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Objective: Outpatient thyroid surgery for thyroid lobectomy has been shown to be safe and feasible. The safety of outpatient completion thyroidectomy in patients who have previously undergone thyroid lobectomy has not been extensively evaluated in the medical literature to date. The authors sought to evaluate postoperative complications associated with completion thyroidectomy in their institution to determine if it would be safe and feasible to perform as an outpatient procedure.Study Design: Case series with chart review.Setting: Tertiary care teaching hospital.Subjects and Methods: Two hundred four consecutive patients, who underwent completion thyroidectomy after previous thyroid lobectomy from January 2000 to June 2010, comprised the study population. Medical records were reviewed for preoperative and postoperative serum calcium levels, preoperative and postoperative fiber-optic laryngoscopic examination of vocal fold mobility, associated comorbidities, length of hospital stay, drain use, seroma or hematoma formation, final thyroid pathology, and postoperative follow-up.Results: Overall, 9 patients (4.4%) developed postoperative complications, including transient symptomatic hypocalcemia in 4 patients (2.0%), transient laboratory hypocalcemia in 3 patients (1.5%), seroma formation in 1 patient (0.5%), and hematoma development in 1 patient (0.5%). There were no cases with permanent or temporary vocal fold paralysis. No significant difference was found in the overall complication rate before and after 4 hours of observation (P = .50).Conclusion: Selected patients who undergo completion thyroidectomy after previous thyroid lobectomy can be safely discharged after 4 hours of postoperative observation with appropriate instructions. [ABSTRACT FROM AUTHOR]

Objectives: A case is reported in which Langerhans cell histiocytosis was found in the thyroid gland. Although the thyroid gland is frequently affected with multiple common diseases, a search of the English language literature suggests that Langerhans cell histiocytosis in the thyroid gland is rarely reported. Study Design: The study design was of a case report and literature review. Setting: Academic tertiary referral practice. Methods: A case was reported, and the literature was reviewed. Results: A 31-year-old woman presented with an enlarged, diffusely firm, nontender, nonmobile, and not particularly nodular thyroid gland with mild compressive symptoms. She had intermittent skin papules and 1 episode of gingival ulceration. Ultrasound showed diffusely, hypoechoic thyroid with dimensions of 36 x 20 x 16 mm on the right and 36 x 16 x 17 mm on the left. No distinct nodules were noted, and thyroid function test results were normal. Laboratory testing for autoimmune abnormalities of the thyroid was negative for antithyroid peroxidase, antiparietal cell, and anti-smooth muscle cell antibodies. She tested positive for serum antithyroglobulin antibodies. A computed tomographic scan demonstrated abnormal low attenuation of her thyroid gland without any distinct nodules or masses. A fine-needle aspiration and core biopsy confirmed the diagnosis of Langerhans cell histocytosis. Dissection was technically challenging because of the firm and nonmobile lobes. Densely adherent strap musculature was encountered bilaterally, and the rare presence of a nonrecurrent laryngeal nerve was noted on the right. Histologically, thyroid parenchyma was largely obliterated by a diffuse infiltrate of mononuclear spindled to epithelioid histiocytes with few residual thyroid follicles. These histiocytes had moderate to abundant pale to eosinophilic cytoplasm, and some had prominent nuclear grooves and indentation/clefts, consistent with Langerhans histiocytes. Plasma cells and lymphocytes were sparsely dispersed. Immunohistochemistry showed that these histiocytes were positive for S-100, and rare lesional histiocytes were also positive for CD1a. Eosinophils were not readily identified in this lesion. Conclusions: Langerhans cell histiocytosis in the thyroid gland is a rarely reported disease, with controversy over its management. This disease should be considered in the differential diagnosis of a diffusely irregular and firm thyroid gland, and multidisciplinary team cooperation is important for its diagnosis and management. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: The aim of the study was to evaluate the role of combined positron emission tomography/computed tomography (PET/CT) fusion imaging in the detection and management of recurrent papillary thyroid cancer. Study Design: A retrospective analysis of 33 patients with suspected recurrent papillary thyroid carcinoma who had undergone PET/CT was performed. PET/CT was compared with standard imaging techniques in each patient to determine whether PET/CT contributed to the therapeutic management plan. Histopathological findings were correlated to PET/CT in patients who underwent surgery. Methods: The senior author reviewed the charts of 33 patients with recurrent papillary thyroid carcinoma to determine the impact PET/CT had on management. PET/CT was compared with conventional imaging results. In surgical patients, PET/CT was compared with histopathological findings to determine its sensitivity, specificity, accuracy, positive predictive value, and negative predictive value. Results: In 67% of the cases (22 of 33), PET/CT supplied additional information that altered or confirmed the management plan. Twenty of 33 patients underwent surgery with 36 sites assessed by histopathological analysis. PET/CT correlated with histopathological findings in 25 of 36 distinct anatomical sites, with an accuracy of 70%. The sensitivity of PET/CT in identifying recurrence was found to be 66%, with a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 27%. Conclusion: Combined PET/CT fusion scanning was most useful in the detection and management of recurrent papillary thyroid cancer in patients who had average thyroglobulin levels greater than 10 ng/mL and when the tumor no longer concentrated radioactive iodine. In 100% of the cases in which PET/CT localized a region suspicious for malignancy, histopathological analysis confirmed the results. When PET/CT is positive, it is a powerful tool for predicting exact locations of recurrent papillary thyroid cancer, thus making it a reliable guide for surgical planning. PET/CT is a supplement to conventional imaging and fine-needle aspiration in the workup of recurrent papillary thyroid cancer. A negative finding on PET/CT is not sufficiently reliable to preclude further investigation and treatment. [ABSTRACT FROM AUTHOR]