Search

Objective: The dramatic increase in papillary thyroid carcinoma (PTC) is primarily a result of early diagnosis of small cancers. Active surveillance is a promising management strategy for papillary thyroid microcarcinomas (PTMCs). However, as this management strategy gains traction in the U.S., it is imperative that patients and clinicians be properly educated, patients be followed for life, and appropriate tools be identified to implement the strategy., Methods: We review previous active surveillance studies and the parameters used to identify patients who are good candidates for active surveillance. We also review some of the challenges to implementing active surveillance protocols in the U.S. and discuss how these might be addressed., Results: Trials of active surveillance support nonsurgical management as a viable and safe management strategy. However, numerous challenges exist, including the need for adherence to protocols, education of patients and physicians, and awareness of the impact of this strategy on patient psychology and quality of life. The Thyroid Cancer Care Collaborative (TCCC) is a portable record keeping system that can manage a mobile patient population undergoing active surveillance., Conclusion: With proper patient selection, organization, and patient support, active surveillance has the potential to be a long-term management strategy for select patients with PTMC. In order to address the challenges and opportunities for this approach to be successfully implemented in the U.S., it will be necessary to consider psychological and quality of life, cultural differences, and the patient's clinical status.

Background: The purpose of this study was to evaluate electromyography (EMG) amplitude and latency changes during tube dislocation in monitored thyroid surgery, which may be observed without recurrent laryngeal nerve injury., Methods: Duroc-Landrace piglets were intubated with the TriVantage EMG tube. We measured EMG changes during both upward and downward tube dislocation (10-20 mm) and rotation (45-90°) with continuous neuromonitoring., Results: The EMG amplitude varied significantly with induced endotracheal tube rotation and depth changes. However, the EMG latency was relatively unaffected by such tube dislocation, just a transient artifactual latency change was observed in the situation of extreme amplitude variation., Conclusion: Amplitude changes without latency changes may be due to changes in tube position alone during surgery, but could still reflect a neurophysiologic event; amplitude changes during neuropraxic injury merit additional investigation. Thus, the combined event (concordant amplitude decrease and latency increase) serves as an appropriate adverse EMG event correlating with impending neural injury. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1004-E1008, 2016., (© 2015 Wiley Periodicals, Inc.)

Background: The oncologic safety and surgical completeness of remote-access thyroidectomies are not yet clearly established. This study evaluates the oncologic outcomes and surgical completeness of three prevalent remote-access thyroidectomies: the gasless transaxillary approach (GTAA), bilateral axillo-breast approach (BABA), and transoral approach (TOA), in comparison with conventional transcervical thyroidectomy (CTT)., Methods: Literature searches were conducted in PubMed, EMBASE, and the Cochrane Library databases, covering the period from 2000 to 2023. Network meta-analyses were performed on selected studies, focusing on recurrence and surgical completeness. Surgical completeness was assessed using stimulated serum thyroglobulin levels and the count of retrieved lymph nodes., Results: The review included 48 studies, encompassing a total of 16,356 patients. The number of retrieved lymph nodes was comparable among BABA, TOA, and CTT, while GTAA might be less effective. Stimulated serum thyroglobulin levels showed no significant differences across the four groups. However, the proportion of patients with stimulated thyroglobulin levels below 1.0 ng/mL was significantly lower in GTAA compared to the other groups. The overall recurrence rates were 1.31% for CTT, 0.89% for GTAA, 0.62% for BABA, and 0% for TOA, with no significant differences in recurrence rates when adjusted for follow-up duration., Conclusions: This study demonstrated that the oncologic outcomes of GTAA, BABA, and TOA are comparable to those of CTT, based on recurrence rates. In terms of surgical completeness, BABA and TOA showed equivalence to CTT, whereas GTAA might be inferior to the other techniques., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Recently, modified radical neck dissection (MRND) for papillary thyroid carcinoma (PTC) has been performed by the transoral endoscopic approach. 1 However, dissection of level II lymph nodes using only the transoral approach is highly difficult because of the inadequate axis of surgical view. Hence, we decided to combine the transoral and chest approaches to perform MRND. To the best of our knowledge, this is the first video case of MRND using the combined approach., Patient and Methods: A 35-year-old woman was diagnosed with cT1aN1bM0 right PTC (metastatic to right level III lymph nodes). The patient underwent total thyroidectomy, bilateral central neck dissection (CND), and right MRND via a combined endoscopic approach: the transoral and chest approaches. Total thyroidectomy and bilateral central neck dissection were performed via the transoral approach, similar to prior studies. 2-6 The chest approach can help the surgeon to perform level II and the transoral approach was used to dissect the lymph node of levels III and IV., Results: The total time for total thyroidectomy, bilateral CND, and right MRND was 190 min. The time for MRND was 90 min. The number of harvested lymph nodes were 14 in the right lateral compartments, and the number of metastatic lymph nodes were 2 in the lateral compartments. There were no major postoperative complications. The patient was completely satisfied with the cosmetic result., Conclusions: The combined approach of the transoral and chest approaches was sufficient to perform total thyroidectomy and MRND for levels II, III, and IV., (© 2024. Society of Surgical Oncology.)

Minimally invasive thyroidectomy (MIT) is increasingly being used for the thyroid tumors. The comparison of bilateral axillo-breast approach robotic thyroidectomy (BABART) with other MIT has not yet led to a unified conclusion with regard to surgical outcomes. To conduct a systematic review and meta-analysis of the literature on the surgical outcomes of BABART compared with MIT. We performed a systematic search in PubMed, Web of Science, Embase and Cochrane Library database for randomized control trials (RCTs) and non-RCTs that compare BABART to MIT. The primary outcomes included perioperative, postoperative complications. The odds ratio (OR) and mean difference (MD) were applied for the comparison of dichotomous and continuous variables with 95% confidence intervals (CIs). Nine studies, comprising 3645 patients, were included in the meta-analysis. Our findings indicated that there were no significant differences in hospital stay, number of retrieved lymph nodes, recurrent laryngeal nerve (RLN) injury, and vocal cord dysfunction between BABRT and MIT. However, BABART was associated with a shorter operation time (MD =  - 21.45 min, 95% CI [- 47.27, 4.38], p = 0.1) and lower rate of permanent hypoparathyroidism (OR = 0.42, 95% CI [0.20, 0.88], p = 0.02). Additionally, the MIT group had reduced postoperative pain score (MD = 0.45, 95% CI [0.02, 0.88], p = 0.04) and lower rate of hypocalcemia (OR = 2.31, 95% CI [1.04, 5.13], p = 0.04) than the BABART group. In comparison with MIT, BABART exhibits better results in terms of operative time and the rate of permanent hypoparathyroidism, with no significant difference in hospital stay, number of retrieved lymph nodes, RLN injury, and vocal cord dysfunction. However, the postoperative pain score and the rate of hypocalcemia of MIT are slightly better that of BABART., (© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

Background: The extent of postoperative pain following transoral thyroidectomy is not well-understood and remains a subject of debate. This study aims to analyze and compare postoperative pain levels between patients undergoing transoral and conventional transcervical thyroidectomy., Methods: A prospective evaluation on postoperative pain was conducted in 310 patients undergoing conventional thyroidectomy and 194 undergoing transoral thyroidectomy. Pain levels were evaluated using the numerical rating scale (NRS, ranging from 0 to 10) through preoperative and postoperative questionnaires at specified time points: 1, 3, and 6 days, and 1 and 3 months following surgery. Propensity score-matched analysis was carried out based on six covariates: sex, age, body mass index, extent of thyroidectomy, tumor size, and central neck dissection., Results: After propensity score matching based on the six covariates, 121 patient pairs were identified from each group. Within this matched cohort, postoperative pain scores significantly worsened 1 day after surgery but showed progressive recovery up to 3 months post-surgery in both groups. The transoral group exhibited higher postoperative pain scores than the conventional group from day 1 (4.43 ± 2.6 vs. 3.11 ± 2.5, p < 0.001) to day 6 (1.76 ± 1.9 vs. 1.13 ± 1.6, p = 0.016) post-surgery, with no significant difference noted at 1 month. Among transoral procedures, pain scores were significantly higher for the endoscopic approach compared to the robotic approach on days 1 (5.52 ± 2.3 vs. 4.29 ± 2.3, p = 0.028) and 3 (3.52 ± 2.5 vs. 2.64 ± 2.0, p = 0.047) post-surgery., Conclusions: Postoperative pain was significantly higher in transoral thyroidectomy compared to conventional thyroidectomy up to 6 days post-surgery. Within the transoral group, the robotic procedure resulted in lower pain levels than the endoscopic approach during the early postoperative period., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Hypocalcemia following thyroidectomy is a common and potentially life-threatening complication. It is caused by intraoperative injury to the parathyroid glands or their blood supply. Although several studies have shown that patients with a prior history of bariatric surgery may be at an increased risk for hypocalcemia after thyroidectomy, no clear recommendations exist for preventing and managing this condition in this population. This paper highlights the significance of understanding this risk and of obtaining a history of prior bariatric surgery before thyroidectomy. We propose concise recommendations for preventing and managing hypocalcemia following thyroidectomy in patients with a history of bariatric surgery., (© 2023 The Authors. Otolaryngology-Head and Neck Surgery published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology-Head and Neck Surgery Foundation.)

Transoral vestibular robotic thyroidectomy can really make the patient's body surface free of scar. This study aimed to compare the surgical and patient-related outcomes between the transoral vestibular robotic thyroidectomy and traditional low-collar incision thyroidectomy. The clinical data of 120 patients underwent transoral vestibular robotic thyroidectomy (TOVRT) or traditional low-collar incision thyroidectomy (TLCIT) were collected from May 2020 to October 2021. Propensity score matching analysis was used to minimize selection bias. All these patients were diagnosed with papillary thyroid carcinoma (PTC) through ultrasound-guided fine-needle aspiration prior to surgical intervention and surgical plan was tailored for each patient. An intraoperative recurrent laryngeal nerve (RLN) detection system was used in all patients, whose RLNs were identified and protected. We performed transoral vestibular robotic thyroidectomy with three intraoral incisions. Additional right axillary fold incisions were adopted occasionally to enhance fine reverse traction of tissue for radical tumor dissection. Clinical data including gender, age, tumor size, BMI, operation time, postoperative drainage volume and time, pain score, postoperative length of stay (LOS),number of lymph nodes removed, complications, and medical expense were observed and analyzed. Propensity score matching was used for 1:1 matching between the TOVRT group and the TLCIT group. All these patients accepted total thyroidectomy(or lobectomy) plus central lymph node dissection and all suffered from PTC confirmed by postoperative pathology. No conversion to open surgery happened in TOVRT group. The operative time of TOVRT group was longer than that of TLCIT group (P < 0.05). The postoperative drainage volume of TOVRT group was more than that of TLCIT group (P < 0.05). The drainage tube placement time of TOVRT group were longer than that of TLCIT group (P < 0.05). Significant differences were also found in intraoperative bleeding volume, pain score and medical expense between the two groups (P < 0.05). The incidence of perioperative common complications such as hypoparathyroidism and vocal cord paralysis in the two groups was almost identical (P > 0.05). However, there were some specific complications such as surgical area infection (one case), skin burn (one case), oral tear (two cases), and paresthesia of the lower lip and the chin (two cases) were found in TOVRT group. Obviously, the postoperative cosmetic effect of the TOVRT group was better than TLCIT group (P < 0.05). TOVRT is safe and feasible for low to moderate-risk PTC patients and is a potential alternative for patients who require no scar on their neck. Patients accepted TOVRT can get more satisfaction and have less psychologic injury caused by surgery., (© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)

The current approach for patients with differentiated thyroid carcinoma should be individualized according to the risk of recurrence, and this stratification could be used to identify the risk of persistent/recurrent disease in three scenarios: preoperatively, immediately postoperatively, and during long-term follow-up. The initial risk of recurrence will tailor the management of the patient in the preoperative and immediate postoperative settings, while the dynamic risk, which considers the responses to treatment, could guide the decision-making process for remnant ablation and long-term management.This review provides a summary of the existing information regarding the dynamic risk of recurrence and recommended management for patients with differentiated thyroid cancer. The application of this approach is essential to avoid unnecessary treatments for most patients who will have a favorable prognosis. On the other hand, it allows specific therapeutic interventions for those patients at high risk of recurrence. In the future, analysis of tumor biology and prospective studies will surely improve the accuracy of recurrence risk prediction., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

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]

Importance: Evaluation of preoperative and postoperative vocal fold function is important in patients undergoing thyroid or parathyroid surgical procedures. Transcutaneous laryngeal ultrasonography (TLUSG) has been proposed as a promising noninvasive technique and alternative to flexible fiberoptic laryngoscopy., Objective: To determine whether TLUSG can be an alternative to flexible laryngoscopy in evaluating vocal fold function., Design, Setting, and Participants: A prospective study was performed from March 1, 2013, to July 31, 2014. Patients who were scheduled to undergo thyroid or parathyroid surgery by a single surgeon at a North American, university-based tertiary care center and who agreed to undergo preoperative and postoperative TLUSG and flexible fiberoptic laryngoscopy were enrolled. Patients were divided into 2 groups: nonoverweight (body mass index [calculated as weight in kilograms divided by height in meters squared] <25) and overweight or obese (body mass index ≥ 25). Follow-up was completed on February 28, 2015, and data were analyzed from March 1, 2013, to February 28, 2015., Interventions: Preoperative and postoperative TLUSG and flexible fiber optic laryngoscopic assessments of vocal fold function., Main Outcomes and Measures: The findings of TLUSG and flexible fiber optic laryngoscopy were compared for all patients and each body mass index group to assess the accuracy of TLUSG in assessing vocal fold function., Results: A total of 250 patients (500 vocal folds) underwent evaluation, of whom 208 (83.2%) were women and with a mean (SD) age of 52.7 (14.3) years. On flexible fiberoptic laryngoscopy findings, 13 patients had preoperative vocal fold paralysis (VFP), and 14 postoperative new incidents of VFP were identified. Only 7 (53.9%) of the preoperative cases of VFP and 15 (55.6%) of the postoperative cases of VFP were identified by TLUSG. The sensitivity, specificity, and accuracy of preoperative TLUSG were 53.8%, 50.5%, and 50.6%, respectively; for postoperative TLUSG, 55.6%, 38.7%, and 39.6%, respectively. In the nonoverweight group, the preoperative TLUSG sensitivity, specificity, and accuracy were 100%, 70.0%, and 70.5%, respectively; in the overweight-obese group, 45.4%, 43.4%, and 43.5%, respectively (odds ratio, 3.16; 95% CI, 2.06-4.84; P < .001). Postoperative visualization of the vocal folds was more challenging, with a sensitivity, specificity, and accuracy of 83.3%, 55.6%, and 56.8%, respectively, in the nonoverweight group, and 47.6%, 32.6%, and 33.4%, respectively, in the overweight-obese group (odds ratio, 2.62; 95% CI, 1.75-3.94; P < .001)., Conclusions and Relevance: When evaluation of vocal fold function is indicated in patients undergoing thyroid and parathyroid surgery, TLUSG should not be considered as an alternative to the current practice of flexible fiberoptic laryngoscopy. Adequate ultrasonographic visualization of the vocal folds and arytenoids is challenging, especially in overweight and obese patients and in the postoperative setting.

Background: We sought to seek the potential role of endoscopic thyroidectomy with the retroauricular (RA) approach prior to future comparative study with the robotic RA thyroidectomy. Therefore, this study aims to verify the surgical feasibility of endoscopic RA thyroidectomy., Methods: Eighteen patients who underwent endoscopic RA thyroidectomy for clinically suspicious papillary thyroid carcinoma or benign lesions from January to December 2013 were retrospectively reviewed and analyzed., Results: All endoscopic operations via RA or modified facelift approach were successfully performed, without any significant intraoperative complications or conversion to open surgery. Based on patient-reported outcome questionnaires, all patients were satisfied with their postoperative surgical scars., Conclusion: Endoscopic RA thyroidectomy is technically feasible and safe with satisfactory cosmetic results for patients where indicated.

Objectives/hypothesis: The Harmonic Focus (HF) is one of the most popular energy-based devices. The aim of this study was to provide recurrent laryngeal nerve (RLN) functional data that define the safety parameters of the HF during thyroidectomy., Study Design: Prospective porcine model using continuous electrophysiologic monitoring., Methods: Ten piglets were used. At varying distances from the RLN, the HF was activated (activation study). The HF was also applied directly on the RLN after activation on sternocleidomastoid muscle for 10 seconds with different cooling times (cooling study)., Results: In the activation study, there was no adverse electromyography (EMG) event at more than 1 mm distance. In the cooling study, there was no adverse EMG event after a 10-second cooling period. When the HF was cooled on the sternocleidomastoid muscle, there was no adverse EMG event after 2 seconds cooling time., Conclusions: The safe distance of the HF was 1 mm, and it should be cooled for more than 10 seconds or 2 seconds after cooling on muscle. The HF should be used in a standardized manner to avoid RLN injury., Level of Evidence: NA., (© 2015 The American Laryngological, Rhinological and Otological Society, Inc.)

Importance: Commercial molecular testing, such as the gene expression classifier (GEC), is now being used in the work up of cytologically indeterminate thyroid nodules. While this test may be helpful in ruling out malignancy in a thyroid nodule, its effect on surgical decision making has yet to be fully defined., Objective: We aimed to determine the effect and outcome of GEC test results on the decision-making process for patients with thyroid nodules presenting for surgical consultation., Design, Setting, and Participants: A surgical management algorithm was developed that incorporated individual Bethesda System for Reporting Thyroid Cytopathology classifications, in addition to clinical, laboratory, and radiological findings. We then retrospectively applied this algorithm to 273 consecutive patients with thyroid nodules and GEC test results who had presented for surgical consultation between February 1, 2012, and December 31, 2014., Interventions: GEC testing., Main Outcomes and Measures: Changes in management were recorded to identify the effect of GEC testing on the surgical decision-making process. An alteration in management of 20% of cases was considered significant., Results: Of the 273 consecutive patients assessed by the GEC, mean (SD) age was 50.8 (14.7) years, 204 (74.7%) were female, and the mean (SD) nodule size was 2.4 (1.3) cm. Test results were suspicious for 233 (85.3%); benign for 31 (11.4%); and indeterminate for 8 (2.9%). The GEC test was also positive for medullary thyroid cancer for 1 patient (0.4%). The GEC test was correctly used as a rule-out test in only 127 patients (46.5%) with indeterminate nodules who lacked a clinical indication for surgery. The clinical management plan of only 23 (8.4%) patients was altered as a result of GEC test results, and of these 23 patients who proceeded to surgery, 16 patients (72.7%) were found to be inappropriately overtreated relative to postoperative histopathology analysis. We found that GEC testing did not affect the surgical decision-making process in 250 (91.6%) of our patients. In 146 cases, the use of GEC testing was not clinically indicated, and the test was being overused in patients for whom the results would not change surgical management. The positive predictive value of the GEC test for cytologically indeterminate nodules was 42.1%, and the negative predictive value was 83.3%., Conclusions and Relevance: The GEC testing did not significantly affect the surgical decision-making process. Gene expression classifier testing is often used incorrectly and is overused in patients for whom the results would not change management. The GEC test demonstrated a lower than expected negative predictive value, and there was evidence of overtreatment among patients whose treatment was altered based on this test.

Background: The purpose of this study was to evaluate the diagnostic utility of BRAF mutation testing on thyroid nodules "suspicious for papillary thyroid carcinoma" (PTC) cytology., Methods: A chart review of patients with fine-needle aspiration (FNA) results "suspicious for PTC" with subsequent thyroidectomy was performed. Corresponding archived FNA slides underwent BRAF mutation testing., Results: Sixty-six patients with FNA "suspicious for PTC" underwent thyroidectomy. Forty-two (63.6%) had PTC diagnosed on final histopathology, whereas 21 (31.8%) had benign findings. Thirty-five patients (83%) with histologically proven PTC underwent total thyroidectomy, whereas 7 (17%) underwent hemithyroidectomy. BRAF mutation was detected in 17 of 49 samples (34.6%) available for testing and had 45.5% sensitivity, 87.5% specificity, 88.2% positive predictive value (PPV), and 43.8% negative predictive value (NPV) for diagnosing PTC. Two of 4 patients (50%) who underwent hemithyroidectomy with subsequent completion thyroidectomy had mutated BRAF detected., Conclusion: BRAF testing is a useful adjunct to improve PPV for patients with "suspicious for PTC" cytology., (© 2014 Wiley Periodicals, Inc.)

Objectives/hypothesis: We aimed to assess voice outcomes following reoperative central neck dissection (RCND) to characterize postoperative voice difficulties experienced, determine the natural progression of vocal recovery, and identify risk factors for the development of voice disorders postoperatively., Study Design: Prospective cohort study., Methods: Consecutive patients with recurrent/persistent thyroid cancer who were deemed appropriate candidates for RCND were eligible for participation in this study. A battery of voice evaluation measures was administered both preoperatively and 2 to 4 weeks postoperatively., Results: Twenty consecutive patients were included. Postoperatively, six (30%) new incidents of vocal fold motion impairment (VFMI) were identified, with two (10%) being due to intentional recurrent laryngeal nerve (RLN) transection. On 1-year follow-up, two patients had full restoration of vocal fold mobility and four had persistent VFMI. No preoperative voice/laryngeal exam factors were predictive of postoperative VFMI. Clinically relevant change in postoperative Voice Handicap Index score was absent in all patients without VFMI and present in five of six patients with VFMI (P=.0004). Patients with VFMI had significantly poorer overall dysphonia grade, less glottic closure, and elevated jitter in contrast to those individuals without VFMI. Patients with malignant tissue in the remnant thyroid were four times more likely to develop VFMI than those with central neck lymph node metastases alone (P=.06)., Conclusion: Patients undergoing RCND are at risk for postoperative VFMI, even when the RLN is anatomically preserved, with subsequent impact on quality of life. Presence of malignant disease in the remnant thyroid appears to be the best predictor for postoperative VFMI., Level of Evidence: 2b., (© 2015 The American Laryngological, Rhinological and Otological Society, Inc.)

Traditionally, bilateral cervical exploration for localization of all four parathyroid glands and removal of any that are grossly enlarged has been the standard surgical treatment for primary hyperparathyroidism (PHPT). With the advances in preoperative localization studies and greater public demand for less invasive procedures, novel targeted, minimally invasive techniques to the parathyroid glands have been described and practiced over the past 2 decades. Minimally invasive parathyroidectomy (MIP) can be done either through the standard Kocher incision, a smaller midline incision, with video assistance (purely endoscopic and video-assisted techniques), or through an ectopically placed, extracervical, incision. In current practice, once PHPT is diagnosed, preoperative evaluation using high-resolution radiographic imaging to localize the offending parathyroid gland is essential if MIP is to be considered. The imaging study results suggest where the surgeon should begin the focused procedure and serve as a road map to allow tailoring of an efficient, imaging-guided dissection while eliminating the unnecessary dissection of multiple glands or a bilateral exploration. Intraoperative parathyroid hormone (IOPTH) levels may be measured during the procedure, or a gamma probe used during radioguided parathyroidectomy, to ascertain that the correct gland has been excised and that no other hyperfunctional tissue is present. MIP has many advantages over the traditional bilateral, four-gland exploration. MIP can be performed using local anesthesia, requires less operative time, results in fewer complications, and offers an improved cosmetic result and greater patient satisfaction. Additional advantages of MIP are earlier hospital discharge and decreased overall associated costs. This article aims to address the considerations for accomplishing MIP, including the role of preoperative imaging studies, intraoperative adjuncts, and surgical techniques.

Objectives/hypothesis: Thermal injury to the recurrent laryngeal nerve (RLN) may not be visually apparent and may go unrecognized intraoperatively. This study aimed to investigate the heat thermal tolerance of RLN and evaluate the electrophysiologic correlates of electromyographic (EMG) signal change during an acute RLN heat damage., Study Design: Prospective porcine model with continuous intraoperative neuromonitoring (CIONM)., Methods: Ten pigs (20 RLNs) undergoing CIONM had their EMG tracings recorded and correlated with heated normal saline (NS) irrigation of varying temperature and duration., Results: In the initial pilot study, the EMG was without change during incremental heated NS irrigation (40/45/50/55 °C for 60 seconds), but adverse EMG combined events (CE) (amplitude decrease with a concordant latency increase) occurred and degraded to loss of signal (LOS) (by 17.5 ± 1.3 seconds) when the temperature was elevated to 60 °C (n = 4). Another 16 RLNs were evaluated to further compare the EMG pattern after various degrees of thermal stress (60/70 °C for 30/20 seconds). Electromyographic recordings showed CEs and LOS in all RLNs, and only six of eight RLNs with 60 °C exposure showed slight EMG amplitude recovery (16%-35%) after 20 minutes. None of the injured nerve segments were visually apparent, but all were detectable by IONM., Conclusion: Sixty degrees Celsius is a critical temperature to cause RLN thermal injury. Continuous intraoperative neuromonitoring can be used as a tool for the early detection of acute thermal stress and may guide use of energy-based devices during thyroid procedures., Level of Evidence: N/A., (© 2015 The American Laryngological, Rhinological and Otological Society, Inc.)

Background: Recent advances in research on thyroid carcinogenesis have yielded applications of diagnostic molecular biomarkers and profiling panels in the management of thyroid nodules. The specific utility of these novel, clinically available molecular tests is becoming widely appreciated, especially in perioperative decision making by the surgeon regarding the need for surgery and the extent of initial resection., Methods: A task force was convened by the Surgical Affairs Committee of the American Thyroid Association and was charged with writing this article., Results/conclusions: This review covers the clinical scenarios by cytologic category for which the thyroid surgeon may find molecular profiling results useful, particularly for cases with indeterminate fine-needle aspiration cytology. Distinct strengths of each ancillary test are highlighted to convey the current status of this evolving field, which has already demonstrated the potential to streamline decision making and reduce unnecessary surgery, with the accompanying benefits. However, the performance of any diagnostic test, that is, its positive predictive value and negative predictive value, are exquisitely influenced by the prevalence of cancer in that cytologic category, which is known to vary widely at different medical centers. Thus, it is crucial for the clinician to know the prevalence of malignancy within each indeterminate cytologic category, at one's own institution. Without this information, the performance of the diagnostic tests discussed below may vary substantially.

To explore the potential of tumor-specific DNA as a biomarker for head and neck squamous cell carcinomas (HNSCC), we queried DNA from saliva or plasma of 93 HNSCC patients. We searched for somatic mutations or human papillomavirus genes, collectively referred to as tumor DNA. When both plasma and saliva were tested, tumor DNA was detected in 96% of 47 patients. The fractions of patients with detectable tumor DNA in early- and late-stage disease were 100% (n = 10) and 95% (n = 37), respectively. When segregated by site, tumor DNA was detected in 100% (n = 15), 91% (n = 22), 100% (n = 7), and 100% (n = 3) of patients with tumors of the oral cavity, oropharynx, larynx, and hypopharynx, respectively. In saliva, tumor DNA was found in 100% of patients with oral cavity cancers and in 47 to 70% of patients with cancers of the other sites. In plasma, tumor DNA was found in 80% of patients with oral cavity cancers, and in 86 to 100% of patients with cancers of the other sites. Thus, saliva is preferentially enriched for tumor DNA from the oral cavity, whereas plasma is preferentially enriched for tumor DNA from the other sites. Tumor DNA in saliva was found postsurgically in three patients before clinical diagnosis of recurrence, but in none of the five patients without recurrence. Tumor DNA in the saliva and plasma appears to be a potentially valuable biomarker for detection of HNSCC., (Copyright © 2015, American Association for the Advancement of Science.)

The worldwide incidence of thyroid cancer is increasing substantially, almost exclusively attributable to small papillary thyroid cancers. Increased use of diagnostic imaging is considered the most likely explanation for this reported rise, but other factors may also be contributing. The increase in health care expenditures related to managing these presumably low-risk cancers, without a clear patient benefit, has resulted in a backlash against the early detection of thyroid cancer. Currently, there is no way to confidently predict which incidentally detected thyroid nodule may be the precursor to a more aggressive process. Predictions such as these would require more accurate characterization of the biology of individual thyroid cancers than is currently possible. With time, we might prove our ability to confidently differentiate low-risk from high-risk thyroid cancers, but until that happens, routine screening for thyroid cancer by imaging billed as a "health checkup" should not be performed. However, incidentally detected thyroid nodules should be reported, and a clear medical team management plan should be developed. Our ethical responsibility is to provide patients with objective, evidence-based information about their disease status, not to assume that we know what is best for them by selectively withholding information. In addition, providing patients with psychosocial assistance will help them process the information necessary to make informed decisions that will provide them with the most value when a small thyroid nodule or cancer is incidentally identified. Herein, we summarize the epidemiological data for disease incidence, discuss some controversies in disease management, and outline the key elements and ethical considerations of informed decision making as they apply to managing incidentally detected thyroid nodules and thyroid cancer.

Background: The transoral endoscopic vestibular approach (TOETVA) for thyroidectomy is gaining popularity (Russell et al. in Thyroid 28(7):825–829, 2018; Le et al. in Surg Laparosc Endosc Percutan Tech 30(3):209–213, 2020; Liao et al. in Laryngoscope 130(6):1603–1608, 2020). TOETVA has been utilized successfully in performing thyroidectomy, parathyroidectomy, and neck dissection, via both endoscopic and robotic techniques (Razavi et al. in Head Neck 40(10):2246–2253, 2018; Otolaryngol Head Neck Surg 159(4):625–629, 2018; Ngo et al. in J ENT, 2020. https://doi.org/10.1177/0145561320943358; Ann Surg Oncol 28(5):2766, 2021). In this video, we show bilateral central neck dissection via transoral approach in papillary thyroid carcinoma. Patient and Methods: A 37-year-old female with no significant medical history was diagnosed pT3bN0M0 intraoperatively with the tumor having slightly invaded the strap muscle. Thus, we decided to perform total thyroidectomy with bilateral central neck dissection via transoral approach. Methods: Prelaryngeal dissection: in the prelaryngeal compartment, soft tissue containing these lymph nodes was intimately associated with the pyramidal lobe. Right paratracheal dissection: fibrofatty tissue was dissected off the prevertebral fascia and the trachea with preservation of right parathyroid glands. Pretracheal lymph nodes were removed with paratracheal dissection. Left paratracheal dissection: the lymphatic tissue was then dissected off the prevertebral and esophageal musculature and the trachea after identifying the left parathyroid glands. Finally, bilateral central neck dissection was finished with preservation of the nerve and parathyroid glands. Results: The operation was completed successfully without conversion to open surgery. The operative time for central neck dissection was 20 min. There were nine harvested lymph nodes in the central compartments, while there were two metastatic lymph nodes of papillary thyroid carcinoma with 3 × 3 mm maximal dimension. There were no major postoperative complications. Conclusion: Central neck dissection via TOETVA is a safe and feasible method in selected patients. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the efficacy and safety of thermal ablation in the treatment of patients with Bethesda IV thyroid nodules (follicular neoplasms) by analyzing large-scale data on various outcomes. Materials and methods: Literature searches were conducted in PUBMED, EMBASE, Web of Science, and the Cochrane Library for studies on the use of thermal ablation in patients with Bethesda IV thyroid nodules published from March 1, 2014, to March 1, 2024. Data on volume change at 12 months; the volume reduction rate (VRR) at 1, 3, 6, and 12 months; the complete disappearance rate (CDR); and the complication rate were evaluated. All the data were analyzed with STATA 15. Results: Five eligible studies were included. The findings indicate that thermal ablation is both effective and safe. The mean change in tumor volume at 12 months postthermal ablation was characterized by a standardized mean difference (SMD) of -1.13 (95% CI: -1.36 - -0.90, p = 0.000). Specifically, the mean changes in tumor volume at 12 months after radiofrequency ablation (RFA) and microwave ablation (MWA) were − 1.19 (95% CI: -1.75 - -0.64) and − 1.26 (95% CI: -1.71 - -0.81), respectively. The VRRs at 1, 3, 6, and 12 months postthermal ablation were 43% (95% CI: 33 − 53%), 47% (95% CI: 20 − 74%), 69% (95% CI: 62 − 76%), and 85% (95% CI: 79 − 90%), respectively. The VRRs at 12 months after RFA and MWA were 84% (95% CI: 76 − 91%) and 85% (95% CI: 75 − 95%), respectively. The VRR at 12 months, stratified by initial nodule size, was 84% (95% CI: 77 − 91%) and 86% (95% CI: 78 − 94%). The CDR at the final follow-up was 88% (95% CI: 80 − 95%). The complication rate was 4.0% (95% CI: 0.0 − 8.0%), with pain and hoarseness being the most frequently reported complications; no life-threatening complications were documented. Conclusions: Thermal ablation is a reliable treatment for Bethesda IV thyroid nodules, and RFA and MWA are advantageous treatment strategies. However, more prospective, multicenter, and large-sample studies are needed in the future. [ABSTRACT FROM AUTHOR]

ABSTRACT: Objective: The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a minimally invasive technique. This study aimed to compare the safety of TOETVA with fibrin sealant (Tisseel) and TOETVA with drainage. Materials and Methods: Patients who underwent TOETVA between January 2018 and December 2021 were divided into drainage (n = 20) and Tisseel (n = 30) groups. Results: The primary outcome was the incidence of complications. The secondary outcomes were operative time and postoperative pain. There were no significant differences in patient demographics, tumor size, intraoperative blood loss, and hospitalization days between the two groups. No patient required conversion to open thyroidectomy. The incidence of complications and postoperative pain was similar in the two groups. The operative time for TOETVA with Tisseel was significantly shorter than for TOETVA with drainage (P = 0.038). Conclusion: TOETVA with Tisseel is a safe alternative to TOETVA with drainage, having a short operative time. [ABSTRACT FROM AUTHOR]

This study aimed to determine whether lobectomy is appropriate for the long-term prognosis of 1–4-cm-sized differential thyroid cancer (DTC). This retrospective study included 2,178 patients with 1–4-cm DTC treated via thyroid lobectomy (LT) or total or near-total thyroidectomy (TT) and who were followed up for at least 3 years. The primary endpoint was a structural incomplete response, which was confirmed via imaging with or without a positive histological or cytological examination. Subgroup analysis was performed according to tumor size. LT was performed in 1,535 patients (70.48%), and TT was conducted in the remaining 643 (29.55%) patients. During an average follow-up period of 48.08 months, the recurrence rate was 7.2% in the LT group and 5.3% in the TT group, which was not significantly different (p = 0.108). There were no significant differences in disease-free survival between both groups (hazard ratio, 1.394; 95% confidence interval, 0.9761–1.990; p = 0.089). In the subgroup analysis, the recurrence rates in the LT group were higher than those in the TT group for both the 2–3-cm (13.6% vs. 2.6%, p < 0.01) and 3–4-cm categories (20.6% vs. 4.8%, p < 0.01). For 1–2-cm DTC, surgeons can choose LT or TT owing to their similar recurrence rate, whereas for 2–4-cm DTC, TT is preferred. [ABSTRACT FROM AUTHOR]

Since its introduction, robotic surgery has experienced rapid development and has been extensively implemented across various medical disciplines. It is crucial to comprehend the advancements in research and the evolutionary trajectory of its thematic priorities. This research conducted a bibliometric analysis on the literature pertaining to robotic surgery, spanning the period from 2014 to 2023, sourced from the Web of Science database. The objective was to delineate the publication trends and trace the development of research topics within the domain of robotic surgery. From 2014 to 2023, there has been a consistent upward trend in the annual volume of publications concerning robotic surgery. The United States emerges as the leading country in terms of both the number of publications (n=3402) and citations (n=57731). The Journal of Robotic Surgery has the highest number of publications (n=506), while IEEE Transactions on Robotics has the highest number of citations (n=53). Yonsei University is the institution with the greatest number of publications (n=196), and the University of Washington has the highest average citation count (n=30). Alexandre Mottrie is the author with the most publications and citations (n=70 publications, n=1816 citations). Keyword analysis revealed seven distinct clusters: (1) applications and techniques of robotic surgery; (2) urological surgery and associated complications; (3) gastrointestinal diseases and surgical interventions; (4) robotic thyroid surgery and related complications; (5) gynecological diseases and corresponding surgical procedures; (6) Da Vinci robot and its training; (7) pulmonary diseases and associated surgeries. Artificial intelligence (AI) has been identified as a newly emerging keyword in the field. The corpus of literature on robotic surgery has seen a steady rise over the past decade, marked by extensive collaboration among various countries, institutions, and researchers. This study has delineated the global trends, identified research hotspots, highlighted emerging topics, and outlined the foundational knowledge within the field of robotic surgery. Looking forward, the integration of AI with robotic surgery is poised to offer substantial benefits and is anticipated to become a pivotal trend and area of focus in the field's future advancement. [ABSTRACT FROM AUTHOR]

Background: Surgery is the preferred treatment for primary hyperparathyroidism. Minimally invasive parathyroidectomy is only feasible with accurate preoperative localisation. Virtual 3D anatomical models can be constructed from patient-specific CT scans using segmentation software. Methods: We aimed to create virtual 3D models from 4D-CT scans of parathyroid tumours using segmentation technology. We designed a small pilot study to assess the utility of 3D models within surgical practice. We assessed surgeon, trainee and patients' opinion and satisfaction with the models. The NASA TLX survey was the primary data collection tool Results: Creation of novel 3D models was achieved, these featured a 360-degree axis of rotation and transparency mode to assist in surgical planning. Models were used intraoperatively with the HoloLens 2 headset to locate parathyroid tumours real time before surgery. Total mean workloads for surgery planning when averaged revealed a decrease workload (39.45 vs 27.45) points with adjunctive use of models (p=0.002). Mental demand showed the greatest decrease in mean workload out of all the 6 subscales tested for in the NASA TLX (210.3 vs 136.7) points. Patient satisfaction score was statistically significant for the difference before and after seeing the 3D model regarding anatomical location (p=≤0.001), Conclusion: In this work, we developed patient-specific virtual 3D anatomical models of parathyroid tumours for use in surgery using novel techniques, previously never applied to parathyroidectomy. Our initial success in model construction and subsequent opinion of surgeons, trainees and patients contributes to the developing body of literature in favour of virtual modelling for parathyroidectomy. [ABSTRACT FROM AUTHOR]

Importance: With advancements in robotic surgery, robotic-assisted thyroidectomy is gaining popularity. The introduction of the 3-port transoral robotic thyroidectomy (T-TORT) offers an alternative approach with potential benefits in postoperative recovery compared to traditional methods. Objective: To assess the safety and feasibility of T-TORT in comparison to the transoral endoscopic thyroidectomy vestibular approach (TOETVA). Design: A retrospective cohort study with 1:1 propensity score matching was conducted to compare perioperative outcomes between T-TORT and TOETVA. The learning curve was analyzed using cumulative summation (CUSUM). Setting: Tertiary A hospital. Participants: One hundred sixty-two patients who underwent either T-TORT or TOETVA were included. Intervention or Exposures: The T-TORT group underwent three-port robotic thyroidectomy, while the TOETVA group received standard transoral vestibular endoscopic thyroidectomy. Main Outcomes and Measures: Demographics and perioperative data were compared. The learning curve was evaluated using CUSUM. Results: Compared with the TOETVA group the operation time in minutes of the T-TORT group was relatively longer (136.14 ± 36.52 vs 122.49 ± 34.85, P =.012), the postoperative stay, in days, was shorter (2.77 ± 0.78 vs 3.51 ± 0.95, P <.001), the drainage volume on a postoperative day 1 (POD1) and POD2, in milliliter, was less (POD1 56.57 ± 23.29 vs 65.12 ± 26.04, P =.029 and POD2 27.43 ± 25.29 vs 38.21 ± 25.09, P =.008). The other statistics, including bleeding amount, retrieved and metastatic central lymph nodes, visual analog scale score, and drainage volume on an operative day were comparable between the 2 groups. Meanwhile, there were no significant differences between the 2 groups in postoperative complication rates. The turning point of the learning curve was in the 16th case with a hemithyroidectomy with central neck dissection (CND) and the 21st case with a bilateral thyroidectomy with CND. Conclusions and Relevance: T-TORT is a safe and feasible option with enhanced postoperative recovery compared to TOETVA. It may be a preferable choice in specific clinical situations. Trial Registration: This study was registered at the Chinese Clinical Trial Registry (UIN: ChiCTR2300069021, https://www.chictr.org.cn) in accordance with the World Medical Association's Declaration of Helsinki, 2013. [ABSTRACT FROM AUTHOR]

Background: A warning system to avoid potential nerve root thermal injury caused by automatic spine robot is essential. However, there is a lack of basic research to support the development of such warning system. The aims of this study are to confirm the feasibility of continuous intraoperative neuromonitoring (CIONM) in spinal nerve root monitoring and study the exposure time of spinal nerve root thermal injury at different temperature in a porcine model. Methods: The experiment was carried out on 32 nerve roots of 4 pigs (bilateral L4-S1 nerve roots). Sham group (CIONM only), control group (Room temperature stimulation with CIONM), and 40 °C, 45 °C, 50 °C, 55 °C, 60 °C, 65 °C temperature stimulation groups were conducted at random in each pig. The change of EMG was recorded continuously. The exposure time of nerve root injury at different temperatures was recorded. Histological analysis of the nerve roots was performed to confirm the injury. Results: The EMG of the sham, control, 40 °C and 45 °C groups were stable during the experiment, and no significant nerve root injury was observed on histological analysis. The time of 50% EMG amplitude decrease in 50℃, 55℃, 60℃ and 65℃ groups were 277.5 ± 18.2, 59.5 ± 6.2, 20.8 ± 1.0 and 16.5 ± 1.3 s, respectively. And the nerve specimens of these groups showed varying degrees of damage. Conclusions: CIONM can be used for continuous monitoring of spinal nerve roots. For 5 min, 40℃ and 45℃ did not cause significant nerve root injury. However, when the temperature reached 50℃ and above, nerve roots appeared injury. [ABSTRACT FROM AUTHOR]

Background: In thyroid-associated ophthalmopathy (TAO), orbital decompression is a critical surgical approach for functional and aesthetic reasons. Meanwhile, the presence of surgical complications, especially the new onset of primary gaze diplopia, also influences postoperative patient satisfaction. This research investigates the effectiveness and potential risks associated with different orbital decompression in patients with TAO. Methods: Systematic searches were conducted to identify pertinent studies from PubMed, Embase, and the Cochrane Library databases. The search was completed on October 11, 2023. And after retrieval, the publication dates of the articles included in the analysis ranged from January 1, 2008, to February 22, 2023. The overall postoperative outcomes were determined using random-effects meta-analyses with corresponding 95% confidence intervals (CI). A network meta-analysis was performed to integrate both direct and indirect evidence. The primary outcomes were defined as the status of exophthalmos and the new onset of primary gaze diplopia. Results: From 1,538 identified records, 87 studies were selected, encompassing 5102 patients and 8,779 procedures. The studies reported varying degrees of exophthalmos reduction based on different surgical techniques: -3.46 mm (95% CI -3.76 to -3.15 mm) for fat removal orbital decompression, -4.02 mm (95% CI -5.14 to -2.89 mm) for the medial wall technique, -3.89 mm (95% CI -4.22 to -3.55 mm) for the lateral wall technique, -5.23 mm (95% CI -5.69 to -4.77 mm) for the balanced wall technique, -3.91 mm (95% CI -4.37 to -3.46 mm) for the infero-medial wall technique, and − 5.80 mm (95% CI -6.47 to -5.13 mm) for the three-wall technique. The incidence of new-onset primary gaze diplopia was reported in 31 studies involving 214 out of 2001 patients, resulting in a weighted proportion of 0.11 (95% CI 0.06–0.14). Notably, the lowest rates were associated with the lateral approach and fat removal orbital decompression, with pooled proportion (95% CI) rates of 3% (1–6) and 3% (2–4), respectively, suggesting that these two techniques may be more effective in preventing the occurrence of this complication during the postoperative period. Conclusions: This meta-analysis establishes that orbital decompression is a beneficial and safe surgical approach. While this study enhances the evidence hierarchy for orbital decompression in treating TAO, it requires further validation through larger, prospective, and randomized studies with long-term follow-up periods. [ABSTRACT FROM AUTHOR]

Background: Injury to the recurrent laryngeal nerve (RLN) and parathyroid glands (PGs) are the most common and serious complications during the transoral endoscopic thyroidectomy vestibular approach (TOETVA), and their exposure and protection are the most important factors affecting the operation time. Here, we report a novel anatomical landmark and surgical method to shorten the operative time and reduce the chance of injury to the RLN and PGs. Methods: According to the different exposure methods of the RLN, patients were divided into the experimental group (from top to bottom, E-group) and the comparison group (from outside to inside, C-group), and 1:1 propensity score-matching (PSM) was performed. The demographics, operative data, postoperative data, and postoperative complications were analyzed by comparing the 2 groups. Results: After PSM, a total of 206 patients were included. Except for tumor size, there were no significant differences between the 2 groups in terms of sex, age, body mass index, presence of Hashimoto's thyroiditis, or extent of surgery. Compared with the C-group, the operative time, in minutes, of the E-group was significantly shorter (hemithyroidectomy with central neck dissection (CND), C = 111.81 ± 25.83 vs E = 100.52 ± 16.47, P =.002 and bilateral thyroidectomy with CND, C = 177.87 ± 36.61 vs E = 156.05 ± 25.60, P =.004), the exposure time, in minutes, of the RLN was reduced (hemithyroidectomy with CND, C = 23.31 ± 7.07 vs E = 11.41 ± 2.75, P <.001 and bilateral thyroidectomy with CND, C = 45.64 ± 14.84 vs E = 21.76 ± 5.57, P <.001). The rate of postoperative temporary PGs and RLN injuries were also reduced (transient hypoparathyroidism, C = 13% vs E = 4%, P =.023 and transient RLN palsy, C = 10% vs E = 2%, P =.017). In addition, the remaining parameters such as the amount of bleeding, number of lymph node metastases, postoperative hospital stay, visual analog scale pain score, recurrence rate, and other complication rates were not significantly different between the 2 groups. Conclusion: It is safe and feasible to construct Thyroid-RLN Entry Triangle (Peng's Triangle) for PGs and RLN protection in TOETVA. It is beneficial to shorten the operation time and reduce postoperative complications, both worthy of clinical promotion. Trial Registration: This study was registered at the Chinese Clinical Trial Registry (UIN: ChiCTR2300067673, https://www.chictr.org.cn) in accordance with the World Medical Association's Declaration of Helsinki, 2013. [ABSTRACT FROM AUTHOR]

Objective: The main objective was to assess the therapeutic efficacy of selenium alone versus a combination of myo-inositol and selenium (MI + Se) in treating patients with autoimmune thyroiditis (AIT). The study aims to determine which treatment option is more effective in restoring euthyroid state, as indicated by changes in thyroid-stimulating hormone (TSH), T3, T4, thyroid peroxidase antibodies (TPOAb), and thyroglobulin antibodies (TgAb) Methods: Google Scholar and PubMed databases were searched for randomized controlled trials (RCTs) and observational studies that reported outcomes of combined treatment (MI + Se) in restoring a euthyroid state, specifically comparing it with selenium-only (Se-only) treatment. Changes in TSH, T3, T4, TPOAb, and TgAb levels from baseline were defined as indicators to compare the effect of combined versus selenium-only treatment in restoring euthyroid levels. The Cochrane risk of bias tool and Newcastle Ottawa Scale were used to assess the quality of the randomized control trials included in the study. Review Manager (version 5.4, Nordic Cochrane Centre, Copenhagen, Denmark) was used for statistical analysis. Result: We pooled three studies, enrolling 151 participants in the MI + Se group and 137 participants in the Se group. Supplementation of Se with MI demonstrated a significant reduction in TSH levels compared to Se alone (SMD = −1.15, 95% CI: −1.60 to −0.69, P <.00001). MI + Se treatment also significantly reduced TgAb levels compared to Se (SMD = −0.51, 95% CI: −0.78 to −0.24, P =.0002). In contrast, TPOAB, T3 and T4 levels were non-significantly reduced from baseline in patients treated with MI + Se when compared to Se alone (SMD = −0.81, 95% CI: −0.44 to 0.09, P =.20), (SMD = 0.16, 95% CI: −0.09 to 0.42, P =.22), and (SMD = 0.30, 95% CI: −0.23 to 0.83, P =.26) respectively. Conclusion: Supplementation of Se with MI showed a significant reduction in TSH and TgAb levels compared to selenium-only treatment, with a non-significant reduction in TPOAB, T3, and T4 levels. This entails the need for powered clinical trials and observational studies with longer follow-ups to critically assess the role of combined therapy in restoring euthyroid state in patients with AIT. Plain Language Summary: Summary of Role of Supplementation with Selenium and Myo-inositol vs. Selenium alone in patients of Autoimmune Thyroiditis The study aimed to determine whether taking the supplementation therapy of myo-inositol and selenium (MI+Se) together is more effective than taking selenium alone for people suffering from autoimmune thyroiditis, a condition in which the immune system attacks the thyroid gland and often leads to hypothyroidism. Researchers reviewed relevant studies from Google Scholar and PubMed, focusing on randomized control trials (RCTs) and observational studies that compared the effects of selenium alone versus selenium plus myo-inositol. They analyzed changes in thyroid-related blood markers TSH, T3, T4, TPOAb, and TgAb levels) to assess effectiveness of the given therapy. The study included three RCTs with 288 participants that were assessed through the supplementation therapy of selenium alone and myo-inositol plus selenium (MI+Se). Findings suggest that the combination of selenium and myo-inositol significantly reduced TSH levels, which indicates thyroid activity and improvement in the condition, more than selenium alone. It also lowered TgAb levels, antibodies that attack the thyroid, more effectively than selenium alone. However, the two groups had no significant changes in other markers like TPOAb, T3, and T4. The results suggest that the combination treatment might be more effective in reducing harmful antibodies and improving thyroid function compared to selenium alone. This finding is particularly relevant for managing AIT and improving thyroid health, pointing to potentially better treatment strategies. Nevertheless, the study emphasizes the need for more extensive and longer-term research to confirm these benefits and fully understand the implications. This research highlights the promise of combining supplementation with selenium and myo-inositol as a more effective approach for people with autoimmune thyroiditis (AIT). This could lead to improved management and outcomes for this common thyroid condition. [ABSTRACT FROM AUTHOR]

Background: This study aimed to identify potential predictors and construct a predictive model for the quality of life (QoL) in patients with laryngeal carcinoma (LC) using the revised core nursing outcomes. Methods: We recruited 331 LC patients underwent laryngectomy between March 2018 and March 2022 from three hospitals. The revised core nursing outcomes contained 14 items in the "Physiologic Health," "Psychosocial Health," "Health Knowledge & Behavior," and "Perceived Health", while the QoL was assessed using the Chinese version of the Functional Assessment of Cancer Therapy-Head and Neck. Potential predictors of QoL were explored using logistic regression analysis, and odds ratio (OR) with 95% confidence interval (CI) was applied as effect estimates. A prediction model was constructed to predict QoL using the receiver operating characteristic (ROC) curve, and the predictive value was assessed using the area under the ROC curve (AUC). Results: Of the 331 included patients, 137 had a poor QoL. After adjusting for potential confounding factors, we noted female sex (OR: 10.91; 95%CI: 1.24–96.14; P = 0.031), and alcohol consumption (OR: 4.55; 95%CI: 1.32–14.29; P = 0.017) were associated with an elevated incidence of poor QoL, while age 50.0–65.0 years (OR: 0.02; 95%CI: 0.00-0.15; P < 0.001), junior high school as the highest level of schooling (OR: 0.10; 95%CI: 0.03–0.33; P < 0.001), living in cities and towns (OR: 0.07; 95%CI: 0.02–0.37; P = 0.002), and partial laryngectomy (OR: 0.10; 95%CI: 0.03–0.41; P = 0.001) were associated with a lower incidence of poor QoL. Moreover, Physiologic Health score (OR: 1.16; 95%CI: 1.06–1.27; P = 0.001), Psychosocial Health score (OR: 0.48; 95%CI: 0.39–0.58; P < 0.001), Health Knowledge & Behavior score (OR: 0.92; 95%CI: 0.86–0.97; P = 0.006), and Perceived Health score (OR: 0.36; 95%CI: 0.25–0.52; P < 0.001) were associated with the incidence of QoL in LC patients. The constructed prediction model based on these factors had an AUC for predicting QoL of 0.96 (95% CI: 0.94–0.98). Conclusions: This study found age, sex, educational status, residential location, alcohol consumption, surgical approach, and the revised core nursing outcomes are significantly associated with QoL in LC patients. The predictive value of the constructed model was high, which suggesting the clinical nurses should pay attention to the evaluation of postoperative care outcomes in order to enhance QoL. [ABSTRACT FROM AUTHOR]

Revision thyroid surgery for residual/recurrent disease is known to have higher complication rates because of parathyroid injury and recurrent laryngeal nerve (RLN) damage. The aim of this study is to evaluate the accuracy of USG in predicting recurrent disease and disease outcomes in patients undergoing reoperation for recurrent/residual thyroid cancer. We performed a retrospective analysis of all thyroid reoperations from 2015 to 2017. Preoperative USG findings were categorized as per prespecified disease stations in the neck and compared with histopathology to calculate sensitivity, specificity, positive predictive value, and negative predictive value of USG. Survival analysis was performed using Kaplan–Meier curves. Two hundred fifty patients were included in the analysis. In a reoperative setting, USG had an overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 89%, 77%, 89%, 94%, and 60%, respectively. We found a significantly lower disease-free survival in patients who had radiologically detected recurrent disease as compared to disease detected only on histopathology. USG has a reasonable accuracy in determining status of lesions in patients undergoing revision thyroid surgeries. [ABSTRACT FROM AUTHOR]