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Post-thyroidectomy bleeding is rare but potentially life-threatening complication. The incidence of post thyroidectomy bleeding ranges from 0.43 to 4.2%. Despite developments in surgical techniques, postoperative bleeding is still the most serious complication in thyroid surgery because it represents an emergency condition, in most cases. A number of different risk factors have been reported in studies evaluating the occurrence of postoperative hematoma. Risk factors range from those related to patients' demographics, thyroid pathology, extent of resection, previous thyroid surgery, to those related to the presence of co-morbidities, or use of anticoagulant or antiplatelet medications. Postoperative hemorrhage is a rare event, therefore studying the risk factors associated with this complication is challenging. Risk factors for hematomas are still largely debatable considering that most of the studies were conducted in single centers. Early recognition and emergency intervention are essential in managing post-thyroidectomy hemorrhage. Therefore, it is especially important to identify risk factors, as well as the time frame for the occurrence of this complication.

Pheochromocytoma is a tumor that arises from adrenal medulla and it is characterized by increased secretion of catecholamines. The incidence of pheochromocytoma is 3 to 8 cases per million inhabitants, of which about 10 to 20% of diagnosed pheochromocytomas occurs in the pediatric population, with a higher frequency in boys. In 1.7% of the pediatric population with hypertension, the cause of hypertension is pheochromocytoma. Due to headaches and verified hypertension on twenty-four-hour holter blood pressure monitoring, the 13-year-old female patient underwent ultrasound, followed by scintigraphy and magnetic resonance imaging of the abdomen, which described an oval change above the right kidney about 4.5 cm in diameter suspected of pheochromocytoma. Twenty-four-hour urine cateholamines showed elevated noradrenaline values as much as 45 times higher than the reference range, as well as elevated Dopamine values. After adequate preparation with phenoxybenzamine and bisoprolol for two weeks, a right laparoscopic adrenalectomy was performed at the University Children's Clinic in Tirsova, which is also the first operation of this type in the pediatric population. Intraoperatively, the maximum value of tension was 180/120 mmHg. Pathohistological findings confirmed pheochromocytoma. Although a rare cause of hypertension in the pediatric population, young patients with newly diagnosed hypertension should be examined for possible pheochromocytoma. Laparoscopic adrenalectomy through both the lateral transabdominal and posterior retroperitoneoscopic approach is the gold standard for the treatment of pheochromocytomas in both the adult and pediatric populations.

Ectopic thyroid tissue is a rare pathological finding bellow the diaphragm and extremely rare finding is ectopic thyroid tissue in the adrenal gland. Thyroid tissue can be located anywhere along the way of embryological migration pathway of thyroglossal duct. In most cases of ectopic thyroid tissue, it is located in the neck. Pathohistologically ectopic thyroid tissue in all cases was formed of follicular cells that expressed TTF-1, Thyroglobulin, PAX8, and cytokeratin 7, and there was lack expression of calretinin. In the literature we found 15 such cases. Women are much more affected than men (14:1), and it usually presents in the fifth decade (mean age 49). In all cases it was composed of normal follicular cells, and C cells were not found. Review of the literature reveals that adrenal ectopic thyroid tissue is almost always cystic, and has distinctive pathologic features. The most important thing is that ectopic thyroid tissue must be distinguished from metastatic deposits from thyroid gland carcinoma.

Background/Aim. Establishing a preoperative diagnosis of thyroid follicular tumors is difficult due to the fact that the cell morphology of adenomas and carcinomas are similar and that capsular and vascular invasion cannot be determined by cytology. We analyzed predictive factors of follicular carcinoma in order to enable a surgeon to indicate operative treatment and to perform an adequate operation for each patient with a follicular neoplasm. Methods. In this retrospective study, we analyzed medical records of all patients with follicular thyroid tumors operated at an endocrine surgery unit of a tertiary referral academic hospital, between 2008 and 2012. A total of 263 operated patients were included and divided into follicular adenomas (n = 97) and follicular carcinomas (n = 166) based on the histopathology results. The most important demographic and clinical characteristics were analyzed by univariate and multivariate logistic regression analysis. Results. In adenoma group (19 males, 78 females) age range was 19–79, mean age 50. In carcinoma group (35 males, 131 females) age range was 15– 78, mean age 48. Univariate analysis showed that thyroglobulin concentration ≥ 500 ng/mL, tumor diameter < 30 mm, presence of more than one thyroid nodule and an afunctional/hypofunctional nodule were significantly more frequent in follicular carcinoma than in follicular adenoma. Independent predictive factors of malignancy were: elevated preoperative thyroglobulin concentration (≥ 500 ng/mL) and presence of more than one nodule. Based on our results we formed a nomogram, a two-dimensional diagram designed to enable estimation of preoperative probability of malignancy. Conclusion. Elevated preoperative thyroglobulin concentration, ≥ 500 ng/mL, and the presence of more than one nodule are independent predictors of malignancy for follicular thyroid carcinomas.

Introduction/Objective. Adrenocortical carcinomas (ACCs) are very rare tumors with grave prognosis despite multimodal treatment. The aim of our study was to determine the incidence and mortality of ACCs in Central Serbia. Methods. The study period was from 1999 to 2012. We used data from the Cancer Registry of Central Serbia. Incidence and mortality rates were sex- and age-standardized according to Segi’s world population. Results. In the defined period of the study, 128 patients with a diagnosis of ACC were registered and the female-to-male ratio was 1.3:1. The median age of affected individuals was 42.3 years. There were two main age peaks – one in childhood (0–9 years), and the other in the fifth and sixth decade of life. In this period, the average standardized incidence rate of ACC amounted to two per million people with slightly increasing trend. The largest number of male patients with ACC (22; 39.2%) was registered in the age group of 0–9 years, while the largest number of patients in females was shown to be in the age group of 40–49 years (29; 40.3%). During the study period, there were 35 deaths registered in patients with ACC (mean age of 61.2 years). The average mortality rate of ACC was 0.3 per million people. The male-to-female ratio was 1.5:1. Most fatal outcomes were registered in the age groups of 50–59 and 60–69 years, so 91.4% of all deaths took place in the age groups 50+. Conclusion. ACC is an extremely rare tumor that occurs more often in women than in men. However, fatal outcomes occur more frequently in males. [Project of the Ministry of Education, Science and Technological Development of the Republic of Serbia, Grant no. 175042]

Backgraund/Aim. The Thyroid Specific Patient Reported Outcome Measure (ThyPRO) questionnaire is self-administered and intended to measure quality of life of thyroid patients. The aim of this study was to investigate the validity and reliability of the translated new, ThyPRO questionnaire in Serbian patients with thyroid disease. Methods. The translation process followed an internationally accepted methodology. The questionnaire was validated in 100 consecutive thyroid patients hospitalized in a tertiary level hospital, between April and August 2012. Internal reliabilities of ThyPRO scales were assesessed using Cronbach’s α coefficient. Association between age, gender, education, marital and employment status, place of living, diagnosis, current treatment, hormonal status and patient quality of life were determined using Pearson’s (r) and Spearman’s (q) correlation coefficients. Results. Internal consistency and reliability for ThyPRO scales were satisfactory. Cronbach’s α coefficients of 13 multi-item scales of the ThyPRO were > 0.83 (range 0.83-0.95). The scores, obtained by this questionnaire, correlated significantly with patients gender, employment status, diagnosis, current treatment and place of living. A highly significant inverse relationship was found between scores and hormonal status as well as between scores and disease duration. Patients’ age, marital status and thyroid-stimulating hormone level did not influence any scale score. Conclusion. The ThyPRO may be useful in measuring health-related quality of life in patients with thyroid disease in Serbia. [Projekat Ministarstva nauke Republike Srbije, br. 175 042]

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Copyright of Medical Gazette / Medicinski Glasnik is the property of Specijalna bolnica za bolesti stitaste zlezde i bolesti metabolizma Zlatibor and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medical Gazette / Medicinski Glasnik is the property of Specijalna bolnica za bolesti stitaste zlezde i bolesti metabolizma Zlatibor and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medical Gazette / Medicinski Glasnik is the property of Specijalna bolnica za bolesti stitaste zlezde i bolesti metabolizma Zlatibor and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medical Gazette / Medicinski Glasnik is the property of Specijalna bolnica za bolesti stitaste zlezde i bolesti metabolizma Zlatibor and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Cilj: Cilj rada je analiza učestalosti pojedinih oboljenja štitaste žlezde kod dece i adolescenata i ispitivanje razlike učestalosti u odnosu na grupu odraslih. Metode: Analizirani su podaci za 170 bolesnika mlađih od 20 godina, čija je prosečna starost bila 16,8 godina, operisanih u Centru za endokrinu hirurgiju KCS u Beogradu zbog oboljenja štitaste žlezde u periodu od 2001. do 2010. godine. Podaci su upoređeni sa grupom odraslih. Rezultati: Maligna oboljenja u grupi dece i adolescenata učestvuju sa 34,1%, a benigna sa 65,8%. Najčešće maligno oboljenje kod dece je papilarni karcinom (30,0%), a najčešća benigna oboljenja čine benigni tumori i ciste (30,59%). Najveći broj operisanih pripada uzrasnoj grupi od 15 do 20 godina (77,06%). U grupi odraslih maligna oboljenja učestvuju sa 27,3%, a benigna sa 72,6%. Od malignih oboljenja najčešći je, takođe, papilarni karcinom (22‚1%), a od benignih polinodozna struma (32,64%). Zaključak: Kod osoba mlađih od 20 godina u značajno većem procentu javlja se papilarni karcinom nego kod odraslih, kod kojih se pojavljuju folikularni i anaplastični karcinomi kojih kod dece i adolescenata nema. Graves-ova bolest i benigni tumori i ciste značajno se češće javljaju kod dece i adolescenata, a polinodozna struma i Hašimotov tireoiditis beleže značajno češću pojavu kod odraslih. [ABSTRACT FROM AUTHOR]