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Background: Multifocal papillary thyroid microcarcinoma (PTMC) has been associated with poor outcomes; however, we often encounter pathologically confirmed unilateral multifocal PTMC after surgery. To date, no consensus on the proper surgical extent for patients with this form of PTMC has been reported., Objective: The aim of this study was to analyze the effect of the type of surgical treatment on disease recurrence in patients with unilateral multifocal PTMC., Methods: We retrospectively analyzed data from 255 patients with unilateral, multifocal, node-negative PTMC between March 1999 and December 2012. We evaluated two groups of patients: those who underwent unilateral lobectomy (Group I, n = 127) and those who underwent total thyroidectomy (Group II, n = 128). During the follow-up period, which lasted a median of 94.8 months, we assessed locoregional recurrence (LRR)., Results: There was no statistically significant difference between the two groups with regard to LRR at follow-up (3.15% for Group I vs. 0.78% for Group II; p = 0.244). The association between the type of surgical treatment and LRR remained nonsignificant after adjusting for potential confounders such as age, tumor size, microscopic extrathyroidal extension, and lymphovascular invasion (p = 0.115). During follow-up, the incidence of transient hypocalcemia (0% vs. 8.6%; p = 0.001) and vocal fold paralysis (1.6% vs. 9.4%; p = 0.011) was higher in Group II than in Group I., Conclusions: Even though randomized controlled trials are the only option to obtain a definitive answer to this question, unilateral lobectomy may be a safe operative option for selected patients with unilateral, multifocal, node-negative PTMC.

Objective: To propose a distinct anatomical classification for the superior thyroid pole that may serve as a surgical landmark and could help reduce complications in thyroid surgery., Materials and Methods: A comprehensive anatomical study based on existing literature and surgical observations., Results: The proposed superior pole classification is based on two parameters that closely interact: one is the shape of the superior pole and the other is the structure of the vascular pedicle of the superior pole. We have come up with three distinct types of superior thyroid pole anatomical structure that may be predictive of the risk for both hemorrhage and nerve injury., Conclusions: Superior pole classification may serve as a guiding tool during thyroid surgery in order to reduce complications such as bleeding and injury to the external branch of the superior laryngeal nerve., (© 2015 Wiley Periodicals, Inc.)

Since minimally invasive thyroidectomy was introduced in 1997, different surgical approaches to the thyroid have been described: the minimal neck incision and the anterior chest, areolar breast or axillary access. Whereas conventional open thyroidectomy is suitable for any thyroid disease, minimal neck incision thyroidectomy or extracervical scarless neck thyroidectomy are limited to small-volume disease. In 11 prospective randomized studies and six systematic reviews, minimally invasive video-assisted thyroidectomy via a central or lateral neck approach afforded better cosmesis in the first 3 months than conventional open thyroidectomy, with less postoperative pain for the first 48 h. Surgical morbidity did not differ in these limited studies. No head-to-head comparison is available for extracervical scarless neck thyroidectomy and conventional open thyroidectomy. Extracervical scarless neck thyroidectomy caused more postoperative pain and gave rise to complications not seen with minimal neck incision thyroidectomy or conventional open thyroidectomy. In the absence of evidence to the contrary, conventional open thyroidectomy continues to remain the gold standard for any nodular goitre., (Copyright © 2014. Published by Elsevier Ltd.)

Purposes: There is an increasing trend towards performing more radical resections instead of a subtotal resection for benign thyroid disease. The aim of this study was to examine the effect of this change in practice on the surgical treatment of bilateral thyroid diseases in this unit., Methods: The data on 367 patients that underwent a bilateral thyroidectomy were categorized by dividing the operation types into 4 groups: (1) total thyroidectomy (TT), (2) near-total thyroidectomy, (3) Dunhill procedure, and (4) bilateral subtotal thyroidectomy., Results: A statistically significant change in the choice of thyroidectomy occured during the study period (p < 0.001). TT has replaced subtotal thyroidectomy (STT; bilateral subtotal thyroidectomy and Dunhill procedure) as the preferred routine surgical procedure for bilateral benign thyroid diseases in this clinic. The permanent complication rates were similar for all surgical procedures. The rate of secondary thyroidectomy for both recurrence of multinodular goiter and incidental thyroid carcinoma were significantly higher in the STT groups, than the total in the TT and near-total thyroidectomy patients., Conclusions: Total or near total thyroidectomy procedures are now being increasingly employed to treat bilateral benign thyroid disease, and are as safe as the sub-total thyroidectomy procedures, which are more conservative and associated with significantly higher recurrence rates.

Objectives: Patients who underwent surgery for thyroid masses were evaluated with regard to clinical symptoms, diagnostic and treatment methods, and the results of treatment., Patients and Methods: The study included 92 patients (72 women, 20 men; mean age 45 years; range 16 to 71 years). Clinical diagnoses were based on findings of ultrasonography, thyroid function tests, thyroid scintigraphy, and fine-needle aspiration biopsy. Operations performed were near-total thyroidectomy (n=40), hemithyroidectomy (n=25), bilateral subtotal thyroidectomy (n=16), and total thyroidectomy (n=11). Patients with carcinoma associated with neck lymph node metastasis also underwent lateral, anterolateral, modified radical, or radical neck dissections., Results: Postoperative histopathologic diagnoses were benign colloid nodule (n=70), papillary carcinoma (n=16), medullary carcinoma (n=2), anaplastic carcinoma (n=2), and Basedow-Graves disease (n=2). Unilateral vocal cord paralysis developed in 11 patients (11.9%), five of which persisted beyond one year follow-up. Two patients (2.2%) had transient hypocalcemia and one patient (1.1%) had postoperative hematoma., Conclusion: Preoperative determination of the structure and confines of thyroid masses increases success rates of surgical procedures and minimizes complication rates.

Background/purpose: Thyroid nodules in children often require surgical treatment. We evaluated management practices for these across Canada., Methods: Patient records from 9 Canadian pediatric centers of children undergoing surgery for thyroid nodules over a 6-year period were reviewed. Demographics, presenting features, investigations, surgical treatment, pathology, and complications were assessed., Results: One hundred and forty-one patients were reviewed (75% female), of whom 117 presented with a palpable mass. Ultrasound and/or thyroid scintigraphy was the most commonly used preoperative imaging studies. Fine-needle aspiration cytology correlated with final pathology in 49% of cases. Overall, the rate of malignancy in this series was 43%, with half being papillary carcinoma. Thirty-two of 57 patients undergoing primary total thyroidectomy had a malignancy; 14 of these had positive preoperative fine-needle aspiration cytologies. Twenty of 71 patients undergoing initial hemithyroidectomy +/- isthmusectomy had a malignancy. Seventeen of these went on to completion thyroidectomy and 3 had malignancy in the second specimen. Hypocalcemia and hoarseness occurred in 14 and 4 patients, respectively. Complications were more common after primary total thyroidectomy; none occurred in patients undergoing completion thyroidectomy., Conclusions: The incidence of malignancy in pediatric thyroid nodules is high, and the risk of surgical complications significant. With variable management practices across Canada, evidence-based guidelines for diagnosis and surgical treatment may be valuable.

Background: We sought to evaluate the predictive value of preoperative fine-needle aspiration (FNA) on surgical decision making by evaluating the final pathologic diagnosis and comparing it to the preoperative diagnosis. Further, we wished to calculate the predictive accuracy of each of several types of preoperative FNA diagnosis., Study Design: A retrospective chart review of 151 thyroid resections between July 1990 and April 1996 at the University of Virginia was undertaken. The mean age was 45 years (range, 11 to 85 years). Preoperative laboratory values, presenting symptoms, imaging studies, and predictive values of preoperative FNA and intraoperative frozen section were analyzed., Results: Symptomatology was poorly predictive of a benign versus malignant postoperative final pathologic diagnosis. Sensitivity, specificity, and accuracy of frozen section versus FNA was 86% versus 86%; 99% versus 93%, and 96% versus 92%, respectively, if the reading "cancer" or "suspicious" were predicted as positive for malignancy and "benign" or "follicular" were predicted as negative for malignancy. If only the reading "cancer" was predicted as positive for malignancy and only "benign" was predicted as negative for malignancy, sensitivity and specificity for FNA were 100% and 96%, respectively, and 100% and 99%, respectively, for frozen section. Forty-nine "follicular" lesions obtained by preoperative FNA resulted in 46 benign diagnoses after surgical resection., Conclusions: The use of preoperative FNA is a powerful diagnostic tool in the hands of skilled pathologists. There is increasing evidence that intraoperative frozen section adds little to intraoperative decision making in patients diagnosed with thyroid cancer by preoperative FNA. Less definitive interpretations decrease the sensitivity, specificity, and accuracy of the FNA diagnosis.

Classification of operations on thyroid gland depending on the tissue volume preserved and basing on the analysis of surgical treatment of more than 2000 patients was presented. Substantiation and characteristics of its headings permits to take into account the intervention volume, what is peculiarly important during the automatized processing of large masses of information.

The causes of transient hypocalcemia after thyroid surgery are not fully understood. In 95 consecutive patients undergoing total thyroidectomy (n = 30), subtotal thyroidectomy (n = 14), or hemithyroidectomy (n = 51), we serially measured total calcium, parathyroid hormone (PTH), and proteins before surgery and 6, 24, 48, 72, and 96 hours after surgery, and we calculated the corresponding ionized calcium levels. In the whole population, there was a statistically significant decrease of PTH, total calcium, and proteins at nearly every time of blood withdrawal, when compared with the preoperative levels. The PTH decreased earlier and total calcium levels were significantly lower after total thyroidectomy than after hemithyroidectomy (at 48, 72, and 96 hours). Ten patients had on 2 occasions serum calcium levels below or equal to 2 mmol/L and were defined as having severe hypocalcemia. Severe hypocalcemia was found in 8 patients after total thyroidectomy, compared with 2 after hemithyroidectomy (p < .05), and was present in 3 of the 5 patients with thyroid carcinoma, compared with 7 of the 90 patients with nonmalignant thyroid diseases (p < .01). Despite careful preservation of the parathyroid glands and their blood supply, thyroidectomy was often followed by transient hypocalcemia, the determinants of which are hypoparathyroidism and hemodilution. No patients had persistent symptoms of hypocalcemia from 2 to 3 months after surgery.