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Aim: To review and to update the management protocols in thyroid surgery proposed two years ago by 1st Consensus Conference called on the topic by the Italian Association of Endocrine Surgery Units (UEC Club)., Method: The 2nd Consensus Conference took place November 30, 2008 in Pisa within the framework of the 7th National Congress of the UEC Club. A selected board of endocrinologists and endocrine surgeons (chairmans: Paolo Miccoli and Aldo Pinchera; speaker: Lodovico Rosato) examined the individual chapters and submitted the consensus text for the approval of several experts. This plain and concise text provides the rationale of the thyroid patient management and wants to be the most complete possible tool for the physicians and other professionals in the field., Conclusions: The diagnostic, therapeutic and healthcare management protocols in thyroid surgery approved by the 2nd Consensus Conference are officially those proposed by the Italian Association of Endocrine Surgery Units (UEC Club) and are subject to review by two years. more...

Aim of the Study: To evaluate the differences about incidence, kind and clinical features of thyroid diseases in young and elderly patients., Materials and Methods: Our study has been conducted in Endocrine Surgery Unit, "S. Luigi and S. Currò" Hospital in Catania, from January 2001 to December 2003. In this period 621 patients affected with different thyroidopathies were observed. They were divided in two groups: elderly (65 years or older), named Group A, and young subjects (under 65 years old), named Group B. Group A included 147 people aged between 65 and 89, with F:M = 3.9:1. Our study was founded on clinical and laboratory evaluation of thyroid hormones and antibodies (AAT, AMT) and subsequently an ultrasonographical evaluation, that has been completed, in some cases, with cytologic examination (FNAc)., Conclusion: The main aspect about thyroid diseases is the different and atypical presentation in the elderly in comparison to young patients, with subsequent difficult diagnosis due to common symptoms to thyroidopathies rather than to physiological ageing. The most common thyroid dysfunctions in elderly are the autoimmune thyroidopathies, responsible of hypothyroidism. Such condition, in elderly, is often clinically irrelevant. more...

Diagnostic-therapeutic itineraries and treatment profiles are instruments of clinical management. The authors report on their experience with the experimental creation of such itineraries in thyroid nodular pathology. These are the fruit of collaboration between the management team, endocrinological surgeons, and the hospital computer staff. The drawing-up of guidelines in the hospital setting allows the systematic organisation of clinical activities to be accomplished in the health-care facility, quantifying costs for all diseases in order to be able to plan and implement changes in resources and staff utilisation. Application of the method, in addition, helps to develop a common language among hospital doctors and nurses, facilitates proper communication with patients, and ensures adequate patient information regarding the clinical itinerary the patient will have to take for his or her condition. more...

Nowadays the prevalence of thyroid nodules in Graves' disease (GD) is estimated as ranging from 15 to 33% and several studies support a high risk of thyroid cancer in this condition. The present study presents a retrospective analysis of 41 cases of GD submitted to total thyroidectomy from 1995 to 2003, aimed at discovering the most useful elements for an optimal diagnostic and therapeutic strategy. We identified 23 patients with coexisting nodular goitre (nodular variants of GD) and among these we carried out a comparative study of 12 cases with only benign nodules and 7 with thyroid carcinoma detected prior to the operation. Four cases were not considered because of incidental microcarcinomas. We found no significant differences in the number, average size and radionuclide imaging of nodules in the two groups. In contrast, analysis of ultrasonographic findings showed that hypoechogenicity correlated closely with malignancy, particularly if associated with ill-defined margins, microcalcifications and intranodular vascular patterns, whereas hyperechogenicity was a typical appearance of benign lesions. Our study suggests that routine thyroid US scans should be considered for complete evaluation of GD, since this pathology frequently implies the development of thyroid nodules which are not always detectable at clinical or radionuclide examination. Surgery is mandatory when nodules with suspicious ultrasonographic features are found and if malignancy cannot be excluded at fine needle aspiration cytology. more...

The diagnostic algorithm of thyroid diseases, the most frequent dysendocrine condition, can be today integrated by the newly developed molecular methodologies. From the early diagnostic approaches, centered on the assessment of thyroid function, either by in vivo radioisotopic techniques, or by in vitro radioimmunological measurement of hormone plasma concentrations, it is nowadays possible to precisely define the molecular events triggered by the iodothyronine signal at the level of target tissues. In this brief review will be discussed the recent progresses on cloning and characterization of several genes involved in the regulation of thyroid differentiation, ability to trap iodine, synthesis and secretion of iodothyronines, regulation of thyroid function by TSH, transduction of the hormonal signal to subcellular structures involved in the translation of the hormone message in specific biological, effects such as those on metabolic homeostasis, cell proliferation and differentiation. It will be also discussed the most recent advancements on the genetics of thyroid diseases which have allowed to characterize the molecular basis of several thyropathies such as congenital hypothyroidism, thyroid hormone resistance syndrome, hyperthyroidism or hypothyroidism caused by TSH-receptor alterations, molecular abnormalities of oncogenes or tumor suppressor genes which are associated with benign or malignant thyroid cell transformation. The most recent developments of the diagnostic procedures of thyroid diseases, also in their pre-clinical stage, will be also reviewed together with a brief highlight on the most recent treatment options, centered on prophylactic therapeutic intervention or on the development of gene therapy strategies which will be possibly applied in a near future. more...

Bleeding represents a rare complication of thyroid surgery but when it occurs it may be life-threatening. To prevent this complication drainage is widely used. However no study has demonstrated the drains' value and recent reports have questioned its benefits. Therefore we have analyzed our experience of a 10 year-period in which 1.217 thyroidectomies were performed by the same surgical team and prophylactic routine drainage was always adopted. In 13 patients (1.06%) a benign hematoma occurred with spontaneous remission. In 6 patients the bleeding was severe and compressive hematoma occurred; it required surgical re-exploration. Such a complication is unusual in the neck surgery (0.49% in the authors' series) performed by experienced surgeons and when life-threatening hematomas do occur they depend on various uncontrolled factors and drainage is often not helpful. Otherwise a meticulous haemostatic technique is necessary and patients should be observed very closely during the few first hours following surgery on the thyroid gland. Therefore on the basis of the analysis of their series, although it is not always possible to prove the benefit of the drainage, the authors suggest its indication in the neck surgery, as in other fields with dead space, to remove blood and secretions reducing postoperative complications. They have never observed wound infections and patients were discharged within 72 hours. more...

In order to verify sclerotherapy efficiency in solitary thyroid cysts, needle aspiration of the cyst followed by instillation of tetracycline hydrochloride into the cyst cavity was performed in 110 patients; in thirty of these the aspirations was ultrasonically guided. A tight dressing on the neck was applied for 48 hours in order to maintain pressure on the cyst cavity. All patients were treated with L-T4 in TSH-suppressive doses. In a few patients (< 155), the tetracycline instillation caused local pain, lasting less than two hours. In no case, did cytological examination of the sediment of the aspirated fluid reveal any evidence of malignant cells. In 82 patients (84.54% of the 97 controlled patients), the last ultrasonic follow-up (performed at 3, 6, 9, 12 or 24 months) showed a decrease in lesion size. In particular, 16 patients (16.50%) had a complete cyst disappearance, 41 patients (42.17%) had a volume reduction of the cyst between 85 and 65%, and in 25 patients (25.77%) the reduction was more than 25%. In the remaining 15 patients (15.46%) a second treatment was performed, 3 of them also required a third treatment but in all these cases, the results seemed to be less satisfactory. The distinction in cyst size seemed to indicate that in the case of a large cyst (> 36 mm diameter), the treatment gives better results (92% success rate against 82% of the other patients). In conclusion, we are able to affirm that needle aspiration of the thyroid cyst with instillation of tetracycline hydrochloride is a simple, well tolerated and low cost technique.(ABSTRACT TRUNCATED AT 250 WORDS) more...