friends ($3524.78) received more funding than those by self ($1672.48) or family ($2147.19) (P < 0.001). Campaign duration, donor number, share number, and hearts were also significant predictors of amount raised. CONCLUSIONS: For thyroid surgery-related crowdfunding, campaigns referring to thyroid cancer had the highest amount of funds raised. Campaigns created by friends and other factors related to increased community engagement such as social media shares were also related to increased funds.


Assuntos
Crowdsourcing/estatística & dados numéricos , Gastos em Saúde , Mídias Sociais/estatística & dados numéricos , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/economia , Adulto , Criança , Crowdsourcing/economia , Crowdsourcing/métodos , Feminino , Humanos , Masculino , Mídias Sociais/economia , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/economia , Estados Unidos
18.
J Surg Oncol ; 122(1): 36-40, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32334445

RESUMO

Transoral endocrine surgery encompasses a group of operations whereby the thyroid or parathyroid gland is removed through the oral vestibule. This operation has the advantage of leaving no cutaneous scar and a risk profile similar to open surgery. Adoption of this technique has increased dramatically over the last several years. It is of paramount importance for surgeons to undergo adequate training before adopting this technique.


Assuntos
Procedimentos Cirúrgicos Endócrinos/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Glândulas Paratireoides/cirurgia , Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Humanos , Neoplasias da Glândula Tireoide/cirurgia
19.
Ann R Coll Surg Engl ; 102(5): e107-e110, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32233872

RESUMO

The brain is a particularly rare site of metastasis from papillary microcarcinoma, with only few cases described in the literature. We present a case of 59-year-old man who presented with seizures and dysphasia due to left frontal lobe cystic mass, which was excised and turned out on histopathology to be of thyroid origin. Total thyroidectomy was performed and histology showed multifocal papillary microcarcinoma with the largest focus of 3mm with no other adverse features. The patient had ablative radioactive iodine postoperatively, with subsequent exit scan showing no uptake in the brain. Follow-up brain magnetic resonance imaging showed continuous regression of the surgical cavity. Although rare, such cases should be aggressively treated and followed up over the long term, because of reported associated high mortality.


Assuntos
Neoplasias Encefálicas/diagnóstico , Carcinoma Papilar/diagnóstico , Procedimentos Neurocirúrgicos , Convulsões/etiologia , Neoplasias da Glândula Tireoide/patologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Encéfalo/cirurgia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/cirurgia , Carcinoma Papilar/secundário , Carcinoma Papilar/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Glândula Tireoide/patologia , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/secundário , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
20.
J Surg Res ; 252: 63-68, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32234570

RESUMO

BACKGROUND: Postoperative hypocalcemia because of hypoparathyroidism is the most common complication of total thyroidectomy in children. We hypothesized that most children with postoperative hypocalcemia would be eucalcemic by 12 mo and sought to define risk factors for permanent hypoparathyroidism. METHODS: We retrospectively reviewed children who underwent total thyroidectomy at a single children's hospital from 2012 to 2019. Patients with prior neck surgery were excluded. Indication for operation, final pathologic diagnosis, and postoperative serum calcium up to 12 mo were recorded. Permanent hypoparathyroidism was defined as supplemental calcium requirement beyond 1 y postoperatively. RESULTS: Sixty-eight patients underwent total thyroidectomy. Graves' disease was the most common benign indication for surgery (38 patients). Twenty-six patients (38%) had cancer on final pathology. Central lymph node dissection (CLND) was performed in 12 cancer patients. Twenty-eight patients (41%) had postoperative hypocalcemia. Eight patients (12%) had hypocalcemia at 6 mo. Risk factors for hypoparathyroidism at 6 mo were a cancer diagnosis (odds ratio [OR] 6.7; P = 0.02), CLND (OR 12.6; P < 0.01), and parathyroid tissue in the surgical specimen on pathologic analysis (OR 19.5; P < 0.01). Only two patients (3%) developed permanent hypoparathyroidism, both of whom had thyroidectomy for cancer and underwent CLND. CONCLUSIONS: Children with thyroid cancer are at high risk for postoperative hypocalcemia after total thyroidectomy. The risk is further increased by CLND, which should be performed selectively. A majority of patients with hypoparathyroidism at 6 mo postoperatively regain normal parathyroid function by 1 y. Permanent hypoparathyroidism in children after total thyroidectomy at a pediatric endocrine surgery center is rare.


Assuntos
Doença de Graves/cirurgia , Hipocalcemia/epidemiologia , Hipoparatireoidismo/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversos , Adolescente , Cálcio/sangue , Criança , Pré-Escolar , Feminino , Humanos , Hipocalcemia/sangue , Hipocalcemia/diagnóstico , Hipocalcemia/etiologia , Hipoparatireoidismo/sangue , Hipoparatireoidismo/diagnóstico , Hipoparatireoidismo/etiologia , Masculino , Glândulas Paratireoides/lesões , Glândulas Paratireoides/patologia , Hormônio Paratireóideo/sangue , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Glândula Tireoide/patologia , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/patologia , Adulto Jovem
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