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Objective: To determine the frequency and its outcome of parathyroid preservation in total thyroidectomy. Study Design: Case Series study. Setting: Department of Otorhinolaryngology, HMC, MTI, Peshawar. Period: 23rd June 2022 to 23rd Dec 2022. Methods: A total of 246 patients who underwent thyroidectomy were included in the study and followed up to determine the preservation of parathyroid gland, hypocalcaemia and recurrent laryngeal nerve injury. Results: The mean age of the sample was 37.7 + 12.3 years. There were 52.8% male patients and 47.2% female patients. 28.9% of patients had thyroid nodule and subtotal thyroidectomy was the most performed procedure Parathyroid gland preservation was recorded in 72%. On follow up, hypocalcemia was recorded in 16.3% and recurrent laryngeal nerve injury in 20.3%. Conclusion: Hypocalcemia and RLNI are significantly common after thyroidectomy. Hypocalcemia was significantly high in patients with low non preserved parathyroid gland. More research on high sample size and addressing other effect modifiers are recommended with intervention to preserve parathyroid gland. [ABSTRACT FROM AUTHOR]

Background: Postoperative hypoparathyroidism is a major complication of thyroidectomy, occurring when the parathyroid glands are inadvertently damaged during surgery. Although intraoperative images are rarely used to train artificial intelligence (AI) because of its complex nature, AI may be trained to intraoperatively detect parathyroid glands using various augmentation methods. The purpose of this study was to train an effective AI model to detect parathyroid glands during thyroidectomy. Methods: Video clips of the parathyroid gland were collected during thyroid lobectomy procedures. Confirmed parathyroid images were used to train three types of datasets according to augmentation status: baseline, geometric transformation, and generative adversarial network-based image inpainting. The primary outcome was the average precision of the performance of AI in detecting parathyroid glands. Results: 152 Fine-needle aspiration-confirmed parathyroid gland images were acquired from 150 patients who underwent unilateral lobectomy. The average precision of the AI model in detecting parathyroid glands based on baseline data was 77%. This performance was enhanced by applying both geometric transformation and image inpainting augmentation methods, with the geometric transformation data augmentation dataset showing a higher average precision (79%) than the image inpainting model (78.6%). When this model was subjected to external validation using a completely different thyroidectomy approach, the image inpainting method was more effective (46%) than both the geometric transformation (37%) and baseline (33%) methods. Conclusion: This AI model was found to be an effective and generalizable tool in the intraoperative identification of parathyroid glands during thyroidectomy, especially when aided by appropriate augmentation methods. Additional studies comparing model performance and surgeon identification, however, are needed to assess the true clinical relevance of this AI model. [ABSTRACT FROM AUTHOR]

Primary hyperparathyroidism (PHPT) is a common endocrine disease characterized by hypercalcemia due to inappropriately high parathyroid hormone secretion. While in the typical, symptomatic form of the disease diagnosis is set easily and standard management is surgical removal of the hyperfunctioning parathyroid (HP), this may not be the case in more subtle forms of PHPT, such as the asymptomatic and the normocalcemic PHPT. Localization of the HP could also be challenging, especially in small-sized adenomas, ectopic lesions or multiglandular disease. An experienced surgical team is essential to achieve curative parathyroidectomy. In this article, we used illustrative clinical vignettes to dissect the approach to the patient with PHPT, from the diagnosis establishment to the suggested investigation to identify classical and non-classical PHPT features and the methodology to locate the abnormal tissue. Accordingly, we elaborated on appropriate management, both surgical and conservative. [ABSTRACT FROM AUTHOR]

The OBJECTIVE of this article was to present a clinical demonstration of the successful experience of using minimally invasive surgical treatment of a patient with primary hyperparathyroidism (PHPT) by percutaneous microwave ablation (MWA) of parathyroid adenoma, under ultrasound guidance. This method provides maximum effectiveness with minimal invasiveness, a shorter recovery period after surgery, and a better cosmetic effect. After the minimally invasive intervention, the patient had complaints related to hypocalcemia, which develops practically after any form of radical PHPT treatment. No other complications were observed. Further dynamic observation was carried out by an endocrinologist at the place of residence. The obtained positive results demonstrated a good perspective of PHPT treatment by using MWA.

Mediastinal parathyroid cysts (MPCs) are extremely rare, benign lesions arising from the parathyroid glands and residing within the thoracic cavity. This study aims to advance understanding of MPC, emphasizing accurate diagnosis and management approaches for this rare condition. A 46-year-old woman presented with dysphagia for one week. Blood tests revealed elevated parathyroid hormone (PTH) (112.8 pg/mL) and normal serum calcium (9.54 mg/dL). Ultrasonography identified a large, well-defined cystic nodule measuring 46 × 30 × 25 mm, extending retro-sternally in the right upper third of the chest. A subsequent high-resolution computed tomography scan of the chest revealed a large space-occupying lesion (47 × 43 × 31 mm) in the superior mediastinum, near the esophagus, suggesting an esophageal duplication cyst or, less likely, a bronchogenic cyst. Video-assisted thoracoscopic surgery (VATS) was performed, and the entire cyst was excised, confirmed histologically as a mediastinal parathyroid cyst. Mediastinal involvement of PCs poses diagnostic challenges due to their rarity and diverse clinical presentations. Surgical excision is necessary for symptomatic cases, with VATS emerging as a favorable approach.

The use of near-infrared autofluorescence imaging during thyroidectomy remains controversial. This study aimed to investigate whether the use of near-infrared autofluorescence imaging results in improved outcomes. This study was a systematic analysis using the following databases: PubMed, Cochrane Library, and Embase. Articles published prior to and during January 2021 were included. The analysis revealed that the rate of hypocalcemia after thyroidectomy in those subjected to near-infrared autofluorescence was lower than those in the control group, and this difference was statistically significant (Z = 4.82, OR = 0.41, 95% CI 0.29 ~ 0.59, P < 0.00001). The rate of inadvertent parathyroidectomy in the near-infrared autofluorescence group was lower than that in the control group, and this difference was statistically significant (Z = 2.37, OR = 0.43, 95% CI 0.22 ~ 0.86, P = 0.02). In addition, the rate of autotransplantation in the near-infrared autofluorescence group was lower than that in the control group. However, this difference was not statistically significant (Z = 1.05, OR = 0.59, 95% CI 0.22 ~ 1.57, P = 0.29). Near-infrared autofluorescence imaging was associated with significantly reduced rates of postoperative hypocalcemia and inadvertent parathyroidectomy. However, there was no statistically significant difference observed in the incidences of autotransplantation between the two groups. In conclusion, this technique results in favorable clinical outcomes and is worth popularizing. Investigate whether the use of near-infrared self-luminescence imaging can improve results. Near-infrared autoluminescence imaging significantly reduces the incidence of postoperative hypocalcemia and accidental parathyroidectomy. [ABSTRACT FROM AUTHOR]

The objective of this study is to investigate the clinical value of carbon nanoparticles to identify and preserve parathyroid glands in situ during papillary thyroid carcinoma surgery. The clinical data of 505 cases with papillary thyroid carcinoma were analysed: 260 cases with carbon nanoparticles were regarded as the study group, and 245 cases with conventional operation were regarded as the control group. The number of identified and misresected parathyroid glands of different types in the two groups was collected and analysed. Additionally, the number of different parathyroid gland types preserved in situ was compared with autotransplantation between the two groups. Significant differences were found between the identification rates of type B1 and total parathyroid glands and the preservation in situ rates of type A1, type A2 and type B1 and total parathyroid glands in the 2 groups (P < 0.05). No statistically significant difference was observed between the identification rates of type A1, A2, A3, B2 and B3 parathyroid glands and the preservation in situ rates of type A3, B2 and B3 parathyroid glands in the 2 groups (P > 0.05). The negative development technique of carbon nanoparticles can effectively identify and preserve parathyroid glands in situ during papillary thyroid carcinoma surgery. [ABSTRACT FROM AUTHOR]

Introduction: Ectopic parathyroid glands have been reported with an incidence of 2–22%. Undescended parathyroid glands, defined as glands situated above the carotid bifurcation or > 1 cm cranial to the superior pole of the thyroid gland, comprise 2–7% of all ectopic parathyroid glands. We report a case of incidentally discovered parathyroid gland located in the retropharyngeal space at the level of the oropharynx. Case Presentation: The patient in this report was a 60-year-old female with squamous cell carcinoma of the tonsil T2N0M0 with MRI showing a hyperintense ovoid structure, medial to the carotids at the level of the oropharynx, corresponding to the location of the lateral group of retropharyngeal lymph nodes. Patient underwent transoral ultrasonic radical tonsillectomy along with a retropharyngeal lymph node dissection by the transcervical route. Postoperative histopathology revealed the retropharyngeal node sampled to be a normal parathyroid gland. Discussion: "High" undescended parathyroid gland as reported here along with 4 other cases of infratemporal fossa parathyroid glands reported previously, can be the cause for recurrent missed adenomas. Being extracervical in location, these are likely to be missed if the skull base has not been included in the preoperative Tc-99 sestamibi scan and also during bilateral neck exploration. [ABSTRACT FROM AUTHOR]

Nephrotic syndrome is a clinical syndrome characterized by massive proteinuria, called nephrotic range proteinuria (over 3.5 g per day in adults or 40 mg/m2 per hour in children), hypoalbuminemia, oncotic edema, and hyperlipidemia, with an increasing incidence over several years. Nephrotic syndrome carries severe morbidity and mortality risk. The main pathophysiological event in nephrotic syndrome is increased glomerular permeability due to immunological, paraneoplastic, genetic, or infective triggers. Because of the marked increase in the glomerular permeability to macromolecules and the associated urinary loss of albumins and hormone-binding proteins, many metabolic and endocrine abnormalities are present. Some of them are well known, such as overt or subclinical hypothyroidism, growth hormone depletion, lack of testosterone, vitamin D, and calcium deficiency. The exact prevalence of these disorders is unknown because of the complexity of the human endocrine system and the differences in their prevalence. This review aims to comprehensively analyze all potential endocrine and hormonal complications of nephrotic syndrome and, vice versa, possible kidney complications of endocrine diseases that might remain unrecognized in everyday clinical practice. [ABSTRACT FROM AUTHOR]

Background/Objective: Severe dysphagia is a rare presenting symptom of primary hyperparathyroidism, whereas the most common hypercalcemia-related causes include gastrointestinal symptoms, such as anorexia, constipation, and pancreatitis. This case presentation aimed to describe swallowing difficulty as a leading symptom of hypercalcemia. Case Report: A 62-year-old man experienced vomiting, dysphagia bordering with aphagia, and 20-kg weight loss in a 2-month period. The parathyroid hormone and serum calcium levels were 102 pmol/L (reference range, 1.8-7.9 pmol/L) and 4.12 mmol/L (reference range, 2.14-2.53 mmol/L), respectively. Ultrasound-guided exploration of the neck revealed a large, rounded hypoechoic mass inferior to the left thyroid lobe, which contained parathyroid tissue on fine-needle aspiration cytology examination. Contrast-enhanced neck computed tomography revealed a mass measuring 3.6 × 2.6 × 2.5 cm behind the left thyroid lobe, alongside massive ventral spondylophytes of the cervical spine at the level of the postcricoid segment of the hypopharynx. Magnetic resonance imaging confirmed ventral tissue displacement due to spondylophyte size and location. Surgical exploration of the left side of the neck was performed, and the left lower parathyroid gland weighing 9.07 g was excised. Pathohistologic findings verified a parathyroid gland adenoma. The postoperative values showed parathyroid hormone and serum calcium levels at 4.54 pmol/L and 2.25 mmol/L, respectively. Discussion: The pathophysiology of dysphagia in hypercalcemia is not fully elucidated. In this case, the patient’s improvement after surgery implies a plausible connection between hypercalcemia and dysphagia, suggesting a causal relationship. Conclusion: Although aphagia is not a typical presenting symptom of parathyroid adenoma, it should be noted in the differential diagnosis.

The combination of thyroid and parathyroid gland pathology is a rather rare combination of diseases that occurs in 2.0–5.0 % of patients with thyroid pathology, and their combination in the population is less than 0.1 %. The aim of the study. To improve the diagnosis and treatment of patients with combined pathology of the thyroid and parathyroid glands. Materials and methods. The retrospective analysis covers the period from January 2013 to December 2023, during which 912 patients with thyroid pathology were examined and operated on. Examination of patients was carried out according to the method of diagnosis of combined surgical pathology developed by us (utility model patent No. 128139, Ukraine). The gender structure was dominated by female patients: 773 (84.8 %) and 139 (15.2 %). The average age of patients in the study group was 54.9 ± 11.7 years. Results. After the examination, combined surgical pathology was found in 201 (22.1 %) patients. In 36 (17.9 %) of them, the pathology of the prostate gland was detected as a concomitant disease. In the structure of parathyroid pathology in 35 (97.2 %) patients, a benign lesion of the prostate gland was detected, in 1 (2.8 %) – cancer of the parathyroid gland. In the structure of the main thyroid pathology, 14 (38.9 %) patients were diagnosed with multinodular euthyroid goiter, 4 (11.1 %) with mononodous euthyroid goiter, 9 (25.0 %) with diffuse toxic goiter, 3 (8, 3 %) – mononodous toxic goiter, 6 (16.7 %) – papillary thyroid cancer. Clinical symptoms of hypoparathyroidism were observed in 21 (58.3 %) patients after surgery. In 3 (8.3 %) patients, seroma of the neck wound was detected in the postoperative period. There were no fatalities. Conclusions. The use of the developed method of diagnosing combined surgical pathology makes it possible to detect concomitant surgical pathology in 22.1 % of patients with endocrine diseases, which requires simultaneous operative intervention. In the structure of combined surgical pathology, in 17.9 % of cases, a combination of diseases of the thyroid gland and parathyroid gland was observed. Simultaneous surgical intervention for combined thyroid pathology and diseases of the thyroid gland does not lead to an increase in perioperative complications and mortality.

Background: The added benefit of using near-infrared autofluorescence (NIRAF) during total thyroidectomy (TT) remains controversial. This study investigated whether or not NIRAF results in improved patient outcomes postoperatively. Materials and methods: We analyzed 1711 TT patients, reported in nine randomized controlled trials, following a systematic search of five databases. NIRAF was compared to the standard of care (naked eye with/without white light). Outcomes included parathyroid gland (PG) and calcium parameters and other clinical outcomes. For dichotomous outcomes, the log odds ratio (logOR) was calculated, and for continuous outcomes, the crude mean difference (MD) was measured. Sensitivity analysis was performed when heterogeneity was significant. The revised Cochrane risk of bias tool was used to assess the methodological quality. Results: Compared to the standard of care, the use of NIRAF was associated with a significant reduction in postoperative hypoparathyroidism [logOR = - 0.31; 95% CI: - 0.57: -0.05], inadvertent PG removal [logOR= -0.93; 95% CI: - 1.60: - 0.26], and postoperative hypocalcemia [logOR = - 0.43 mmol/l; 95% CI: -0.77: -0.09]. It was also associated with significantly higher postoperative PTH levels [MD =4.78 pg/ml; 95% CI: 2.13: 7.43], PG identification rate [logOR=1.02; 95% CI: 0.31: 1.72], postoperative serum calcium [MD =0.05; 95% CI: 0.00: 0.09], and operative time [MD= 9.38 min; 95% CI: 6.68: 12.09]. No difference was seen regarding PG autotransplantation, length of hospital stay, and hospitalization due to hypocalcemia. Seven trials had low risk and the remainder had some concerns. Conclusion: NIRAF is superior to the naked eye in identifying all four PGs during TT. The reduced risk of postoperative hypoparathyroidism and hypocalcemia reflected this preservation value. However, it was not associated with a change in the length of hospital stay. Although rare, the readmission rate due to hypocalcemia was similar across both methods. [ABSTRACT FROM AUTHOR]

Transient receptor potential canonical sub-family channel 3 (TRPC3) is considered to play a critical role in calcium homeostasis. However, there are no established findings in this respect with regard to TRPC6. Although the parathyroid gland is a crucial organ in calcium household regulation, little is known about the protein distribution of TRPC channels—especially TRPC3 and TRPC6—in this organ. Our aim was therefore to investigate the protein expression profile of TRPC3 and TRPC6 in healthy and diseased human parathyroid glands. Surgery samples from patients with healthy parathyroid glands and from patients suffering from primary hyperparathyroidism (pHPT) were investigated by immunohistochemistry using knockout-validated antibodies against TRPC3 and TRPC6. A software-based analysis similar to an H-score was performed. For the first time, to our knowledge, TRPC3 and TRPC6 protein expression is described here in the parathyroid glands. It is found in both chief and oxyphilic cells. Furthermore, the TRPC3 staining score in diseased tissue (pHPT) was statistically significantly lower than that in healthy tissue. In conclusion, TRPC3 and TRPC6 proteins are expressed in the human parathyroid gland. Furthermore, there is strong evidence indicating that TRPC3 plays a role in pHPT and subsequently in parathyroid hormone secretion regulation. These findings ultimately require further research in order to not only confirm our results but also to further investigate the relevance of these channels and, in particular, that of TRPC3 in the aforementioned physiological functions and pathophysiological conditions. [ABSTRACT FROM AUTHOR]

The preservation of parathyroid glands is now understood to be quintessential during neck surgeries mainly thyroid surgeries. Because of its small size, colour, shape and variability in position and number, they are very prone to inadvertent resection of one of the glands or devascularization leading to either transient or permanent hypocalcaemia during thyroid surgery. Permanent hypocalcemia being a serious complication causing life-long morbidity. This understanding necessitated the need to invent a reliable and simple modality for identification and consequent preservation. With this systematic review, we aim to describe a comprehensive timeline of how the parathyroid gland was discovered, its physiology and relevance in life established along with that we aim to outline and concise most of the methods used in intra-operative parathyroid gland identification which have been developed and experimented upon. Numerous modalities have been used such as frozen section, intra-operative parathyroid hormone levels, methylene blue injection, local methylene blue spray, indocyanine green angiography, carbon nanoparticle injection, Raman spectroscopy, shear wave elastography, laser speckle contrast imaging, dynamic optical contrast imaging and near infrared-induced autofluorescence. To conclude, we have come a long way in discovering the gland and knowing its importance and its surgical preservation, but we still have a long way to go in finding a more cost-efficient and universal method to identify glands intra-operatively. [ABSTRACT FROM AUTHOR]

Parathyroid glands are small endocrine glands that regulate calcium metabolism by producing parathyroid hormone (PTH). These are located at the back of the thyroid gland. Typically, four glands comprise the parathyroid glands, although their numbers may vary among individuals. Parathyroid diseases are related to parathyroid gland dysfunction and can be caused by problems with the parathyroid gland itself or abnormal serum calcium levels arising from renal disease. In recent years, as comprehensive health checkups have become more common, abnormal serum calcium levels are often found incidentally in blood tests, after which several additional tests, including a PTH test, ultrasonography (US), technetium-99m sestamibi parathyroid scan, single-photon-emission CT (SPECT)/CT, four-dimensional CT (4D-CT), and PET/CT, are performed for further evaluation. However, the parathyroid gland remains an organ less familiar to radiologists. Therefore, the normal anatomy, pathophysiology, imaging, and clinical findings of the parathyroid gland and its associated diseases are discussed here.

Background: This study aimed to assess the benefits and limitations of four intraoperative visualization of parathyroid gland (IVPG) strategies in the identification and functional protection of parathyroid glands (PGs). Methods: We searched PubMed, the Cochrane Central Register of Controlled Trials, CNKI, EMBASE, Web of Science and Google Scholar databases until 30 June 2023. Four IVPG strategies were composed of the naked eyes (NE) and three imaging strategies: autofluorescence (AF), indocyanine green fluorescence (ICGF), and carbon nanoparticles (CN). We performed a pairwise meta-analysis (PMA) for direct comparisons and a Bayesian network meta-analysis (NMA) for indirect comparisons. Results: A total of 29 eligible studies were included. According to NMA and PMA, AF had significantly lower rates of postoperative hypocalcemia and hypoparathyroidism, PG inadvertent resection, and PG auto-transplantation compared to NE, while had significantly higher rate of PG identification. CN showed significantly lower rates of postoperative hypocalcemia and hypoparathyroidism, and PG inadvertent resection compared to NE in PMA and NMA. ICGF showed a significantly higher rate of PG auto-transplantation compared to NE in PMA and AF in NMA. According to SUCRA values, AF showed the best advantage in reducing the rate of postoperative hypocalcemia (0.85) and PG inadvertent resection (0.89), and increasing the rate of PG identification (0.80). CN had the greatest advantage in reducing the rate of postoperative hypoparathyroidism (0.95). ICGF ranked the highest in the rate of PG auto-transplantation (0.98). Conclusions: Three imaging strategies demonstrate significant superiority over NE in the intraoperative PG identification and functional protection. AF is the best strategy in reducing the incidence of postoperative hypocalcemia, increasing the rate of PG identification, and reducing the rate of PG inadvertent resection and auto-transplantation. ICGF has great value in assessing PG viability, leading to the trend towards PG auto-transplantation. CN is the best strategy in reducing the incidence of postoperative hypoparathyroidism. [ABSTRACT FROM AUTHOR]

Background: Reoperation for recurrent or persistent secondary hyperparathyroidism (SHPT) after parathyroidectomy is challenging due to surgical scars and postoperative adhesions. Therefore, there is an increasing need to develop a new minimally invasive therapy. Objective: To analyze the efficacy of ultrasound (US)-guided radiofrequency ablation (RFA) in patients with recurrent or persistent SHPT after parathyroidectomy. Patients and methods: From March 2013 to January 2022, 20 enlarged parathyroid glands in 10 patients with recurrent or persistent SHPT were treated with US-guided RFA. The levels of serum intact parathyroid hormone (iPTH), calcium (Ca), phosphorus (P), and alkaline phosphatase (ALP), as well as clinical symptoms, were compared before and after RFA. The ablation procedure-related complications were also evaluated. The target range for iPTH levels was approximately 2–9 times the upper limit of normal (130–585 pg/mL). Results: The mean follow-up time was 49.6 ± 34.5 months (range from 6 to101 months). The levels of serum iPTH, Ca, and P decreased significantly one day post-ablation. Six months after RFA, 70% of patients reached the targets for iPTH, and 50% of patients reached targets at the end of follow-up. Two patients underwent repeat ablation at 9 months and 6 years after RFA, respectively, due to persistently elevated iPTH levels, and both had serum iPTH concentrations in the recommended range at the recent follow-up visit. The patients' clinical symptoms significantly improved after ablation. Major complications after RFA included hoarseness (2/10) and permanent hypoparathyroidism (1/10). Severe hypocalcemia occurred in four patients (4/10) after ablation. Conclusion: US-guided percutaneous RFA for recurrent or persistent SHPT is safe, efficacious, and repeatable, and can significantly improve hyperparathyroidism-related symptoms. [ABSTRACT FROM AUTHOR]

Introduction: Near‐infrared autofluorescence imaging (NIFI) can be used to identify parathyroid gland (PG) during surgery. The purpose of the study is to establish a new model, help surgeons better identify, and protect PGs. Methods: Five hundred and twenty three NIFI images were selected. The PGs were recorded by NIFI and marked with artificial intelligence (AI) model. The recognition rate for PGs was calculated. Analyze the differences between surgeons of different years of experience and AI recognition, and evaluate the diagnostic and therapeutic efficacy of AI model. Results: Our model achieved 83.5% precision and 57.8% recall in the internal validation set. The visual recognition rate of AI model was 85.2% and 82.4% on internal and external sets. The PG recognition rate of AI model is higher than that of junior surgeons (p < 0.05). Conclusions: This AI model will help surgeons identify PGs, and develop their learning ability and self‐confidence. [ABSTRACT FROM AUTHOR]

The combination of thyroid and parathyroid gland pathology is a rather rare combination of diseases that occurs in 2.0–5.0 % of patients with thyroid pathology, and their combination in the population is less than 0.1 %. The aim of the study. To improve the diagnosis and treatment of patients with combined pathology of the thyroid and parathyroid glands. Materials and methods. The retrospective analysis covers the period from January 2013 to December 2023, during which 912 patients with thyroid pathology were examined and operated on. Examination of patients was carried out according to the method of diagnosis of combined surgical pathology developed by us (utility model patent No. 128139, Ukraine). The gender structure was dominated by female patients: 773 (84.8 %) and 139 (15.2 %). The average age of patients in the study group was 54.9 ± 11.7 years. Results. After the examination, combined surgical pathology was found in 201 (22.1 %) patients. In 36 (17.9 %) of them, the pathology of the prostate gland was detected as a concomitant disease. In the structure of parathyroid pathology in 35 (97.2 %) patients, a benign lesion of the prostate gland was detected, in 1 (2.8 %) – cancer of the parathyroid gland. In the structure of the main thyroid pathology, 14 (38.9 %) patients were diagnosed with multinodular euthyroid goiter, 4 (11.1 %) with mononodous euthyroid goiter, 9 (25.0 %) with diffuse toxic goiter, 3 (8, 3 %) – mononodous toxic goiter, 6 (16.7 %) – papillary thyroid cancer. Clinical symptoms of hypoparathyroidism were observed in 21 (58.3 %) patients after surgery. In 3 (8.3 %) patients, seroma of the neck wound was detected in the postoperative period. There were no fatalities. Conclusions. The use of the developed method of diagnosing combined surgical pathology makes it possible to detect concomitant surgical pathology in 22.1 % of patients with endocrine diseases, which requires simultaneous operative intervention. In the structure of combined surgical pathology, in 17.9 % of cases, a combination of diseases of the thyroid gland and parathyroid gland was observed. Simultaneous surgical intervention for combined thyroid pathology and diseases of the thyroid gland does not lead to an increase in perioperative complications and mortality. [ABSTRACT FROM AUTHOR]

Abstract Background The published rate of incidental parathyroidectomy (IP) during thyroid surgery varies between 5.8% and 29%. The risk factors and clinical significance of postoperative transient hypocalcemia and permanent hypoparathyroidism are still debated. The aims of this study were to assess the clinical relevance of avoidable IP for transient hypocalcemia and permanent hypoparathyroidism, and to describe the risk factors for IP. Methods This retrospective cohort study included 1,537 patients who had a one-step total thyroidectomy in a high-volume endocrine surgery center between 2018 and 2019. Pathology reports were reviewed for incidentally removed parathyroid glands. Intrathyroidal parathyroid glands were excluded from the study. Demographic characteristics, potential risk factors, and postoperative calcium and PTH levels were compared between IP and control groups. Results Avoidable IP occurred in 234 (15.2%) patients. Patients with IP had a higher risk of transient hypocalcemia (17.9% vs. 11.5%, p = 0.006; odds ratio [OR] 1.68, 95% confidence interval [95% CI]1.16–2.45) and permanent hypoparathyroidism (4.7% vs. 1.6%, p = 0.002; OR 3.01, 95% CI 1.29–6.63) than patients without IP. Multivariate analysis showed that central lymph node dissection (CLND) and incidental removal of thymus tissue were independent risk factors for IP (OR 4.83, 95% CI 2.71–8.86, p

Abstract Introduction Near‐infrared autofluorescence imaging (NIFI) can be used to identify parathyroid gland (PG) during surgery. The purpose of the study is to establish a new model, help surgeons better identify, and protect PGs. Methods Five hundred and twenty three NIFI images were selected. The PGs were recorded by NIFI and marked with artificial intelligence (AI) model. The recognition rate for PGs was calculated. Analyze the differences between surgeons of different years of experience and AI recognition, and evaluate the diagnostic and therapeutic efficacy of AI model. Results Our model achieved 83.5% precision and 57.8% recall in the internal validation set. The visual recognition rate of AI model was 85.2% and 82.4% on internal and external sets. The PG recognition rate of AI model is higher than that of junior surgeons (p

Context: Previous studies, including our own, have demonstrated a highly variable incidence of primary hyperparathyroidism (PHPT) from year to year. Objective: We planned to provide a current estimate of the incidence and prevalence of PHPT in a community-based study. Methods: A population-based retrospective follow-up study was conducted in Tayside (Scotland) from 2007 to 2018. Record-linkage technology (demography, biochemistry, prescribing, hospital admissions, radiology, and mortality data) was used to identify all patients. Cases of PHPT were defined as those with at least 2 raised serum corrected calcium concentration CCA (> 2.55 mmol/L) and/or hospital admissions with PHPT diagnoses and/or surgery records with parathyroidectomy during the follow-up period. The number of prevalent and incident cases of PHPT per calendar year by age and sex were estimated. Results: A total of 2118 people (72.3% female, mean age 65 years) were identified with an incident case of PHPT. The overall prevalence of PHPT over the 12 years of the study was 0.84% (95% CI, 0.68%-1.02%), steadily increasing from 0.71% in 2007 to 1.02% in 2018. From 2008, the incidence of PHPT was relatively stable from 4 to 6 cases per 10 000 person-years, declining from 11.5 per 10 000 person-years in 2007. The incidence varied from 0.59 per 10 000 person-years (95% CI, 0.40%-0.77%) for those aged 20 to 29 years, to 12.4 per 10 000 person-years (95% CI, 11.2%-13.3%) in those aged 70 to 79 years. Incidence of PHPT was 2.5 times higher in women than in men. Conclusion: This study is the first showing a relatively steady annual incidence of PHPT at 4 to 6 per 10 000 person-years. This population-based study reports a PHPT prevalence of 0.84%. [ABSTRACT FROM AUTHOR]

The refinement of thyroid surgery has become a standardized requirement and a symbol of improved technical level in thyroid surgery. Endoscopic equipment magnifies the surgical field of view in high definition, making it more conducive to perform the surgery meticulously. Here we explored the key points of refined surgery based on the technical points of endoscopic thyroid surgery. We also focused on the establishment of endoscopic operation space, exposure of thyroid tumors, and protection of key organs and tissues. With regard to the establishment of endoscopic operation space, the separation of subcutaneous layer should show the view of “red sky and yellow ground”, which means the gap between the platysma muscle and the deep layer of the superficial fascia. The subcutaneous dissection area should be present as “long tunnel, small cavity”, and the shape from the bilateral sternoclavicular joints to the bilateral areola, which seems like the fan-shape with “thin neck and wide bottom”. With regard to the exposure of thyroid tumors, the key technical points include the dissociating and traction of anterior cervical muscles. Three spaces [the median space (the white line space of the neck), the inner space (the space between the thyroid surgical capsule and the anterior cervical muscles) and the outer space (the space between the anterior cervical muscles and the sternocleidomastoid muscle)] need to be fully dissociated. Furthermore, the assistant with special sutures or hooks to fully dissociate the anterior cervical space and the use of a reasonable grasping method as well as a suitable energy platform to prevent thyroid bleeding. With regard to the protection of key organs and tissues, nerve monitoring technology helps to find and locate the recurrent laryngeal nerve. In addition, careful manipulation at the entrance to the larynx is the key to avoid the damage of recurrent laryngeal nerve. Lymph negative imaging techno-logy helps to identify the parathyroid gland. Accurate identification of the anatomical type of the parathyroid gland and meticulous dissection of the intermembrane space of the parathyroid gland is benefit to protect the blood supply of the parathyroid gland in situ. To achieve the refinement and minimally invasive surgery, it is necessary to improve the surgical instruments and materials. What is more important, surgeons should update their surgical concepts, be well acquainted with anatomical relationships and constantly improve surgical techniques.

Purpose This study aimed to evaluate the US features of the parathyroid glands (PTGs) using surgical specimens of normal PTGs obtained during thyroid surgery. Materials and Methods This study included 34 normal PTGs from 17 consecutive patients who underwent thyroid surgery between December 2020 and March 2021. All normal PTGs were histologically confirmed by intraoperative frozen-section biopsy for autotransplantation. Surgically resected parathyroid specimens were scanned in sterile normal saline using high-resolution US prior to autotransplantation. The US features of echogenicity (hyperechogenicity or hypoechogenicity), echotexture (homogeneous or heterogeneous), size, and shape (ovoid or round) were retrospectively evaluated. The echogenicity of the three PTGs was compared with that of the thyroid parenchyma of the resected thyroid specimens in two patients. Results All PTGs showed hyperechogenicity similar to that of gauze soaked in normal saline. Homogeneous hyperechogenicity was observed in 32/34 (94.1%) patients, and the echogenicity of the three PTGs was hyperechoic compared with that of the thyroid parenchyma. The long diameter of the PTGs ranged from 5.1 mm to 9.8 mm (mean, 7.1 mm) and the shape of the PTGs was ovoid in 33/34 (97.1%) patients. Conclusion The echogenicity of normal PTG specimens was consistently hyperechoic, and the small ovoid homogeneously hyperechoic structure was a characteristic US feature of the PTGs.

Background: The published rate of incidental parathyroidectomy (IP) during thyroid surgery varies between 5.8% and 29%. The risk factors and clinical significance of postoperative transient hypocalcemia and permanent hypoparathyroidism are still debated. The aims of this study were to assess the clinical relevance of avoidable IP for transient hypocalcemia and permanent hypoparathyroidism, and to describe the risk factors for IP. Methods: This retrospective cohort study included 1,537 patients who had a one-step total thyroidectomy in a high-volume endocrine surgery center between 2018 and 2019. Pathology reports were reviewed for incidentally removed parathyroid glands. Intrathyroidal parathyroid glands were excluded from the study. Demographic characteristics, potential risk factors, and postoperative calcium and PTH levels were compared between IP and control groups. Results: Avoidable IP occurred in 234 (15.2%) patients. Patients with IP had a higher risk of transient hypocalcemia (17.9% vs. 11.5%, p = 0.006; odds ratio [OR] 1.68, 95% confidence interval [95% CI]1.16–2.45) and permanent hypoparathyroidism (4.7% vs. 1.6%, p = 0.002; OR 3.01, 95% CI 1.29–6.63) than patients without IP. Multivariate analysis showed that central lymph node dissection (CLND) and incidental removal of thymus tissue were independent risk factors for IP (OR 4.83, 95% CI 2.71–8.86, p < 0.001 and OR 1.72, 95% CI 1.02–2.82, p = 0.038). Conclusions: Patients with IP were more likely to develop transient hypocalcemia and permanent hypoparathyroidism, indicating the clinical significance of avoidable IP for patients and the need for raising awareness among surgeons. Patients undergoing CLND are at a higher risk for IP, and should be adequately informed and treated. Any removal of thymus tissue should be avoided during CLND. [ABSTRACT FROM AUTHOR]

Serum calcium homeostasis is mainly regulated by parathormone (PTH) secreted by the parathyroid gland. Besides PTH and Gcm2, a master gene for parathyroid differentiation, many genes are expressed in the gland. Especially, calcium-sensing receptor (CaSR), vitamin D receptor (VDR), and Klotho function to prevent increased secretion of PTH and hyperplasia of the parathyroid gland under chronic hypocalcemia. Parathyroid-specific dual deletion of Klotho and CaSR induces a marked enlargement of the glandular size. The parathyroid develops from the third and fourth pharyngeal pouches except murine species in which the gland is derived from the third pouch only. The development of the murine parathyroid gland is categorized as follows: (1) formation and differentiation of the pharyngeal pouches, (2) appearance of parathyroid domain in the third pharyngeal pouch together with thymus domain, (3) migration of parathyroid primordium attached to the top of thymus, and (4) contact with the thyroid lobe and separation from the thymus. The transcription factors and signaling molecules involved in each of these developmental stages are elaborated. In addition, mesenchymal neural crest cells surrounding the pharyngeal pouches and parathyroid primordium and invading the parathyroid parenchyma participate in the development of the gland. [ABSTRACT FROM AUTHOR]

Background: To investigate the application value of 980-nm/1470-nm dual-wavelength fiber laser in thyroidectomy. Methods: The clinical data of 130 patients undergoing thyroid surgery from March 2017 to December 2018 were retrospectively analyzed. According to the use types of energy devices, the patients were divided into laser group and ultrasonic scalpel group, with 65 patients in each group. The baseline data, operation-related indicators, operation complications, postoperative pathological conditions, and follow-up results of the two groups were compared. Results: The operations were successfully completed in both groups. The median operative time of total thyroidectomy (TT), lobectomy+central lymph node dissection (CLND), TT+CLND in the laser group were longer than that in the harmonic scalpel group, and the difference was statistically significant (p < 0.05). The incidence of parathyroid gland congestion in the laser group (10.3%) was lower than that in the harmonic scalpel group (19.2%), and the difference was statistically significant (p < 0.05). No significant differences were found in operative type, intraoperative blood loss, postoperative drainage volume, operative complications, postoperative hospital stay, and lymph node metastasis rate between the two groups (p > 0.05). No incidence was noted of recurrence, metastasis, or death in both groups. Conclusions: The 980-nm/1470-nm dual-wavelength fiber laser had an efficacy in open thyroidectomy similar to that of the harmonic scalpel, was safe and feasible, and less damage to the parathyroid gland blood supply than a scalpel. It can be used as a new option for thyroid surgery. [ABSTRACT FROM AUTHOR]

Objective: Multiple endocrine neoplasia type 4 (MEN4) is caused by a CDKN1B germline mutation first described in 2006. Its estimated prevalence is le ss than one per million. The aim of this study was to define the disease characteristics. Methods: A systematic review was performed according to the PRISMA 2020 criteria. A literature search from January 2006 to August 2022 was done using MEDLINE® and Web of ScienceTM. Results: Forty-eight symptomatic patients fulfilled the pre-defined eligi bility criteria. Twenty-eight different CDKN1B variants, mostly missense (21/48, 44%) and frameshift mutations (17/48, 35%), were reported. The majority of patients were women (36/48, 75%). Men became symptomatic at a median age of 32.5 years (ran ge 10–68, mean 33.7 ± 23), whereas the same event was recorded for women at a media n age of 49.5 years (range 5–76, mean 44.8 ± 19.9) (P = 0.25). The most frequently affected endocrine organ was the parathyroid gland (36/48, 75%; uniglandular disease 31/36, 86%), followed by the pituitary gland (21/48, 44%; hormone-secreting 16/21, 76%), the endocrine pancreas (7/48, 15%), and the thyroid gland (4/48, 8%). Tumors of the ad renal glands and thymus were found in three and two patients, respectively. The present ing first endocrine pathology concerned the parathyroid (27/48, 56%) and the pituit ary gland (11/48, 23%). There were one (27/48, 56%), two (13/48, 27%), three (3/48, 6%), or four (5/48, 10%) syn-or metachronously affected endocrine organs in a single patient, respectively. Conclusion: MEN4 is an extremely rare disease, which most frequently affect s women around 50 years of age. Primary hyperparathyroidism as a unigla ndular disease is the leading pathology.

Introduction: Following total parathyroidectomy (PTx), transcervical thymectomy, and forearm autograft for secondary hyperparathyroidism (SHPT), recurrent SHPT can occur in the autografted forearm. However, few studies have investigated the factors contributing to re-PTx due to autograft-dependent recurrent SHPT before the completion of the initial PTx. Methods: A total of 770 patients who had autografted parathyroid fragments derived from only one of the resected parathyroid glands (PTGs) and who had undergone successful initial total PTx and transcervical thymectomy--defined by serum intact parathyroid hormone level < 60 pg/mL on postoperative day 1--between January 2001 and December 2022 were included in this retrospective cohort study. Factors contributing to re-PTx due to graft-dependent recurrent SHPT before the completion of the initial PTx were investigated using multivariate Cox regression analysis. Receiver operating characteristic (ROC) curve analysis was performed to obtain the optimal maximum diameter of PTG for autograft. Results: Univariate analysis showed that dialysis vintage and maximum diameter and weight of the PTG for autograft were significant factors contributing to graft-dependent recurrent SHPT. However, multivariate analysis revealed that dialysis vintage (P=0.010; hazard ratio [HR], 0.995; 95% confidence interval [CI], 0.992-0.999) and the maximum diameter of the PTG for autograft (P=0.046; HR, 1.107; 95% CI, 1.002-1.224) significantly contributed to graft-dependent recurrent SHPT. ROC curve analysis showed that < 14 mm was the optimal maximum diameter of PTG for autograft (area under the curve, 0.628; 95% CI, 0.551-0.705). Conclusions: The dialysis vintage and maximum diameter of PTG for autograft may contribute to re-PTx due to autograft-dependent recurrent SHPT, which can be prevented by using PTGs with a maximum diameter of < 14 mm for autograft. [ABSTRACT FROM AUTHOR]

The accurate detection of parathyroid glands (PGs) during surgery is of great significance in thyroidectomy and parathyroidectomy, which protects the function of normal PGs to prevent postoperative hypoparathyroidism and the thorough removal of parathyroid lesions. Existing conventional imaging techniques have certain limitations in the real-time exploration of PGs. In recent years, a new, real-time, and non-invasive imaging system known as the near-infrared autofluorescence (NIRAF) imaging system has been developed to detect PGs. Several studies have confirmed that this system has a high parathyroid recognition rate and can reduce the occurrence of transient hypoparathyroidism after surgery. The NIRAF imaging system, like a magic mirror, can monitor the PGs during surgery in real time, thus providing great support for surgeries. In addition, the NIRAF imaging system can evaluate the blood supply of PGs by utilizing indocyanine green (ICG) to guide surgical strategies. The NIRAF imaging system and ICG complement each other to protect normal parathyroid function and reduce postoperative complications. This article reviews the effectiveness of the NIRAF imaging system in thyroidectomies and parathyroidectomies and briefly discusses some existing problems and prospects for the future. [ABSTRACT FROM AUTHOR]

Purpose This study aimed to evaluate the US features of the parathyroid glands (PTGs) using surgical specimens of normal PTGs obtained during thyroid surgery. Materials and Methods This study included 34 normal PTGs from 17 consecutive patients who underwent thyroid surgery between December 2020 and March 2021. All normal PTGs were histologically confirmed by intraoperative frozen-section biopsy for autotransplantation. Surgically resected parathyroid specimens were scanned in sterile normal saline using high-resolution US prior to autotransplantation. The US features of echogenicity (hyperechogenicity or hypoechogenicity), echotexture (homogeneous or heterogeneous), size, and shape (ovoid or round) were retrospectively evaluated. The echogenicity of the three PTGs was compared with that of the thyroid parenchyma of the resected thyroid specimens in two patients. Results All PTGs showed hyperechogenicity similar to that of gauze soaked in normal saline. Homogeneous hyperechogenicity was observed in 32/34 (94.1%) patients, and the echogenicity of the three PTGs was hyperechoic compared with that of the thyroid parenchyma. The long diameter of the PTGs ranged from 5.1 mm to 9.8 mm (mean, 7.1 mm) and the shape of the PTGs was ovoid in 33/34 (97.1%) patients. Conclusion The echogenicity of normal PTG specimens was consistently hyperechoic, and the small ovoid homogeneously hyperechoic structure was a characteristic US feature of the PTGs. [ABSTRACT FROM AUTHOR]

Parathyroid gland lesions in anurans are infrequently reported and most often occur secondary to experimental interventions. Husbandry-related parathyroid changes have not been documented in this order of Amphibia. Three American bullfrogs (Lithobates catesbeianus) living in a captive colony were euthanized due to clinical concern for metabolic bone disease secondary to lack of consistent dietary supplementation with vitamin D 3. Necropsy revealed cystic dilation and variable proliferation of unidentified structures within the cranial coelom corresponding to the anatomical location of anuran parathyroid glands. Histologically, the structures consisted of sheets and whorls of elongated cells. Immunohistochemistry for pan-cytokeratin revealed strong cytoplasmic staining and Grimelius staining identified neuroendocrine granules in the elongated cells of these structures, supportive of a parathyroid origin. [ABSTRACT FROM AUTHOR]

Background: Near-infrared light can penetrate the fat or connective tissues overlying the parathyroid gland (PG), enabling early localization of the PG by near-infrared autofluorescence (NIRAF) imaging. However, the depth at which the PG can be detected has not been reported. In this study, we investigated the detectable depth of unexposed PGs using NIRAF during thyroidectomy. Materials and methods: Fifty-one unexposed PGs from 30 consecutive thyroidectomy patients, mapped by an experienced surgeon (K.D. Lee) with the use of NIRAF imaging, were included. For NIRAF detection of PGs, a lab-built camera imaging system was used. Detectable depths of the unexposed PGs were measured using a Vernier caliper. The NIRAF images were classified as faint or bright depending on whether a novice could successfully interpret the image as showing the PG. Data on variables that may affect detectable depth and NIRAF intensity were collected. Results: Detectable depth ranged between 0.35 and 3.05mm, with amean of 1.23 ± 0.73 mm. The average NIRAF intensity of unexposed PGs was 3.13 au. After dissection of the overlying tissue, the intensity of the exposed PG increased to 4.88 au (p < 0.001). No difference in NIRAF intensity between fat-covered (3.27 ± 0.90 au) and connective tissue-covered PGs (3.00 ± 1.23 au) was observed (p = 0.369). PGs covered by fat tissue (depth: 1.77 ± 0.67 mm) were found at deeper locations than those covered by connective tissue (depth: 0.70 ± 0.21 mm) (p < 0.001). The brightness of images of the faint group (2.14 ± 0.48 au) was on average 1.24 au lower than that of the bright group (3.38 ± 1.04 au) (p = 0.001). A novice successfully localized 80.4% of the unexposed PGs. Other variables did not significantly affect detectable depth. Conclusion: Unexposed PGs could be mapped using NIRAF imaging at a maximum depth of 3.05 mm and an average depth of 1.23 mm. A novice was able to localize the PGs before they were visible to the naked eye at a high rate. These results can be used as reference data for localization of unexposed PGs in thyroid surgery. [ABSTRACT FROM AUTHOR]

Surgical resection remains the most effective treatment of papillary thyroid carcinoma at present, and it is crucial to make the optimal extent of lymph node dissection as well as to reduce the incidence of surgical complications. Carbon nanoparticles have played an important role as a new generation developer in protecting parathyroid glands and tracing lymph nodes during papillary thyroid carcinoma surgery. Many studies have been reported in recent years, but the application value of carbon nanoparticles has not been definitely confirmed. In this review, the application progress of carbon nanoparticles in papillary thyroid carcinoma surgery is summarized to provide further reference for optimizing surgical treatment strategies. [ABSTRACT FROM AUTHOR]

BackgroundThe risk factors for hypoparathyroidism after thyroid surgery have not been fully identified. This study analyzes the risk factors of hypoparathyroidism before and after total thyroidectomy.MethodsWe retrospectively collected the clinical data of 289 patients who underwent total thyroidectomy at the Thyroid Surgery Center of Lishui Central Hospital from June 2018 to June 2020. For the anatomy and protection of parathyroid glands during the operation, one group of patients used the parathyroid avoidance method, and the other group used the active exploration method. Various risk factors affecting parathyroid dysfunction were studied using logistic regression models.ResultsA total of 289 patients were included in this study. The average age of patients was 47.21 ± 11.78 years, including 57 males (19.7%) and 232 females (80.3%). There were 149 (51.6%) patients with transient hypoparathyroidism and 21 (7.3%) with permanent hypoparathyroidism. The main risk factors of hypoparathyroidism were parathyroid avoidance method (P = 0.005), parathyroid autotransplantation (P = 0.011), bilateral central neck lymph node dissection (CND) (P = 0.001), lymphatic metastasis (P = 0.039), and parathyroid in the specimen (P = 0.029). The main risk factors associated with permanent hypoparathyroidism were bilateral CND (P = 0.038), lymphatic metastasis (P = 0.047), parathyroid hormone (PTH)

Abstract Objective We investigated the factors affecting postoperative parathyroid gland (PTG) function and devised an objective index to predict the postoperative PTG function during total thyroidectomy. Method This was a retrospective clinical review of 21 consecutive patients who were diagnosed with papillary thyroid carcinoma and underwent total thyroidectomy. The maximum intensity ratio (MIR) was determined as the maximum fluorescence intensity after ICG injection divided by the intensity before ICG injection. Results Postoperative hypoparathyroidism is significantly associated with simultaneous central neck dissection (CND) and lateral neck dissection (LND) (p = .032). The Spearman correlation test showed a moderate correlation between the MIR and iPTH levels (p = .0047). The optimal MIR cutoff value for predicting postoperative hypoparathyroidism was 2.14 with area under the curve = 0.904 (sensitivity: 0.769 and specificity: 1.00). Conclusion CND + LND was significantly associated with postoperative hypoparathyroidism. MIR was found useful in predicting the postoperative PTG function. Level of Evidence: 3b.

Background Prediction of postoperative hypocalcemia is a fundamental issue in thyroidectomy. Indocyanine green (ICG) angiography of parathyroid glands is a feasible method to detect the perfusion of parathyroid glands and predict postoperative hypocalcemia. Materials and Methods A prospective observational study was conducted at Ain Shams University Hospitals between April 2018 and April 2021. The included cases of total thyroidectomy underwent intraoperative ICG fluorescence angiography to identify the four parathyroid glands and score each gland according to the viability. Patients in which less than four glands were identified were excluded. Intraoperative intact parathyroid hormone (ioPTH) level assay was also measured to compare with ICG in predicting postoperative transient hypocalcemia. Results A total of 134 cases underwent total thyroidectomy during the study period. We could identify the four parathyroid glands in 90 patients, including them in the study. We had postoperative hypocalcemia in 28 cases (31.1%). The diagnostic accuracy of ICG angiography and ioPTH level assay was high and almost similar (82.22% versus 87.78%). Both were higher than the surgeons’ diagnostic accuracy of visual inspection (62.22%). Conclusions ICG angiography of the parathyroid gland is a safe, reliable predictor for postoperative transient hypocalcemia with a high and almost similar accuracy compared to intraoperative parathyroid hormone level.