scholarly journals PROBABILITY OF CANCER DETECTION DURING REPEATED OPERATIONS IN PATIENTS WITH BENIGN THYROID DISEASES

2019 ◽  
Vol 21 (1) ◽  
pp. 94-98
Author(s):  
A F Romanchishen ◽  
A V Gostimsky ◽  
A L Akinchev ◽  
I V Karpatsky
Keyword(s):  
Malignant Lesion ◽  
Needle Aspiration ◽  
Thyroid Diseases ◽  
Endocrine Surgery ◽  
Thyroid Remnant ◽  
Recurrent Goiter ◽  
Surgical Tactics ◽  
Toxic Goiter ◽  
Probability Of Cancer ◽  
Benign Thyroid

Introduction. Suspected malignant growth in patients with recurrent goiter is one of the main causes of repeated operations. Focuses of carcinoma can be detected in patients operated on for multinodular goiter with compression of the organs of the neck, recurrent diffuse toxic goiter. Objective of investigation is to assess the risk of a malignant lesion of the thyroid remnant in patients with recurrent goiter, to justify the surgical tactics in this group of patients. Material and methods. In the St. Petersburg Center of Endocrine Surgery and Oncology 28138 patients with various thyroid diseases were operated on for the period from 1973 till 2016. Results. In a retrospective analysis of the group consisting of 1106 patients with recurrent goiter, a new thyroid disease was detected in 156 (14.1%) cases. Thyroid cancer in thyroid remnant was detected in 57 (36.5%) cases or 5.2% of all the patients with recurrent goiter. The work describes the risk of malignant lesion of the thyroid remnant in patients with recurrent goiter and surgical tactics in this group of patients. Conclusion. Cancer of the thyroid gland, as a new disease of the thyroid remnant, in patients previously operated on for benign thyroid pathology, is found in 5.2% of observations. The possibilities of fine-needle aspiration biopsy in this group are reduced. Active surgical tactics in cases of multinodular transformation of the thyroid remnant is justified. The operation of choice is reresection up to thyroidectomy. Careful intraoperative study of removed tissue and close cooperation with the morphological service helps to reduce the number of diagnostic and tactical errors in patients with both recurrent and ordinary multi-node goiter.

scholarly journals Epidemiology and results of surgical treatment of euthyroid and toxic goiter depending on the peculiarities of clinical course, tracheal compression and comorbidity

2020 ◽  
Vol 66 (1) ◽  
pp. 87-92
Author(s):  
Elena A. Ilyicheva ◽  
Gleb A. Bersenev ◽  
Valeriy N. Makhutov ◽  
Gennadiy Yu. Aldaranov ◽  
Eugene G. Grigoryev
Keyword(s):  
Pulmonary Hypertension ◽  
Surgical Treatment ◽  
Thyroid Gland ◽  
Multinodular Goiter ◽  
Thyroid Diseases ◽  
External Respiration ◽  
Tracheal Compression ◽  
Toxic Goiter ◽  
Endocrine Surgeon ◽  
Benign Thyroid

BACKGROUND: At the time of seeking medical help, some patients have nodular/multinodular goiter of large and gigantic sizes, which leads to compression of the neck organs. In the structure of benign diseases, neck compression is diagnosed in 10% of cases, and tracheal narrowing is found in 84% of patients in this group. It was experimentally established that narrowing of the trachea leads to the development of hypertension in the pulmonary circulation. Patients with nodular/multinodular goiter with compression of the neck organs belong to the age group of 50 years and older, the peculiarity of which is comorbidity of varying severity. Cardiopulmonary syndromes may mask compression of the organs of the neck by the thyroid gland. As a rule, patients come and/or go to a cardiologist, pulmonologist, gastroenterologist and other specialists, as a result of which the timelines for timely surgical treatment are missed. Often, patients are delivered to the endocrine surgeon urgently due to the development of asphyxiation. The symptoms of impaired external respiration and the initial manifestations of pulmonary hypertension, as a result of compression syndrome, preceding this condition are evaluated only retrospectively. AIMS: To study the frequency of tracheal compression and symptoms of chronic hypoxia in the structure of benign thyroid diseases requiring surgical treatment, as well as an assessment of the nature of comorbid pathology and the results of surgical treatment. METHODS: A retrospective analysis of the results of surgical treatment of benign thyroid diseases for the period from March to August 2019 was carried out (100 observations). RESULTS: Toxic goiter prevailed in the structure of benign thyroid diseases (74%). Tracheal compression was observed in 69% of cases. When trachea was compressed, arterial hypertension statistically significantly prevailed (2, p0.01). The appearance of wheezing on inhalation/exhalation and an increase in its frequency were detected when the trachea narrowed to the thyroid gland to 10 mm or less in 10 cases (10%) with a statistically significant prevalence of pulmonary hypertension (2, p0.01). Thyroidectomy prevailed in the structure of operations (80%). There was no statistically significant increase in surgical complications depending on the severity of tracheal compression, age, and concomitant pathology. There were no fatal outcomes. CONCLUSIONS: Surgical treatment of patients with benign thyroid diseases complicated by compression of the neck organs is also shown safely regardless of age and associated pathology.

scholarly journals Evaluation of Total Thyroidectomy for Treatment of Benign Diseases of Thyroid Gland

2020 ◽  
Vol 8 (B) ◽  
pp. 166-170
Author(s):  
Risto Cholancheski ◽  
Natasha Tolevska ◽  
Ardit Qafjani ◽  
Ilir Vela ◽  
Borislav Kondov ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Total Thyroidectomy ◽  
Nerve Palsy ◽  
Laryngeal Nerve ◽  
Thyroid Diseases ◽  
Recurrent Nerve ◽  
Recurrent Nerve Palsy ◽  
Laryngeal Nerve Palsy ◽  
Toxic Goiter ◽  
Benign Thyroid

BACKGROUND: The controversy of using total thyroidectomy (TT) in treatment of benign thyroid diseases still remains controversial over the rates of complication, mostly recurrence nerve palsy and hypocalcemia, compared to non-total thyroidectomies. The latest reports in this field of research showed that that the number of complications of TT is decreasing as the skills of surgeons increase. AIM: In this study, we reviewed 209 cases of total thyroidectomies for benign thyroid diseases where such surgery was indicated. The results were evaluated whether they support the previous reports that TT is save method of treatment of diffuse multinodular goiters, Graves’ disease thyroid adenomas with diffuse goiters and thyroiditis. METHODS: Two hundred and nine patients, 36 males and 173 females, medium age 47 (17–77) operated with TT between 2016 and 2018 were included in the evaluation study. We evaluated the: Diagnosis, indications for operation, pre-operative medication administration, laryngeal recurrent nerve palsy, hypocalcemia, hypoparathyroidism, and patohistology findings. The follow-up for hypocalcemia and laryngeal nerve palsy was performed 1 year postoperatively. RESULTS: The age of the patients was between 17 and 77 years, medium-range 47 years old. Of 209 patients, 173 (83%) were female and 36 (17%) male with a gender ratio of 1:4.8 males to females. Diagnoses before surgery were established as follows: Multinodular euthyroid goiter (MNEG) n = 106 (48.80%), multinodular toxic goiter n = 12 (5.74%), Graves’s disease n = 6 (2.87%), adenoma with multinodular goiter n = 73 (34.92%), and n = 16 (7.65%) patients with thyroiditis. Recurrence laryngeal nerve palsy (RLNP) occurred in 6 patients (2.87%), temporary within 3 months after the operation in 4 patients (1.92%) and permanent palsy within 6 months and more after an operation in 2 patients (0.95%). Voice hoarseness immediately and within 1 month after the operation was registered in 32 patients (15.3%). RLNP and hoarseness were registered mostly in patients with pre-operative problems, mostly with extra big MNEG. One of the permanent injuries of RLN was bilateral and all others were one sided. All patients were operated with normal pre-operative vocal cord movement findings. Post-operative hypocalcemia was registered in 35 patients (16.74%). Temporary nonsignificant hypocalcemia in 10 (4.78%), temporary significant hypocalcemia in 17 (8.13%), temporary severe hypocalcemia in 6 patients (2.87%), and permanent hypocalcemia in 2 patients (0.95%). CONCLUSION: Many studies have shown that the rate of complications is almost even for TT and NTT done for benign and malignant diseases of thyroid gland. Our data have shown that the risk of post-operative complications with TT is proportional to the number of complicated pre-operative findings of benign thyroid glands.

Mean Platelet Volume as a Biomarker for Thyroid Carcinoma

2016 ◽  
Vol 101 (1-2) ◽  
pp. 50-53 ◽  
Author(s):  
Zulfu Bayhan ◽  
Sezgin Zeren ◽  
Isa Ozbay ◽  
Cuneyt Kahraman ◽  
Faik Yaylak ◽  
...  
Keyword(s):  
Platelet Count ◽  
Platelet Activation ◽  
Mean Platelet Volume ◽  
Thyroid Diseases ◽  
Hemoglobin Level ◽  
Endocrine Surgery ◽  
Platelet Volume ◽  
Wbc Count ◽  
Thyroid Malignancies ◽  
Benign Thyroid

This study aimed to determine the relationship between mean platelet volume (MPV) and thyroid malignancy by comparing patients who underwent surgery for benign or malignant thyroid diseases. MPV is a useful early indicator of platelet activation. Platelets differ in terms of functional activity and size. Large platelets are relatively new, more reactive, and produce more thrombogenic factors. Therefore, in conditions that involve increased platelet activation, an increase in the proportion of young platelets and MPV is expected. This study involved 146 patients who underwent total thyroidectomy because of benign (99 patients) or malignant (47 patients) diseases of the thyroid. Data on age, sex, MPV, white blood cell (WBC) count, hemoglobin level, and platelet count were collected retrospectively. MPV was significantly higher in patients with malignant thyroid diseases than in those with benign thyroid diseases. Age, sex, hemoglobin level, WBC count, and platelet count did not significantly differ between the 2 groups. MPV was significantly higher in patients with thyroid malignancies than in patients with benign thyroid diseases. We propose that MPV might be an important predictive factor for thyroid malignancies. Further prospective studies with a larger number of patients in high-volume endocrine surgery centers are required to confirm our findings.

scholarly journals Diagnostic Accuracy of FNAC Diagnosed Benign Thyroid Lesions Compared with Post-Operative Histopathology Results

2020 ◽  
Vol 28 (2) ◽  
pp. 161-165
Author(s):  
Santosh UP ◽  
Shreelakshmi V ◽  
Sanjay VC
Keyword(s):  
Diagnostic Accuracy ◽  
Histopathological Examination ◽  
Thyroid Function Test ◽  
Needle Aspiration ◽  
Thyroid Diseases ◽  
Diagnostic Tools ◽  
Age Group ◽  
Thyroid Malignancy ◽  
Nodular Goitre ◽  
Benign Thyroid

Introduction Fine Needle Aspiration Cytology (FNAC) is one of the important diagnostic tools in diagnosing the thyroid diseases, however incidental thyroid malignancies among patients operated for a benign thyroid disease is not infrequent. The incidence ranges between 3 and 16%. The clinical significance of these tumours cannot be ignored once a correct staging has been carried out. The objectives of this study were to assess the diagnostic accuracy of FNAC of Thyroid gland and to know the incidence of incidental thyroid malignancy.   Materials and Methods This was a prospective study conducted from August 2018 to December 2019, after taking institutional ethical clearance, with a study population of 72 patients with thyroid swelling of either sex between age group (18-72yrs). Pre operative FNAC was done and underwent thyroid surgery in our hospital. Post operative thyroid specimen were sent for histopathological examination. All reports were collected and analyzed statistically.   Results Total 72 patients were included within age group of 18-72yrs among them, 8 were males and 64 were females having biologically normal thyroid function test. FNAC was showed 91% sensitivity and 68% specificity in diagnosing the colloid goiter and also 62% sensitivity and 75% specificity in diagnosing the nodular goitre. However, 8(11.1%) patients were showing incidental thyroid malignancy postoperatively.   Conclusion FNAC is an effective tool in diagnosing the thyroid diseases; however incidental thyroid malignancy should also be considered and correlated with clinical diagnosis.  

Guideline for radioiodine therapy for benign thyroid diseases (version 3)

2004 ◽  
Vol 43 (06) ◽  
pp. 217-220 ◽  
Author(s):  
J. Dressler ◽  
F. Grünwald ◽  
B. Leisner ◽  
E. Moser ◽  
Chr. Reiners ◽  
...  
Keyword(s):  
Radioiodine Therapy ◽  
Thyroid Volume ◽  
Thyroid Diseases ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Co Morbidity ◽  
History Of ◽  
Individual Decisions ◽  
Prophylactic Use ◽  
Benign Thyroid

SummaryThe version 3 of the guideline for radioiodine therapy for benign thyroid diseases presents first of all a revision of the version 2. The chapter indication for radioiodine therapy, surgical treatment or antithyroid drugs bases on an interdisciplinary consensus. The manifold criteria for decision making consider the entity of thyroid disease (autonomy, Graves’ disease, goitre, goitre recurrence), the thyroid volume, suspicion of malignancy, cystic nodules, risk of surgery and co-morbidity, history of subtotal thyroidectomy, persistent or recurrent thyrotoxicosis caused by Graves’ disease including known risk factors for relapse, compression of the trachea caused by goitre, requirement of direct therapeutic effect as well as the patient’s preference. Because often some of these criteria are relevant, the guideline offers the necessary flexibility for individual decisions. Further topics are patients’ preparation, counseling, dosage concepts, procedural details, results, side effects and follow-up care. The prophylactic use of glucocorticoids during radioiodine therapy in patients without preexisting ophthalmopathy as well as dosage and duration of glucocorticoid medication in patients with preexisting ophthalmopathy need to be clarified in further studies. The pragmatic recommendations for the combined use of radioiodine and glucocorticoids remained unchanged in the 3rd version.

scholarly journals Follow-up of Benign Thyroid Nodules—Can We Do Less?

2019 ◽  
Vol 70 (1) ◽  
pp. 62-67 ◽  
Author(s):  
Manijeh Mohammadi ◽  
Carrie Betel ◽  
Kirsteen Rennie Burton ◽  
Kevin McLughlin Higgins ◽  
Zeina Ghorab ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
Thyroid Nodules ◽  
Descriptive Study ◽  
Needle Aspiration ◽  
Thyroid Malignancy ◽  
Fine Needle ◽  
Nodule Size ◽  
Benign Thyroid Nodules ◽  
Benign Thyroid

Objective To determine the incidence of malignancy, follow-up ultrasound (US), and repeat fine needle aspiration (FNA) in thyroid nodules that have been previously biopsied as benign. Methods This is a retrospective, descriptive study of benign thyroid nodules evaluated by US between 2010-2011. We determined the frequency of follow-up ultrasounds and FNAs, mean years of follow-up, interval between follow-up US, change in nodule size, reasons for repeat FNA (rFNA), frequency of thyroidectomy, and thyroid malignancy during 5 years of follow-up. Results A total of 733 benign thyroid nodules were reviewed in 615 patients. Mean years of US follow-up was 3.47 ± 1.65 years; 275 (37.5%) had no follow-up US; 109 (14.9%) had 1 follow-up US; 93 (12.7%) had 2 follow-up US; and 256 (34.9%) had 3 or more follow-up US. Assessment of thyroid nodule size showed that 215 (28.8%) nodules decreased in size, 145 (19.4%) increased in size by less than 50%, and 91 (12.1%) increased in size by more than 50%. Of the 733 nodules, 17 nodules (2.3%) underwent thyroidectomy for which the pathology result of 9 (1.2%) showed malignancy, and 65 (8.9%) thyroid nodules underwent rFNA. When applying the 2015 recommendations for repeat FNA, 35% were done unnecessarily. Conclusion In our sample of initially benign thyroid nodules, only 9 patients (1.2%) had pathology-proven malignancy after a mean follow-up of 3.5 years. Over 30% of patients had more than 3 rUSs. Decreased interval and frequency of rUS should be considered in future guidelines for thyroid management.

Molecular alterations in Hürthle cell nodules and preoperative cancer risk

2021 ◽  
Vol 28 (5) ◽  
pp. 301-309
Author(s):  
William R Doerfler ◽  
Alyaksandr V Nikitski ◽  
Elena M Morariu ◽  
N Paul Ohori ◽  
Simion I Chiosea ◽  
...  
Keyword(s):  
Distinct Type ◽  
Needle Aspiration ◽  
Copy Number Alterations ◽  
Cancer Rate ◽  
Nodule Size ◽  
Molecular Alterations ◽  
Hürthle Cell ◽  
Dna Copy Number Alterations ◽  
Probability Of Cancer ◽  
Generation Sequencing

Hürthle cell carcinoma (HCC) is a distinct type of thyroid cancer genetically characterized by DNA copy number alterations (CNA), typically of genome haploidization type (GH-type). However, whether CNA also occurs in benign Hürthle cell adenomas (HCA) or Hürthle cell hyperplastic nodules (HCHN), and have diagnostic impact in fine-needle aspiration (FNA) samples, remains unknown. To address these questions, we (1) analyzed 26 HCC, 24 HCA, and 8 HCHN tissues for CNA and other mutations using ThyroSeq v3 (TSv3) next-generation sequencing panel, and (2) determined cancer rate in 111 FNA samples with CNA and known surgical outcome. We identified CNA, more often of the GH-type, in 81% of HCC and in 38% HCA, but not in HCHN. Among four HCC with distant metastasis, all had CNA and three TERT mutations. Overall, positive TSv3 results were obtained in 24 (92%) HCC, including all with ATA high risk of recurrence or metastasis. Among 111 FNA cases with CNA, 38 (34%) were malignant and 73 (66%) benign. A significant correlation between cancer rate and nodule size was observed, particularly among cases with GH-type CNA, where every additional centimeter of nodule size increased the malignancy odds by 1.9 (95% CI 1.3–2.7; P = 0.001). In summary, the results of this study demonstrate that CNA characteristic of HCC also occur in HCA, although with lower frequency, and probability of cancer in nodules with CNA increases with nodule size. Detection of CNA, in conjunction with other mutations and nodule size, is helpful in predicting malignancy in thyroid nodules.

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