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Background and Objective: Pediatric thyroid cancer is on the rise, especially among adolescents. It is more aggressive than adult thyroid cancer and often presents with advanced features. This review aims to examine the current trends in the management and outcomes of pediatric thyroid cancer in Saudi Arabia. Methods: A comprehensive literature search was conducted to identify relevant studies on pediatric thyroid cancer in Saudi Arabia. PubMed and Google Scholar were searched from inception until December 2023. Extracted information included study identifiers, patient demographics, clinicopathological features, treatment modalities, complications, surveillance practices, recurrence patterns, and survival outcomes. Key Content and Findings: The literature search identified ten eligible studies on pediatric thyroid cancer in Saudi Arabia. Pediatric thyroid cancer in Saudi Arabia often presents with advanced features, including higher rates of lymph nodes and distant metastases at diagnosis compared to adults. Fine-needle aspiration remains accurate, correlating well with final histopathology. Treatment primarily involves surgery, with total thyroidectomy being common, followed by radioactive iodine therapy for high-risk patients or those with positive iodine uptake. Survival rates exceed 95%, indicating a generally favorable prognosis. Recurrence rates can reach up to 30% in some studies, particularly with larger tumors or distant metastases. Hypocalcemia and recurrent laryngeal nerve injury are common postoperative complications, highlighting the need for experienced surgeons and meticulous technique. Genetic alterations in pediatric thyroid cancer are being investigated, but their impact on prognosis and treatment response is unclear. Limited data on management and outcomes in other regions of Saudi Arabia calls for multicenter studies to address healthcare disparities. Conclusions: Pediatric thyroid cancer in Saudi Arabia has unique characteristics compared to its adult counterpart, mandating specialized management approaches. More research is needed on early detection, risk stratification, personalized treatment, and addressing regional disparities to improve outcomes for this vulnerable population.
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Aim: This systematic review and meta-analysis of randomized controlled trials (RCTs) compare the impact of platysma muscle layer closure technique among patients undergoing thyroidectomy in terms of postoperative outcomes, specifically pain. Methods: Five electronic databases (PubMed, Scopus, Web of Science, Google Scholar, and Cochrane Central Register of Controlled Trials) were searched from inception until July 22, 2023. The Cochrane risk of bias tool 2 was employed for risk of bias (ROB) assessment. Data were pooled as mean difference (MD), standardized MD (SMD), or risk ratio (RR) based on data type (continuous or dichotomous) using RevMan software. Results: This meta-analysis included four RCTs with a total of 426 patients. Three RCTs had a low risk of bias, while one had some concern regarding bias. The overall MD of the postoperative pain score favored the non-closure group over the closure group (MD = 0.63; 95% CI: [0.09, 1.18]; P = 0.02). However, no significant differences were observed between the two groups in terms of patient scar assessment scale (MD= -0.61; 95% CI: [-3.39, 2.17]; P = 0.67), observer scar assessment scale (SMD = 0.26; 95% CI: [-0.30, 0.81]; P = 0.37), length of the scar (MD = 0.27; 95% CI: [-0.12, 0.67]; P = 0.17), wound infection (RR = 0.63; 95% CI: [0.13, 3.16]; P = 0.57), and seroma or hematoma (RR = 3.00; 95% CI: [0.49, 18.55]; P = 0.24). Conclusion: Our findings suggest that the platysma muscle layer closure during thyroidectomy might lead to increased postoperative pain but does not significantly impact scar outcomes or postoperative complications. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-024-04503-3.
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OBJECTIVE: The objective of this report is to emphasize the importance of considering thyroid cancer in the differential diagnosis, when the origin of a metastatic boney lesion is indeterminate. METHODS: Diagnostic studies performed included a thyroid function test, an ultrasound, and a computed tomography (CT) scan of the neck, biopsies of the bone, and thyroid lesions. RESULTS: A 61-year-old man was found to have incidental sclerotic bone lesions in the lumbar region on CT scan performed in the setting of a prostate abscess induced sepsis. The bone biopsy suggested metastatic follicular thyroid carcinoma. Imaging studies of the neck showed markedly enlarged left greater than right thyroid nodules. A surgical specimen from the staged total thyroidectomy showed no evidence of thyroid malignancy, despite a thorough review of microscopic tissue sections at 5 µm. A whole body scan 2-months after radioactive iodine therapy demonstrated persistent uptake in the metastatic lesion at L4 and interval progression of widely metastatic disease. CONCLUSION: Metastatic thyroid cancer may be present without a histopathologic evidence of thyroid malignancy, albeit rarely. When the origin of a metastatic boney lesion is unclear, thyroid cancer should be included in the differential diagnosis.
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The conventional robotic endoscopic remote access techniques detailed in this article have been discussed in a series of increasing volumes in the literature, including for the treatment of thyroid cancer. Lower-volume centers now perform most robotic thyroidectomies in the United States and are responsible for recent increases in utilization patterns despite higher complication rates. These trends highlight the importance of increasing surgeon exposure to and experience with these techniques in order to improve procedure safety. Additional large-volume, multicenter studies to define patients who will most benefit from these conventional robotic endoscopic procedures for thyroid cancer are needed.