The Correlation of age and gender with prevalence of histopathological patterns of thyroid diseases among Iraqi patients

Objectives: The aim of this study was to investigate the prevalence of histopathological patterns of thyroid lesions and their relation to age and gender in patients underwent total or near total and partial thyroidectomy. Methods: 430 biopsy blocks examined for patients who had undergone total or near total and partial thyroidectomy for both non-neoplastic and neoplastic thyroid lesions, between January 2018 to December 2020 at Surgical Department, Medical city, Baghdad, Iraq. Results: Out of 430 thyroidectomy specimens, 275 (64%) cases of non-neoplastic lesions, and 155 (36%) cases of neoplastic lesions were present. There were 63 males and 367 females with a male to female ratio of 1:5.6. The age ranged in males from 12 to 83 years with a mean age of 47.5 years and the age ranged in females from 10-68 years with a mean age of 39 years. In non-neoplastic lesions, the predominant lesion was the nodular hyperplasia with 233 (84.7%) cases followed by Hashimoto thyroiditis with 24 (8.7%) . In neoplastic lesions, papillary carcinoma was the commonest lesion with 98 (63.2%) cases followed by follicular carcinoma with 11 (7%) cases. Conclusion : Nodular colloid goiter was the most common non –neoplastic lesion with female predominance . Papillary carcinoma was the most frequent thyroid cancer accounting for 84.4% of thyroid cancers. with micropapillary variant making 44.89 % with most cases occurring in the third and forth decade.There appears to be a slightly increased trend of papillary carcinoma diagnosis. The present study highlights the necessity for time to time assessment of neoplastic lesions in young and middle-aged female for initial detection.

Use of Vivostat® Autologous Fibrin Sealant in Thyroid Surgery

Introduction: Post-thyroidectomy hemorrhage is a rare but potentially life-threatening and unpredictable complication of thyroid surgery. Therefore, intraoperative bleeding control and hemostasis are crucial. However, the most efficient, cost-effective, and standardized way to achieve this is not clear. This study aimed to evaluate the outcome of total thyroidectomy (TT) and partial thyroidectomy (PT) performed using the Vivostat® hemostatic system (Vivostat A/S, Lillerød, Denmark). Methods: Patients underwent TT and PT for benign and malignant diseases (multinodular goiter, Graves’ disease, differentiated thyroid carcinoma). The primary endpoint was 1st-day postoperative drain output and bleeding that required reintervention. Secondary endpoints included surgery duration and postsurgical complications (vocal fold palsy, hypocalcemia, seroma, wound infection). Results: Between October 2020 and December 2020, 56 patients were enrolled; 69.6% female; mean age 49.5 years. The mean 24-h drain output was 40 ml. No redo surgery was needed. Seroma was present in 5.3% of cases; no permanent vocal palsy or hypocalcemia was observed. Conclusion: This study shows that the Vivostat® system is both safe and effective for hemostasis during thyroid surgery.

Delayed Tracheal Perforation After Partial Thyroidectomy: A Case Report and Review of the Literature

Tracheal perforation is an extremely rare and potentially dangerous complication of a partial thyroidectomy. The current case represents a unique presentation of delayed tracheal perforation following an uncomplicated thyroid isthmusectomy for tissue diagnosis of an aggressive appearing thyroid mass in the setting of high-dose steroid administration and recent intubation and self-extubation. While conservative management of tracheal perforation can sometimes be appropriate, our patient was successfully managed via primary closure and infrahyoid muscle transposition flap to cover a 5 mm right lateral tracheal wall defect. We recommend caution be exercised following thyroid surgery in the setting of intubation and high-dose steroids.

Use of Vivostat® Autologous Fibrin Sealant in Thyroid Surgery

Introduction: Post-thyroidectomy hemorrhage is a rare but potentially life-threatening and unpredictable complication of thyroid surgery. Therefore, intraoperative bleeding control and hemostasis are crucial. However, the most efficient, cost-effective, and standardized way to achieve this is not clear. This study aimed to evaluate the outcome of total thyroidectomy (TT) and partial thyroidectomy (PT) performed using the Vivostat® hemostatic system (Vivostat A/S, Lillerød, Denmark). Methods: Patients underwent TT and PT for benign and malignant diseases (multinodular goiter, Graves’ disease, differentiated thyroid carcinoma). The primary endpoint was 1st-day postoperative drain output and bleeding that required reintervention. Secondary endpoints included surgery duration and postsurgical complications (vocal fold palsy, hypocalcemia, seroma, wound infection). Results: Between October 2020 and December 2020, 56 patients were enrolled; 69.6% female; mean age 49.5 years. The mean 24-h drain output was 40 ml. No redo surgery was needed. Seroma was present in 5.3% of cases; no permanent vocal palsy or hypocalcemia was observed. Conclusion: This study shows that the Vivostat® system is both safe and effective for hemostasis during thyroid surgery.

Impact of thyroid cancer treatment on assisted reproductive technology outcomes in women with infertility

Purpose We investigated the effect of different surgical procedures and radioactive iodine treatment (RAIT) on in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes and evaluated whether possible risk factors, including age, thyroid-stimulating hormone (TSH) levels, and thyroid antibody positivity, were associated with adverse IVF/ICSI outcomes. Methods This retrospective study included 76 women with infertility who had received thyroid cancer (TC) treatment among 137,698 infertile women who underwent IVF/ICSI cycles at the Peking University Third Hospital between 2010 and 2019. Clinical pregnancy and live birth rates were assessed. Results We found that the clinical pregnancy and live birth rates in women who underwent partial thyroidectomy were 7- and 6-fold higher, respectively, than those in women who underwent total thyroidectomy. We observed no significant differences in the clinical pregnancy and live birth rates between the RAIT and non-RAIT groups, even after adjusting for age, TSH levels, surgical treatment, and thyroid antibody positivity. Multivariate logistic regression analysis showed that age and TSH levels were not associated with decreased clinical pregnancy and live birth rates. Women with thyroid antibody positivity had significantly lower clinical pregnancy and live birth rates than women without thyroid antibody positivity. Conclusion Our study showed lower clinical pregnancy and live birth rates in women who underwent total thyroidectomy than in women who underwent partial thyroidectomy. Thyroid antibody positivity is an important risk factor for adverse IVF/ICSI outcomes in women who have received TC treatment.

Completion Total Thyroidectomy in Occult Thyroid Cancer Patients after Partial Thyroidectomy

Thyroid cancer is one of the commonest cancer while the incidence of occult thyroid cancer is only 0,05%. Completion total thyroidectomy as one of the treatment choice for thyroid cancer which initially diagnosed preoperatively as benign thyroid mass, remains controversial. The aim of this study is to understand the effectiveness of completion total thyroidectomy after partial thyroidectomy, by analyzing from: proportion of malignant contralateral thyroid tissue, post operative complications, and recurrence of cancer. This retrospective study collected medical record datan between 2011 and 2016. Total sample were 16 patients (15 females, 1 male). There was no significant difference on contralateral thyroid tissue malignancy proportion between completion total thyroidectomy and without total thyroidectomy (p=0,375). It was found 3 surgical complications (50%) from 6 patients with completion total thyroidectomy and 3 complications (30%) from 10 patients without completion total thyroidectomy. The complications were temporary injury of recurrent laryngeal nerve (p=0,511), seroma (p=0,375), and hypoparathyroidism (p=0,375). No recurrence event after 4 years follow up amount both groups. In conclusion, there is no advantage in completion total thyroidectomy analized from proportion of malignant contralateral thyroid tissue, post operative complication and recurrence in 4 years-follow up.

Total or less than total thyroidectomy for multinodular goiter long term follow-up

Objective: Multinodular goiter is a common surgical disease. There is no common consensus regarding the extent of thyroidectomy for multinodular goiter. This study aims to present personal experience on treating patients with multinodular goiter and to compare complication rates and results of total and partial thyroidectomy for multinodular goiter. Material and Method: Three hundred fifty patients underwent thyroidectomy for multinodular goiter between May 2003 and October 2010. All patients were diagnosed as multinodular goiter and were referred to surgery by one endocrinologist. All operations were also performed by one surgeon using microsurgical techniques. Partial thyroidectomy (bilateral subtotal or unilateral total thyroidectomy and contralateral subtotal thyroidectomy) was performed in 65 patients (Group-1) and extracapsular total thyroidectomy was performed in 285 patients (Group-2). All patients are being followed followed from the day they were diagnosed until now by the same endocrinologist. Fisher exact test was used for statistical analysis. Results: In Group-1, one patient had transient vocal-cord palsy and but none had hypoparathyroidism. On the other hand, in Group-2, two patients had transient vocal-cord palsy, five had hypocalcemia (one was permanent), and one had a hematoma. Mortality and wound infection were absent in both groups. The histopathological studies showed that 40 incidental thyroid carcinomas occurred among Group-2 patients. During long-term follow-up, 13 patients had goiter recurrence (n = 65, 20%) in Group-1, whereas none had goiter recurrence in Group-2. Conclusion: There were no statistically significant differences in the complication rate between subtotal and total thyroidectomy groups (p>0.05). However, the recurrence rate was higher (statistically significant) after subtotal thyroidectomy than after total thyroidectomy (p<0.05). Total thyroidectomy eliminated future recurrence of the disease and is also curative in incidental thyroid carcinomas. In addition, it can be safely performed using microsurgical techniques.

Routine Use of Preoperative Neck Ultrasound in Primary Hyperparathyroidism Identifies Coexisting Thyroid Disease and Improves Parathyroid Localization

Background In Jan 2018, we began routinely obtaining neck ultrasound (US) with 123I/99Tc-sestamibi (MIBI) for parathyroid gland localization and to identify thyroid pathology in the setting of primary hyperparathyroidism (1HPT). The aim of this study is to assess if routine neck US is a useful adjunct to 123I/99Tc-MIBI in 1HPT. Methods Patients undergoing surgery for 1HPT with both 123I/99Tc-MIBI and US at our institution after implementation of routine US were reviewed. Biopsy and surgical management of thyroid pathology was evaluated. 123I/99Tc-MIBI and US results were compared to intraoperative findings to determine sensitivity and positive predictive value (PPV) for parathyroid localization. Results From January 2018 to September 2019, there were 423 patients (mean, 61 years) that met inclusion criteria (80% women). Thyroid nodules were found on US in 57%, mean size 1.3 + 0.8 cm. Fine needle aspiration (FNA) was performed in 87 patients with nodules (36%). 35 patients (8.5%) required total or partial thyroidectomy for diagnoses/treatment. Papillary thyroid cancer (PTC) was found in 3.5% of the cohort with micro-PTC 53% and PTC 1-2 cm 40%. A successful parathyroid operation for 1HPT was achieved in 98.6% of patients. Positive predictive value for localization of abnormal parathyroid glands was 97% when US and 123I/99Tc-MIBI had concordant findings. Discussion Routine use of US in 1HPT commonly identifies nodules that are benign or low-risk PTC. Ultrasound is less sensitive for parathyroid localization but when used with 123I/99Tc-MIBI, concordant imaging has a high PPV.